The Hidden Half: Unmasking Male Infertility

June is Men’s Health Month, and we want to bring attention to male infertility. Why this is an important health topic is one of the questions we ask our expert for this episode, Samuel Prien, Ph.D., professor and director of clinical research laboratories in the Department of Obstetrics and Gynecology in the School of Medicine. Dr. Prien explains what factors contribute to male fertility and infertility, what is considered a healthy sperm count and what lifestyle factors could affect sperm health. He encourages us to talk about this topic more openly so couples thinking about conceiving might possibly save time and money by first checking the male’s fertility. 

Transcript

Melissa Whitfield  00:09
Hello and welcome back to Texas Tech Health Check from Texas Tech University Health Sciences Center. I'm your host, Melissa Whitfield. We want you to get healthy and stay healthy with help from evidence based advice from our physicians, health care providers and researchers. It's Men's Health Month, and we want to bring attention to male infertility. Why this topic is important is one of the questions we ask our expert for this episode, Dr Samuel Prien, Professor and Director of Clinical Research Laboratories in the department of obstetrics and gynecology in the School of Medicine. Dr Prien explains what factors contribute to male fertility or infertility, what is considered a healthy sperm count, and what lifestyle factors could affect sperm health. He encourages us to talk about this topic more openly, so couples thinking about conceiving might possibly save time and money by first checking the male's fertility. Dr Prien, welcome to our podcast.

Melissa Whitfield  01:12
Thank you so much. How are you today? And happy birthday.

Samuel Prien, Ph.D.  01:15
Well, thank you for the birthday, and I am doing very, very well. Thank you.

Melissa Whitfield  01:19
Well, thanks again for coming on our podcast. Can you tell us a little bit about yourself, your expertise and what you do here at the Health Sciences Center?

Samuel Prien, Ph.D.  01:26
Okay, so to go and do everything I do at the Health Science Center, it would take forever, but I've been part of the infertility program here at the Health Science Center for the last 38 years, actually, as of yesterday.

Melissa Whitfield  01:40
Well, congratulations. Speaking of fertility, we're going to talk about male fertility. And can you tell us why male fertility is such an important health topic?

Samuel Prien, Ph.D.  01:51
It's an important health topic because most people think of infertility as being a woman's partner issue. But what works out is up to 30% of the time it's the male partner. There are issues with his sperm count, or other issues that the reason they're not conceiving can be solely assigned to an issue with him. And then there is another 20% of the time it's a combination of him and her. So 50% of the time it can be the male partner.

Melissa Whitfield  02:28
What factors contribute to male fertility or infertility?

Samuel Prien, Ph.D.  02:32
I wish I could tell you all of them, absolutely, completely, but some things that we do know are exposures to various chemicals, exposure to a lot of heat in their workplace. For example, in this region, people who are in agriculture and don't have the nice air conditioned cabs and such, we see their sperm counts drop in the summertime when they're actively outside. Or, you know, mail workers that deliver the mail, things like that, you'll see their counts drop in the summertime because sperm don't like high temperature. And then in the fall, things will come back. So sometimes it's just environmental. Sometimes it's chemical exposure. Unfortunately, those individuals who might take illicit drugs, that can be it. And there are a whole lot of other factors as well.

Melissa Whitfield  03:27
Is there a global decline in sperm count? And how dramatic is a decline? Is it a recent occurrence?

Samuel Prien, Ph.D.  03:33
It has been occurring over the last 30 years. There's a huge debate as to how bad the decline is. Everybody agrees there is a decline going on, and we do truly believe it's environmental changing and all the things we're exposed to. But we don't know the actual real decline because what we tend to look at are people who come to the fertility clinic seeking treatment, and a lot of them have much lower sperm counts. So it may not be quite as dramatic, but it is falling off over time.

Melissa Whitfield  04:10
How do you measure sperm count and what is considered a good count, a healthy count?

Samuel Prien, Ph.D.  04:15
Okay, so there are three things that go into a sperm count that really, really matter, or maybe four, but the actual count is measured. We can do it manually, but we now use computer assisted programs that can count it much more accurately than we do. But we'll measure the count. We'll measure how many of the cells are moving, which is what we call motility. We will measure how well they're moving, which we call forward progression. And then outside of all that, we'll look at their shape, which is morphology, and a good sperm count is basically any where you take all that you have an algorithm. Of them, and you put it all together, and you have 30 million modal, normal looking cells, that's a good sperm count. And it may be a lot of combinations of all those things, because you can have actually a fairly low count, but a really high motility. Or a sample I actually just looked at that had a whole lot of count, but the motility was 1% so you can get all kinds of combinations.

Melissa Whitfield  05:30
I guess that leads to the next question: Is sperm quality just as important as quantity? And does age make a difference in either?

Samuel Prien, Ph.D.  05:38
Age can make a difference. It's not as dramatic. Males are not like females. We don't have the equivalent of menopause, but we do know that there is a time period when males are reproductively more healthy than they are later in life. So that tends to be between the age of about 18 and about 45 and then things will start falling off. But males can father children way late into life. If you remember the senator, Strom Thurmond. He's been gone a while now, but he has two claims to fame. He was a senator past the age of 100 and he fathered a child at 94 years of age. So males can be fertile for a very long time, but their count will drop off. And, you know, lots of other factors can go into it, but age will play a factor there. But as far as what is good and what is bad, there are all kinds of other things are much more important in determining whether it's a good quality sample or not.

