How a Man's Health Affects Pregnancy

Fertility Is a Two-Person Equation

Interviewer: Dr. Smith, it seems like when it comes to when there are issues with a couple getting pregnant, starting a family, the blame tends to go to the woman first. Why is that? Why is it always on the woman? Because we're going to learn today that us guys, we have to realize that we're contributing something as well.

Dr. Smith: I'm sure that's probably just stigma from the decades and decades, because really 50% of fertility issues end up being men, and 50% end up being women when you get down to the brass tacks of it.

Interviewer: Yeah. But that perception's out there, right?

Dr. Smith: Oh, yeah.

Interviewer: If there's a problem, it's the woman's issue, it seems like.

So if you or a partner thinking about getting pregnant, or you've been trying and it hasn't been going the way you hoped, this conversation is for you. And I think you've already picked up on what we're going to talk about today. We spend a lot of time telling women what to do before conception, the types of healthy behaviors they need to engage in, but we don't really talk about the part of the equation that never gets discussed, and that's what the man brings to it.

Like Dr. Smith said, it turns out there's a lot more than most people realize, and we're going to dive into that. This could be a really useful conversation if you've been struggling.

Dr. John Smith is a physician who trained in family medicine, and then he went on to complete a fellowship in genitourinary medicine. He brings a whole-person kind of approach to urology, which I really dig.

So when couples start thinking about having a baby, the focus is on the woman. She takes the vitamins, no alcohol, watch your weight. But that's not the complete picture. What is a man's role in all of this? And we'll get specific, but give me a general idea. What's the man's role? What's his 50% to this?

Your Sperm Reflects the Last 90 Days

Dr. Smith: A man's role should be the exact same thing. He should be avoiding alcohol, losing weight, and doing all the things to be healthy that the woman is doing. Because as we know, there's a sperm and an egg, and both of those things contribute 50% to the fetus. So both of those things are... all the things you listed that women do, men should look to do as well.

Interviewer: Right. We've got to do our part there.

I thought this was fascinating, that a man's sperm or what a man contributes to the pregnancy is kind of like a log of the past 90 days of their life. Is that true? Is that an accurate statement?

Dr. Smith: Yeah. I mean, the life cycle of a sperm, from production, to maturity, to conception, takes about that long. There are people out there that'll say one way or another, but that's a good rule to look at and think about.

Interviewer: Right. And so the health of a man's sperm really reflects everything that that man's been doing, eating, feeling, emotions play into it as well, for the past 90 days.

Dr. Smith: And sometimes even a little longer on some of those things. The literature isn't completely... there are still some questions that are unanswered. But yeah, those are all things that are real.

Interviewer: So I think the big takeaway for me when I read that is that's a window of real influence. That's an opportunity for us guys to go, "All right. If we've been struggling or if we want to make sure we have the healthiest baby possible, for the next 90 days, I need to kind of clean up my act a little bit," if it's not as clean as they want it to be.

Dr. Smith: Yeah.

Epigenetics: How Lifestyle Can Influence Gene Expression

Interviewer: So talk to me a little bit about the field of research that's changed how we think about all of this. Epigenetics, what is it and why does it matter here? Why is this the magical word that men need to know?

Dr. Smith: Because it's on Reddit, I think. I'm just kidding. Epigenetics is something that you hear a lot about, and people go, "What the heck is that?" It's the study of how our behaviors, the environment, our diet, stress levels, toxins that we hear, all the things we eat, drink, breathe, can change and affect how our genes are actually expressed.

And that's one of the interesting things that we see over time, is we can actually see... not to get into the weeds, but there are certain things where genes will be turned on and off by different things that are going on, chemical compounds in our bodies, methylation patterns, certain RNA sequences that are turned on and off from our genetic material that have to do a lot with our environment.

There have been some interesting studies over the years. We can dive into those if you want to. But I think it's an interesting thing to think about. Of all of the things that we do... when you mentioned the alcohol, you mentioned a lot of those different things; those are things that will affect these genetic on-and-off for genetics.

