Fertility Road go behind the scenes with UK’s National Sperm Bank Situated at Birmingham Women’s Hospital the team spent a day with the staff, looking into how this major operation does its job.
The first member of staff arrives for work at the National Sperm Bank. The sperm bank is open 24 hours a day, but Maureen, the outreach and admin assistant, is the first of the team to start work in the morning. Maureen checks the emails for any new enquiries from men who are interested in donating or finding out more about what is involved in being a donor, and for any test results or doctors’ letters that may have been sent in for newly accepted donors.
Rachel Jennings, the National Sperm Bank’s healthcare science practitioner arrives. She checks in with Maureen, who updates her on emails. Rachel gets changed into her ‘blues’ (the blue top and trousers that she wears when she is working) and prints a clinic list so the receptionists know who is expected later that day.
The first donor who is booked for screening is due to arrive. Most donors or potential donors are employed and want to book their appointments so that they can attend on their way to or from work. This is not like a standard hospital appointment which you would fit in around your work; the donors are helping the National Sperm Bank so the staff aim to be flexible and to fit appointments around the donors’ availability as far as they can.
The purpose of the screening appointment is to explain the process to the potential donor, to go through the necessary consent forms and to take a family history. Rachel needs to find out whether there are any health conditions in the family that could disqualify the donor before they can make a decision about whether they are suitable. This part of the appointment takes around 40 minutes, although Rachel says it can take longer if the donor is chatty! Then, she shows the donor to a private room where he is left to produce a sample which will be used for a ‘test freeze’ to see if the sperm is suitable.
Rachel puts on another suit of special clothes and plastic clogs to go into the lab where she can look at the donor’s sample to see if it meets requirements. She needs to check whether the sperm are moving well (their motility) and how many there are in the sample (the sperm count). She will also need to check whether the sperm look abnormal (morphology).
If the sample is suitable, she will freeze it slowly by adding a special solution to prevent it being damaged when hanging it over the vapour rising from some liquid nitrogen.
Rachel goes to check her emails, which may be from new donors saying which days they can attend for blood tests or counselling sessions. She books suitable appointments with the receptionist and replies to as many emails as she can, as she has to keep going back to the sample which is freezing. She checks it after 10 minutes and then after another 15 minutes to ensure the temperature of the sample is gradually decreased.
One of the regular donors is due. The donors arrive at a special entrance so they don’t mix with fertility patients having treatment at the clinic. Rachel meets the donor and takes him to the procurement room. When he has produced a sample he rings a bell so that she can collect the sample from him and give him his expenses payment. While he is in the room providing a sample, Rachel prepares special barcoded labels ready for freezing the sample and sends out email reminders to donors who have appointments the following day.
Another new donor also arrives for his blood and urine test, and counselling session. He is sent off to produce his urine sample and Rachel escorts him to the main clinic where a nurse will take blood samples and ensure he gets to his appointment with the counsellor.
Rachel goes to the lab to assess and freeze the sample from the regular donor. She checks the sperm to see that it is moving and looks normal, and then she can start the freezing process.
Once Rachel has left the sample hanging over the liquid nitrogen vapours, she goes for lunch in the coffee room but takes a timer with her so that she can go back to decrease the temperature of the sample after 10 minutes and then again after 15 minutes.
An embryologist comes in to witness Rachel putting the donated sample in the liquid nitrogen tanks. Any time a sample is put into the tank, it has to be witnessed by another one of the embryology team. Rachel updates the database to include the freshly frozen sample and the log for the tank. All samples held at the clinic are recorded in this way. While she has been in the lab, Rachel has missed a couple of telephone calls. The other half of her job involves seeing oncology patients to store sperm samples before they undergo cancer treatments such as chemotherapy or radiotherapy, and a nurse has a patient who needs to be seen fairly urgently. Rachel returns the call and books in the patient for a couple of days’ time.
Another potential donor has an appointment for his screening test and while she waits for him to arrive, Rachel uses the time for some research. The potential donor who came in during the morning has a relative with a medical condition and it looks as if there might be a genetic element. Rachel emails the genetics department at the hospital outlining the family history and asking whether they can determine if there would be any risk to donor-conceived offspring. Their reply will help her to make a decision as to whether they can accept the donor or not.