Melissa Whitfield  06:47
What are the treatments for low sperm count?

Samuel Prien, Ph.D.  06:49
The most common one is what's called intrauterine insemination, where we will take the sperm in the laboratory, which is my side of the world. We will concentrate it. We will do things to it to hopefully make it more modal. We'll find cells, because a fair number of the cells may be alive but not moving well, we can trick them back into moving in the laboratory. So we're we can get that count up to a reasonable level. And to have a reasonable level of success, you needed approximately 10 million modal cells. If you can't get that, then you're going to have to go very high tech. So you may have to go to in vitro fertilization, or you may even have to go higher tech, which is what we call intercy plasmic sperm injection, or Ixy, where you inject single sperm inside the egg cell. And so we can do all that here at Texas Tech. We do it routinely, but it is, you know, it is gets more and more complex. It gets more and more expensive. And another treatment, just to mention it, for my good friends in urology, is sometimes men are making sperm, but they're not leaving the body for various reasons. So the urologist can go in and I go and assist them with this. They'll go in and aspirate sperm directly out of the testes or the epididymis, another part of the reproductive system. I will say, "Yes, we have sperm." I will bring those back. We will freeze them. Those are definitely destined to end up in a very high tech procedure.

Melissa Whitfield  08:33
That's interesting. I didn't know you could freeze sperm.

Samuel Prien, Ph.D.  08:36
We do it all the time. In fact, there are commercial sperm banks. That's another option for patients, if, if they are willing, and some patients are and some aren't, they go, oh yes, it doesn't necessarily have to be my gametes. We just want a child together. They can go to a sperm bank. Sperm bank will have done lots of testing on the individuals they bring in they they'll know all about the genetics and what these people like to do for hobbies, and the couple gets to match it up so they can, they can select sperm from another donor. We used to long ago, you could recruit a family member or something like that, but federal government requires now that we do a lot of testing, and that kind of is taking that option off the table.

Melissa Whitfield  09:25
What lifestyle factors could affect sperm health? I know you mentioned the heat and the difference in the summer and the winter. What lifestyle factors could affect sperm health in a positive or negative way?

Samuel Prien, Ph.D.  09:36
Basically, anything you would consider a healthy lifestyle is good for sperm. So not smoking, you know. Not drinking in excess. Anything that is going to basically be detrimental to overall health is def detrimental to reproductive health. And usually first, by the way, so you know, somebody that is obese, for example, will see diminished sperm count or at least diminished motility. So all those play a factor.

Melissa Whitfield  10:10
Is there stigma around male fertility or infertility, and what can we do to encourage more open conversations about it?

Samuel Prien, Ph.D.  10:18
Okay, so this is where I'm going to get up on my soapbox. Please stand because obviously, I work with both males and females, and we put the female partner through the ringer. She gets it starts out with physical exam and then blood work, and then she may have surgery. She may have multiple surgeries before we ever get to the point of treating, which, for sure, if we're if we're doing a treatment with her with her gametes, it's always surgical. For the male, the first step is that is coming and getting what we call a semen analysis, or sperm count. That, yeah, it might be embarrassing for the moment, but there is not all this other involved. It's very simple. It's very quick. It takes, you know, usually, less than 30 minutes of someone's time, and we get so much information from it. So you know me being on my soapbox, I will tell the men in the audience: Man up, do what you need to do, because we need that information. We don't want to wait. I, like I said, I've done this a long, long time now. And you see people go through all these other things on the female side, and then we do the male side, and we go, "Oh, he's not making any sperm." That's just not a fair way to treat your partner. We both sides need to take responsibility.

Melissa Whitfield  11:50
Is there anything else that you would like to add?

Samuel Prien, Ph.D.  11:54
I guess the only other thing is, obviously, you know, we're involved in a lot of research in this area, and what we have spent the last, oh, 20 years doing is coming up with better ways at the point of collection, so that those counts are better and the motility is better, and all those things. We can't make sperm for a patient, but we may be able to capture it for them better now. And we're very proud, not just necessarily the work we're doing, but the fact that this technology is now beginning to spread across the United States and is beginning to actually even spread out to the world, so that there's a better option for males up front, and we may get better sperm, and hopefully we send people home with more babies quicker.

Melissa Whitfield  12:43
Well, thank you very much for coming on our podcast and telling us all about this and just really educating us.

Samuel Prien, Ph.D.  12:50
Well. Thank you for having me. I'm glad to be here. Thank you.

Melissa Whitfield  12:52
Can't wait to have you back on.

Samuel Prien, Ph.D.  12:54
Thank you.

Melissa Whitfield  12:54
Thanks for listening to Texas Tech Health Check. Make sure to subscribe or follow wherever you listen to podcasts. This information is not intended to be a substitute for professional medical advice. Always seek immediate medical advice from your physician or your health care provider for questions regarding your health or medical condition. Texas Tech Health Check is brought to you by Texas Tech University Health Sciences Center and produced by T.R. Castillo, Suzanna Cisneros, Mark Hendricks, Krystal Meazell, Kay Williams and me, Melissa Whitfield.