Not just for women: Why preconception care is important for men, too

Statistically, the vast majority of patients seeking assistance for fertility are women. Most of these women have male partners, however men are less likely to to undertake treatment or lifestyle change for preparing to have a baby, or believe that there is much they can do to improve their sperm count and quality.

​However, it takes two to make a baby – an egg, and a sperm, and there are many things we can do – including acupuncture, herbs and supplements – to optimise the health of both of these very important ingredients (also called 'gametes'). Investing some time and effort into improving the health of your sperm before you try to conceive will have untold benefits for the health of your future children and should be an essential part of your fertility plan as a couple.

Most men produce 200 – 300 million new sperm (spermatozoa) every day, however when sperm are initially formed they lack the ability to swim forward or fertilise an egg. It can take 3-4 months for these sperm to fully mature, and only about half (100 - 150 million) of the original spermatozoa become viable sperm. That means you should allow for at least three months of preconception care to start to see the benefits. I'll explain a little as to why its so important to do this, even if you have had a semen analysis conducted and been told that your sperm was fine.

What is a 'good sperm count', and why is it important to aim higher?
The standard semen analysis conducted by doctors and IVF clinics follow the WHO Reference Values or the Strict Criteria Guidelines. Both of these are extremely conservative and state that the sufficient number of sperm in a semen sample is 15 - 20 million. If you have had a semen analysis done, and met this criteria, you might have been told that your sperm count is great. However, keep in mind this is just the bare minimum, and not an indication of the optimal number of sperm in a sample for excellent natural fertility. Take a look at the preceding paragraph – can you see a discrepency in the numbers? If a healthy male produces 200 – 300 million spermatozoa a day, he should have much more than 15 million sperm in his ejaculate!
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According to an article in the British Medical Journal, the average sperm count has fallen by up to 50% in the last 50 years, due in large part to the large number of 'endocrine disruptors' (environmental toxins and chemicals) in our food and water (BMJ, 1996; 312:457-458). The number of sperm in your ejaculate is directly proportional to the likelihood of conceiving – obviously, the more sperm in your semen, the greater the likelihood that they will reach the egg and have a chance at fertilising it. So you can see it should be a real priority to boost your sperm count beyond what is labelled as 'normal' according to current medical criteria.

​What is 'good sperm morphology', and why is it important to improve these numbers?
Just like with sperm count, the standard semen analysis follow the same conservative guidelines and classifies 4 - 15% normal morphology as adequate. Viewed the other way, this means the standard guidelines claim that having up to 96% abnormal sperm is perfectly fine! If the sperm is to be used for fertility treatments such as IVF, the low percentage is not so problematic as the normal sperm can be retrieved and utilised using highly advanced technology. However, if you are attempting to conceive naturally, it should be obvious that having a higher percentage of sperm with normal pathology would be optimal.

Just like with sperm count, the greater the number of normally formed sperm, the greater your chances of a healthy pregnancy. Abnormal sperm can still fertilise an egg, but will sadly not be viable, and this accounts for a very large percentage of miscarriages.

What is 'good sperm motility', and why is it important to increase this variable?
Sperm motility is another important semen analysis parameter, and indicates how well a sperm can swim. The WHO state that your sample is normal if >32% of your sperm have adequate motility (that is, they are assessed as moving quickly, and in one direction). However, that is less than one third of your total sperm count. Remember that this is a numbers game – the bare minimum is not optimum. Improving the percentage of sperm that have the energy and strength to swim the (relatively) long distance to an awaiting egg is going to be of benefit.

Overall sperm quality – are there other things to consider?
The answer to this question is a resounding Yes. As well as the standard three parameter of sperm count, morphology and motility, there are many other factors that affect the health, resilience and lifespan of sperm. In terms of a semen anaylsis, there will be things like pH, viscosity, and vitality, but there are also less easily measurable factors such as oxidative stress, dna fragmentation and endocrine disruptors. Clearly, there is much more to the story of sperm than at first meets the eye!

​What is the Chinese Medicine perspective on all this?
Traditional Chinese Medicine (TCM) has long placed an extremely high value on optimising the health and wellbeing of parents-to-be prior to conception. A fundamental principle in TCM is that we have two sources of energy, or qi in our bodies, that determine our overall health and vitality – prenatal qi and postnatal qi. Our prenatal qi is the qi that was provided to us in the moment of conception – an equal amount from both our biological mother and father. Our postnatal qi is the qi that we sustain ourselves with in this physical world, including the food we eat and the air we breathe.

Over the course of our lives, we can work on improving our postnatal qi through lifestyle, diet and treatment, however unfortunately we can never improve or increase our prenatal qi – it is a set and finite quantity. Thus, ensuring that the strength of a prospective parent's health and reproductive energy, or jing, is of the highest standard before conception is incredibly important for the lifetime health of the child. Consciously cultivating their health before attempting to have a baby is seen as one of the greatest gifts each parent can give their child.

So what does this all mean?
It means that improving sperm/semen health as well as overall health is of fundamental importance to all men who are seeking to have a baby. Too often, optimising fertility is seen as a woman's job and that men just need to provide the sperm – you only need one, right? As we have seen, taking measures to improve sperm count, morphology, motility above and beyond the 'minimum' amounts is going to vastly increase your chances of conceiving a healthy viable pregnancy. There are also numerous other factors that influence sperm health, not to mention the TCM concept that the vitality of the sperm will leave an imprint on the constitution of your child for their entire lifetime.
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There are many, many practical things you can do to boost your overall health and the health of your sperm. I'm going to talk about how acupuncture, Chinese herbal medicine and supplements can play a huge role in this, in an upcoming blog post. Until then, I hope I have made a case for preconception care for men as something that should be a real priority and something to consider for all couples who are hoping to have baby. You might even be pleasantly surprised at how good it makes you feel as your health and well-being improves – think of it as a gift your future baby is giving to you, too.