What’s happened to sperm?

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0:08Today, the lonely reality of male infertility.

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0:50Prof Michael Carroll:i thought trying for a baby would be quite romantic and as a memory and whatnot and here i am you know in effectively a toilet cupboard room, masturbating into a pot to create a sample. And it's honestly horrible. Toby Trice and his wife, Katie, had been referred to an NHS fertility clinic after trying and failing to have a baby. They were in their 20s, in good health, ready to become parents, but it just wasn't happening. Which is how he found himself in a toilet, surveying a collection of well-thumbed porn mags and thinking, You know, what am I doing here? this is just just awful i remember being at a waiting room actually on a facility clinic where men were arriving to obviously create samples for obviously checks um in the laboratory and honestly the awkwardness around the room of each guy that kind of stepped away into into the facilities and then come back flushed red-faced and full of embarrassment when it was toby's turn he told himself that his wife had been through far more invasive tests on their fertility journey so i just kind of dug deep and thought right i just gotta get on with this you You know, it's the easy bit, we joke about that, but there is obviously the emotional value that is difficult.

1:59When we talk about infertility, the focus tends to be on the woman. We've left it too late. We've prioritised our careers. We were too picky when it came to finding a partner.

2:13That's certainly how I felt when I was going through IVF. It felt like it was all my fault. But half of the time, infertility is actually caused by issues with the man's sperm. and sperm counts are on the decline worldwide. Plunging testosterone is also making headlines. But how much should men worry? And what can they do to have the best chance of becoming a dad? From The Guardian, I'm Helen Pidd. Today in Focus, the stigma of male infertility.

2:43Toby Trice, welcome to Today in Focus. Thanks very much for being here.

2:46Prof Michael Carroll:Hello, Helen. How are you? Yeah, good. Thank you very much, albeit melting. Can you just start by telling me, did you always want to be a dad? Absolutely. Yeah, absolutely. I think, um, I think from a, from a young age, um, I, I've got my partner and we were just 15 years old at school. Um, and from a very young age, we always spoke about being parents and stuff. Um, my sister, my older sister had children, um, when I was kind of just a teenager and I loved being the, the fun, silly mad uncle, um, and realized that at a very young age, that's, that's, you know, ideally I'd love to have a child or two or more in the future.

3:20Prof Michael Carroll:Um, so yeah, become a dad was always a dream for me and how old were you by when you decided that you were ready to be parents we're into our late 20s actually before we we got to that phase um sort of 25 26 is when we kind of started thinking about it um and that's when we started actually trying um we both wanted to land good jobs get a house set the foundations up for it you know for a good start of a family um so we were quite some time into our relationship and yeah we just thought that from that point, we would quickly have a baby. And did it ever occur to you, before you started actively trying to have children, that it might be tricky?

3:55Prof Michael Carroll:Never at all. Fertility issues was never a thing spoken about, certainly through my childhood, teenage years, into early adulthood. So, you know, when the time comes that me and my wife decided to start a family, we just assumed that we'd fall pregnant really quickly and we'll have a baby in nine months' time kind of thing. But of course, that wasn't the case. Yeah. And how long were you actively trying before you sought some help? So we were actively trying for the best part of 12 months. So under the NHS sort of GP guidelines, at the time it was very much that 12 months of trying for a family would be needed prior to any kind of consultation as to what might or might not be going on.

4:39um so those 12 months are really weird it was a really strange time for us because the first month we just expected it to happen it obviously didn't okay maybe maybe two or three months time and you know we'll be okay but um each of those months that kind of ticked by we were slowly starting to look at each other and go what the hell is going on why why have we not fallen pregnant um at the time of that that that journey you know there was friends and family of ours that also were falling pregnant really quickly it seemed and having having pregnancy announcements and babies and whatnot because of our closest friends and and people around us were having children um we just started isolating ourselves from friendship circles and stuff because we just couldn't handle being around kids yet we love them you know we absolutely love love children and um we were so happy for our friends but we just had this huge level of jealousy that that i we just