Interviewer: Right, the way the genes express themselves. I heard this expressed like it's sheet music in an orchestra. So the sheet music is how things are supposed to be expressed, but then the conductor comes along and sometimes changes some things. And that's what all these external forces are doing. It might not be for the best when you start messing with what the composer had in mind.

Dr. Smith: And some of this stuff, again, some people look at it like computers. They say hardware and software. DNA is the hardware, and the epigenetics is the software of what programs are running on your computer at any given time, type of thing.

There are a lot of different things that... just whatever resonates with you and helps you understand, but those are kind of the things that I've heard over the years.

Interviewer: Yeah. Do you have good code or do you have some errors in your code? And if you have errors in your code . . .

Dr. Smith: Right. Exactly.

Interviewer: ...that can cause problems. Maybe it doesn't cause problems, but it could cause problems.

Dr. Smith: Exactly.

Stress May Affect More Than You Think

Interviewer: So when we talk about a man's environment, diet, weight, exposures, even where you live, if you live in a place where there's a lot of air pollution or if you work in an industry where perhaps you're exposed to chemicals or something, that can have an impact, but so can stress. And I don't think we talk about that enough.

There's some interesting research I heard about the impact of stress on the way a man passes those modifications we talked about onto the embryo. Can you talk about that a little bit?

Dr. Smith: Yeah. So it initially started . . . there was some research done where they took some mice, and they exposed these mice to stress. And then they actually saw that there was RNA that was associated with this in the offspring that continued to perpetuate. And so the stress responses of these mice were actually impacted by the father of the sperm that was created during that stressful environment, stressful time. Then they tried to look at that in the human population, and they found that there were some similarities.

And so those are things we've kind of seen over the years. It's kind of been put to fruition that some of these stressful things, people who undergo big stressful things can actually pass on some of that genetic predisposition to kids as well.

Interviewer: That is crazy.

Dr. Smith: Yeah. It's starting to be shown. I mean, there have been some studies that have been done. In 2018, the author of the paper before the paper was published came out and said, "Hey, we found some of this." And there's been more research done since then. But it's an interesting, fascinating look into, "Hey, try to kind of bring these things down and reduce your stress."

The thing is, we don't know how long that kind of lasts, but there are ways of undoing it, is what it looks like in the literature as well.

Weight and Metabolism Can Influence Sperm Health

Interviewer: Right. Man, super important. I know that some guys might be listening going, "Well, my life is stressful. How am I supposed to do that?" But I guess if you really want to give your kids the best chance, you've got to figure out if you've got to get help or whatever it takes. Do some breathing exercises, because it can be passed on.

Also, interesting that calorie and metabolism also are an impact as well. If a father is overweight, they can pass that on to their kids as well. Can you talk about that research?

Dr. Smith: Yeah. So there's been some research done with people who had weight loss surgery, and they kind of looked at some of these epigenetic things as well as things that are kind of passed on and that are activated during that.

And so a lot of these proteins and different things that you see, really the genes that produce these things change and the expression of these non-coding RNAs . . . Some of this is getting into the weeds, but the take-home of it is there are changes to the genes that are expressed when obesity is present versus when weight loss is present.

And so they looked at these folks who underwent bariatric surgery. The study showed that related to the epigenome, or the active genes, they identified some potential biomarkers that were predictive of some of those things that may be beneficial. Insulin resistance, things like that, excess body weight, cardiovascular disease, and high blood pressure.

Interviewer: Right. You could be passing that onto your potential kids. It's associated with childhood obesity.

Dr. Smith: Right. And a lot of this stuff has still not been proven-proven, but I think if we want to give ourselves . . . If you're going to bring a baby and you're like, "Hey, I want to do this the right way. I want to do the best I can. I want to be healthy, and I want to have a healthy family," these are things you can obviously optimize before getting pregnant.