The potential donor has still not arrived. Rachel calls him to see if he is on his way but there is no answer. She leaves a message, but she knows from experience that it is unlikely he will turn up. This happens quite frequently even when potential donors have confirmed that they will be attending after getting a reminder. Sometimes they change their minds at the last minute. Donating is a sensitive subject and it’s accepted that people may not inform the clinic of non-attendance.
Rachel carries out two test thaws on samples from potential donors. She has to check that a potential donor’s sperm is suitable for freezing by doing a test thaw because all donor sperm is frozen. About 75% of sperm won’t meet the threshold and Rachel always warns donors that they are looking for samples that are way above average. She contacts donors by email to tell them the outcome of the test thaws, but reassures them that it wouldn’t mean they were not fertile if their sperm is not suitable for freezing.
The test thaw involves preparing the sample first to get rid of the protective liquid that was added during freezing, and then selecting the ‘best’ sperm. This is washed and Rachel counts the sperm and looks at how well they are moving about. If the sample is suitable, she will be able to accept the donor. In this case, one of the samples passes, but not the other.
Rachel emails the two potential donors whose samples she’s tested. She tells the first he is accepted, and asks him to let her know when he can come in for medical checks and a counselling session. The email to the other donor has to be carefully worded to ensure he doesn’t worry that he isn’t fertile because his sperm is not suitable for freezing. Rachel will have prepared the donors during their very first screening appointment to ensure they know how few people pass the test thaw. She explains this isn’t a reflection of their natural fertility, but is just that some samples don’t freeze and thaw well.
Rachel sends out some appointment confirmations to the potential donors who have completed an initial questionnaire earlier in the week.
Rachel prepares her paperwork for the morning, making sure she has copies of the consent forms she will need for donors, as it is important that they clearly understand what they are agreeing to by donating sperm. Then she is finally ready to go home.
Rachel and Maureen may have left the National Sperm Bank for the day, but work still continues. Laura Witjens, the Sperm Bank’s chief executive, and the press officer Vicci Mace have a telephone conference to discuss the progress of their latest recruitment drive. They’ve had a campaign in the local media in Birmingham and the West Midlands to appeal for more donors and need to catch up. Several interviews have been booked in over the next few days for Laura to explain how important sperm donation is, and what a difference it can make to people’s lives. Laura has interviews for local and national media lined up, including two television appearances.
Laura Witjens leaves her home in the south-east to drive to Birmingham where she’s due to appear on a West Midlands news channel on the breakfast show first thing in the morning. She’ll be discussing the recruitment drive and the impact it has had on getting more potential donors to the bank.
Laura arrives at the hotel in Birmingham where she’ll be staying the night before the TV programme. She goes straight to bed so she’s ready for her early morning start and another busy day at the National Sperm Bank.
Why Are Sperm Counts Dropping Across The World?
The statistics on male infertility make for scary reading. One in five otherwise healthy young men between the ages of 18 and 25 have low sperm counts that put them at risk of infertility. Overall, infertility affects as many as one in 25 men. At an average rate of 1.4% a year, the sperm count of Western men has been falling for decades. Since 1973, sperm counts have dropped by an average of 52%.
There are stories of real people behind the statistics. Millions of people across the world who want a child but must now go through testing, appointments, medical procedures, expenses, delays, dealing with insurance companies, and all the stress that comes with it. It can be an emotional roller-coaster where relationships are stretched to the limit.
But why are sperm counts dropping all over the world? What is causing it? The problem is, we just don’t know. Research and studies are delving into the issue and attempting to come up with answers. There are a lot of theories.
Rather than competing, it seems more likely that many of these theories are in fact contributing factors. It could be this combination of a number of influences that is wreaking havoc on sperm counts. If each potential factor has even a little part to play then it’s easy to see how they could stack up.
There are some causes of infertility that we can’t do anything about. Levels have a genetic factor, inherited and the general lottery of our biological form. Other illnesses or conditions can contribute. But the other factors we will discuss here are not handed down by fate and can, to some degree, be controlled and curbed.
