Over 2 decades ago, ICSI (intracytoplasmic sperm injection) revolutionized the treatment of male infertility. The ICSI procedure involves injection of a single sperm into each egg at the time of IVF (in vitro fertlization). Before the development of ICSI, couples with sperm issues, what we call “male factor,” had very low fertilization and pregnancy rates, even when undergoing IVF. Now a days, because of the use of ICSI, poor sperm quality is a very unusual reason for an IVF cycle to be unsuccessful or to blame for poor fertilization. Over concerns about potentially poor fertilization, many fertility centers have chosen to use ICSI routinely to ensure optimal fertilization even when the male partner’s sperm is perfectly normal. At Princeton IVF, our philosophy has always been to allow fertilization to happen “naturally” in the dish when there is no history of sperm issues or poor fertilization. While ICSI had been shown to be quite safe, we feel that a more natural selection process makes more sense and research in the past has suggested that ICSI is only beneficial in male factor patients. A recent large-scale study recently published in the Journal of the American Medical Association has borne this out. ICSI when used in IVF cycles used in couples without sperm issues had lower fertilization and lower implantation rates than non ICSI cycles.
In women who suffer from infertility, their difficulty in conceiving is sometimes a sign of underlying health issues. For instance, it will know that women who suffer from infertility have a higher rate of pregnancy complications, even if they conceived without treatment. One of the most common causes for infertility, polycystic ovarian syndrome (PCOS) is often associated with underlying metabolic problems and women with PCOS are more likely to develop medical problems such as diabetes, high blood pressure and heart disease. However, what is less clear whether this is also true in men. A recently published study suggest that men with fertility issues and sperm abnormalities may be more likely to have other seemingly unrelated medical problems.
There are plenty of reasons to quit smoking. The health effects of smoking are well known and well documented, not just on your fertility, but a whole number of health issues including heart disease and cancer. Now, there’s yet another reason to quit smoking if you are pregnant or trying to get pregnant. Cigarettes may actually affect a woman’s male offspring’s sperm quality. As reported in Human Reproduction, the male offspring of pregnant mice exposed to high levels of cigarette smoke had sperm with lower counts, lower motility and more abnormally shaped sperm (low morphology), and these male mice took longer longer to impregnate female mice who in turn gave birth to fewer mouse pups. So, what does this all mean? While we don’t yet know if this is true in humans (or even 100 % sure it is true in animals), exposure to tobacco smoke could not only harm your fertility (among other things) but also could harm your unborn son’s chances of fathering children. This is another good reason to quit.
And why might this be important? Unless you are a Spanish farmer raising swine, or unless you live in Spain and are in the market for pork or ham, it should not matter. But is you work in the fertility field or are trying to get pregnant, it may be an issue. The concern over what is going on with Spanish pigs, is really about why the pigs were having trouble reproducing. It turns out that back in 2010, there was a marked drop in fertility in pig farms across difference regions of Spain. Investigators at first had trouble figuring our where there problem was. The one common thread in each of these farms was that all of the farms used plastic bags from the same manufacturer to collect semen for insemination. A researcher at the University of Zarazoga, Cristina Nerín, then analyzed the bags and found that an ingredient in the plastic bags was the cause of infertile Spanish pigs. The scary part is that this chemical (and similar compounds) are found in plastic products that are used to package foods and beverages we eat every day. The good news is that the pigs of Spain and happily producing lots of piglets again. However, there is likely more to come on this topic in reproductive medicine and potentially in other areas of medicine as well.
A recent study suggests that men who keeps their cellphones in their pants pockets, may have lower sperm motility. Researchers at the University of Exeter in the UK, found that men who kept cell phones in their pockets had lower sperm motility than those who did not, about an 8% reduction. Is this an issue? It remains to be seen whether this decrease really affects a couple’s chances for pregnancy and truly causes infertility.
With some states choosing to legalize marijuana, we hear very little of cannabis’ effects on health, and even less on its impact on reproductive health. We have know for years that pot smoking can cause chromosomal breakage, and so for those couples trying to get pregnant, many reproductive specialists encourage both partners to quit when attempting pregnancy. Now, some new data out of the UK shows men who use marijuana are considerably more likely to have abnormally shaped sperm, Interestingly, in the same study, alcohol and tobacco did not. Since even in normal men, it is normal to have some proportion of misshapen sperm, this finding in itself is not enough information to say that marijuana causes infertility. Still, why take the chance? This is just another good reason to quit if you are planning to start a family in the near future.
Researchers at the National Institutes of Health, looked at the effects of obesity on sperm quality. They determined that men who were overweight (high BMI) or has a high waist circumference had significantly lower sperm counts and significantly low semen volumes than men of normal weight. Other semen parameters such as motility (percent swimming), morphology (percent normal shaped) and DNA fragmentation (proportion of sperm with normal DNA) interestingly were unaffected.
Patients are always asking me are there dietary changes they can make to enhance their chances for pregnancy. In the case of men with low sperm counts, the answer is often no. However, researchers from Harvard School of Public Health looked at men’s diet and the quality of their sperm in a study presented at the American Society for Reproductive Medicine (ASRM) meeting. Interestingly, they found that men who consumed lots of processed meats such as bacon and sausage had poorer quality sperm and those who consumed lots of dark meat fish such as salmon and tuna had better quality sperm. While these findings are preliminary; the study size is small and the data has not been published yet, this does suggest that nutrition may play a real role in male infertility.