Sperm DNA Damage Can Affect Pregnancy

Interviewer: Beyond the epigenetics, how does sperm quality more broadly affect whether a pregnancy is successful? Because I think a lot of times when we talk about successful versus unsuccessful pregnancies, it's, "Did it happen?"

Dr. Smith: Right. And another kind of thing you'll hear is DNA fragmentation. What that means is the genetic material is broken or damaged, and this can contribute to a miscarriage. And then people say, "Well, how does that happen? What happens?" When you look at it, and you see how that actually occurs, a lot of times you'll hear people say "oxidative stress," and that means two things.

Smoking, Alcohol, Heat and Other Sperm Stressors

And so the things we see in our daily lives would be just aging in general as we get older. Our lifestyle and food choices, the healthy things that we eat. We mentioned alcohol. Smoking as well. Environmental exposures. Our skin is our largest organ, and so if we're around things that can go there.

Ionizing radiation, people who've undergone radiation for cancer treatments, things like that are going to have a higher percentage of these, as well as people who are exposed to higher risk factors can have some breakage of this DNA or some damage.

And that gets passed on, where some of those things just don't translate when the egg is fertilized, and you end up with a miscarriage, which is really unfortunate when you're trying to have a child.

Interviewer: It is. And again, it just comes back to this idea of, I think miscarriages were always kind of the burden the woman carried, right? It was her fault. And we're learning more and more that that's not the case, that guys are contributing a significant amount to whether or not a pregnancy is successful.

Dr. Smith: Another one we always ask people about is heat. Hot tubs, saunas, things like that can be damaging as well. There's also something called a varicocele, which can cause an increase in the temperature of the testicle. It's kind of a varicose vein in the scrotum that increases the temperature, and that can affect sperm production. And so heat is another big one that people don't think about and that we always mention and talk about as well.

What Men Can Do Before Trying to Conceive

Interviewer: So if a man comes to you and says, "I want to do everything I can before we start trying," and I think probably we keep this 90-day window in mind because this seems like a real thing to hold onto, what do you tell that man?

Dr. Smith: I say, "Hey, do everything that you think you can to be healthy, all of the changes that you would make to get yourself the healthiest you can be, to get ready for a big event or something that you would do, whether it be running a marathon, something where you're going to take care of your body."

Getting enough sleep is another big one. Avoid those things, the foods and beverages and avoid being exposed to harmful things. I would avoid all those things and just give yourself the best chance you can to have the healthiest sperm possible.

Eating correctly, vitamins, minerals, making sure that if you are deficient, supplementing some of those things, and making sure that your body has all the building blocks it needs to do the right thing.

Interviewer: Right. So optimizing that weight, eating, moving. I hear that you get better sperm quality if you exercise.

Dr. Smith: Yeah.

Interviewer: That was interesting. You said some sort of a supplement. So maybe go to your doctor and find out if you have any vitamin deficiencies.

Dr. Smith: Yeah.

When Should Men Get a Fertility Evaluation?

Interviewer: Get rid of the vices, manage the stress. And what about getting evaluated? Do you evaluate men for risk factors?

Dr. Smith: We can. I mean, a lot of times if you've been trying for a short amount of time, we'll usually say, "Change some of those things and keep trying." But if you've been trying and you've made those modifications, or some of them, and you're still just feeling it, go in and just get checked out.

I think it's one of those things where if you have that in the back of your mind, that that's something that'll be beneficial for you, just get in there and get the process started.

The fertility journey can be one that's challenging and a bit of a trial with relationships, and it's tough. And so if you think you need help, reach out. Find a fertility specialist in your area. We've got awesome ones at the University of Utah for both men and women on the reproductive endocrine side for the ladies, as well as the andrology side for the men.

I'm not pubbing that, but I know the folks that I work with in that space, and they're great. I know there are great folks all over the country that do this. And so find somebody that you can trust and just get in there and do it.