It’s a tenet of American culture that if you try hard, you’ll succeed. Hard work pays off. The early bird gets the worm. No goal met without sweat. But, try telling this to sperm.
It’s always been thought that the best looking, fastest moving sperm wins the egg. It’s why Woody Allen in Hannah and Her Sisters, when he finds out his sperm don’t cut it, says: “Isn’t there anything I can do, push-ups or hormones?” But alas, this may not be enough.
Sperm Are People Too
Evidence now suggests that simply looking good and moving with a swagger is not enough for sperm to be fertile. As we’d like to think of men, sperm have to be well sorted out too, at least from the standpoint of their genetic payload. For example, not very many men (<5%) with proven fertility have sperm with “broken” or “fragmented” DNA, unlike the much larger chunk of men (>25%) with infertility who do. Thinking more broadly, after introducing a perfectly fine egg to a sperm with a faulty genetic payload, one of three things can happen:
- No fertilization. Too much sperm dysfunction to either penetrate the eggshell or to be able to properly undress its DNA for the egg. A hard and early stop.
- Fertilization but no ongoing pregnancy. The dance begins, and egg thinks it can work with the sperm, but later decides it can’t. At IVF, this could appear as “dissolving embryo syndrome.” Game over.
- Pregnancy. The egg decides it can work with the sperm, straightens it out and cleans it up, and keeps moving on to baby.
The same executive decision-making by eggs likely underlies the fate of sperm with faulty epigenetic or RNA profiles, an issue much different than simply broken DNA. The problem with epigenomics and transcriptomics is that we simply don’t know enough about biology of these things to peg sperm as good or bad at this point. It’s also true that eggs are pretty strict about their sperm standards in any situation in which they meet, whether it be during sex, intrauterine insemination (IUI), or IVF-ICSI.
Show Some Respect
So what’s a man to do? Should you take the Woody Allen approach and do more push ups? Maybe. The first step is to realize that health affects fertility and treat your body like a temple. Take great care of yourself and pursue a life of moderation. Avoid some things completely, such as tobacco, pot, hot tubs, and excessive alcohol. Also, eat well, sleep well, exercise, and try to reduce stress. Consider taking antioxidant supplements. I know it seems kind of a simple recipe, but it’s more than likely that your lifestyle choices and overall health affect semen quality more than you know. I believe this from my own studies that have shown excellent natural fertility rates in men whose treatment consisted of simply and consciously made lifestyle choices. Finally, if you are having trouble putting a bun in the oven, get thee to a specialist for a quick and proper evaluation that includes a history and physical examination. Every man deserves it. With sperm, as with life, sometimes the fastest way isn’t always the best way to true success.