In the UK, unexplained infertility accounts for around 1 in 4 cases of infertility. This is when no cause can be identified in either partner
It is commonly thought that fertility issues revolve around women, however, according to a study published in the journal of human reproduction in the last 50 years average sperm concentrations dropped by 51.6 per cent and total sperm counts by 62.3 percent.
Male factor fertility has been an overlooked area of the fertility treatment pathway and is rapidly becoming a recognised and important branch of fertility medicine.
As an acupuncturist, I try to identify the root cause of why a couple are finding it hard to conceive and may refer a patient for further diagnostic tests. I often refer to Fertility Solutions, a clinic set up by UK leaders in Male fertility, Ms. Clare Mooney, and Mr Jonathan Ramsay.
Ms. Claire Mooney is a consultant embryologist and leading expert in male fertility with 24 years’ experience and medical director at Fertility solutions.
Claire specialises in male fertility and set up fertility solutions to provide expert care for men to increase the chances of natural conception and IVF and ICSI. The work of Claire Mooney and Mr Ramsey is to be featured in a TV documentary highlighting male fertility on Channel 4.
I am delighted to share a conversation with leading fertility expert embryologist, Claire Mooney on the importance of male fertility.
Colette: Is a standard/routine semen test adequate as a diagnostic tool for male fertility?
Claire: A very low sperm count semen analysis is diagnostic, but for a majority of men with normal sperm counts semen analysis alone is a blunt tool. “Normal” values do not mean a man is fertile or indeed infertile…. This is usually very surprising to couples.
This misconception exists because of the use of the word normal describing semen analysis results. An assumption is made that normal equals fertile, but this is not the case.
A Semen analysis should be the first test done yes, but it should just be one of many tests and investigations.
Colette:Can more be done for couples with unexplained infertility who are told to keep trying for 2 years and then consider IVF?
Claire:I do not recommend a couple wait for two years, we are having children later in life than our parents or grandparents and the effect of this is to lower our baseline fertility levels when we do start to try to conceive. If you then find yourself struggling to conceive it is better to start the investigation process much earlier, ideally around 6 months after you stop using contraception. Ideally the couple should seek fertility investigations and consultation at this point so that any fertility issues can be investigated early and addressed quickly.
Colette:What are your views on having IVF/ICSI as a treatment without further male factor investigation?
Claire:I do not recommend that a couple-diagnosed with a male cause of infertility go straight to this treatment. I have carried out over 20,000 ICSI procedures in my career and overall, only 1 in 4 couples has a baby after ICSI treatment and this disappointing statistic proves that IVF/ICSI is not the universal answer to male infertility.
The reasons for this are quite simple….
ICSI that is the process of injecting sperm into a women’s egg does not address any underlying issues of sperm quality. We are not able to select sperm during the ICSI process based on the actual health of the sperm, that is the genetic health of the sperm.
The function of sperm is to deliver the DNA to the egg, and it is the DNA that is the most fundamental component, this can be a reason why IVF/ICSI fails. To increase the success rate of ICSI and improve the chances of natural conception it is best to investigate the man thoroughly to uncover the cause of his infertility to find out why the sperm numbers are low in the first place. The urologist is best placed to do this. In treating male infertility, you improve sperm quality. This should ultimately be our goal. If the couple still needs IVF the sperm will then be better quality and then the IVF ICSI process in turn has a much better chance of working.
Colette:As an acupuncturist one of the further tests that I suggest is a sperm DNA fragmentation test. Claire says:
Claire:Ideally all tests for the investigation of male fertility should be done under the guidance of a urologist/specialist andrologist. It is reasonable for couples to begin with a DNA fragmentation test of the sperm, that is a genetic test of the sperm. The results of this test are more closely associated with fertility and IVF success. I would also recommend a semen culture test; this is inexpensive and checks sperm for the present of harmful pathogens such as bacteria. We find for a lot of couples with unexplained infertility and male infertility have a presence of bacteria in the semen and this causes both IVF/ICSI failure and infertility…. Really importantly if you are having these tests done is that they be interpreted in a clinical context by a urologist or andrologist specialist as we should not adopt a one size fits all.
