Men's fertility and wellbeing under the microscope

I recently met a young man, whose intention was to be a known sperm donor to friends. His first semen analysis at the fertility clinic being used by the couple he was donating to, showed some areas of concern and he was advised to take supplements and repeat the test. He did this and the follow up reported an improvement in the original area of concern but picked up some new worries.

In my opinion, as a fertility counsellor, this should have been the point at which the clinic referred him to a urologist for further checks to determine the cause of the abnormalities highlighted in his semen analysis. He is also aware that he has a varicocele and would like to get this examined to help give his friends the best possible chance of having a child, using the healthiest sperm he can produce. He was therefore surprised the fertility clinic didn't suggest this, and instead proposed the use of ICSI as a solution and also asked if he would consider donating as an unknown donor via the clinic's sperm bank. This was particularly surprising considering becoming a donor for fertility clinics is notoriously difficult: over 90 percent of prospective sperm donors are turned away due to not fulfilling criteria (see BioNews 1174).

He is now seeking independent medical advice, and he is far from the only man I have met through my counselling service who has been left confused about the best course of action. These men often find they get little direction from fertility clinics about the meaning of their test results and treatment options, and these stories come through our counselling doors on a frequent basis.

A couple I have been supporting through my private practice had been trying to conceive for over a year before heading to a fertility clinic. They spent 18 months undergoing various fertility treatments, including almost 10 embryo transfers. One of these resulted in a single ectopic pregnancy, and the loss was traumatic for them both.

Upon deciding to take a break from fertility treatment, the husband remembered something one of the doctors had commented on in passing about his testicles. He decided to get this checked by a urologist, and was diagnosed with a varicocele. He had a varicocele embolisation, and just shy of three months later, they were pregnant naturally. She was furious with the amount of time, effort and money spent, and how much she'd endured emotionally and physically because her clinic was so focused on her and didn't focus appropriately on him!

Another male I have been supporting told me that two separate GPs, months apart from one another, when reviewing and advising on two separate samples confirmed his sperm as healthy. This resulted in his wife going through months of invasive testing. Over a year later, for a doctor's appointment about something completely different, a locum GP asked what treatment he had sought for the issues detected with his semen results. He was perplexed, then enraged, and sadly depressed, when his world came crashing down upon discovering that he was azoospermic. A year on, he is still trying to find a way through this, and manage the guilt he is carrying surrounding what his wife went through.

Frequently I hear about men's semen analysis results showing a variety of abnormalities or concerns, but clinics offer ICSI as a panacea, and the patient tells me they have been advised their sperm is healthy and fine.

I've had couples sit in front of me with one partner looking petrified having to inject herself, pump herself full of medication, feel immense guilt, shame and even responsibility, because she thinks all fingers are pointing at her. While partners are most often empathic, it is not uncommon to see men continue to drink or smoke because they've been told that their sperm is healthy because ICSI is being used.

I do appreciate there is a difference between what we are told, what we hear and what we then go on to say or even believe. Clinics may tell men that their sperm results are lower in certain parameters and taking supplements would be helpful. A consultant may also provide further advice, and suggest supplements, and the patient himself simply hears 'everything is okay, I don't have to change anything'.

Please do not think I am anti-fertility clinics or treatment as this couldn't be further from the truth. It is great that fertility treatment is available and so many clinics are accessible. Equally brilliant is the ICSI technique and I have met many people who may not have been able to create embryos, fall pregnant or experience parenthood without this, but it does, in some instances, seem to used to 'let men off the hook'.

Given the well documented psychological and emotional impact of fertility treatment and that 50 percent of fertility visits are now male factor related, a seed change (pun very much intended) would be helpful within clinics and from clinical teams, including GP practices.

I'm not going to tar every clinic with the same brush. Some of those I am working with have changed their stance around this and I have noticed more men being asked to repeat their semen analysis, take supplements and be referred to specialists. This is encouraging and perhaps it is something the HFEA could highlight on their website alongside the information they offer about UK licensed clinics. This could make patient expectations around treatment of male-factor infertility clearer and may also encourage more clinics to step up in this area.