‘A lot of shame’: Why we need to talk about male infertility

TVO.org speaks with fertility expert Marjorie Dixon, of Sunnybrook Health Sciences Centre, about the challenges men can have fathering a child — and what can be done about them
By Daniel Kitts - Published on May 07, 2021
Marjorie Dixon is CEO and medical director of Anova Fertility & Reproductive Health. (Marjorie Dixon)

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Is humanity in danger of extinction due to rapidly decreasing fertility in men?

Some researchers, including Shanna Swan, believe it is. That’s the topic of her new book, Count Down: How Our Modern World Is Threatening Sperm Counts, Altering Male and Female Reproductive Development, and Imperiling the Future of the Human Race.

Shanna Swan appeared on Wednesday’s episode of The Agenda to discuss her research on male fertility.

Before you start to panic, it’s important to note that not all fertility experts agree with Swan. Wednesday’s episode of The Agenda with Steve Paikin got into that scientific debate.

What isn’t up for debate is that many men do struggle with fertility problems — and they’re often uncomfortable talking about it and reluctant to get help.

So let’s talk about it. To get a better sense of what can go wrong with male fertility, what men go through emotionally when they are unable to help conceive a child, and where men struggling with fertility can seek help, TVO.org spoke with Marjorie Dixon, a physician at Sunnybrook Health Sciences Centre in Toronto and CEO and medical director of Anova Fertility & Reproductive Health.

A man filming in The Agenda studio

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TVO.org: What can go wrong with male fertility?

Marjorie Dixon: What’s interesting is that women get referred to me all the time for infertility. And it’s almost like male fertility is not considered as a major component. But it does comprise approximately 50 per cent of the reasons couples present with infertility: 35 per cent is kind of a combo of male and female. And then the other 10 to 15 per cent can be male factor alone.

Sixty-five to 80 per cent of male infertility problems are primarily testicular issues. And there are issues that are idiopathic, meaning we don’t know why. That’s the next largest category at 10 to 20 per cent.

There are a lot of things that people don’t even know can be associated with male fertility. Obesity. Acquired things like groin injury, testicular torsion, mumps, sometimes toxins.

TVO.org: When male infertility is mentioned popular culture, such as in movies, usually what gets mentioned is low sperm count. But there’s a lot more that can go wrong with sperm other than the count, correct?

Dixon: There is a very small proportion of sperm that is actually perfectly safe — has a perfect head, perfect tail — in the order of only 4 per cent of sperm. It’s not uncommon for men to have sperm that just don’t move with purpose. Some sperm have two heads. Some sperm can have pinheads. They can swim backwards and spin in circles. So it’s very important to have a proper semen analysis, but not just to look at the count.

TVO.org: What are some basic things that a man concerned about his sperm count or the quality of his  sperm can do to try to improve his fertility?

Dixon: Lifestyle changes are a big one. Often getting healthy or adjusting your diet or modifying consumption habits can go a long way to improving sperm quality. The difference between testicles and ovaries is that testicles are sperm-production factories. Insults can occur, but, generally, if the machinery is functional, and there are no obstructions, they can be rehabilitated to a point by changes in lifestyle. Dietary supplements, things that are antioxidants — such as vitamins A, C, E, selenium, zinc — those things are good.

TVO.org: You’ve pointed out that male factors are often the cause of infertility for couples. But when fertility problems are discussed, they’re almost always about female infertility. Why do you think that is?

Dixon: There’s a lot of shame around male infertility, and there’s a lack of support for men who struggle with infertility. When you look at the chat rooms, there are a lot of places where those that identify as female can go and find supports. But for those individuals who have sperm, or who identify as men, and who struggle with infertility, there aren’t many resources. And it ends up being a really private thing.

TVO.org: Have you noticed differences in the way men and women respond to finding out that they have fertility problems?

Dixon: This would be anecdotal, because we haven’t done a very good job of having objective studies or good surveys that will help to guide us around male fertility. This is purely in my experience. It is just as distressing, but there is, say, a brave-face approach initially. An initial “It must be wrong, let’s figure this out” kind of resolute approach. Sometimes anger. Sometimes mistrust of the test. And, of course, the approach of “Let’s do it again to make sure that this isn’t wrong. It must be wrong.”

We see family and having children as a thing that a woman dreams of. There aren’t that many stories of men who say, “I always wanted to be a dad; I knew when I was young I’d have kids.” It’s not part of the usual dialogue of a locker room. And it is kind of heterosexist.

And I don’t just see heterosexual couples. I see gay men. I see trans women, trans men. I think it’s important to consider how our vision of family has changed and maybe how our perceptions need to change about how people mourn their infertility, even as men.

TVO.org: If a man in Ontario thinks that he may have a problem with respect to fertility, what’s the first thing he should do?

Dixon: They should speak to their family doctor and have a sperm test. That’s the easiest screen. And I talk a lot about advocating for your fertility in your 20s. Because, in your 20s, you’re less likely to be obese; you’re less likely to have other medical issues. If the sperm is normal and your testicles are healthy, then you’re sent on your way. But if there’s any indication, if there’s an abnormal mass on the testes, if they’re low-volume testicles, if the sperm is abnormal, then you can actually be proactive.

This interview has been condensed and edited for length and clarity.

For more on fertility issues, watch this 2015 segment on The Agenda where Marjorie Dixon talks about fertility technology, and this discussion on the myths and truths of life without children.

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