5:28Prof Michael Carroll:couldn't explain i was very much in denial you know didn't want to admit that there might be a problem my wife bless her she was the one that was the kind of researcher and trying to learn what could be going on and here's some vitamins and here's some things to do and whatnot. And, and yeah, we were kind of soon sat in front of a GP and trying to ask further questions as to why. Yeah. And when the investigation started into why you might be struggling to conceive, what sort of tests did your wife undergo versus, versus you? So we went straight to a gynecology led fertility clinic after seeing our GP and the team there were great in terms of looking at her and and all the investigative tests that are required you know blood samples hormones um egg reserve is the tubes blocked um is kt ovulating um there was a whole host of things going on there um my tests were very much just a a one-stop semen analysis but that was it for me i had i didn't have any hormones checked i didn't have any physical examinations and you could say that the the differences between our kind of care at that point were vastly different and so you you went through these you and your wife went through these various tests you had to provide your sample and then I think you were referred for IVF is that right or did you have to go private yeah pretty much yeah so in in our area um we had um two rounds of NHS funding here sadly that's changed um it's gone down to one now in in the Kent region Okay.

7:00And were you told what the problem might be at that stage? Well, we kind of had some ideas. So the gynecologist that we were under under the NHS mentioned to us that Katie may have or has polycystic ovary syndrome. Apparently quite common. It was something that wouldn't be so much of a problem for IVF. um but because we by this point were about four years deep into um sort of trying for a family and no luck um we were just told that IVF is what we need we've got sperm and Katie has a good reserve of eggs we just need to get those together in a in a clinic um in a laboratory and um that's what we need and at that point where was your head at how are you feeling um really mixed I'd say my head my head at that point was probably in quite an optimistic positive way um i'm i'm typically quite an optimist anyway i was thinking well maybe this is the solution we need maybe this is the fix of course there was the the sadness that that kind of was with us at that point that you know we probably can't have a child naturally and and that dream of having a you know that memory and that conception was probably not going to be the case but we just wanted just to crack on We were, you know, we were so far into this at this point.

8:19We just wanted to just have our family. And were you talking to your male friends about what was going on?

8:25Prof Michael Carroll:No, no, no. I spoke to nobody really. There was probably one or two really, really close friends that had an idea we were going through this. But I just wouldn't open up to talk to anyone about it. I felt quite, I don't know if ashamed is the right word, but I felt really embarrassed to think that we were going through facility treatment. and we didn't because we didn't really know the cause um at the time I was told that I I was okay that I wasn't the problem um because you were producing sperm but exactly that yeah and I had no further tests and that at that point um but it but it was just it was just that kind of almost shame really that here we were going to a clinic to have a baby and um so it was better for us just to stay away from everyone and just kind of be locked in a house almost that's kind of how it felt for ages yeah hard relate to everything you're saying here and tell me about the so you went you had two initial rounds of ivf tell me about that yes we had two initial rounds of ivf at our local clinic um those rounds of ivf well certainly the first one we was kind of told that we were both young fit healthy and we took all the right boxes that this should just work and the first the first round of ivf was that we managed to get i think it was about 12 eggs collected um all of those fertilized um and then they started incubating them to grow obviously for eventually a transfer five days later and throughout each of those days we were slowly losing one by one um yeah so to the point where we got to day five um we only had two embryos still you know kind of there um but yes we had that transfer done um the horrible two-week wait was was then after that um and we got to the end of the two-week wait with no real symptoms of loss or anything um and there were some symptoms of pregnancy but maybe that was because of the the medication that my wife was on um and sadly that that ended up as a negative and it was it was devastating absolutely devastating um we then took um a few months off um and prepared for the the second round and the second round helen was exactly the same and i'll never forget when we came out of the clinic after the second transfer we both come out and looked at each other and just when we there was no words but there was just like a i don't think it's going to work you know there was that kind of eye contact that just said it just felt the same and yeah two weeks after that one sadly we we didn't make that one either so from from there on out um we went back to the clinic to consult and to look at what was next um obviously from this point onwards it was going to be fully funded privately um by you guys right by us yeah we run out six seven grand whatever it was yeah so we were kind of offered um a scheme to basically pay an amount of money um to have almost like an unlimited rounds of ivf for a couple of years um and it was a huge cost um but it was sold as like how much was it um i think i think at the time it was about 12 14k i think it was and this was the first time that i kind of really spoke up in the consultation um because i felt like the donor um through most of it that just i was just some weird person in the room yeah we were starting our family together and i just said to this this consultant i said look we're going to take some time out this this is not the right time for me or my wife um she was really struggling katie was really struggling with with kind of her mental health um all of the hormones and stuff that had gone on over the last sort of few months has took her toll a little bit um and quite frankly i just run out of energy i was just like i just need some time away from this is this needs to stop so we spent um 2019 away from fertility um and it was at that point that i started then reaching out to um counselors um the facility clinics um and and i created a um an online male fertility support group to try and just speak to other guys because i just was imploding um i was in a really depressed state didn't know where i was going to be um didn't really want to be around anymore and needed help but throughout that support group we we decided to um to bring on expert expert panelists um to to do talks on facility and in particular male facility because us guys were in there kind of asking for answers and um there was this guy that joined um who i'm very fond of today um a gentleman called um mr jonathan ramsey who's a one of the world's best consultants in my opinion for for men and he came on and did a talk about um male factor infertility issues and one of the things he was talking about this particular day was um varicocels and some of the symptoms that men can have such as dull aches in their testicles um a lump that's visible um almost like a kind of bag of worms as it's described and um i was sat there nodding away thinking this is me this this feels this is feels like our scenario our embryos were dying off very quickly like he explained could happen and we didn't have any answers as to what our fertility treatment was at the time.

