‘One in 15 men have a problem with their fertility’

My favourite sport is rugby. A game of big hits and end-to-end tries, mud, grit and demands both physical and emotional. And so it was that I found myself part of a passionate crowd singing ‘Flower of Scotland’ at Murrayfield stadium at the recent Autumn International Rugby series. But aside from the fact that I graduated with my medical degree the same year that rugby became a professional sport, why is any of this relevant to National Fertility Awareness week?

Infertility is a common health problem, estimated to affect 1 in 7 couples worldwide. Its effects are largely unseen, yet fertility problems have a profound impact on psychological wellbeing and quality of life.

Male fertility problems accounts for around half of infertility cases

Male infertility (low sperm count and/or poor sperm swimming) accounts for around half of all cases. One in 15 men have a problem with their fertility: that’s around 2260 men in a capacity crowd at Murrayfield (assuming 50/50 male/female attendees) – or around 2500 at the Millenium stadium, 2700 at Twickenham or 1700 at the Aviva stadium, depending on your home nation.

Treatment options limited

The point is that male infertility is a common problem, but there is often no clinical explanation and, except for specific and rare circumstances, there are no treatment options for affected men. With no other choice, many couples embark on in-vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI), which is expensive and invasive but without guarantee of success (25-30% live birth rate per treatment).

Sperm start to swim in response to higher (alkaline) pH on ejaculation and are incapable of fertilising an egg until a complex series of cell and membrane events (termed capacitation) have occurred. Either in parallel to or as part of the capacitation process, they also acquire specialised (hyperactivated) swimming behaviour and release enzymes to assist with fertilisation following removal of a membrane cap over the sperm head (acrosome reaction).

Sperm work very differently to other cells. They interact with the endometrium (lining of the womb) and fallopian tube as well as responding to natural chemicals from the egg and its follicle (progesterone, prostaglandin). Changes in calcium levels within sperm cells are essential to message pathways, with a trilogy of specialised membrane pores (CatSper, KSper and HV1 ion channels) fundamental for sperm function.

How sperm work not fully understood

However, the finer details are not fully understood. And the problem is that if we don’t understand how sperm work, then we can’t possibly understand why they don’t, nor how to fix the problem.

So how do we move forwards from this position? Research funding, co-operation and collaboration was key to rapid advances in vaccine and treatment development during the pandemic.

Applying a similar approach to male infertility would be a real game-changer. So, we need money for research, scientific collaborations of the brightest minds and teams working to better understand sperm function and to develop treatments for male infertility. We certainly need more than the luck of the Irish.

Dr Sarah Martins da Silva is a senior lecturer in reproductive medicine, University of Dundee and honorary consultant gynaecologist, NHS Tayside.

If you’re a man affected by a fertility issue, either your own or your partner’s, why not join HIMfertility, our male-only online fertility support group.