What you should know about men’s and women’s fertility

“The truth is male fertility has lived in the shadows for far too long and women have been forced to bear the brunt of infertility for far too long. And so I really hope this book helps change that conversation and brings men to the table because it’s long overdue.”

Leslie Schrock, Author of “Fertility Rules”

When it comes to starting or growing a family, many of us come face-to-face with a painful reality: Infertility. Even if you had an easy time conceiving, it doesn’t guarantee subsequent pregnancies will be just as easy. 

Problems in men’s bodies are the cause of around half of all infertility. Does that statistic shock you? That could be because women of child-bearing age are bombarded with marketing for expensive fertility supplements and treatments, while men remain largely in the dark about their reproductive health. Women’s lifestyle choices—what they eat, drink, and use on their bodies—are scrutinized and judged. Yet sperm is influenced by the same lifestyle factors. 

Here to educate us on fertility for both men and women, is Leslie Schrock, top-selling author of the modern guide to pregnancy “Bumpin’”. She has now written a second book called “Fertility Rules”. Learn more about Leslie’s books @leslieschrock. 

Transcript:

Understanding the basics of fertility

Leslie: I couldn’t be happier to be back on this podcast with you. 

Jessica: Well, I’ve loved reading your book, and I’m so grateful you’re taking a science backed empathy led approach to this really important topic around fertility. 

So can we get down to the basics? Could we get a summary, a high level summary of some of the surprising things about understanding your own biology, understanding male and female biology that people often don’t know who are trying to conceive? 

Leslie: People don’t understand that, a woman is born with all the eggs she will ever have and men regenerate sperm around every three months. So while, for women, unfortunately, there are very limited things that you can do once you begin to get a bit older. And chromosomal abnormalities happen in eggs. Men have age-related fertility decline too. That’s another big surprise. But there is a lot that men can do to improve their sperm supply because they regenerate it so frequently. 

I think the other thing that, you alluded to in the introduction is that we don’t give enough weight and power to male fertility. It is really important. Speaking to all the women out there, how many of you have been on Instagram or TikTok lately and somehow it knows you’re trying to conceive or you’re pregnant or whatever state you find yourself in. But does your partner get ads like that? Are they targeted in the same way ever for male prenatal vitamins or fertility improvement programs or detoxes or cleanses? Probably not. Because the truth is male fertility has lived in the shadows for far too long and women have been forced to bear the brunt of infertility for far too long. And so I really hope this book helps change that conversation and brings men to the table because it’s long overdue.

How to talk to your partner about fertility

Jessica: Yeah, I mean, it can be so sensitive for men and women, but especially I think for men. How do you coach women to broach the subject with their partners? 

Leslie: It is really hard because we sort of conflate virility with a man’s self-worth. And it’s been that way for a long time. I think we’ve always had these kind of cultural beliefs around sperm. Even sperms first researcher was kind of afraid to talk about it because he thought educated people would find talking about it gross. It’s still a very taboo subject. It’s still very much considered kind of a gross thing to talk about when in reality it’s just biology. A lot of the researchers and experts in this area that I spoke to and interviewed in the writing of this book emphasized how information and history and context and empathy is so important for men.

Most men do not find it funny. They just want information. They want facts. That is what drives the most impact and respect. It is really difficult to talk about. I mean, one of the incredible things that I’ve experienced, no one has any secrets from me anymore. So a lot of the time I’m the first person to find out somebody’s pregnant before they’ve even told their husband. But, is that men will come to me now and say it was me. The reason we had to go through IVF with our second baby was because my sperm parameters were off. And like we had no problem the first time, but the second time something was off and there was, I tried, but there was nothing I can do. And so I think we just have to get to a place where this is not so wrapped in identity and it’s got to be normalized because it’s about half, a third is women, a third is men, a third is unexplained or a combination of both.

Drop in sperm concentration 

Jessica: You write in your book that sperm concentration total count have dropped more than 50% since the 1970s. That is so surprising. Like, what is behind this drop? 

Leslie: That depends who you ask. Sperm is a biomarker. It is an indicator of a man’s overall health. And so if sperm counts are dropping, clearly something sinister is at work with men’s health overall too.

They already live five years less than women. They have more chronic conditions and comorbidities. Men are just unhealthier than women. That’s just the reality. They access healthcare services far more infrequently. And so we don’t know, we think it’s BPAs and phthalates that is one of the very common assumptions, but I think that we still need a lot more research. There was an update to that study that was originally done in 2017 published showing that it’s actually a global drop. So it’s everywhere. So clearly it’s probably exposure to chemicals. I think it’s a lot of things, food sources, inactivity, sedentary lifestyles, also THC. So I think we’ll probably get into what hurts sperm later. But, if you are trying to conceive and you are a THC user, man, you need to stop.

