When an IVF consultant told John Flynn and his wife Rachel that the results of his semen analysis indicated they would be unlikely to conceive a baby naturally and would need assisted reproduction, they were devastated.
“It was a body blow,” says John simply.
Intracytoplasmic Sperm Injection (ICSI), where a single sperm is injected into an egg in the lab, was recommended. “My sperm was viable, the problem was the viscosity, it just wasn’t breaking down,” he says.
Although still in their mid-20s when they married in August 2014, the couple, who live in Carrick-on-Suir, Co Tipperary, had no success in trying to start a family over the next six months. After consulting a GP, they decided to try a fertility clinic.
They attended two before starting IVF treatment at a third. After three failed rounds there, they went to a clinic in Prague, where they had a fourth cycle, again unsuccessful.
At that stage, after two years, the whole IVF process was taking its toll physically, mentally and financially.
“We were desperate for a child – that’s what we wanted,” says John. “We were looking at going down the route of donor embryo because we didn’t know what the problem was at this stage. All they kept telling us was that it was just ‘bad luck’.”
When one attempt with a donor embryo also failed, "we were at our wits end altogether", he says. They decided to give it a break and then heard of Siobhan Kehoe (Fertility Treatment Centre) in Co Wexford.
A nurse and midwife by training, who once worked in an IVF clinic in Dublin, Kehoe has since trained in traditional Chinese medicine. Her approach to fertility is a combination of Chinese medicine, nutrition and conventional western treatment. “The more I do, the more I realise it is back to basics. Animal breeders understand this concept, but humans don’t and with animal breeding there is a big emphasis put on the male aspect,” she says.
When it comes to human fertility, the focus tends to be very much on the woman who is going to be carrying the pregnancy. But, as the embryo is 50 per cent male and 50 per cent female, good preconception health is important for both partners – not only to maximise the likelihood of achieving pregnancy but also for the health of the resulting child.
Up to recent years, while women were warned about the risks of delaying pregnancy beyond their mid-30s, scant attention was paid to the age of the father. But research published earlier this year linked advance paternal age to various health risks for the baby.
Advice on basics
"A healthy father produces a healthier sperm essentially," says GP Dr Emmett Byrne, who runs a male health clinic in Bray, Co Wicklow. It's not a bad idea, he suggests, for both partners to engage with a doctor at the outset of starting to try for a family, to get advice on basics such as improving lifestyle, most effective timing of intercourse and to address any underlying problems.
“The good news is that if you haven’t built a healthy lifestyle and you adopt a healthy lifestyle, you can turn this around fairly quickly if you want to have a family,” he says. Unlike women’s egg reserves, men’s sperm supplies are totally renewed about every 64 days.
Irish men are typically slow to make appointments to see health professionals. If fertility proves challenging for a couple, almost invariably it is the woman who will be proactive about seeking advice.
It's why Dr Helen Spillane, of the Merrion Fertility Centre in Dublin, can find herself in a situation "where a [female] partner will come and I will have a sperm test that's terribly abnormal and has massive implications and I have no man in front of me".
While a man wouldn’t get an MRI done on his knee and then expect his partner to go in and discuss his anterior cruciate ligament surgery, the equivalent is happening when it comes to matters of fertility, she points out.
A big challenge for fertility clinics, for whom the female is usually the primary contact, is how to engage fully with the man. “They feel like they are an add-on,” she suggests.
John didn't accompany his wife to her first visit to Kehoe, who is based in Gorey, but he noted Rachel's new mood of optimism on her return and they went back together soon after. "She put us on a plan to help us conceive naturally," says John. They had a healthy eating plan, started going to a personal trainer and took vitamin and herbal supplements. "We religiously cut out fizzy drinks, maybe one bar of chocolate a day, just drinking water, exercising, gluten-free meals – even though neither of us was intolerant."
‘A bit surreal’
Within five weeks, he says, Rachel was pregnant and their daughter Pippa arrived safely on March 9th, 2018. “It was a bit surreal after everything that had happened.”
