The Roadmap to Fertility: A comprehensive guide to fertility for men and women
272
The Roadmap to Fertility: A comprehensive guide to fertility for men and women
272eBook
Available on Compatible NOOK devices, the free NOOK App and in My Digital Library.
Related collections and offers
Overview
Getting pregnant is not easy for many couples – infertility affects one in six couples worldwide. Dr David Greening REI, who is a subspecialist in obstetrics and gynaecology, has written The Roadmap to Fertility specifically for men. He believes men are often quiet passengers as a couple drive their own lonely road to fertility, despite being a vital part of the partnership. Dr Greening explores the issues around getting pregnant and explains how to improve both partners’ fertility.
Dr Greening includes real-life stories of couples’ journeys dealing with infertility, in their own words, and explores his own experiences from many years working in the reproductive medicine field in Europe and Australia.
Product Details
| ISBN-13: | 9781925429763 |
|---|---|
| Publisher: | Rockpool Publishing |
| Publication date: | 07/18/2018 |
| Sold by: | SIMON & SCHUSTER |
| Format: | eBook |
| Pages: | 272 |
| File size: | 4 MB |
About the Author
Read an Excerpt
CHAPTER 1
The basics of conception
In the minds of many men, just being male should be enough. For many, the assumption is that real men can father a child. But sometimes that isn't the case. You might be an amazing specimen of manhood, with defined muscles, a jaw as square as a right angle, tall and handsome, but if you have a fertility problem that self-perception can crumble. I have seen it many times.
One of my patients ticked every box and had an abundance of self-confidence that literally oozed out of him. When he and his partner returned for their second visit I went over their results. His partner was fine – there were no obvious problems with her fertility. However, he had a very low sperm count of about one to two million (around forty million is considered 'fertile'). When I told him, he slumped forward and couldn't speak for several minutes – elbows on knees, head down processing this news. His ego was like a balloon that had popped.
Men see themselves as fathers, outside playing with a son or daughter, reading to their children at night, passing on their wisdom, providing for their children and watching them grow up. They expect to be grandparents one day. To be denied this is one of the toughest situations men and their partners will ever find themselves in.
I fortunately sorted this couple out with IVF. It worked well, and they have a family now.
Before we look at the basics of male fertility, how it works and how it fits into the big picture, I want to mention this: millions of years ago life was simple. Nowadays we live in an extremely complex society that has undergone huge changes. Men live longer and reproduce later – they want to become fathers much later than a generation ago. Their partners are also aiming to become mothers much later in life. First-time Australian mothers for example are now some of the oldest among Western countries, with an average age for having their first child of thirty-two.
Men live in a world flooded with chemicals that affect fertility, from smoking to oestrogen-releasing chemicals that affect the environment and may lower sperm counts. They are exposed to anabolic steroids, alcohol, marijuana (which lowers fertility) and anti-depressants, which affect libido. Depression can be a factor, and there are relatively new sexually transmitted diseases (STDs) that can also affect fertility.
It has recently been reported that sperm counts in men from America, Europe, Australia and New Zealand have dropped by more than 50 per cent in less than forty years. Environmental chemicals and hormones seem to be behind this.
Five fertility factors
Individually men and women can affect their own fertility but let's get started on understanding the road to fertility: what's required to make it work. I have described this in my own terms from many years in the field of reproductive medicine.
There are five absolute requirements for fertility.
• Sperm: you need to have sperm to father a child. There must be enough (the count), that swim forward well (motility) and have a decent shape (morphology) to do their biological job.
• Ovulation: your partner must produce an egg and ovulate approximately once a month. Extra eggs are bonuses, like twins.
• Sex: it's obvious, but sex is required for the sperm and eggs to meet. Well, it was for the last few million years at least. Those rules have changed with the advent of in vitro fertilisation and intra-uterine insemination.
• Tubes: to be specific, your partner must have open and functioning fallopian tubes. That's where the sperm and eggs meet.
