Male pre–conceptual care – IS IT REALLY NECESSARY? BY DIANA ARUNDELL
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esearch is confirming that the health status of BOTH parents at the time of conception can have a significant impact on the future health of the baby. 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. In Australia, our children are getting sicker. There have been significant increases in asthma, overweight/obesity, autism spectrum disorders and the quality of the health of both parents at conception may be a contributing factor. 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 and 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. Smoking, toxic exposure, advanced age, obesity and medication use have been associated with low birth weight, congenital heart issues 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, is the lowest 5th percentile of healthy sperm really good
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ON T H E C OA S T – FA M ILIES
enough? How about aiming for the 50th percentile for semen parameters, to aim for the healthiest possible pregnancy and life birth outcome. We are talking about making human life here after all. 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. Assisted reproductive medicine such as IVF, IUI etc is a modern, medical miracle which has given the gift of children to many couples who otherwise would not have experienced parenthood, however some couples who are classified as ‘sub–fertile’ or ‘unexplained infertility’ may be shuffled down a very expensive 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 due to improved overall cellular health. There are many diet and lifestyle choices that can improve semen parameters in 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 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 diet/ lifestyle changes haven’t 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 3rd hand (in clothing/curtains etc) smoke affects reproductive health. A child born to a male smoker is 4 times more likely to develop cancer in childhood. The earlier in life a male starts smoking is linked to an increase in Body Mass Index (BMI) of their sons.
CHANGES IN SEMEN/SPERM PARAMETERS 5th lowest percentile used in semen analysis in australia Parameter Volume Concentration Progressive Motility Normal forms
WHO 1999 2ml 20million/ml 50% 14%
WHO 2010 (5th edition) 1.5ml 15million/ml 32% 4%
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