At a post-pregnancy check-up, Rachel was advised that their best chances of conceiving again would probably be in those first few months after birth. They re-connected with Kehoe and, within weeks, Rachel was pregnant again and the first scan showed it was twins. Isabelle and Sheena were born on March 6th this year. The couple went, as John says, from “so many years and so many blanks, to having three children under the age of one – for three days”. The twins’ big sister celebrated her first birthday three days after their birth.
While traditional Chinese medicine is one end of a spectrum and what Spillane describes as “the mind-blowing” science of embryology practised in IVF clinics is at the other, there is universal acknowledgment that the western lifestyle is affecting the quantity and quality of men’s sperm.
Last October, two studies launched at a reproductive medicine congress in Denver indicated that US and European men's sperm count and sperm motility, ie their "swimming" ability, have declined in the past decade. This was continuing a trend observed over previous decades too.
This could have serious implications for future generations, points out Spillane. “It’s a bit like climate change, with people saying we should be doing something about it now.”
For today’s would-be fathers, there are ways to help themselves be “fit for fertility”. As Byrne says: “What you can do for your health is always more than what a doctor can do for you, particularly in the initial stages. It’s only when you’re fire-fighting that a doctor steps in.”
Sceptical
Martin Stones and his wife Caitriona, a nurse, were sceptical about the idea of traditional Chinese medicine but they were looking for some alternative when they were still childless after two years of conventional fertility treatment.
After Caitriona had a miscarriage in April 2010 at the age of 31, the Co Offaly couple had no luck in starting a family over the next six to nine months and sought medical advice.
Fertility issues on both sides were diagnosed. First, they tried the ovulation-stimulating drug Clomid, then two rounds of intrauterine insemination (IUI), before an IVF attempt in a Prague clinic also failed.
When Caitriona read on an online parenting forum about fertility expert Siobhan Kehoe, the couple immediately made an appointment in November 2012. “Within five minutes of meeting Siobhan, I said ‘yeah, this one is going to get us pregnant’ – it was just the things she knew,” says Martin. After looking at his tongue she was able to tell him he was very warm, “which I am. I don’t wear pyjamas in bed, only boxer shorts.” She could tell it was the opposite with Caitriona “and she is like an onion at times, wrapped up”.
Kehoe assured them, he says, that they wouldn’t have to return to Prague for another planned round of IVF the following March. She did acupuncture on both, gave them some Chinese herbs and advised them to change their diet.
“To make stuff from scratch, like bolognese instead of using a jar,” says Martin. “Eat lots of fruit, drink water at room temperature, drink wheat grass, avoid fatty foods, eat lean meat – a lot of that kind of stuff.”
They followed her advice closely and within six weeks, Caitriona found out she was pregnant in January 2013.
When they decided to try for a second child, a year after the birth of Katie (now aged five) they went back to Siobhan and started taking herbs and following a good diet from July 2014.
Emma, now aged three, was born in September 2015 and, after one more visit, their third daughter, Rosie was born nine months ago.
Three visits, three babies: no wonder their scepticism about Chinese medicine is long gone and Martin says happily, “it worked for us”.
Pre-conception health: For men to think about
Sexual health
Sexually transmitted infections (STIs) can impair both the production and movement of sperm. As men are waiting longer before trying to father children they are, by default, likely to have had more sexual partners, says Dr Mary Short, director of sexual and reproductive health with the Irish College of General Practitioners. Condom use is vital to help protect against infection and if they have been relying on women to use other kinds of birth control, they need to be mindful of the risk of contracting STIs, which may not show any symptoms.
Intercourse
“It starts with an erection,” points out Byrne. “If the guy can’t get an erection you’ve a problem straightaway and we have to fix that, and make sure he can ejaculate.”
They may be unsure of the best time to have sex, or how often they should be doing it. Men’s libido is a sensitive subject.
