Abdus Salam was worried. Extremely worried. Seated in the waiting room of Dr Pankaj Shrivastav’s Conceive Fertility Hospital, he had broken into a sweat and his hands had started to tremble.

In his mid-20s, the Syrian man was muscular, with well-developed biceps and shoulders – perhaps a tad unnaturally developed. And that was to blame for his stress.

‘Very small built, Abdus* had been going to a gym for a couple of weeks, but was unhappy that he wasn’t seeing any major results,’ says Dr Shrivastav, director of Conceive Fertility Hospital that has branches in Dubai and Sharjah.

Keen to bulk up instantly, the young man approached his gym trainer, who sent him down a dangerous road – putting him on a course of anabolic androgenic steroids. Performance enhancing drugs, they are said to boost body mass, but come with a package of serious side effects. As medication, they need to be administered only under strict professional supervision. In the past there have been reports of abuse of these drugs and the UAE initiated strict laws that ban using, distributing and selling such drugs for recreational purposes.

[How to get fit without breaking the bank]

Such steroids and certain supplements that unscrupulous trainers give wannabe male body builders can negatively interfere with the natural production of testosterone in the body, impacting the libido and resulting in serious fertility-related issues for men, says Dr Shrivastav.

In Abdus’ case, the young man was preparing to get married in a couple of months when he realised that he was experiencing extremely low libido, says the doctor. ‘With his marriage fixed, he was worried this would affect his marital life. Although Abdus had stopped taking steroids for more than four months, he had still not recovered his libido,’ says the doctor, who has a wealth of experience treating patients – male and female – with infertility problems.

Abdus is not alone. And the abuse of banned or controlled steroids is not the only reason for an upswing in fertility issues for men.

A much publicised report published in 2017 revealed that over the last four decades, sperm counts – a main marker of male fertility – in the US, Europe, Australia and New Zealand have fallen by more than 50 per cent. Sperm counts were down from 99 million per mm of semen in 1973 to 47 million per mm in 2011, the report added. To put that in perspective, a count of less than 15m per mm is considered low, and defined as oligozoospermia – meaning conceiving is likely to be difficult.

‘Some reports have said that about 15 per cent men have low sperm counts. But I’d say around 8-10 per cent of men have issues with sperm quality,’ says Dr Shrivastav.

From lifestyle issues such as obesity, smoking, alcohol use and inadvertently consuming growth hormones that enter the food chain through meats like battery chickens, to health conditions such as diabetes, hypertension and varicocele – a kind of knot of varicose veins in the testes – among others, all have an effect on male fertility. Then there are a few factors like wearing very tight trousers and innerwear, excessive cycling, and frequent use of jacuzzis and saunas, which some experts suspect could have a negative impact on male fertility, but more on that later (no, you don’t have to cancel your spa membership yet).

Environmental issues

Dr Shawket Alkhayal, consultant urologist - andrologist at Novomed Men’s Health in Dubai Healthcare City, one of the few andrologists in the city who has over two decades of experience treating issues related to men’s reproductive health, admits that a lot of data is coming in regarding dropping rates of male fertility. ‘There are many factors including environmental apart from health that could be playing a part,’ he says.

Unlike in women who have a limited reproductive lifespan because they experience menopause at around age 50, in men age doesn’t really have a big role to play when it comes to fertility. A man in his 80s could have the fertility of a 20-year-old man if he has no major health issues and if his hormones are well balanced, says Dr Shawket.

Dr Shrivastav is on the same page. Men may have it easier than women because their sperm production doesn’t decline that rapidly with age, he says. But what does is performance, particularly if the man has health conditions. ‘With obesity, diabetes and dropping levels of testosterone, libido could be affected,’ he says.

Obesity is of course a major issue particularly in the UAE, where the levels are extremely high. ‘Fat cells have this ability to convert the male hormone testosterone, produced by the testes, into the female hormone oestrogen,’ says Dr Shrivastav. ‘So with increasing obesity, the man ends up with more female hormones in his body, which could negatively impact libido. This is also a reason some obese men develop [gynecomastia] or male breasts.’

Diabetes, also a huge problem in the region, is another culprit. Apart from causing a string of problems, the condition also leads to the narrowing of blood vessels resulting in, among other issues, erectile dysfunction, he says.

Among lifestyle factors, Dr Shrivastav lists smoking right on top. Not only does nicotine cause blood vessels to constrict, it also has a toxic effect on sperm production, quality and shape – factors that could affect fertility, he adds.