Which is good news, because sperm production is ongoing and can respond to positive changes as well as negative ones. It could also explain why sperm counts are dropping worldwide and have done so drastically in such a short time.
There are many environmental factors, such as the increasing use of plastics, of pesticides, GMOs and so on. Some of them are more obvious: the antibiotics and hormones fed to the animals we consume, for instance. We absorb these chemicals into our body through the meat.
Modern farming practices have become more and more intense which is why we are also seeing a big push towards organics. While the use of harsh pesticides is controlled in many parts of the world it could still have lingering effects. It takes years for soil to become certified organic, even smaller levels of pesticides could be causing health issues and there are some food-producing areas that are less regulated.
But we also absorb plastics and other chemicals as they leach into the water supply or contaminate the food and drink they hold. Tiny amounts can build up in the body and it introduces a whole new array of problems that our grandparents certainly didn’t have to deal with.
Similarly, since the late 1960s, the contraceptive pill has been widely used and there are studies ongoing about how much of the estrogen hormone passes into the general water supply. By drinking tap water we could be exposing ourselves to tiny amounts of estrogen that could cause havoc on a man’s reproductive system. Testosterone is essential for sperm production and estrogen acts in direct opposition. It may only be a tiny amount, but all these contributions stack up.
Male infertility is on the rise all over the world and so is another health problem: obesity. It’s a modern epidemic and can cause poor health in many ways. The modern diet is rich, high in sugar and in plentiful supply. A man’s overall health and fitness has a big part to play in his fertility. Improving the diet and getting in shape are often the first steps in fertility treatment and there are sometimes restrictions on that treatment until certain conditions, like body mass index are reached.
Obesity also has a direct, negative effect on testosterone. It inhibits testosterone production, which in turn inhibits the production of sperm.
If this all sounds very stressful that’s exactly the point too: stress is also linked to male infertility. It’s a vicious cycle because dealing with infertility is also incredibly stressful. But aside from that, our 24/7 highly commercialized modern life is very stressful and stress has become yet another modern epidemic.
Stress causes health problems because high levels of the stress hormones adrenaline and cortisol wreak havoc on the body. It disrupts sleep, which is an essential restorative for the body to heal, and means we are operating on high alert all the time which puts other bodily functions on the low-priority backburner. It means we have little time for exercise and are prone to eating badly, linking back to other infertility factors.
There are more cell phones in the world than there are people and they are an essential part of life for most of us. As is WiFi, allowing us to stay connected on the go, and enabling the growing use of wireless technology and the Internet of Things. Which means that the world is fast becoming blanketed in an “electromagnetic smog”.
All the cell phone radiation and electromechanical fields are also contributing to male infertility according to many studies. In one of those studies, mobile phone radiation was described as ‘cooking’ sperm. The radiation passes through the body and damages cells and DNA. There are some very important and delicate cells developing close to where many men carry a cell phone in their pocket or on a belt.
When all these contributing factors come together it’s easy to see how they can stack up. Even if each individual factor – and potentially more that we aren’t yet aware of – was responsible for a tiny percentage decrease in sperm count, together they could add up to a drop that takes a man from a healthy, average sperm count, to infertility.
“Sperm count” is a simplified way of referring to a man’s overall fertility. It’s not just the quantity of sperm, but their health and viability that is an issue.
Sperm motility is the sperm’s ability to move. This has four classifications from strong progress to not being able to move at all and includes sperm that can move but in circles rather than a forward motion. Having sperm that doesn’t move at all or just chase their tails is not any use for conception.
Sperm viability means that the sperm is able to do its job. Some sperm are formed with faults, some have DNA that is corrupted, some are too weak to withstand the acidic environment through which they must travel. Sperm that arrives at its destination but has a fault in its DNA is not going to conceive a viable embryo.
So it’s not just sheer quantity that matters, but also the state of those sperm that are produced. And because sperm are in constant production by the millions it is easy for something to go wrong. On a more positive note, it is also fairly simple to work on the factors we have discussed and give sperm the best chance to do their job, and raise male fertility levels once more.
So what can men, and all of us, do for the best chance of avoiding infertility, or even once a diagnosis has been made?