13:36So I thought, do you know what? I need to go and see this guy and have a physical examination and some further investigative tests. So I popped along to Jonathan Ramsey just a few weeks later, actually. And within about five minutes of talking to him and him observing me, he said, look, you've got clearly a varicocele present, but let's do the other test just to kind of quantify everything and make sure that we know what we're working with. And I got those results back very quick. And very quickly, the compass from my wife turned straight to me as the issue the whole time. And how did it feel when you learned that, as you said, the compass had shifted towards you and that it was your issue?

14:17The feeling of emotions was quite frankly brutal. Up to that point, Katie would always say to me, why don't you leave me for another woman that can give you a child? um and bless her heart I always used to reassure her that you know she was my love we've been together from from childhood and there's no way if we couldn't ever have children there was no way I was going anywhere um and I couldn't ever relate to why she said those things um and she had this guilt on on her shoulders for you know for nearly five years um and suddenly that changed to me and all of the things that she felt I immediately felt I immediately felt so much guilt shame um anger um that she had gone through all of that all of that invasive treatment and yet I was the problem that whole time um but equally I thought well at least now we have a reason and we have a treatment pathway that probably will benefit us and may not guarantee us having a child at the time but it was definitely going to be an improvement.

15:27Dr Michael Carroll, you're an Associate Professor in Reproductive Science at Manchester Metropolitan University and you are the author of Your Nuts, the science of how they work for your fertility. How did you get so interested in testicles and sperm? I've been interested in reproductive of science for many years as a biologist. There's kind of a deficiency of information out there for men. And one of the reasons why I'm vocal about this is to give men that safe space to be okay to talk about it. I remember one time I was in a pub and I was talking to two guys. They ask what you do and I told them.

16:01And then his pal went to the bar and he just kind of looked around sheepishly and then started to talk about his infertility. And he's going through IVF and he's not producing and quality spermin and how it's affecting him. And I listened and let him talk. But then he said, don't tell anyone. Just don't tell anyone. And I think, you know, infertility is very lonely, you know, for men and women, but I think particularly lonely for men. It's very lonely, yeah. Often men suffer in silence with this. It's something they keep to themselves. I think when couples are trying to conceive, it's often quite far down the road of investigations when they find out that actually it's male factor, infertility.

16:40So we've spoken earlier in this episode to a guy called Toby Trice, who said that he had a very late diagnosis of varicocel. But he'd been told at the start of all of their investigations, oh, you've got a normal sperm count, no problem. Do you think that's quite common? And is there a different approach that could have prevented all that anguish? Yeah, that is a problem. You wait until you're trying for a child before you have a reproductive health assessment or a fertility assessment. It's often the first time that a man becomes notified that his sperm quality is poor. or there are some issues there.

