Approximately one in six couples in Northern Ireland experience infertility or have difficulty conceiving. Fortunately, advances in medical science have given many of these couples the opportunity to become parents. However, for many women, the journey often involves invasive, stressful and sometimes painful procedures.
According to emerging research, some of those investigations may be unnecessary.
Despite significant advances in fertility medicine, cultural attitudes have been slower to change. Women frequently shoulder the burden of fertility investigations, even though male factors contribute to around half of all infertility cases. Yet many men receive only a basic semen analysis before attention shifts almost entirely to their partner.
Dr Lalana Songra, medical adviser and chair of the Medical and Scientific Advisory Board at Examen, an advanced male fertility diagnostic centre in Belfast, believes it’s time to change that approach.
“For many couples struggling to conceive, the first port of call is their GP,” says Dr Songra. “They may then be referred to an NHS fertility specialist. Others choose private fertility clinics, where they are offered what’s known as a Fertility MOT. Typically, this includes a semen analysis for the man and blood tests, and sometimes a scan, for the woman. The same basic tests are generally carried out in both the NHS and private sectors.”
Dr Lalana Songra
A standard semen analysis measures sperm count, movement and appearance. While it provides useful information, Dr Songra says it tells only part of the story.
“A standard semen analysis looks at the number of sperm, whether they appear healthy and how well they move. If those boxes are ticked, the result is considered ‘normal’ and the man is often given a clean bill of health.
“But instead of relying solely on that basic analysis, we should also assess the man’s overall health, including his BMI, diet and lifestyle. He may have an infection or a condition such as varicocele, where enlarged veins around the testicles increase temperature and affect sperm production.
“Standard semen analysis is an excellent first-line test, but it is very rudimentary. It tells us nothing about the quality of the sperm’s DNA.”
Examen uses a specialist test called SpermComet, which measures sperm DNA fragmentation by examining the damage within individual sperm cells. The results help doctors diagnose infertility more accurately and predict the likelihood of success with treatments such as IVF.
“In couples struggling to conceive, around 15 to 20 per cent of men receive a normal semen analysis despite having poor-quality sperm because of DNA damage,” Dr Songra explains. “This test gives us much more information and allows us to help men improve their chances of achieving a successful pregnancy.”
Many people assume the sperm’s role ends once an egg has been fertilised, but Lalana says that is far from the case.
“It takes both healthy sperm and a healthy egg to create a good-quality embryo. Both parents contribute DNA, and if either is impaired, the embryo may fail to develop properly, resulting in pregnancy loss.”
Research also suggests damaged sperm DNA may contribute to recurrent miscarriage.
“When we looked at men whose partners had experienced repeated pregnancy loss, 66 per cent had previously received a normal semen analysis. However, around 60 per cent actually had significant sperm DNA damage. This shows there is a strong association between sperm DNA damage and miscarriage.”
Not all causes of sperm damage can be prevented. Genetics, childhood illnesses such as mumps and environmental factors all play a role.
However, many lifestyle factors are within a person’s control.
“The encouraging news is that some sperm damage is reversible,” says Dr Songra. “Obesity, poor diet, excessive alcohol consumption, smoking cigarettes or marijuana and other unhealthy lifestyle habits all increase inflammation within the body, which can damage sperm. Improving those habits can significantly improve sperm quality.”
Unlike women, who are born with all the eggs they will ever have, men produce new sperm every day.
“Sperm production takes around 70 days from start to finish,” Lalana explains. “That gives men a valuable opportunity to improve their fertility before trying for a baby. I encourage couples to use the two or three months before conception to optimise their health. They may never need fertility treatment or IVF.”
Even if medical intervention is eventually required, a healthier lifestyle can still improve outcomes.
“A healthy lifestyle means the sperm available will be the best quality possible. It only takes one healthy sperm to create a baby, and fertility specialists can then select the strongest one available.”
Lalana believes fertility health deserves a place alongside other health education in schools.
“We teach children about nutrition, exercise and contraception, but we rarely explain how to protect their fertility for the future. Young people should understand how lifestyle choices made today can affect their ability to have children later in life.”
For couples hoping to start a family, that knowledge could make all the difference.
For further information visit the website at https://examenlab.com