Rachel Feltman: For Scientific American’s Science Quickly, I’m Rachel Feltman.
When heterosexual couples struggling to conceive seek medical assistance, sperm often don’t get as much attention as they should. Standard tests measure sperm count and motility, but this ultimately just shows how likely a sperm is to make it to the egg. And that moment of conception is just the first of many steps to the implantation of a growing embryo, let alone the gestation of a healthy fetus.
We now know that, even if couples manage to conceive, problems with sperm can interfere with the pregnancy. Research has shown a connection between DNA fragmentation, which is when the genetic information stored within sperm is broken or otherwise damaged, and miscarriage. It’s also been linked to lower IVF live birth rates, which makes sense: in vitro fertilization gets the sperm through the door, so to speak, but if half of the resulting embryo’s DNA is potentially damaged, it’s less likely to develop normally and progress into a healthy pregnancy once implanted.
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The good news is that there are tests for DNA fragmentation in sperm. In fact, they’ve been around for decades. And the even better news is that, at least in some cases, successful intervention can be as simple as cutting out alcohol, improving your diet and exercise and taking a few supplements.
Earlier this year, the American Society for Reproductive Medicine updated its recommendations for assessing and treating recurrent pregnancy loss for the first time since 2012. Sperm DNA fragmentation testing was finally recommended but not for all patients who’ve had repeated miscarriages—only in cases where genetic evaluations of miscarriage tissue and tests on the structure of the uterus haven’t revealed another cause. Which begs the question, why aren’t people hoping to conceive being taught about the importance of sperm DNA and offered testing for it from the start?
Here to unpack this for us is freelance science journalist Sarah Elizabeth Richards, the author of a recent story on the subject for Scientific American.
Thanks for joining us today. So for listeners who don’t have as much, you know, experience reading about writing about this field, just how big is the disparity between the research and even conversation around female infertility issues and those same conversations and studies related to sperm?
Sarah Elizabeth Richards: Well, that’s a great question. So the background, and people don’t really know about this, is that men contribute to 50 percent of infertility problems. And I think there was a quote in the story, it’s like I think 20 percent of cases are just the sperm alone, and then another 30 to 40 percent are the sperm and the egg alone, or the sperm and women—whatever they’re dealing with.
So men obviously play a huge role; they have to give half of the DNA they have to make the baby, but they also, there’s a lot that can go wrong or a lot to explore on, you know, why they might be experiencing infertility as a couple.
So there’s a lot of science behind it, and it’s getting a lot more recognition. A lot more doctors are paying a lot more attention to it. Culturally, there’s another piece: [it] is that I think more, you know, people are recognizing the role of sperm. You’ve got this trend of “sperm maxxing” and men doing all of these things to have the optimal sperm and eating well, drinking less, smoking less pot, which are obviously really important things. So at the same time, you’ve got a lot more medical and scientific research. You’ve got, culturally, a lot more people paying attention to sperm.
Feltman: Yeah. So what do we know, currently, about the ways in which sperm can contribute to, you know, this risk of recurrent miscarriage?
Richards: So for this test specifically, which measures what they call DNA fragmentation, and that’s the idea that on a piece of DNA, there’s these little breaks, and these little breaks can mess up the instruction booklet, right, when you, you make a baby. And so what this test does is: it measures that level. So a doctor can go back to a man and say, you know, “You’ve got a high level of sperm damage,” which is measured in this DNA fragmentation, “You’ve got a light level,” “You’ve got a high level.” And then, based on that, you know, there are certain surgical techniques they can do. But, like, the bigger message or one way it can be helpful in the clinic is that it sends the message to men as like, “Okay, well, what things can I do to improve the health of my sperm?” You know, “Can I eat better, eat more fruits and vegetables? Can I drink less, smoke less pot, exercise?” I think there’s a whole list of different vitamin supplements you can take, this is beyond my knowledge, but apparently there’s a whole literature on things you can do to improve your sperm. I think, in that way, it can be useful to say, like, “Look, your sperm actually ain’t great, and it could be causing the problem. So it’s something you might wanna pay attention to.”
Feltman: Yeah. Well, and if I’m remembering correctly, one of the physicians you talked to had patients have success with these very straightforward interventions—you know, lifestyle interventions, just sort of general improvements in health that presumably may have addressed this issue with DNA fragmentation in their sperm.
Richards: Yeah. And that’s, I think, where this is such a big cultural shift, right? It’s always presumed that it was a problem with the women. And so the fact that the doctor said, “Look, we’ve tried all the testing of your partner. What can you do? Like, we’ve done this test for your sperm. Now we know you’ve got some level of damage.” You know, basically, “Hey, what can you do to help this equation?” One part that does bother me, and, you know, obviously I didn’t make the recommendations, but, like, why they have to wait till a woman has two or more miscarriages?
