On the Coast – Families Issue 104 I February/March 2020 | Page 18

Pre-conceptual care
do the males have to do it?
BY DIANA ARUNDELL
I
n Australia our children are getting sicker. There have
been significant increases in asthma, overweight/
obesity and autism spectrum disorders and more
research is confirming that the health status of
both parents at the time of conception may be
contributing to these factors in our offspring.
Often women are the focus of fertility
issues and pre-conceptual care. Reality is
that men contribute 50% to the genetic
composition of the offspring and almost
half of fertility issues experienced by
couples include a male fertility factor, yet
there are no guidelines for male fertility
health. Many men may not be infertile
as such but ‘sub-fertile’, meaning there
are factors affecting the quality and/
or quantity of their sperm. Sperm are
highly susceptible to oxidative damage
that can occur due to poor diet and
lifestyle choices. These choices as well as
environmental factors can contribute to
difficulty in conceiving, miscarriage and
can increase risk factors of the offspring
developing certain diseases later in life.
Trans-generational inheritance has been
observed in both mouse models and
human studies.
Male pre-conceptual care and
lifestyle issues have been associated
with malformations and birth defects
of offspring. Smoking, toxic exposure,
advanced age, obesity and medication
use have been associated with low birth
weight, congenital heart and anorectal
malformations, and an increased risk of
infant cancers and neural tube defects.
The current guidelines to assess
semen parameters are the World Health
Organisation (WHO) guidelines 2010.
Up until that time the semen analysis
parameters were based on the WHO
guidelines from 1999. The benchmark
or acceptable figures for sperm health
used by WHO and consequently fertility
doctors, are based on the lowest 5th
percentile of men. When it comes to
making babies, the lowest 5th percentile
of healthy sperm in my opinion is not
good enough. I aim for all of my male
fertility patients to be closer to the 50th
percentile for semen parameters to aim
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ON T H E C OA S T – FAM ILIES
for the healthiest possible pregnancy and
life birth outcome, which is why pre-
conceptual care in males is so important.
Once the sperm and egg have combined,
the genes of the baby are locked in so the
health of both the female and the male
parent pre-conceptually is significant and
can impact conception, live birth rate and
the health of the offspring later in life.
Another interesting factor to note
about the WHO semen parameters
is how sperm health has decreased
between 1999 and 2010. (see table
below) This suggests that male fertility is
declining and from a health perspective
we need to be asking why semen
parameters in men have dropped so
much in a 10 year period, rather than
just moving the goal posts of what we
accept as viable or healthy. We need
to be identifying why men’s fertility
health is dropping and what we can do
to address these issues so things don’t
continue to get worse, rather than simply
shoving couples down the expensive
and not always necessary drug assisted
reproductive pathways such as IVF.
Assisted reproductive medicine such as
IVF, IUI etc is a modern, medical miracle
which has given the gift of children
to many couples who would have
otherwise not have experienced such
a gift however, I believe many couples
who are classified as ‘sub-fertile’ or
‘unexplained infertility’ may be shuffled
down a medically assisted fertility
path prematurely. 4-6 months of pre-
conceptual care can not only improve
chances of a natural conception but also
improve success rates of IVF and other
assisted fertility treatments.
There are many diet and lifestyle
choices that can improve semen
parameters in many men. If you are
thinking of conceiving, why wait for
1 year after ‘trying’ before looking
into what can be done to improve
male fertility? Pre-conceptual care
ideally needs to start 6 months prior to
conceiving. Sperm takes 72-90 days to
mature before it’s ejaculated so the effort
that is put into a man’s diet and lifestyle
now will be ultimately be reflected in
his fertility health after 3 months. This
is also why if a repeat semen analysis
needs to be done, it should be 3-4 months
after the first one and there is no point in
retesting if no changes have been made.
For something to change… something has
to change.
Pre-conceptual guidelines for the males:
Stop smoking – even 1 per day,
including vaping. Active, passive and
1
CHANGES IN SEMEN/SPERM PARAMETERS
5TH LOWEST PERCENTILE used in semen analysis in Australia
Parameter
WHO 1999 WHO 2010 (5th edition)
2ml 1.5ml
20million/ml 15million/ml
Progressive Motility 50% 32%
Normal forms 14% 4%
Volume
Concentration