17:11One thing is with varicocele, it's a very common condition in infertile couples. So I think it's over 40 % of infertile men will have some grade of varicocele. And varicocele is like varicose veins in the scrotum. There's a network of blood vessels in the scrotum that feed into the testes. It's like a heat exchange pump. It keeps the testicles warm or cool because the testicles need to be between two to four degrees lower than body temperature for sperm production. now sometimes they become laxed so you get a pooling of blood or within this state is scrotum and that increases testicular temperature damages the sperm most men don't realize they have that and one thing i would say if your scrotum looks like a bag of worms then that's a good indication that you may have varicosea and go get it checked and it's often something that can be rectified fairly straightforward with with surgery how much of a growing problem is male infertility around the world?

18:06It is a growing problem. One in six couples are considered experiencing infertility throughout their reproductive life. That's the WHO, World Health Organization, statistic. And 50 % of that infertility is attributed to the male. Why do you think that the focus appears to be primarily on women's issues rather than the male factors? It's probably historical. Women are more aware of the reproduction. They're the ones who give birth. They're also aware of the reproduction because they go through cycles. Men don't. They don't have those cycles of reproduction. They get an erection and ejaculate. And if they can do those two things, it's assumed that they're okay.

18:47But we know it's not true anymore. It's 50-50 for men and women. Yeah. I'm sure many listeners will have read the headlines in recent years about the decline in sperm count in your average man. Is that true? And what might be the cause of this drop in sperm quality and count? Yeah, two major international studies were published. In the first study, they showed that overall sperm count was 60 % decline. And in the follow-up study, they showed that there was a decline of about 2.6 % per year in sperm count. And that's a drastic drop. Subsequent studies have shown that there was an increase in sperm count.

19:26So what it demonstrates is that regionally there is a decline in sperm count, but universally it may not be as drastic as you think. Yeah. And what are some of the causes of decline in sperm? The studies attributed that to the Western diet and also an increase in environmental toxicants, chemicals, in particular endocrine disrupting chemicals, which can mimic hormones and as a result disrupt the normal hormonal signaling that makes sperm. And where would you find those chemicals? They're everywhere. They're usually used in plastics, in fire detergent or retardants. These are the PFAS, the forever chemicals.

20:06Yeah, forever chemicals, yeah. And we live in a soup, we're surrounded by these chemicals. Now, there's a close association, but a causative link is something that has to be determined yet. There are causes that we know do result in poor sperm quality. Smoking is one of them, and that can damage sperm. What about vaping? Vaping is not the healthy alternative. There's evidence that suggests that it can impact testicular health as well. But the data is still emerging. The things that definitely cause post-spam quality is anabolic steroid use. And people who take testosterone replacement therapy or TRT, we see an increased growth in that.

20:44Men are influenced by social media pundits who are saying, take these TRTs and it'll invigorate you if you have low testosterone. Taking those and anabolic steroids definitely can damage sperm quality or testicular health. Obesity is another one. Yeah, and it's interesting that you mentioned taking testosterone as being something that has been proven to reduce sperm quality. Because there was a study last week which said that average testosterone levels have halved over the past 50 years. How worrying is that in terms of the decline in male fertility? The decline in testosterone is not a new notion.

21:23It's been recognised for a few years now. It's most likely linked to lifestyle factors. So sedentary lifestyle, lack of exercise, poor diet, in particular processed foods. Chronic stress is another one. Again, lack of sleep. So it's multifactorial. Taking testosterone, exogenous testosterone, is not healthy without proper clinical investigation. If you take exogenous testosterone, like anabolic steroids, for instance, that tells the brain that there's enough testosterone swimming around or floating about in the body. You don't need to tell the test it's produced anymore. So it shuts that system down.

21:57And then that's where you have poor sperm output.

22:03Coming up, how the manosphere is politicising male infertility. And what happened after Toby got his diagnosis.

22:25And this drop in testosterone is becoming kind of a big culture war topic. It's a big talking point among the MAGA movement in the US. We are below replacement right now. That is a national security threat to our country. RFK Jr., Trump's health secretary, has talked about it. For men in 1970, men had twice the sperm count as our teenagers do today. This is an existential crisis for our country. And it seems to be certainly in the mouths of those kind of people bound up in this idea of there being a crisis in masculinity, as well as those who are worried about forever chemicals, microplastics and so forth.