Each of these issues can be tackled and together could add up to amounts that can hold back the creeping statistics on male infertility.
First off, general health and wellbeing is always important but never more so than when you are on the path to conceiving. Eating well, avoiding too much sugar and switching to organics wherever possible ensure you are getting the best fuel into your body.
Give your body the chance to rest and repair by getting enough sleep – 8 hours a day should be the aim. But also, get active. Take some time for yourself to start an activity you’ve always wanted to try or enjoyed when you were young.
These tips will help with stress-busting too. Exercise produces great hormones to combat the stress-related ones. Getting enough sleep and downtime will help too. If you regularly feel stressed out then maybe look into mindfulness and meditation, try to avoid working after-hours and limit your screen time.
Limiting your screen time on a cell phone, especially in the evening, will help you sleep better and also avoid getting drawn into answering work emails and the like. But what about that cell phone radiation? Some experts described it as “cooking” sperm, which could put back all your hard work in other areas.
An anti-radiation phone case blocks the cell phone radiation from passing through your body, bouncing it back away. You can still use your phone as normal – you don’t need to completely give up your cell to work on your fertility, thankfully. Or protect the specific body parts with special radiation shielding briefs.
Once you understand all these different factors in male infertility you start to see where changes can be made. Most of these changes will also benefit your overall quality of life and thinking about starting a family is just the motivation you need. It’s still possible to buck the trend of dropping sperm counts.
How Male Infertility Is An Increasingly Modern Problem
In 1973 the UK entered the European Union, Pink Floyd released Dark Side of the Moon and the Watergate scandal picked up steam. Since 1973, sperm counts have dropped by 52%.
At an average rate of 1.4% a year, the sperm count of Western men has been falling for decades.
It’s a shocking fact and a shocking number. The modern world is supposed to bring more opportunity, more innovation. Instead, we are confronted by an increasingly modern problem. Infertility isn’t a uniquely modern problem, though it is becoming an urgent one.
To our ancient ancestors thousands of years ago the whole process of conception, pregnancy, and childbirth was mysterious. The easiest analogy was the fertility of the earth, of agriculture, and we owe a lot of the language and concepts to that still. The ideas of Mother Earth, and “planting a seed” have been around almost as long as humanity has.
Fertility deities were big business: gods and goddesses that could promote fertility and the getting of many children. Across the world, there are fertility myths, gods, rituals and rites. Independent of each other, from Scandinavia to the Indigenous Australians and the empires in Central and South America.
Childbirth was incredibly dangerous. Plus, the responsibility for fertility solely fell to the woman. Any medical or religious response to a lack of children was centered around her. Male infertility was not considered as a factor.
Treatments for fertility continued to be centered around women and it was viewed as a female “problem” throughout much of history. Even now much of the emphasis is on the woman. However, the facts paint a different picture. The NHS says that 35-40% of trouble conceiving is thought to be an issue with the female partner, and the same 35-40% with the male. The rest is simply unknown. But it shows that the problem has an equal chance of being with either partner and either sex.
The rise of assisted reproductive technology in the 1970s led some people to claim that infertility was “invented” alongside the first “test tube baby.” We know that’s not the case and that attempts at treating infertility have been around for a long time.
Something has happened and has become increasingly more prominent since the 1970s though. Sperm counts have been dropping across the globe. Sperm counts in Western men have halved in the last 40 years. Clearly, male infertility is on the rise and it has led some news outlets to make near-apocalyptic predictions for the future of humanity.
It’s now thought that infertility affects one in 25 men. As many as one in five otherwise healthy young men between the ages of 18 and 25 have low sperm counts that put them at risk of infertility according to Professor Niels Shakkebaek from the University of Copenhagen.
Even the official measurements of male fertility have undergone some massaging. The official definition of infertility in men used to be less than 20 million sperm per milliliter of semen. Now that the average sperm count has dropped to around 20-40 million sperm per milliliter the official designation of low has been dropped too. An official low sperm count has been slashed by a quarter, down to under 15 million.
Using the falling average the official definition of male infertility has been massively changed. Overnight a man could have gone from classified as infertile to average. Clearly, this isn’t based on any science, just on the downward trajectory of male fertility.
