Infertility is often treated as a woman’s problem, but male factors alone are responsible for one-third of reproductive challenges, and a combination of male and female factors account for another third.
“Frequently, I have infertile couples in my office, and the woman has already been through major procedures, but the man has never been tested,” says Dr. Marc Goldstein, director of the Center for Male Reproductive Medicine and Microsurgery at the Weill Cornell Medical Center in New York. “Often, I can tell what the problem is with a basic male exam or sperm analysis.”
We asked Dr. Goldstein for his take on the most significant — and surprising — threats to male reproductive health.
Heat. You may have heard to avoid hot tubs and saunas if you’re trying to conceive, and that’s true—sperm cannot survive high temperatures, so prolonged heat exposure can affect production and quality. “The reason a man’s testicles are hanging outside the body is to keep them cooler,” Dr. Goldstein says.
But a more widely used source of heat is also a danger: laptops. A study published in the journal Fertility and Sterility last fall found that after 10-15 minutes of holding a computer in their laps, men’s scrotal temperatures were higher than a fertility-safe range.
Men should also check for varicose veins in their scrotum, a seemingly innocuous condition that can, in fact, keep sperm too warm. The veins are typically visible after a warm bath or shower, from a standing position.
The good news about infertility related to heat is that it is reversible. Since new sperm is generated every three months, sperm quality should improve in about that period of time after the heat-generating condition or behavior is stopped.
Your medical history. “The most common operation in male children aside from circumcision is hernia surgery,” says Dr. Goldstein. “That operation can result in an accidental vasectomy.” Having had undescended testicles, on one or both sides, at any point in a man’s life can also affect his fertility, as can cancer, especially if treated with chemotherapy.
Medications. Recent headlines linking over-the-counter painkillers, especially in certain combinations, to male infertility have in fact referred to the use of the drugs by pregnant women, which European researchers suspect may increase the risk of giving birth to a boy with undescended testicles. But while adult men needn’t worry about their own over-the-counter painkiller use just yet, there are other medications that can inhibit fertility, including commonly prescribed anti-depressants. Besides the diminished sex drive many people experience as a side effect of selective serotonin reuptake inhibitors (SSRIs), a common class of anti-depressants, SSRIs can also lower testosterone and sperm count, making conception more difficult.
“Men who are taking these should talk to their psychiatrist and see if there are any alternatives,” Dr. Goldstein says. In fact, it’s a good idea to let all your doctors know you’re trying to conceive as a matter of course, so they can adjust any of your medications if need be.
Age. It’s not nearly as significant a factor in men as in women, and it’s not as crucial as the other factors mentioned, but sperm quality and testosterone do slowly decline as men age. Children born to fathers older than age 45 also have an increased risk of Down syndrome, schizophrenia and autism.
Weight. As is the case for women, excess weight in men has been shown to inhibit fertility. One reason, surprisingly, goes back to heat: Having a lot of fat surrounding the thighs can keep the groin area too warm.
But there’s also the matter of hormonal balance. Two hormones crucial to fertility in both men and women are FSH and LH, and they’re produced by the pituitary gland. “These are fat soluble hormones, and they have to get down to your testicles,” says Dr. Goldstein. In heavier people, the hormones can be absorbed by fat in the body before they reach the reproductive organs.
Plastics and cellphones. Research on these two threats is still in its infancy, but the preliminary evidence based on animal studies is compelling enough that Dr. Goldstein recommends his patients avoid carrying their cell phones in their front pockets, and reduce their use of plastic food wrap containing phthalates.