Dr Shawket agrees, going on to add more pointers. Among factors that he lists affecting male fertility are lack of exercise, alcohol consumption, poor dietary habits, lack of quality sleep, certain medications for cholesterol, hypertension and diabetes, among others. ‘Plus, there is a very important factor – mobile phone use,’ says Dr Shawket. ‘Several studies have shown that this can have an effect on fertility.’ That is why it is not advisable to keep the phone in the front pocket of your trousers because it would be very close to the testicles and radiation and the heat from the smartphone could have an effect on sperm production, say some studies.

On the same note, extensive laptop use too has been blamed – inconclusively – for male fertility issues. ‘Spending a lot of time with a laptop on your lap could have an effect on sperm health, but more research needs to be conducted before we can conclude,’ says Dr Shrivastav.

Varicocele

A common condition affecting about 10 to 15 per cent of men is varicocele. While many men may not exhibit any symptoms, some may have fertility issues. ‘It could result in reduction in the number and quality of sperm,’ he says. ‘We are seeing more and more of such cases.’ Left unchecked, the condition could worsen.

I ask about body builders abusing steroids. ‘I believe all young men should be worried about wrong gym practices,’ says the soft-spoken Dr Shawket. ‘A lot of men visit gyms to workout but there is a percentage among them who, in their haste to put on muscle quickly, resort to taking dangerous and controlled substances like steroids and hormones.’ This, he says, could seriously hamper their fertility.

While on wrong gym practices, he draws attention to those going heavy on protein shakes. ‘They think it is normal to consume a lot of protein or protein shakes to bulk up quickly. It is not devoid of risks. In fact, the more protein you take the more it binds to your testosterone [affecting fertility]. A test may reveal their testosterone levels to be normal, but in reality the hormone may not be functioning because a large part of it is attached to these proteins.’ His advice: to go easy on protein shakes and to consult professionals before consuming them.

‘More and more supplement and protein shops are popping up. They need to be monitored and protein shakes should be dispensed only under strict expert supervision.’

Dr Shawket mentions the case of a trainer in a gym ‘who was taking extra physiological doses of testosterone and growth hormones. The result – he suffered erectile dysfunction’. He also recalls the case of a patient who abused these hormones for about six years and is ‘now suffering the consequences’.

Can the effects of abusing these drugs be reversed? ‘Not all users will recover completely,’ he says. ‘There is some medication that can be given in the hope that the testicles will start working again. But the longer they use [banned] stuff, the greater the probability they will not recover.’

Excessive cycling an issue?

I mention how certain unsubstantiated studies suggest excessive cycling could affect fertility in men. The narrow saddle, popular on many bicycles, could be a factor, admits Dr Shawket. Sitting for extended periods of time on a narrow seat produces a lot of pressure on the prostate because you are actually sitting pretty much on the prostate or the pelvis and not on the buttocks. ‘The more recent saddles have an opening in the centre that can help relieve the pressure to a certain extent,’ he says.

Dr Shrivastav though believes that a 30-40 minute session of bicycling is ‘unlikely to have a serious impact on sperm production or quality.

‘That said, constantly wearing tight cycling shorts or clothing, cycling for an extended period of time, and spending a lot of time in hot tubs and jacuzzis might not be a good idea if you are planning to start a family. Doing all this in moderation is OK,’ he says.

Does stress, that has been blamed for just about every health condition, have a role to play in reproductive health? After all, there have been some reports that high levels of cortisol can reduce testosterone.

Dr Shawket says stress can lead to some hormonal imbalance. Increase in stress levels could result in hypertension and that could have a cascading effect. Proper and adequate sleep and regular exercise is very important, he stresses.

Dr Shrivastav believes more tests and research needs to be conducted for conclusive findings regarding stress and fertility. ‘See, people have had babies during war times, so I am not sure stress is a huge issue. It is unlikely to affect sperm, but it’ll probably hinder the libido.’

The consultant urologist also points his finger at jacuzzis. ‘I know of a couple who were wanting to have kids but could not. After a detailed consultation I learnt that the man was a frequent user of jacuzzis and saunas,’ he says.

Men who work in very hot environments – like near furnaces and industrial ovens – could also be at risk of having a low sperm count, say some experts.

Pesticides and plastics

‘A major concern is what is getting into our food chains,’ warns Dr Shrivastav. ‘Pesticides, chemicals, preservatives… all have a detrimental effect. A lot of pesticides that get into the food chain through the ground water have an oestrogenic effect on the system. So a man is subjected to unnecessary female hormones.’

Plastic usage is the other major concern. ‘Products that leach bisphenol – found in polycarbonate plastics often used in containers that store food and beverages like water bottles and food savers – are known to be toxic for sperms,’ says Dr Shrivastav.

So, at the end of the day, what should men keep in mind if they are planning on becoming dads? ‘Very simple,’ says Dr Shrivastav. ‘Follow a healthy lifestyle – eat healthy and in moderation, exercise regularly, don’t smoke, sleep well.’

* Name changed