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Scenario

Customer Alison Kilian has come back into the pharmacy to speak to pharmacy technician Vicky.

“It’s occurred to me that I shouldn’t be taking all this baby making business on myself, should I?” says Alison.

“What do you mean?” asks Vicky.

“Well, I’ve done a load of the stuff you told me a few weeks ago to try and improve my fertility,” Alison explains. “And while some of it definitely helps on Simon’s side too, I wondered if there was anything more specific that he can do to improve our chances. Are there supplements? Or is his first step to have his sperm checked?”

Answer

Alison is correct in thinking it is best for both she and her husband to take simple steps to maximise their chances of conception – in around 40 per cent of couples experiencing infertility, problems are found with both partners. Some measures Simon can take include:

• Managing stress levels
• Making sure body mass index is within the healthy range – men with a BMI of 30 or higher often have reduced fertility
• Stopping smoking, which has been linked to poor semen quality, and any recreational drug use
• Exercising, though not excessively
• Staying under the recommended alcohol limit of 14 units per week
• Wearing loose-fitting underwear as there’s a link between elevated scrotal temperature and reduced semen quality
• Controlling any underlying conditions, such as diabetes or thyroid dysfunction
• Avoiding medicines that can affect fertility, for example, sulfasalazine, androgens, anabolic steroids and chemotherapy, plus herbal remedies
• Staying away from pesticides, x-rays, solvents, paints and chemicals used for welding and similar.

The bigger picture

Male infertility is estimated to affect 30 per cent of couples who are having problems conceiving, and, as Alison says, semen analysis is the usual first step taken when seeking medical advice. The man’s semen sample is checked to establish the quantity and quality of his sperm. The test might reveal a lower than usual number of sperm (oligozoospermia), sperm that don’t move as they usually do (asthenozoospermia), or a large number of sperm of abnormal appearance (teratozoospermia). In many cases, all three occur together.

If sperm quality or quantity is found to be low, the couple is usually told to continue trying to conceive naturally through regular, unprotected sex, because more than 90 per cent will fall pregnant within two years. If it hasn’t happened within this timeframe, they may be offered in vitro fertilisation (IVF).

Another problem that can cause male infertility is a blockage that prevents sperm flowing from the man’s testicles. If this is found to be the case – an indicator would be a very low number of sperm in the semen sample, or none at all – surgery may be performed to remove the blockage, or a procedure called surgical sperm recovery may be carried out and then the sperm used for IVF. If low hormone levels are found to be the issue, drug treatment may improve fertility.

As stated in last month’s scenario, infertility can take its toll on people’s emotions, and pharmacy staff are well placed to support individuals as they try to improve their chances of conceiving naturally, or embark on what can be uncomfortable tests and procedures. Signposting to resources and healthcare professionals form part of this, but being there to listen can also be very valuable.

Extend your learning

• Are you clear on alcohol guidelines? Check your understanding
• Varicocele is a common abnormality found in over a quarter of men with abnormal semen. Find out what this is
• Read the Fertility Network UK factsheet
• Discover what Fertility Network UK has to say about lifestyle changes.