Talking about such big numbers on a global scale can be overwhelming. It also blinds us to the very real emotional trauma and difficulties that infertility can cause. Behind all these statistics are real people, wanting desperately to start a family but instead going through invasive testing, expensive medical procedures, and a lot of heartbreak.
The emotional burden falls harder on men than society at large might expect. Difficulty conceiving and a diagnosis of infertility is stressful and upsetting. Men generally feel less able to express their emotions, and much of the focus on infertility is on women. But men also carry feelings of shame, anger, grief, helplessness, and frustration. This can be compounded by feeling they have to suppress these feelings in order to be supportive of their partner.
So why is this happening? What about our modern world has caused this massive drop in male fertility? There are many theories and research is ongoing. No definitive answer has been put forward. Perhaps because there are a number of factors at play, all contributing to an individual diagnosis and the general decline.
There are the obvious variables, like genetic predisposition and pre-existing illnesses or conditions. Layered on top of these hands dealt by fate are many other factors. And most of them have become much bigger issues since the 1970s.
There are environmental factors like pesticides or chemicals in our water and food. Leaked from plastics, introduced by modern farming practices, genetically modified organisms, antibiotics and hormones fed to our meat. In the last few decades, these fields have seen huge changes. These chemicals enter our body through our food and drink and are known to have changed the natural running of the body. They could well be having an effect on male fertility.
Another candidate, becoming more and more ubiquitous since the late 1960s and found in our water supply is the female hormone, oestrogen, from the use of the contraceptive pill. Oestrogen levels have been rising in the water supply as the water is recycled through the sewage system. Oestrogen acts in opposition to testosterone, an essential hormone linked to the production of sperm. The less testosterone is produced, the fewer viable sperm there are.
Also related to the modern diet and lifestyle is obesity. Obesity is described as a modern epidemic, much as male infertility threatens to be. We know that a man’s general well-being, health and fitness, can be linked to his fertility. The health of the sperm can be influenced by the health of the man and weight plays a part in that. Obesity cuts testosterone production, essential for sperm production too.
Stress is yet another lifestyle factor tied to male infertility. It causes and can be caused by trouble conceiving and can affect all areas of life. Too much of stress hormones such as adrenaline and cortisol disrupts the body’s natural functions.
Not only does stress have a physical effect on the body but it can contribute to less of the act of babymaking too. It is often closely intertwined with someone’s health and fitness, causing over eating or a lack of exercise. It can disrupt sleep, which is essential to our wellbeing.
Another modern convenience: mobile phones were barely being developed in the 70s and now they are an essential part of everyday life. The growth of this technology has been unprecedented in such a short amount of time. It also goes hand in hand during this last decade with the blanket coverage of WiFi and devices using wireless technologies.
Increasing numbers of scientific studies and medical research links mobile phone radiation with damage to cells and DNA, including sperm. The radiation that powers our phones and WiFi networks has been described by some experts as “cooking” sperm.
At the same time as all this, it seems that we live in an age of increasing regulation. We expect these concerns to be thoroughly tested and vetted against. That’s not always the case. With mobile phones, for example, there just hasn’t been the opportunity to survey the long-term effects. We don’t fully know the effect of WiFi networks in schools, or what decades-worth of carrying a phone around in your trouser pocket might be doing to your body and your sperm.
One thing is clear, the modern world is not good for male fertility. Sperm counts in Western men have halved in the last 40 years at the same time as many other potential factors have increased. Anyone of these factors and any combination of them could be making the critical difference in the numbers game of male fertility. The good news is that the spotlight is finally turning onto the issue and it’s not too late.
Men may not be able to do anything about their genetics but still, male fertility is robust and is not set in stone. Men can influence their fertility and can start making changes now that will have effects within the next six weeks or so thanks to the regenerating nature of sperm
Lifestyle changes such as exercising more, tackling stress and going organic can turn back the clock on these modern maladies. You can keep the modern gadgetry too, with an anti-radiation mobile phone case.
