When couples encounter challenges starting a family, the reproductive health of the woman is usually called into question first.
But since the spread of the coronavirus, the question of sperm health has become topical – though the virus has since been debunked as a contributor to male infertility.
In fact men's part in infertility has been under the microscope for much longer.
Dr Catherine Minto-Bain of the TT IVF and Fertility Centre said evidence gathered over the past 20 years shows male infertility in Trinidad and Tobago accounts for more than half the number of cases of couples assessed as needing assistance in conceiving.
Minto-Bain said, "It's different in different countries across the globe. In the UK the statistics show that it is probably 30 per cent women and 30 per cent men, another ten per cent is unexplained and the rest is as a result of mixed causes.
"So we did some research here in the last couple of years to have a good look to see what is going on in TT."
She said research findings in the UK differ from those in TT.
When she first came from the UK to practise in TT over 15 years ago she thought, "Wow, I have never seen so many sperm problems. Maybe we are encountering some of the most challenging cases, or maybe this is just an unusual period."
But she said science director and embryologist Natalie Jess, who came to practise in TT from Australia, made the same observation, adding that there are similar cases in other Caribbean territories, such as Jamaica.
Asked about the ideal research approach, Minto-Bain said it would require a wide, random sample of men from a range of backgrounds. But that would be challenging to complete, because the process of sample-gathering would require volunteers being willing to participate in a process that generally has proven uncomfortable for most men.
What the team at the centre has done instead is take random samples for analysis from over 10,000 people they've seen. From the analysis, they found most of the challenges experienced by couples came from the men.
"This comes up in about 60 per cent of the couples we see. Whether that is reflective of what is happening in the general population is another thing, but we have been doing this for over 20 years and this is what we have seen over the past ten years."
Asked what might be some of the causes for male infertility, which is, of course, linked to sperm health, Minto-Bain said there are several reasons such as genetics.
Sperm researchers around the world have concluded that genetics account for 80 per cent of sperm defects. A large number of issues with sperm health are also linked to unhealthy lifestyle practices and toxic living environments.
Diet affects what flows through the bloodstream, inevitably affecting the quality of sperm. So a man can have perfectly good sperm count, but if his lifestyle includes taking drugs, smoking, a diet with little to no fruit and vegetables (which help combat the amount of toxins in the body) – he is more prone to heart problems, for example – all of this can show up in the quality of sperm much earlier than other side effects.
"It's often not one thing. It is normally several things affecting the sperm health at different times." She said these things include toxins in the environment, the plastics people wrap food in, things in the water supply and pesticides in food.
She said people living in developing countries may have many things in their systems from the environment and food-production practices that affect male fertility and which would have been traded out for healthier options in the developed world.
Asked if there is any specific area in TT where male infertility is more prevalent, Newsday was given a synopsis and findings of research done by Jess and her team, in which 500 semen analyses were plotted on a map.
"We looked at ethnicity, location and to see if it clustered around any specific industry – but nothing stood out."
The outstanding factor was that older men and men who smoke had more challenges with sperm health – which research has found to be a factor on a global scale.
Minto-Bain said while research continues, to a greater extent, many of the issues linked to male infertility and less-than-ideal sperm health remain in the realm of mystery.
"If people tell you they know what's causing sperm problems, they haven't worked in the industry of male infertility for 15 years.
"It's why there is no pill that just sorts it out. It is why it's so frustrating in TT that men will see a doctor and they will be given hormones like testosterone – which makes things worse.
"That just stops sperm production altogether, because it switches off testosterone production in the testicles. And we still have urologists here who give that injection, and I wish they would stop, because it harms men."
Rumoured causes of low sperm production or poor sperm health generally seen floating around on social media include exposure to radiation from cellphones, tight pants and underwear and even the use of fabric softener.
Minto-Bain said while fabric softener is highly unlikely, there is some evidence of a link between sperm health and exposure to electromagnetic radiation or heat from phones, but there is very little data.
She said tight-fitting pants and underwear may cause some damage, as is the case with anything that keeps heat around the testicles.
"So women's ovaries are inside the body for protection, and because eggs don't need to be in a cool environment. But the testes are designed to hang outside the body to keep them cooler. Theoretically, if men wear tight pants, or if they are normally seated on hot surfaces, there is a link there."
Asked how much information a man can get on his general health from a sperm analysis, Minto-Bain said sperm analyses can indicate possible blockages in the reproductive area.
"Risk of heart attacks, stroke, chronic illnesses and general health can be detected in a sperm test."
Ways of improving sperm health may help improve men's health generally: "Better diet, cutting out smoking and vaping, cutting back on alcohol consumption and putting greater thought into their general health."
She said while this is the case, many men who seek help from the fertility clinic are healthy and lead healthy lives, which is an indication that sperm defects are genetic.
"So, for example, if a mother had a virus when she was pregnant when the male's sperm precursor cells were forming, that could set in train damage for the future."
But, asked if men should do random testing, even if they aren't trying to start a family (in an ideal world one would not want to check how healthy sperm are by getting a woman pregnant), Minto-Bain said not necessarily.
"If you aren't trying to have a baby there is no evidence that we have at the moment to say a sperm test can improve general health, but that may very well change in the future.
"But the moment men become concerned about fertility, that is the time to do a test."
Minto-Bain said the school curriculum should include more information on fertility in sex education. This, she believes, can change the culture of blame and shame around infertility in the Caribbean.