When Spillane asks a couple how often they are having intercourse, “sometimes they answer at the same time completely different answers”. She tries to couch such questions with the assurance that there is no right answer, she just needs to know, but is mindful of the “shaming” effect men can feel in front of a stranger.
Sex three times a week is usually recommended for those trying to get pregnant. As for timing, Short believes couples may do themselves no favours constantly using fertility predictor kits, which can lead to “performance anxiety” among men. “Fertility predictors have a limited place if the couples are supposed to be enjoying their intimacy.”
Stress
Kehoe believes a major blockage to fertility is “chronic stress”, along with poor diet, weight, environmental factors and temperature. Typically, she sees highly driven, professional males, giving a lot for everybody else, “the golden child of the family and not taking time for themselves”. This puts a stress on the system, which can cause semen fluid to thicken, she says, making it more difficult for sperm to be produced and to move.
Ironically, “once you walk across the threshold of a doctor’s office, you have added to the stress”, says Spillane. But on any first visit to the Merrion centre, the importance of destressing will be discussed.
Diet
The normal principles of healthy eating apply, such as: avoiding high-fat, high-sugar and highly processed foods, eating lots of fresh vegetables and fruit, taking the wholemeal option for regular foodstuffs and consuming nuts and seeds that are full of nutrients and antioxidants.
Simple multi-vitamin supplements containing, say, selium, zinc, vitamins D, E K and C are usually recommended, says Spillane, even if their benefit can’t be proven. But she warns against men buying testosterone supplements through the internet. “Testosterone in the blood stream is what makes men feel well, gives them an edge and supports sperm function. But if that is given in a supplement form, the body thinks there is no need to stimulate the testicles, so the sperm production stops.”
There is also cause for concern “about guys in the gyms taking protein shakes that might be adulterated and those who are out and out taking anabolic steroids”.
Kehoe doesn’t recommend synthetic vitamins, only natural, and tailors natural Chinese herb medicines for each individual. Is there a placebo effect? “Maybe, I don’t know,” she replies. “However, men will report their sex drive is higher, that their semen is runnier, the slight yellow tinge off it is gone.”
Weight
If might not be obvious to men that their weight really matters for fertility, says Spillane, but research shows that for those with a body mass index (BMI) over 30 “even if we don’t see a reduction in his sperm, we see a reduction in fertility success rates for him and his partner – all other things being equal”.
“Everything comes back in line if you lose weight,” says Byrne. Men who lose weight get better erections, their testosterone levels are regulated and their sperm is healthier. He singles out diet and sleep as being more important to losing weight than exercise, which, of course, has other benefits.
Exercise
Exercise is for function and strength and this helps everything, continues Byrne. However, unless you’re doing at least 30km a week, you’re not going to lose weight, he says, and he recommends upper body and lower body weight sessions at least once a week, along with cardiac work-outs.
Recreational drugs
Marijuana and cocaine can have big impacts on sperm. Spillane says she would not be concerned about occasional marijuana use but if it’s a consistent habit, it “chills” the sperm, stopping them moving.
Meanwhile, smoking nicotine affects male fertility and excessive drinking of alcohol will also have a negative impact, on both sperm quality and sexual performance.
Byrne reckons one to two glasses of wine, just two nights a week, or the equivalent in beer, is okay. “If you’re doing everything else right, it will have no impact on your health.”
Temperature
The testes that produce sperm hang outside the body for a reason – it is cooler. That’s why prolonged use of laptops, saunas, hot baths and long cycles or running marathons, with testes cooped up close to a hot body, can affect sperm production. “We want to keep the testes cool – I often recommend an ice pack on the area,” says Kehoe.
Environmental factorsIf you are exposed to environmental toxins and you're not expelling them out of your system, your sperm levels drop, says Byrne. Of course, it is impossible to avoid exposure to modern-day toxins, but being mindful can help to cut down contact. For instance, look for organic options; wash fruit and vegetables that might have pesticide residue; reduce use of plastic containers, canned foods and products with the term "fragrance".