• Timing: this is as simple as one, two, three. It helps if sperm (one) arrives before the egg (two), and that usually happens via sex (three). If you are going to have sex for fertility reasons, then having it during ovulation is a requirement.
There are a lot more requirements for fertility, but in my view these are the top five. If there is a problem with any of these factors infertility arrives on the scene, and its arrival is surprisingly common. One in six couples has a fertility problem, and in 30 to 40 per cent of those cases male infertility is the reason that couple is not conceiving. Men are the number one fertility problem in the world but hardly any men realise this. So, let's find out more about sperm and about ovulation.
Sperm
Humans reproduce by sexual reproduction – the mechanism by which two members of a species, one male and one female, produce the next generation. There are other ways to reproduce without sex, but humans do it sexually. Some species just split in half, which sounds painful and is not as much fun as having sex.
For many millions of years we have successfully managed this, but it has only been very recently that we have managed to understand it.
Eggs have been understood for thousands of years. After all, the chicken came from an egg and everyone knew that the female bird made the egg. But the male contribution to reproduction was not understood for most of civilisation. In the ninth century BCE, Homer believed that women became pregnant through the air or by divine means. Approximately four hundred years later another Greek, Pythagoras, decided that men had something to do with it, but he viewed women as simple carriers in which an embryo developed.
The dark ages descended and for around the next one thousand years the accumulation of knowledge stopped.
Around the sixteenth century the famous British physician, William Harvey, realised semen had something to do with pregnancy, but what? It took the development of the microscope for scientists to begin to understand the role of semen. Antonie Van Leeuwenhoek, a Dutch draper known as the father of the microscope, found that semen contained small tadpoles he called 'animalcules'. Sperm are very small – almost three thousand could fit inside one single female egg.
Things were a little confused back then. Many believed the egg was perforated by the sperm and the egg then provided it with a place to grow. As science was dominated completely by men, this misunderstanding was not surprising. Finally, in 1857 German biologist Oscar Hertwig discovered fertilisation and the idea of a 'blend' had finally arrived. One must remember that the science of genetics was still unknown. A monk called Gregor Mendel was breeding peas around this time and over many years he discovered the rules of hereditary genetics. These ideas were yet to surface in mainstream science.
It has always been surprising to me that back in those times a man and a woman could mate and have children that looked like either their mother or father and no one worked out that both parents contributed to the child. But then, the Dark Ages were famous (or infamous) for a lack of inquiry or thinking. In the age of enlightenment that followed, mankind got on with some serious questioning of everything.
Now we know that the sperm and the egg contribute equally to the embryo. Inside sperm, those tiny creatures that look like tadpoles with a head and a tail, is half the genetic potential required to make another human being. Sperm is a form of taxi that can deliver its vital passenger, the genetic material in the head of the sperm, to a meeting with a female egg. Although nearly three thousand times smaller than the egg, sperm has an amount of DNA equal to that found in the egg.
Sperm, which is made in the testes, is slightly alkaline, which helps neutralise the acid pH of vaginal fluid. Sperm are very acid sensitive, so an alkaline fluid protects the sperm.
The saying 'all you need is one' is commonly heard and while that's literally true for conception – a single sperm is needed per egg – natural fertility needs a lot more. Millions and millions of sperm are needed, and male testicles produce them in abundance. It's also important for the sperm to be in top shape.
A semen analysis
Semen is analysed against three variables. The World Health Organization (WHO) guidelines are the most commonly used, however, they're only guidelines and don't represent the minimum requirement for fertility. Even low sperm counts can sometime be enough for a pregnancy – I've seen it happen.
How many?
Greater than forty million is considered the fertile range, but sperm counts vary enormously and long-term studies have shown great fluctuations. A concentration of fifteen million/ml is the minimum criteria for fertility that the WHO uses.
Be aware that sperm counts, and concentrations vary greatly. If one is abnormal not all is lost. The test should be repeated and the sperm count may well be normal at the next test.
Motility: are they moving?