The modern encroachment of all these infertility factors is avoidable. Modern technology can fight the ill effects of other modern technologies. Research can show us how to take better care of our bodies despite all the modern temptations and a difficult environment. Greater understanding of the impact modern life is having on our planet and our bodies is leading a revolt against intensive farming practices, or against stress. Medical science is tackling infertility in new and exciting ways.
Male infertility is an increasingly modern problem but the solutions are modern too and the modern world gives us the tools to understand and combat the issue.
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Top Five Male Fertility No Nos
Diet and lifestyle play important roles in male health and fertility. There is evidence that specific nutrients support fertility. Good sperm health includes count, morphology (structure) and motility (movement). There also needs to be good levels of semen to transport and provide energy for the sperm.
It is generally said that sperm takes 90 days to mature but it is closer to 2 ½ months. Sperm develops in the testicles for 50-60 days and are then excreted into the sperm-maturing tube, the epididymis, to complete their maturation for another 14 days. Healthy habits including diet and lifestyle should be encouraged to increase the chances of healthy conception and also for the development and future health of the baby. The genetic material in sperm reflects exposure to stress, nutrient deficiencies and environmental toxins.
Check out these five tips from Emma Cannon.
Too Much Heat
Don’t cook your testes!
Research demonstrates that heat impacts on semen quality so it is important to keep the testicles cool. This is why nature has designed them to hang in sacks outside of the body so they keep cool. Using laptops directly on the lap, becoming over heated through excessive exercise, sauna’s, external heat sources such as ovens, hot baths and car seats, all cause problems to sperm quality. Male chefs, for example, have a high incidence of infertility since their testicles are exposed to a constant heat source. Tight underwear and prolonged periods spent cycling may also cause problems with sperm
Too Much Partying!
Drinking too much alcohol, smoking weed and taking cocaine can all impact on male fertility.
An observational study of the alcohol intake of 1221 Danish military recruits published in the BMJ suggests that moderate alcohol intake of at least five units every week is linked to poorer sperm quality. Marijuana has a negative impact on sperm production and makes it less mobile (in other words it gives you lazy sperm). Although short-term cocaine use can increase libido, long-term users report a decrease in sexual function, including difficulties in maintaining an erection and ejaculating
Exposure to Environmental Toxins
Don’t breath in toxic fumes!
Studies from the Czech Republic (2000) demonstrated that men living in areas with high air pollution have a larger percentage of abnormal sperm, decreased motility and DNA fragmentation. In other words, their sperm was damaged even at the level of the DNA. Other studies in this area confirmed these findings. One study showed that DNA seemed to be a major issue and was often damaged even when other aspects of the sperm looked ok.
Since most clinics or GPs do not measure Sperm DNA damage it is important for men living in highly polluted areas to consider that even a normal semen sample does not tell you about the DNA damage. Toxic Household Products; Avoid Soft Plastics and Use Natural products at home where possible. Bisphenol A (BPA) for example, found in plastic and food packaging, is an endocrine disruptor shown to decrease both sperm quality and sexual function, as well as being associated with chromosomally abnormal oocytes and recurrent miscarriage. Replace plastics in the kitchen with glass and other products that do not contain BPA’s
Saving Sex Just for Ovulation
Don’t save sex for ovulation – ejaculate regularly
This is a common mistake in couples trying to pinpoint the ‘fertile window’. They wrongly think that by having sex at ovulation they will increase their chances. This is flawed, as although it is important to have sex at ovulation it is as important to have regular sex throughout the month. This is because the sperm needs to be as potent as possible. If it has been sitting around all month just waiting to be ejaculated at ovulation then it may have passed its ‘sell by date’ (so to speak). There is also evidence to suggest that couples that have regular sex outside of the fertile window are more fertile. The only time this may not be true is when the man has very low sperm count (i.e not much sperm). In which case there is some evidence that saving sex to ovulation maybe of benefit.
Steroids Shrink Your Balls
Men who use use anabolic steroids fool the body into thinking that the testicles do not have to produce testosterone.
The body then produces less testosterone and follicle stimulating hormone ceases to be released. The result of this combination of factors shrinks the testicles and very little sperm is produced. This is mainly reversible 3 months after stopping using performance enhancing drugs.
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