I will never forget reading a summary of a new patient’s history provided by her Reproductive Endocrinologist (RE) at her first visit with me. It explained how long her and her husband had been trying to conceive, what testing had been done, the results of that testing, and the RE’s recommendation for treatment. Pretty standard stuff, but what made this summary burn into my memory was the part where it said the husband had a “normal sperm analysis,” and the wife had “unexplained infertility.” Each had had all the usual tests, both had “normal” results, and yet the he in this situation was given the label of “normal,” while she was given the label of “unexplained infertility.” It seemed so unfair to me that she was given the label of infertility when we really can’t be sure if it is an issue with the female or male or both (with the current state of testing, when all findings are normal). Also, it is not as though it is a news flash that statistically, it is just as likely that difficulty in conceiving is related to a male factor as it is to a female factor (for more on that click here.)
Similarly, it has always bothered me when a couple goes through IVF, and if the eggs retrieved don’t fertilize as well as expected the couple is given the message that this is a sign of “poor egg quality.” This has always made me scratch my head, since egg and sperm are both active during the process of fertilization. Why so quick to jump to an egg quality issue? I have a feeling untangling the ways in which we frame fertility issues, and tend to think of it as more of a woman’s than a man’s problem is quite complex. And I am really not interested in laying blame in the lap of either party, but I do want my patients to get the best treatment possible, and that has to include both parties involved!
That’s why I am so encouraged when I see researchers digging deeper into the male factor. A recent study published in the journal of Human Reproduction, looked at the relationship between a man’s urinary phthalates levels, and his sperm’s ability to fertilize an egg in an IVF cycle. Need a reminder on what phthalates are and how/why to avoid them? Click here.
The study found that the more phthalates in the man’s urine, the lower the quality of the blastocysts he and his partner produced. High concentrations of phthalates also lowered the likelihood that there would be transferable embryos during their IVF cycle.
The researchers found that embryo development started out normal, but that development started to “drop-off” at the point where paternal genes kick in and start directing the progress.
More studies are of course needed, and pregnancy outcomes were not reported, but it is encouraging nonetheless to see this sort of study focusing on the sperm’s role, and better yet, reducing phthalate exposure is something we are all capable of!