Why is male infertility a growing problem?

And why does no one seem to care?

Professor Shanna Swan, professor of environmental medicine and public health at Mount Sinai school of medicine in New York City (studying fertility trends) highlights a serious problem. She says that,

“If you follow the curve from the 2017 sperm-decline meta-analysis, it predicts that by 2045 we will have a median sperm count of zero.”

The cause(s) of such a decline in male reproductive health is unknown, despite it being a global health issue and little to no research is being translated into meaningful clinical interventions. But why is this? Some interesting academic papers, referenced below, illustrate the medical community’s view of broader ‘*andrological ignorance’ with male infertility being part of a dynamic and rapidly growing health industry. ART (assisted reproductive therapy, such as IVF) is a worldwide, highly innovative, billion dollar enterprise. Combined with the fact that reproductive medicine is newsworthy and rapidly captures the attention of the general public, the perception from the outside is that all is well in the world of male reproduction. This is an illusion. Numerous basic clinical and scientific questions in andrology remain unanswered—some for over 50 years.

(*andrology = medical specialty which deals with the male reproductive system and urological problems found only in men)

The first birth of an ICSI-conceived child happened in 1992. It is increasingly used even when no male problem exists. However, ICSI is not a treatment, as the man’s fertility is not improved; it is a treatment of the female partner (encompassing ovarian stimulation, egg recovery and embryo transfer). Thus, the woman carries the treatment burden for male infertility, a fairly unique scenario in medical practice. Ironically, ICSI’s success has effectively diverted attention from identifying what causes male infertility and focussed research onto the female, to optimize the provision of eggs and a receptive endometrium, on which ICSI’s success depends.

So, why is male fertility in decline?

Here are the universally understood top 3 reasons for the continuing decline in male fertility:

1. Older parents - it’s not just the woman who suffers from a “body clock”. See blog about male menopause

2. Environmental - factors such as men using laptops, overheating and other factors including plastics, but these are harder to quantify and more research is needed to fully understand their impact

3. Lifestyle - increased access and standard of living leading to smoking, drinking, obesity. All take a heavy toll on a man’s fertility

Got any ideas about how to improve things? Write them down in the comments below for others to see.

References

• The forgotten men: rising rates of male infertility urgently require new approaches for its prevention, diagnosis and treatment

• ‘Man Up’: the importance and strategy for placing male reproductive health centre stage in the political and research agenda

• The top 3 reasons infertility is on the rise

• Interview with Professor Shanna Swan: 'Most couples may have to use assisted reproduction by 2045'