Can men enhance their fertility?

Jessica: Yeah. So let’s talk about it now. I mean, you you’ve mentioned endocrine disrupting chemicals. You’ve mentioned THC, you mentioned lifestyle factors. Can we double click on what men can do to enhance their own fertility? 

Leslie: Yes. So the first is book a preconception appointment. Just go to your primary care doctor and go over your list of medications with them. Go over what you’re taking because for example, there was a study done on metformin, which is the most common drug used to treat type two diabetes, showing that when it was used in the three months before a couple conceived, that it can cause general birth defects in young boys. There is just so much we do not tell men because they are not there. Drugs are not labeled with reproductive health warnings for men the way they are for women. But metformin is one example. THC, cannabis products, are not labeled to show that they hurt sperm parameters. Propecia, male hair loss products, can also cause a decline in sperm quality. It’s very specific, right? 

Like you’ve got to go talk to your doctor about the drugs that you are on, have that conversation. Everybody’s health conditions and the kinda risk reward ratio of continuing a drug regimen versus getting off of it. You’ve got to work with a provider directly to make those decisions. But aside from that, I think there are easy things men can do at home, with endocrine disruption, stop microwaving food in plastic, stop storing food in plastic, use glass. Just minimize your exposure to it. For women, we know that retinoids are not a good idea when you’re pregnant, it’s not really even a good idea when you’re trying to conceive. You should just let it all clear your system. Really men stop cycling a lot. Go see your doctor. Don’t microwave food in plastic, get active, Mediterranean diet. Like these very simple things that we kind of know. 

Testosterone and fertility 

Jessica: And to build on this, a lot of men are looking at their testosterone levels and saying, we’re seeing drops in testosterone. And so I think a lot of people are assuming that boosting testosterone levels would make a man more fertile. But why is this not the case? 

Leslie: This is not the case because too much testosterone actually drops your semen parameters. So this is another reason that steroid use is such a problem. And a lot of men lie about it too. And it’s really sad. Steroids have really become common for aesthetic purposes. This is another thing that’s so wonderful about the relationship that you can have with a medical provider if you’re honest, which is that they can help, they can help you taper off, they can help find other ways.  You’ve just got to go into these appointments and be honest. But I think it’s incredibly difficult. It’s all tied up in appearance and masculinity and virility and it’s very complicated to unravel.

Can women enhance their fertility?

Jessica: So we’ve talked a lot about male fertility. What about female fertility? What can women do to enhance their fertility? 

Leslie: Women can do so many of the same lifestyle moves that men do, and actually, I really encourage couples to do this together. It’s way more fun when you have an accountability buddy. Diets stick more, activity sticks more when you do it with another person, but the truth is, it’s similar. Get some activity going, find an exercise that you like. Go for walks. You don’t have to do yoga if it’s not for you, it’s fine, but really maintaining a moderate level of activity is the thing that you want to do first and foremost. Mediterranean style diet. Great. Please do not do cleanses and detoxes, unless you need a hard reset in the months before you try to conceive. Caloric restriction is not what you want because it can cause anovulation, which basically means you will not ovulate and you cannot get pregnant. So moderate activity, Mediterranean diet, get some sleep, hydrate, all the things that everyone tells you to do anyway. I think we make it incredibly difficult for women to feel successful when it comes to improving and optimizing their fertility. I think we have all these fad diets and all these supplements.

There are only two supplements that you should really be universally taking if you’re a man or a woman, and the evidence on one isn’t even that great. So there is CoQ10 which, there are no side effects if you want to take it, be my guest. The evidence is fine, but there are no side effects unlike many other kinds of supplements. And then the other one is prenatal vitamins, and this is something men and women really should take. Men can take a multi-vitamin, women can take a prenatal vitamin. Folic acid is the main thing that you’re going to see in the ingredients because that is what helps with sperm parameters, it’s also what helps reduce the likelihood of birth defects, neural tube defects early in pregnancy. You really want the folate levels in your body to build up. You do get folate through your diet, but it’s best to boost it with a prenatal vitamin, so that’s the only thing that is non-negotiable.

