21 July 2015
Should Australian couples stop their ‘headlong rush’ into IVF therapy as the solution to infertility? One expert tells Sunday Extra the missing piece of the puzzle is a better understanding of male reproductive health.
Infertility is common in modern Australia, just as it is in other parts of the developed world. One in six couples here are said to experience it, and it’s related to female biology roughly half the time.
But what about when infertility has more to do with the male partner? The University of Newcastle’s Professor John Aitken says that’s when patients come up against a neglected part of medicine, with very few specialists available to help men.
‘There is no recognised discipline in most hospitals for coping with subfertile or infertile males,’ he says.
‘In some countries you’ll be referred to a urologist, in some countries you’ll be referred to an obstetrician or gynaecologist, some places an endocrinologist, and in Germany, bizarrely, you get referred to a dermatologist if you have a male reproductive problem.’
Professor Aitken says the science of how the male reproductive system works—andrology—is a decade or so behind its female equivalent, gynaecology.
‘I think it’s partly our own fault that we haven’t really until recently recognised the important male contribution to a couple’s infertility. Infertility was always traditionally thought to be something that was the fault of the woman,’ he says.
‘The way that society is now currently resolving this problem is we treat male infertility by basically working on the female partner. So she has to go through an IVF cycle because we don’t understand what’s wrong with the male. And it will be like that until we start to really investigate why it is that so many men are not necessarily infertile, but subfertile.’
Professor Aitken believes it’s essential to focus properly on male reproductive health. He wants andrology to become either a recognised clinical discipline, or a sub-discipline of another specialty. And he’s also urging hospitals to take seriously the training of young clinicians in the area of male reproduction.
‘Pathologies of the male reproductive tract are very common [but we only] have a few people who have the specialist knowledge in order to deal with it,’ he says.
‘I think most IVF specialists are quite happy when they look at a male partner; the only question they really ask is, “is there a sperm there?” And if they can find a sperm then that’s fine, we’ll just treat the female partner, inject the sperm into her eggs, and the problem is solved. But that’s not really a solution to the problem.
‘What we really need to do ideally is get to the heart of why it is that these men are suffering from infertility in the first place.
‘Most men produce enough spermatozoa to fertilise an egg; the major problem is the sperm has lost the ability to actually fertilise the egg. We don’t know why. We have very little in the way of insights into this, but it a major problem for us. Roughly one in 20 men is infertile.’
IVF technology is responsible for thousands of successful pregnancies in Australia each year, with around one in every 25 babies born as a result of the treatment.
Some US companies made news last year with their offer to freeze their female employees’ eggs, but Professor Aitken says this is a symptom of the problem, not a solution.
‘On the female side, most of the women who are in IVF programs are there because they have delayed childbirth until they’re basically reaching a period of time when they’re just spontaneously losing fertility because of their age,’ he says.
‘This is something as a society we have to think about. There are many things we can change in life, but we can’t change our biology. We have to really change our social structures to better support couples to have their children earlier in life. That would certainly do a lot to stop this headlong rush into IVF therapy as the solution to all infertility.’
He believes it’s important to highlight the risks of overusing IVF.
‘If we don’t understand the aetiology—the origins—of the infertility, we’ll never be able to treat it,’ he says.
‘As time goes by, something I think we have to recognise is that the more we’re forced to use IVF in one generation, the more we’re going to need it in the next.
‘Currently we’re in a situation where one in every 25 children is an IVF baby. That’s an enormous number of IVF children. At least half of those babies are born because there’s something wrong with the fertility of the fathers. We need to try to be able to understand what that is so that we can address the problem at its source.
‘For many couples being infertile is a very devastating situation and it is a shame that we just don’t have more insight into the reasons behind the infertility that affects so many couples.’