More than 50 per cent of sperm need to be motile. This can be further broken down into 'rapid progressive' that is, the quick swimmers, down to 'slow' or even 'non motile'. Motility is important and lots of things can affect this; there will be more detail on this later. A sperm not swimming isn't going anywhere.
Morphology: are they the right shape?
More than 50 per cent of sperm shapes are normal. The genetic data is in the 'head' of the tadpole and the tail gets it moving. With a microscope you can also see the small engine-like mid-piece of a sperm, however, the head part is the most important in terms of shape.
The average sperm is rather abnormal when it comes to shape. There are various guidelines for assessing shape and many IVF labs use another criterion – commonly called the 'strict' criterion – where semen is considered normal if greater than 4 per cent of sperm have a normal shape. That means up to 96 per cent can be abnormal and yet the semen is still considered to be normal!
A good way to think of sperm is like little salmon swimming upstream. You need enough (the count), they need to be good swimmers (the motility) and they must have a decent shape (the morphology). Fertility also depends on how many of these factors are out of range. One factor out of range can influence fertility. When two or three factors are out of range the overall effect is considerable. If count, motility and shape are all out of range the effect on fertility can be up to eight times worse than if one factor is out of range.
Semen analysis also looks at volumes, pH (acidity) and a lot of other things but for now the big three – count, motility and morphology – are the important factors. For the sperm this is no cruisy late-night drive down empty streets. The journey sperm must make would leave even the world's best rally drivers white-knuckled with terror. Put it this way: in human terms it would be like a man meeting a woman who is twenty-nine metres (95 feet) tall and weighs three thousand times as much as he does.
Just one in a million sperm will make it to the egg. The rest will die.
It only takes one sperm to fertilise the egg, but the odds against them are so high that in a healthy male ejaculation not hundreds, not thousands, but millions of sperm are released.
The saying goes 'it takes just one (sperm) to get pregnant'. And that is true in that one egg is fertilised by one sperm, but you need millions to make that happen.
It's the job of the testes (testes being the plural of testicle) to keep churning out these sperm throughout most of your adult life. An average male will produce over one to two trillion sperm in a lifetime.
DNA, the genetic code that will later join with the DNA in your partner's egg to make the first conceived cell that will become an embryo, later a foetus and finally a baby, is carried in the head of the sperm. Many modern labs can measure the sperm DNA to assess if it is in good condition and not damaged. There are many names for this test, the most common being DNA fragmentation index (DFI). Chapter 4 is entirely about sperm and will help to explain this.
Male puberty
Almost all of us males go through a big change at puberty. What makes this happen? Testosterone does!
Testosterone is the very male hormone that does amazing things when it becomes part of the equation at puberty. Testosterone is what turns smooth-skinned, high-voiced boys who want to play with toys into hairy, pimply, shaving, deep-voiced, competitive, strong men who find women (or sometimes other men) very attractive.
Testosterone is made in the testes in abundance. Some helps turn boys into men and some stays locally in the testes to nourish the sperm. In fact, the local testosterone levels in the testes surrounding the sperm are fifty to one hundred times that in the blood stream in the rest of the body. Luckily nature keeps it mostly in their testes, otherwise there might be some serious repercussions – think body builders on anabolic steroids but ten times worse! The Hulk character from DC comics comes to mind.
Testosterone is what makes boys become men. Let's go right back to a male foetus. The male embryo has the genetic blueprint of 46XY. There is a large increase in testosterone in the male foetus during pregnancy that comes from the testes. The testosterone masculinises the foetus, developing male organs and changing the brain. After the male child is born the testosterone levels drop down and remain low during childhood.
Boys have reproductive potential but have no mature sperm. So what occurs? Puberty happens, and a genetic switch is thrown in the male brain and the big male engine turns on. A few years later our wee boy is a man. He starts making sperm at an amazing rate of almost one to two hundred million per day.