But I also want to talk about something else that was another driving factor in me writing this book, which is that eggs are important. Eggs are incredible. Eggs are the largest cell in the human body. But there is no fixing chromosomally abnormal eggs. So all of these diets and all of these protocols that are claiming to fix your egg quality, it’s not a thing. Your body’s ability to perform cell division just gets less efficient with age. That’s it. That’s why when we talk about a fertility decline at 35, 37, and 37 is when it actually really starts to see a decline. 39, it goes down even more, and into the 40s is when it gets tough, and it’s just because your body is just not as good at doing that job anymore.

So the reasons that most problems happen with eggs are errors during meiosis. So eggs start as these little primordial cells in the ovaries, immature oocytes, and then they take about three months to mature, and during that time, there is a split of the chromosomes, and sometimes it is not even. But there is nothing you can take and nothing you can do other than optimizing your overall health to make your body better at that process, and someone who is 24 is going to be much more efficient at doing it than someone who is 44. I really come at this with a very personal struggle, which is that I’ve had three losses. It was a moment in my life that really changed my trajectory in a lot of ways.

Do miscarriages affect fertility? 

Jessica: That’s so helpful and encouraging to hear your personal story, thank you. And you shared this experience with your early losses, do those statistically impact subsequent fertility. What meaning do we make from a loss? 

Leslie: I had five total pregnancies, I got pregnant the first time we tried, four out of the five times. These are the stories we hear, these are the stories we hear from people. One miscarriage does not mean you’re never going to conceive again. Once you’ve experienced three in a row, that’s a condition known as recurrent miscarriage, it is very rare. But no, miscarriages do not affect your fertility.

Secondary infertility 

Jessica: And what about secondary infertility? Talk to us about how frequently that happens. Is there any insight that you can provide? 

Leslie: One of the conversations we have a lot when it comes to infertility is people assume it’s… You just can’t get pregnant. Well, there’s also, you can’t stay pregnant. It’s a different problem. And then there’s the assumption that this only happens to first-time parents. Primary infertility, which is infertility that occurs with first-time parents is just as common as secondary infertility. Secondary infertility means you have an existing child or children and you cannot get or stay pregnant. So, there are some couples who get pregnant no problem the first time, and then they need a little bit of help, whether it’s medication or IVF the second time. The opposite can also happen, which is fascinating, which is that perhaps the first time you did need IVF, and then you conceive spontaneously the second time. We don’t have enough research to understand it. It is possible, it’s not a guarantee, but there’s a lot of mystery around exactly why one couple will get pregnant once or need assistance another time, and some of it can be linked to lifestyle changes.

Jessica: What percentage of the population did you say is affected by secondary infertility? 

Leslie: It is about 11%, much higher than many people believe to be true, but it is.

Breastfeeding and fertility 

Jessica: Let’s talk about breastfeeding. So related to secondary conception, what about women who are trying to conceive while they’re breastfeeding. What’s the impact on conception around breastfeeding, if you want to conceive? 

Leslie: Breastfeeding does suppress some hormones in your body, even if your now 1-year-old or 2-year-old or however old your child is, is still breastfeeding. Breastfeeding signals to your body that you’re still feeding a human and maybe pregnancy should not be on your mind. It doesn’t mean you’re not ovulating, it doesn’t mean you can’t. Just means it might be slightly more difficult, but not for everyone, and I think that for most people… A lot of people end up with a period again by the time their kids are a little older and eating solid foods.

When to seek help with fertility

Jessica: Okay, and now I want to switch and talk about Clomid and IVF and what can you tell us? So many friends and so many people that I know have gone through three, even four rounds of IVF and had success, and it’s just a huge celebration. So I want to say this to all of the listeners here who are going through this really challenging time, hang in there, it really can work and it can be such a joy when it does. Can you tell me about the science on these methods. What do women, in particular and parents, hope-to-be parents not know about these methods. Where is the nerdy edge here?

Leslie: There are two different timelines to seeking help if you are not getting pregnant when you’re trying. If you’re under 35, you take a year and then you seek help. If you’re over 35, it’s six months of not getting pregnant to go seek some help. One thing that a lot of people assume is that you jump straight to IVF. There are many medications and many things that you typically try before you do IVF, so one of them is intrauterine insemination. Six tries, I think is the average to get a live birth. There are medications that you can take. There are now at-home kits. Frida just came out with a kit for at-home insemination, Mosie Baby is another one, if you want to do a kit instead of having sex. This is a thing that a lot of people don’t talk about, which is that when you’re experiencing infertility and you’re timing sex around ovulation and the fertile window, after a few months, it begins to feel like a job. And a lot of parents, and a lot of prospective parents just feel like they can’t do it anymore. 

