PRINTSwimming upstream
If pollution in cities such as New York isn't affecting sperm count, why is mid-Missouri's count so low?
April 26, 2007 | 12:00 a.m. CST
So a guy walks into a fertility clinic and tells his doctor that his wife is having trouble getting pregnant. The doctor says the first thing needed is a sperm sample, so the man goes back to the “M” (sounds like “aspiration”) room to get the job done. Six or seven hours later, the man has still not come out. The doctor knocks on the door and asks the patient if he’s doing all right. The patient responds: “Not really. I’m having problems filling the cup.”
This is the type of joke that Dr. Gil Wilshire, a reproductive endocrinologist with Mid-Missouri Reproductive Medicine and Surgery Inc., might tell one of his new male patients. Most men find fertility issues tough to discuss, but it’s a topic they’re forced to deal with because low sperm counts are a relatively common problem in mid-Missouri.
Wilshire says that in the 11 months he has been working in Columbia, he has seen 250 couples, and only about 2 percent of the men have normal sperm counts. “Sperm counts are bad everywhere,” Wilshire says. “But sperm counts are especially crappy in mid-Missouri.”
Research conducted from 1999 to 2001 by Shanna Swan, a former researcher in the MU Department of Family and Community Medicine, supports Wilshire’s statement. Swan conducted a study comparing the sperm concentration of 493 men from Columbia, Minneapolis, Los Angeles and New York City.
The study found that men from Columbia had significantly lower sperm counts than men from the three urban areas. The mean sperm concentration was 75 percent higher in New York, 67 percent higher in Minneapolis and 38 percent higher in Los Angeles compared to Columbia.
In 2003, Swan researched again to explore why sperm counts in Columbia were so low. She analyzed urine samples from the men in Minneapolis and Columbia for the prevalence of certain pesticides and found that men with lower sperm counts had higher levels of pesticides in their urine. The study supports the idea that agricultural pesticides, more prevalent in mid-Missouri than in urban areas, might have contributed to lower sperm counts.
Swan found the results surprising. “I thought New York would be the worst,” she says. “That was based on prejudice. I thought of New York as polluted and crowded while I thought of the country as being healthy and clean.”
Not all doctors believe that sperm counts are significantly lower in mid-Missouri when compared to other cities. Dr. Stephen Weinstein, a urologist in the MU School of Medicine, says that male fertility problems are standard across the U.S. “There is some data showing sperm counts are lower in some areas, like the Midwest, but there is an equal amount of data showing no difference,” he says.
According to Weinstein, 15 percent of couples are considered subfertile. Of those couples, 50 percent of the time only the woman has a fertility problem, 25 percent of the time it is just the man, and in 25 percent of cases, both have a fertility problem. To diagnose a fertility problem, doctors conduct a semen analysis, which examines sperm concentration, motility (percent of sperm moving) and morphology (size and shape of the sperm). About 90 percent of men with fertility issues have low sperm counts, low motility or both, Weinstein says.
Half of these men have varicocele, or varicose veins on the scrotum. The veins tend to heat the area, which kills sperm or reduces motility. Varicocele can be fixed through a $5,000 surgery with a 75 percent success rate, Weinstein says.
The other half of men with low sperm counts can be helped by clomiphene, a pill that stimulates sperm production. This drug costs $50 per month, has to be taken for at least three months and is successful in 70 percent of cases, Weinstein says.
Wilshire says that he first evaluates a patient’s lifestyle and habits to determine if they have a negative effect. Exposure to toxins in tobacco, marijuana, large doses of alcohol and gasoline can affect sperm quality. “Making sperm is very nutritionally demanding,” Wilshire says. “Men need protein, good oils and good fats.” He encourages his patients to take supplements such as fish oil, zinc and copper and to eat a nutrient-rich diet.
Some men improve by changing habits, but Wilshire can’t prove if lifestyle changes or just dumb luck cause increased sperm counts. Because sperm takes 72 days to produce, a change is usually not noticed for two or three months.
If lifestyle modifications or medications are not enough, the next option is intrauterine insemination, in which a concentrated dose of sperm is introduced into the woman. “This gives the sperm a boost,” Wilshire says. This procedure costs about $200 and is 20 percent successful per try. Weinstein says, “It may take three or four tries to get pregnant, but it’s fairly inexpensive.”
If insemination does not work, the next step is standard in vitro fertilization, in which the egg and sperm are joined in a lab. Weinstein says this procedure has a 25 percent success rate and costs $10,000 per procedure.
If the man has very few, or even just one sperm, doctors can use ICSI, or intracytoplasmic sperm injection. In this form of in vitro fertilization, one sperm is injected into one egg, and successfully fertilized eggs are inserted into the woman’s womb. “ICSI can overcome almost all male factors in fertility unless the guy has no sperm,” Wilshire says. The national success rate for ICSI is 25 percent, but the best centers can be 50 percent successful. The cost for this procedure is $15,000, making getting pregnant an expensive prospect.
For men with severe fertility problems, treatments won’t work. About 10 percent of men who undergo a semen analysis have no sperm, which is either due to a blockage of sperm moving from the testicles to the scrotum or a complete lack of sperm production. Blockage can be helped through surgery, but men with no sperm production must consider other options.
“Telling a couple that they are completely infertile can be a devastating blow,” Weinstein says, but he encourages the couple to remember that other options, such as adoption and sperm or egg donation, are available. “With donor sperm, the process can be completely anonymous. By the time that couple has carried that pregnancy to term, dealing with the morning sickness and all the other pains of pregnancy, that baby is theirs.”
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