By now the male has become potentially reproductive, potentially fertile. Mature sperm are being produced in the testes in abundance, and when the whole system is working, strange things start to happen. What are the strange changes in the male at puberty? Girls become interesting. Sexual thoughts enter the male mind, often at an alarming rate. Where once playing, sports and food filled the male mind, a new interest develops – females. Males are programmed to be interested in females. The surging testosterone in the male bloodstream is biologically linked to attraction to the female of the species, and not just any female – the reproductive ones. The wiring in the male brain was all laid down during foetal development. Along comes a surge in testosterone, which provides the electricity to turn the male on.
Strange events begin to occur at night – another basic requirement of male fertility, erections, arrive on the scene and waking with these becomes common. The male 'wet dream' starts. Reproductively speaking, all systems are now switched on in the male. Hormones have now reached mature levels and the nervous system has changed. This often leads to some embarrassment but is just another milestone on the path to full maturity. Not surprisingly, wet dreams are one of the least discussed milestones! Adolescent males discuss many things but not that one. Hands up if you ever have?
Strange events occur with the male penis. Whereas once it was a small organ with little use other than to pass urine, it has now grown considerably in proportion to the male body size. It acquires accompanying pubic hair. But what is most interesting is the penis's ability to become erect, to go from a flaccid, floppy state to a hard 15 cm (6 in) structure. And it does this a lot! A state of sexual arousal may occur for up to three hours a day (much of that is when you're asleep).
Masturbation may become part of the young male's life. The cause-and-effect relationship of tactile stimuli to the penis is obvious to the young male; the system works and works often. Biology has linked erection and ejaculation to the pleasure systems in the amygdala area of the male brain, thereby reinforcing the relationship. This creates a biological imperative that encompasses attraction, erection and ejaculation. The purpose of this process is reproduction. Masturbation, like wet dreams, remains a subject only rarely talked about by males. When it comes to reproduction, sex is what men prefer to talk about.
So now we have matured as males. Our hormones have switched on, our testes are producing sperm in abundance, our penis has developed, and erections and ejaculations are part of our lives. Our interest in mature females has developed and our thoughts wander to sex on a regular basis. It's time to turn now to the other sex.
Ovulation
Just as male puberty progresses until sperm are made, female puberty progresses until ovulation of a mature egg occurs. This event is signalled by menstruation, commonly called a period – another basic requirement for fertility. Female puberty happens at the same time as, or perhaps a little earlier than, it does for boys. Their surging oestrogen acts on the oestrogen-sensitive tissues and interesting things happen to the female body. Breasts develop and become a great source of interest to pubescent boys. The breasts tell the males that this female is now in the reproductive age group. Males are programmed to respond.
There are many fascinating studies that have considered this area of reproduction. It will come as no surprise that the concept of 'sexy' is merely a reproductive potentiality grade that men give to females. Excellent hormone levels produce excellent anatomical proportions that men can recognise at a glance. If the female's anatomical shape is not the hourglass and is either too thin or more rounded and apple shaped, men know intuitively that this reflects poorer reproductive potential. It really is that simple. Modern man has changed some of the rules with cosmetic surgery to enhance breasts, but the basic philosophy still applies.
(Continues…)
Excerpted from "The Road Map to Fertility"
by .
Copyright © 2018 David Greening.
Excerpted by permission of Rockpool Publishing Pty Ltd.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
About the author,
One patient's story,
You are not alone,
Chapter 1. The basics of conception,
Chapter 2. The male body: the reproductive bits,
Chapter 3. The female body: the reproductive bits,
Chapter 4. Those all-important sperm,
Chapter 5. Sex: facts and fun,
Chapter 6. Factors affecting fertility,
Chapter 7. Age,
Chapter 8. Causes of infertility in men,
Chapter 9. Causes of infertility in women,
Chapter 10. Getting help,
Chapter 11. Pinpointing his problem,
Chapter 12. Pinpointing her problem,
Chapter 13. Male infertility treatments,
Chapter 14. Female infertility treatments,
Chapter 15. In vitro fertilisation,
Chapter 16. Further options: the roads less travelled,
Chapter 17. The journey onwards,
Glossary,
Resources,
Appendix,
Acknowledgements,
Index,