Can Unhealthy Sperm Cause Miscarriage? (A New Study Says Yes.)
When a pregnancy ends in miscarriage, many women report feelings of guilt, shame, and self-blame after the loss. But a growing body of research reveals that in some cases, a pregnancy can fail due to abnormalities in the sperm. Despite the instrumental role of sperm in healthy pregnancies, men aren’t routinely screened when pregnancies fail. Dr. Anastasia Dimakopoulou, a clinical research fellow in the Department of Medicine at the Imperial College of London, says that should change.
Dr. Dimakopoulou is a co-author of a new study, published this month in the journal Clinical Chemistry, which illuminates the role of unhealthy sperm in recurrent miscarriage. The study looked at male partners of women who had recurrent pregnancy loss, typically defined as three or more losses. They found that the semen in these men had high levels of what’s called oxygen radicals, a biomarker of a man’s overall health.
Men and women should be equally screened after a pregnancy loss
When trying to determine the cause of miscarriage, Dr. Dimakopoulu says, “men and women should be equally investigated with standard specialized tests.” But this is not currently standard practice. In fact, Dr. Dimakopoulou says, “most men are not even asked a single question when attending recurrent miscarriage clinics.” Though this particular study only examined male partners in recurrent pregnancy loss, Dr. Dimakopoulou says that isolated miscarriages will be included in future research.
It seems that sometimes women conflate carrying the pregnancy with causing it to fail. Dr. Jessica Zucker, Ph.D. is a licensed psychologist, specializing in women’s reproductive and maternal mental health with over a decade of experience counseling women. She says that following a miscarriage, many women have an immediate sense that their body has somehow failed them. Their first instinct is often to look within. “Sometimes it takes a bit for people to turn to sperm as a possibility.”
Miscarriages aren’t caused by what a woman does or doesn’t do
There’s also an issue of public misperception about miscarriages, especially what causes them. One of the largest studies ever conducted about miscarriage misconceptions—published in the journal Obstetrics & Gynecology—showed that 40% of women felt they miscarried because they did something wrong, nearly 50% said they felt guilty, and 75% believed a stressful event might have caused it.
But studies have shown stress doesn’t cause miscarriage, and even the data on the relationship between extreme stress and miscarriage is unclear. Most miscarriages, about 50 – 60%, are the result of a chromosomal abnormality—some of which may be contributed by the male. The other 40% are unexplained. Dr. Dimakopoulou says that in those cases, the woman and the man should be equally screened for the potential cause.
Misperceptions exacerbate feelings of shame
The Obstetrics & Gynecology study also showed that miscarriage misperceptions can exacerbate negative feelings such as shame, isolation, and depression over the loss. Women who were given a medical reason for their loss were less likely to have these feelings. But this particular study didn’t include questions about whether the male partner’s sperm health—or other biological factors attributed to the male—were perceived as a potential cause.
If women everywhere knew—if they deeply understood—that health of the sperm is critically important, not just for getting pregnant but for staying pregnant, might some of the shame and self-blame surrounding miscarriage be assuaged? Dr. Dimakopoulu thinks so. But it has taken medicine a long time to catch on to this idea.
A loaded etymology coupled with cultural silence
When you consider the etymology of the word miscarriage, it’s perhaps no surprise that women have long blamed themselves. Consider the meaning of the three roots of the word miscarriage: “mis,” “caryen,” and “age.” According to the etymological dictionary:
Mis = “wrongly”
Caryen = “to carry”
Age = “belonging to, related to”
If early pregnancy loss had been named something different—something more akin to “unexplained biological error”—might this have impacted the way miscarriages have historically been perceived? It seems plausible. But Dr. Zucker thinks that the cultural silence around miscarriage is perhaps more to blame.
Open conversations about loss are key
She points out that most women—as a result of the antiquated stigma—don’t openly talk about their loss. But if they did, these medical details, whether it was caused by a heart-shaped uterus or a damaged sperm DNA, would emerge from those conversations. “People would probably talk more fluidly about the medical information if they were even talking about it at all,” she says. Dr. Zucker—who sadly experienced a miscarriage herself—has also been proactive in encouraging women to speak up through her popular Instagram handle, #IHadAMiscarriage.
Eradicating the cultural silence around miscarriage will likely take some time. But for now, science is beginning to back up what seems obvious when you consider biological facts apart from etymological, societal, psychological, or cultural influences: it takes a healthy egg and a healthy sperm to create a viable embryo, fetus and ultimately—a child.
For more information on Dr. Dimakopoulu’s research on sperm and recurrent miscarriage, here is the transcript* of our interview.
*This transcript has been edited for clarity by myself as well as by Dr. Dimakopoulou.
Q&A with Dr. Anastasia Dimakopoulou
What new information did your new study reveal?
Dr. Dimakopoulou: Recurrent miscarriage is the loss of a pregnancy before 20 weeks of gestation on three consecutive occasions. There is significant research performed [on what is causing the miscarriage] for the female partners but not for the male partner so far. Our study was novel in that we investigated seminal reactive oxygen species, the specific level of the oxygen radicals in the semen and we found that this was elevated. Reactive oxygen species is a marker representative of a man’s overall health and warrants further investigation.
Was this the first study showing sperm could play a role in recurrent miscarriage?
Dr. Dimakopoulou: Good question. There actually have been previous studies that looked into the quality of the sperm and the DNA material within the sperm but no previous studies on the seminal reactive oxygen species.
Did you look into single miscarriages, too? (i.e. miscarriages that are not defined as recurrent)
Dr. Dimakopoulou: This particular study looked at male partners of women with recurrent miscarriage, but we will look into this area in future research.
Why has it taken so long to investigate the role of sperm when pregnancies fail?
Dr. Dimakopoulou: This is an interesting question because we know what causes recurrent miscarriages due to female factors—but that only represents 50% of cases of recurrent miscarriage.
The remaining 50% of miscarriage cases are unexplained—but all emphasis is still given to women, men are not investigated. My gynecological colleagues admit that male partners are not even asked a single question when attending recurrent miscarriage clinics.
It’s not clear why men are not examined or investigated in this context. Most likely there is lack of clarity in the required tests or a stigma to the male partner who may not be comfortable with investigations with regards to his fertility, while women are more open to investigation.
When should a couple see a specialist regarding miscarriages?
Dr. Dimakopoulou: So, in the UK we have established guidelines outlining that recurrent miscarriage should be investigated when the couple experiences 3 or more consecutive pregnancy losses, but again, it’s a very valid question as the guidelines have recently changed. On December 2017 recurrent pregnancy loss was defined as the loss of 2 or more pregnancies by the European Society of Human Reproduction & Embryology. We actually performed the paper before the change in guidelines and despite this we observed important abnormalities in the sperm.
Are male partners routinely tested as a result of miscarriage?
Dr. Dimakopoulou: In the context of recurrent miscarriage, male partners are probably not tested at all. And in the cases of couples that are trying to conceive and are not successful, men are only tested as per local services available or personal preference.
So, this paper brings up a novelty on this issue suggesting that men and women should equally be investigated with standard specialized tests—and in the cases of idiopathic [meaning unexplained] pregnancy loss, this is even more relevant.
What other research are you working on?
Dr. Dimakopoulou: Since we now know that that reactive oxygen levels are elevated in men whose partners experience recurrent miscarriage, we will be looking into targeted therapies. Right now, there is no specific drug or treatment strategy addressing high reactive oxygen species other than lifestyle changes. So we will be leading new studies in the field of male fertility and we will hopefully be able to develop new therapies for couples with difficulty to conceive.
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