Diagnosis results that maybe normal for one couple may not be normal for another. This depends on the circumstances specific to the couple.
Colette:What is sperm DNA fragmentation?
Claire:The DNA inside a sperm goes on to pass on one half of a baby’s DNA and so it is vitally important that this DNA is healthy. The DNA can be damaged when sperm are being made, snapping some of the DNA strands. Men with high levels of damaged sperm DNA are less likely to get their partner pregnant and have double the risk of miscarriage. If your sperm count is normal, the sperm may not be of good quality. Sperm DNA damage can prevent you from having a baby. Sperm fragmentation testing looks at these breakages and assesses how damaged the sperm are on the inside.
Colette:What happens if there are high levels of fragmentation in the DNA?
Claire:If there are high levels of fragmentation of the DNA in the sperm this confirms the diagnosis of male infertility. The treatment for this depends on the cause of the infertility and the best person to address this is the urologist so treatment is generally different for each man. As an example, a lot of men have enlarged veins in their testicles called varicoceles and these veins can increase the temperature in the testicle and affect the DNA inside the sperm. The treatment for this is to remove the veins. The urologist diagnoses this and sends the man for the appropriate treatment.
Colette:How do you view the role of acupuncture and holistic care for your patients?
Claire:It is becoming clear that the role of acupuncture and more holistic treatments overall are important for the infertile couple. The human body is very complex, and fertility involves many different systems all working together. Acupuncture has been shown to increase sperm count and motility, and significantly increase the percentage of normal forms, in as little as 3 weeks. Acupuncture may improve sperm quality by addressing the imbalances that are contributing to the cause of the man’s infertility in conjunction with a man seeing a urologist this technique enhances the man’s overall treatment and efficacy.
Acupuncture
Acupuncture as a bio – medicine can also encourage healthy and sufficient blood flow to the testes and reproductive organs as well as research that suggests an improvement in male sperm parameters. Stress levels can be high when trying to conceive and acupuncture can help to regulate hormone level and promote relaxation.
It is clear there are a range of factors all of equal importance that contribute to improving fertility including: optimum nutrition and diet, lifestyle, and environment and the importance of a multifaceted and integrative approach to treatment.
Colette:What is the future for sperm DNA fragmentation and male fertility medicine?
Claire:The investigation of male infertility stalled in the 1990s due to the introduction of ICSI into IVF treatments. However, as we have discussed, these treatments are still so relatively unsuccessful that investigations into male fertility have now restarted due in a large part to patients themselves. We are working to make treatments such as DNA fragmentation testing available to all by setting this service up in house and at a cost more assessable to all patients and hopefully one day this test will be available on the NHS.
It will be a game changer if this happens as more patients will be correctly diagnosed with male infertility and then offered treatment. The key to changing male fertility services is information, getting the word out.
We have now been involved with four major documentaries on male infertility with the aim of informing and educating patients on the importance of male fertility. We are also now combining urology assessment and treatment of male infertility together with new technologies such as the Zymot slide. A new sperm preparation device to select more healthy sperm and offering more comprehensive bacteria studies called the male microbiome. It is becoming much more evident of the role pathogens play in all areas of medicine and male fertility is no exception.
Our own consultant Dr Kalsi has also just set up one of the first fertility clinics on the NHS that combines male and female fertility care investigations and treatments from the beginning of a couple’s fertility journey. Indeed, our clinic now has a 70 percent pregnancy rate using this combined approach. It’s hard to predict the course of male fertility care but it is my hope that more fertility clinics adopt this approach in the future for the good of the infertile couple. “
Claire Mooney is a consultant embryologist and leading expert in male fertility with 24 years’ experience and medical director at Fertility solutions.
Colette Assor is an accredited acupuncture practitioner, based in North London and is on the membership services committee at the British Acupuncture Council.
When choosing your acupuncturist It is important to ensure that your Acupuncture practitioner is a fully qualified member of The British Acupuncture Council (BAcC), accredited by the Professional Standards Authority (PSA, ) and trained to degree level in TCM.
To find a local acupuncturist and qualified BAcC member please go to: https://acupuncture.org.uk/find-an-acupuncturist/
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