Feltman: Exactly. Yeah.
Richards: And the miscarriage is horribly traumatic, so why would you make someone go through that level of trauma, of just heartbreak, and then say, “Oh, you know, the man contributes, too. Maybe we should check his sperm”? And I know you have to make guidelines, and you have to make cutoffs. And the sperm, the test, I don’t know, costs anywhere from $300 to $500, and it requires a man to give another sample.
And one doctor I spoke to made the point that if a man actually already gave a sample in the beginning—so when men go into a clinic, usually, when they’re starting a treatment or as a couple, a man will get a workup. They’ll give a sample, a sperm sample, a semen sample, and they’ll, you know, they’ll test the motility and the morphology and the count. And so that’s sort of like the first checkpoint. And then I guess the way they’re using it in the clinics is that, you know, later if, you know, you’ve got these multiple miscarriages, then let’s ask for another sample, and then we’ll look at the DNA fragmentation. But again, like, I don’t know. I wish, in a world, you could introduce it into the process a little quicker, you know? And yeah, they’ve made the point, like, it’s expensive, it’s $500. But, you know, for a couple going into infertility treatment, by the time they’ve got multiple miscarriages, if, you know, paying out of pocket, they’re in tens of thousands of dollars, like, why wouldn’t you use this test that’s a couple hundred dollars, you know? And hopefully more insurance companies will pay for it earlier.
Feltman: Well, and I mean, obviously, you know, not all issues with DNA fragmentation will necessarily be remediated as well as, you know, that case I was talking about from your piece. But it does seem like, maybe at the bare minimum, it would be great if men also received the message that if they are hoping to conceive, they should make some healthy lifestyle changes, drink less, take vitamins, things that are, sort of, the barrier-to-entry, minimum buy-in for a woman starting to try to get pregnant.
Richards: Yeah, so I, I mean, the good thing is if it sends that message more, right? That like, “Hey, you’re half of this equation, you know, let’s both make really good decisions and, you know, try to get our reproductive bits as healthy as possible before we go and pay all of this money for, you know, medical help to have a baby.” It’s kind of a no-brainer, in my opinion.
Feltman: Yeah. And I, you know, I think, it’s great that there’s more of a conversation about it now, but I think in a lot of cases, it’s simply that people don’t know. It doesn’t occur to them that it’s important what’s going into and going on with, you know, the potential father’s body, which is wild. It seems wild that that’s such a surprise to people, but….
Richards: And one thing I do like about this, if you think about the impact, you know, even if more doctors are bringing it up with patients, you know, and the fact obviously, hopefully this will be discussed more in the clinic if you’re having these, you know, recommendations issued, is that, you know, men suffer as much from the loss of a pregnancy. They suffer, too. And so the fact that that’s recognized that, like, you’re part of the process of making the baby, but it’s also a loss on that level, and you’re participating in that emotional weight of it, too. So I think that’s a nice outcome, right? It includes them in the conversation of all levels.
Feltman: Yeah, absolutely. And what other impacts do you and, you know, the researchers you spoke to think that this could have?
Richards: I talked to a therapist who counsels men in infertility treatment, and he said men go through so much emotionally that we don’t talk about as a culture. They might feel helpless because they can’t fix the problem that they’re experiencing as a couple. If it is their sperm contributing, they might feel shame about it or all sorts of different emotions are coming up. So the fact that even highlighting this in the medical field, if it can initiate and start those conversations where men recognize like, look, these are just parts, and there’s ways to fix them or hopefully ways to rehabilitate them, and this is just a problem to solve, and it doesn’t matter who’s responsible. It’ll just open up those conversations, maybe, to reduce some of the stigma and, you know, neutralize it and not make it so loaded and, you know, maybe encourage conversations among men and between couples and hopefully just to make it a little easier for people to go through this, and I think that would be a wonderful outcome.
Feltman: Absolutely. Well, thank you so much for coming on to talk to us about this, and our listeners, of course, can read your piece online, and I, I hope they will.
Richards: Okay. Thank you, Rachel.
Feltman: That’s all for today’s episode. We’ll be back on Friday to talk about some troubling new changes to the Endangered Species Act.
Science Quickly is produced by me, Rachel Feltman, along with Fonda Mwangi and Jeff DelViscio. This episode was edited by Alex Sugiura. Marielle Issa and Aaron Shattuck fact-check our show. Our theme music was composed by Dominic Smith. Subscribe to Scientific American for more up-to-date and in-depth science news.
For Scientific American, this is Rachel Feltman. See you next time!