23:05Do you worry that this issue becomes politicized rather than being based in the science? It can be. And I think what's happened in the US, the science is becoming politicised. There's a massive step back in science in the US, which is unfortunate. Do you monitor stuff on social media? I do. I watch a few things. Testosterone replacement therapy, hormone replacement therapy. I started doing all that when I was 40. All that matters is that you have it in your system. If you don't have it in your system... There are a few certain podcasts that kind of measure masculinity in terms of numbers. There's a lot of masculine mythology out there.

23:44In my experience, if you eat shitloads of raw onion, it's going to increase your testosterone. Massive. Raw onion. Do women want to be around you, though? The low teammate is if men are lethargic, they're not measuring up to whatever standards the Jim Brose might portray, then one of the suggestions is take testosterone and take mTRT and build up your your testosterone levels and then that would reinvigorate you. As far as the main thing obviously let's start off with the testosterone so this is good old testosterone enanthate this is 200 milligrams per milliliter and I am right now using 120 milligrams per week.

24:27That's not a new idea. I mean, it's going back to the 1800s when George Sequard Brown used to mash up dog testicles and guinea pig testicles and inject himself with those extracts. Oh, what? Yeah, it was called the Brown Sequard Elixir. And there's a whole quackery industry built around that. Maybe there are men who are listening who really want to be a father one day and maybe they're worried. And what can they do to make sure that they're in tip-top shape when it comes to their sperm and testosterone and anything else you need to have the best chance of becoming a father. I think don't look at reproductive health or testicular health as separate to your overall health.

25:06They're all connected. And any advice for good health will help your sperm production unless you have a condition or a very obvious reason for that. So get enough sleep, eat well, exercise, don't smoke, moderate alcohol, things like that. And if they are concerned or if they want to know, get a semen analysis test. And that will tell you if you are producing sperm and the quality of the sperm at that time. It's about information. It's about health literacy. It's about being informed and making informed choices as you go along. If they pull the bicep in the gym, they would talk about that. If they're not producing sperm, they can talk about that.

25:45The fact that your testicles aren't producing sperm doesn't make you less of a man. There's more to that.

25:56toby did you ever link your fertility issues to your own masculinity i certainly questioned that once i got that that information to say that i was the problem i actually felt less of a man because i couldn't give our relationship what we intended to but it should never be the case um it's so so important that men understand that fertility and masculinity are completely

26:21Prof Michael Carroll:completely separate camps um you can be the best husband in the world and struggle for conception because you have infacility um you could be very fertile and um be the worst husband in the world yeah that's right yeah um so so for me you know i think i questioned it for sure um but you know that i i really strongly believe that men should never ever question that and it seems amazing that after all those years and having gone through all of the tests on the nhs for your first two rounds that nobody looked at your testicles if it was that obvious in a five-minute examination because as you said this sort of bag of worms effect is visible in in some men anyway isn't it yeah that's right yeah and if you know a gp could have picked this up very quickly the guidelines have changed thankfully that varicocele is now recognized as a as a male factor infatility issue at the time it wasn't so in fairness to to the gps at the time that that perhaps wouldn't be looked at but you're quite right you know just just by doing a physical examination and checking that things are working you know my wife had physical examinations to make sure things work in her end so why is that equality not spread across across men um and i think the most frustrating but equally thing that i'm most grateful for today is that that diagnosis that i had in the treatment that i then subsequently went on to have um finally allowed me and my wife to have a natural conception um and a little boy was born nine months later and he's now um he's now pushed on for nearly five years old which is crazy when i say that out loud but um but it completely changed my life that was toby trice thanks so much to him and to dr michael carroll if you are struggling with infertility i would really recommend the charity fertility action and if you appreciated this episode perhaps you'd consider giving us a review we always enjoy hearing what you think of the show and it also helps other people to find us.

28:14And if you want to hear more about the drop in testosterone worldwide, our sister podcast Science Weekly did a great episode on just this topic last week. And that is all for today. This episode was produced by Ruth Abrahams and Alex Atak and presented by me, Helen Pitt. Sound design was by Ross Burns and the executive producers were Sammy Kent, Khama Khalili and Danielle Stephens. We'll be back in your feeds this afternoon with the latest.

28:45This is The Guardian.