Sex is lost. The allure, and it can be really hard. And as someone who’s been through it, I can absolutely tell you that it’s difficult. You’re not always going to be in the mood, it’s not always easy to muster up some enthusiasm for it after you’ve been through so much.

Jessica: And anything else that you can share with people who are going through IVF of what you uncovered in your book that was surprising? 

Leslie: One thing that I was surprised by, and that continues to surprise people is that it’s three cycles. Three cycles is the average to achieve a live birth. It very infrequently works the first time. And a lot of it is just because there’s so much we don’t understand and the technologies are pretty new. Louise Brown was the first IVF baby. She was born in 1978, and things have gotten much better since then, but this technology has only been around for 40 years, so we have a lot of work to do. There are some really incredible companies working on improving things using AI, using robotics, really trying to abstract away some of the more mechanical bits of the process today. But we’re still a work in progress, and I think until we see a huge leap forward again, it will continue to be for most couples, three cycles, which is very expensive and out of reach for so many people.

Tips for supporting friends with infertility

Jessica: How can we support our friends who are struggling with infertility, just finding the right words and supporting them. What tips do you have and what suggestions? 

Leslie: Listen. It’s the number one thing you can do. I think that we all want to say the perfect thing, and having been on both ends of this, as someone who’s gone through it and someone who talks to many, many people about this all the time. I express that I’m there. I listen, I tell them that if they want to talk about it, they can. If they don’t want to talk about it, they can. Be there, don’t stop checking in. A couple of weeks after something like this happens sometimes is the worst part because everyone’s there at the beginning, and then no one’s there all of a sudden because time has passed. So, yeah, I think it’s just being there.

Jessica: And then couples who often don’t get as much empathy from their friends and community when facing secondary infertility, there’s this assumption that, “Oh, you should be thankful because you already have one child,” What’s your advice to those families that are on the receiving end of that kind of not so sensitive reaction.

Leslie: I think what is generally most effective is stepping back and realizing that the person saying this probably doesn’t mean anything malicious. They probably don’t mean to be hurtful. I think it can be as simple as taking a deep breath and just saying, “Hi, friend, I know that you didn’t mean anything by this comment, but we’re really struggling right now and talking about it in this way is very hurtful, so I prefer just that we don’t discuss it, or it actually is a big deal to us, and we do feel lucky that we have a child, but it doesn’t diminish the fact that we’re going through something very hard.” 

Jessica: Yes, yes. Anything else, Leslie, this has been so informative. You have a best seller book in “Bumpin’”. This is going to be another best seller. You’re taking on such hard topics with such rigor. Anything else that you want to share with our community before we go? 

Leslie: I want everyone to be in it together. I want men and women to both be in this together. The cost to women is substantial if we continue to allow men to be left out of this conversation. Women are undergoing unnecessary treatments and testing and they’re invasive and they’re expensive, and men just need to step up and be honest and be involved. I think that if we could get men involved in this process sooner, perhaps they would be more involved in pregnancy and more involved fathers from the get-go. I think men want to be. I see this in the research. I see this in the questions and the conversations that I have. I truly believe that we could create a more empowered, more loving, more communicative family moving forward if men just got involved a little bit sooner and took ownership of their health. Other than having two young boys and worrying about the future for them, that’s really what I want, and that’s what my writing has always been about really, is just giving people the information and the frameworks to help them make the decisions that are best for them because everyone is so different.

Jessica: Thank you so much for being with us. 

Leslie: Thanks for having me.

Takeaways:

1. Men are just as likely as women to have health complications that contribute to infertility. The good news: There is a lot that men can do to improve their sperm supply because they regenerate it so frequently.
   
2. The first step, says Leslie, is to book a preconception appointment. Have an honest conversation with your doctor about any medications or supplements you may be taking. Some people think that supplementing with testosterone will make a man more fertile, but it actually drops a man’s semen parameters.
   
3. Leslie recommends only two supplements for women and men trying to conceive: CoQ10 and a prenatal vitamin with folic acid. She cautions women away from products that claim to regenerate your egg supply, which is not medically possible. Focus instead on ​​optimizing your overall health.
   
4. It takes an average of three IVF cycles for a couple to have a baby. But fertility treatments rarely start there. Leslie spoke about kits for at-home insemination as well as timed intercourse as a first step you can try at home.
   
5. While breastfeeding shouldn’t be relied upon for birth control, if you’re breastfeeding and trying to conceive, your body is not going to put its best foot forward to facilitate a second pregnancy. This is because the priority is feeding the human relying on your milk supply.
   
6. When supporting those who are experiencing infertility, Leslie reminds us to listen. There is no greater gift.

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