This week to mark Men's Mental Health Week, we are putting the spotlight once again on Male Fertility issues with two conversations to share with you.

We welcome back to the podcast Professor Sheena Lewis to talk about DNA Fragmentation. Sheena is the CEO of Examen and a professor in Reproductive Medicine and has been working on male fertility tests for the last 25 years. You'll also hear from Shaun, who has created an account on Instagram called Knackered Knackers, where he has shared his story of having male factor infertility, having had mumps and ultimately had to use donor sperm.

Male infertility is on the rise but luckily, we’re beginning to make progress in the research surrounding this. Sheena talks about as well as sperm counts declining, sperm quality is also reducing and the DNA of sperm, in particular, is becoming worse, in part due to 20th century living such as environmental factors, having children later in life – the things we can’t do anything about. However, there are factors that we can influence, and we need to do all we can to start focusing more on men, rather than just the woman.

If you go back to basics, the first thing a man needs to do is to get a sperm test. This looks at the count (how many there are), motility (are they swimming), and morphology (the shape of the sperm). What you don’t find out from a sperm test, is what’s inside the sperm – the DNA. Sheena feels that we should be doing more DNA fragmentation tests. However, as fertility clinics are ‘female focused’, this is rarely offered. We need to bring urologists into the picture to also focus on men and have better joined-up working.

Sheena talks about the misnomer of unexplained infertility. 25% of couples are given the frustrating diagnosis of unexplained infertility, but the reality is we’ve not actually searched hard enough for the answer because men are left out of the picture.

Sheena’s research at Queens University in Belfast has shown that 40% of men given a diagnosis of unexplained infertility have DNA fragmentation. A startling figure indeed! It may not be the only answer, but it certainly is one reason for their inability to conceive.

40% of men with fertility problems have varicoceles but as men are not generally examined this is not diagnosed or treated. As a result of male infertility women have to go through ICSI treatment but, as Sheena says, why can we not have equality in reproductive health where men are examined, tested, diagnosed and treated in the same way women are? This would put the man right back in control and be empowered to make the right lifestyle changes to improve sperm.

Sheena also talks about the importance of nutrition. Many men have a calorie-rich and nutrient-poor diet. Sheena recommends getting the right expert advice on nutrition and the right supplements to help improve sperm health. Sheena recommends vitamins A, C and E, with vitamin E being especially beneficial.

Natalie asks Sheena about DNA fragmentation and miscarriage. Research in 2012 and 2020 showed the association between DNA quality and miscarriage. The need for DNA fragmentation testing following miscarriage is now in international guidelines but is sadly rarely done. Sheena recommends that men should be empowered to be proactive and ask for this test to be done.

It was just Natalie chatting with Shaun and the pair didn’t discuss his story in detail as Shaun has set it out brilliantly on his instagram account, talking about how he had mumps which always made him think there might be a problem. He then had to have a number of operations including a varicocele and a microtese and in the end, Shaun and his wife Jenna had successful treatment using donor sperm and Jenna gave birth to their twins Ray and Evelyn in February...