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      A man’s general health is just as important to conception as a woman’s, although this often gets overlooked by fertility experts, who tend to be gynaecologists and obstetricians – specialists in female, not male, reproductive health. And your health is never more important than when you and your partner are trying to conceive. Very often, problems in conception are thought to be wholly the woman’s, but this is not the case. When a couple have a problem with conception, the problem is only with the woman in around 35 to 40 per cent of cases and with the man between 30 and 35 per cent of the time. Problems that arise from combined difficulties in both partners account for the other 25 to 35 per cent of cases.

      I do think that, slowly, the message is getting through: The health of the sperm is just as important as a woman’s gynaecological health when it comes to conception. At our clinic we will offer a semen analysis straight away; if you focus all clinical attention on the woman, valuable fertility time may be wasted.

      Unlike women, men do not have cycles which could alert them to the fact that there may be problems – so very often it can come as a real shock when the results of a semen analysis are poor. And semen analysis is only part of the story: the sperm may look fantastic but there may be infections or DNA fragmentation, which will not show up on semen analysis. Specimens sent to standard general microbiology or pathology labs may not receive immediate attention, and morphology assessment in particular (see page 286) may be inadequate, giving false or misleading results. We have seen this happen so many times.

      Twenty-five per cent of male infertility remains unexplained. Sperm counts have been steadily declining over the last 50 years. Scientific evidence clearly points towards our constant exposure to toxins in our everyday modern lives, contributing to our reproductive downfall. These factors are known to affect male reproductive function seriously, and may well contribute to this high number of unexplained cases.

      Insufficient emphasis is put on the contribution of lifestyle factors to sperm quality and male infertility. Infertility is multi – factorial and, in many cases, the severity of male infertility is exacerbated by lifestyle factors, which can and should be addressed to optimize whatever fertility potential there is. Even if the semen analysis is good, good sperm genetic health and metabolic fitness can always be improved by cutting down on the lifestyle factors that are known to harm the sperm, and eating a good healthy diet to reduce oxidative damage to the sperm.

      Sperm Production

      Sperm are produced in the seminiferous tubules of each testis. The two testes are contained in the scrotal sac, next to the penis. Unlike women, who are born with around 2 million immature eggs in their ovaries, although they don’t begin to mature and ovulation doesn’t occur until after puberty, a man doesn’t produce sperm at all until puberty, when his reproductive hormones become active.

      Hormones are sometimes called the ‘chemical messengers’ of the body. Secreted by a gland in one part of the body, hormones are transported via the bloodstream to another area of the body, where they have an effect. At puberty, for both men and women, an area of the brain called the hypothalamus starts secreting gonadotrophin – releasing hormones, which cause the pituitary gland to produce two other hormones: follicle – stimulating hormone (FSH) and luteinizing hormone (LH). When these two hormones are produced, the gonads – testes in men, ovaries in women – are stimulated, to produce sperm in the man and to stimulate ovulation in a woman. The average age for male puberty is between 12 and 14, although this can vary quite widely and is influenced to some degree by genetic make – up, race and diet. Hormonal stimulation of the testes leads to the production of sperm and, as long as the necessary hormones are available and at the correct levels, and there is no disease or illness affecting production, this is a continuous process from puberty onwards.

      The other effect of FSH and LH on the testes is to stimulate the production of testosterone, within the testes, responsible for the development of male characteristics like facial, armpit and pubic hair, and body hair in general. The voice also deepens as the testosterone makes the Adam’s apple at the front of the neck enlarge. Muscle tissue is increased and strengthened, and mood is also influenced – not least in promoting sexual interest. Some men seem to produce more testosterone than others, but this doesn’t mean they are more fertile than other men. Testosterone is responsible for the secondary sex characteristics described above, and isn’t particularly an indicator of the quality of sperm or a man’s fertility.

      The process by which sperm are formed in the testes takes around 100 days – 74 for the sperm to develop, and then another 20–30 days to reach maturity, which is what you have to allow before you can expect to see any improvement in sperm quality or quantity. But as sperm production is happening continuously, a man is continuously fertile, unlike a woman who is only fully fertile for about eight hours during each one of her fertility cycles!

      Within the testes, the sperm start their journey through the thousands of tiny, coiled seminiferous tubules. Sperm start as spermatocytes, primary cells that divide and develop into spermatids, which are immature, tail – less sperm. During their journey along the seminiferous tubules, where they are nourished by the sertoli cells that line the tubules, each spermatid grows a head that contains all the chromosomal material. Chromosomes carry all of a man’s genetic material ready to pass on to a child, including the chromosome (usually referred to as the sex chromosome) that decides whether a baby will be a boy or a girl. Whereas every one of a woman’s eggs contains the genetic material for a girl (the X chromosome), a man’s sperm will contain either an X chromosome or a Y chromosome (for a boy).

      As well as growing a head during their 74-day

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