Male infertility crisis

The male infertility crisis is an observed increase in male infertility since the mid-1970s.[1] The issue attracted media attention following an influential 2017 meta-analysis that found that sperm counts had declined by 52.4% between 1973 and 2011.[2][3] The crisis is particularly prevalent in Western countries such as New Zealand, Australia, Europe and North America.[4] It has also been observed in non-western countries such as China.[5]

Male infertility crisis
Scatter plot of the declining trend in male sperm quality and quantity in Western countries between the years 1950 and 2000
RelatedMale Infertility, sub-replacement fertility, sperm quality, female infertility, testicular infertility factors

The decline in male fertility is an actively researched and debated topic. Proposed explanations for the decline in sperm counts include lifestyle factors, such as diet, and environmental endocrine disruptors, such as plastic.[4][6] Some scientists[7] have called into question the extent of the crisis, pointing out that sperm-count studies are geographically sparse, often fail to account for the subject's age, and use the single metric of sperm count as a predictor of male fertility.[8] However, the scientific community generally accepts that it is a key issue of male health.[9]

Media coverage and terminology

The term male fertility crisis dates to the 1970s.[10] Increased awareness during the 1990s expanded the scope of research to address social and biological factors.[11] Academia and the scientific community have reached consensus in favor of the use of the term, citing it as necessary to prompt preventative action to remedy the issue in the present time before it affects future generations on a greater scale.[10] Social commentators have argued that the wide-ranging consequences that follow the male infertility crisis necessitate the use of crisis terminology,[12] since widespread involuntary childlessness can be viewed as a crisis.[13]

Research analysis has found that amongst a sample of British newspapers in the 1990s, there had been a recognizable discourse in the tone of a male fertility crisis.[11] In the 2010s, there was substantial growth in the frequency of media coverage often coinciding with and in response to releases of studies, often using such words as "crisis", "apocalypse", "timebomb", and "threat to human race". Mass media coverage is subject to significant controversy, as the use of such terms has led to arguments that it has given rise to clickbait or hysterical coverage elevating fears within the community.[10][14] Media coverage often entails vivid comparison, such as with sperm counts in other animals.[11] Some have compared the long term effects with the fertility collapse in dystopian fiction works such as Children of Men and The Handmaid’s Tale.[1][15]

Development and history

1970s–1980s

Beginning in the 1970s and 1980s, the first studies were published that observed declines in the semen quality, and later sperm quantities, of men. One of the earliest studies, published in 1974, observed a reduction in sperm quality characterized by lower sperm concentration and lower semen volume, as well as increased percentage of sperm with abnormalities.[16] Often these earlier studies' methods have been criticized, having been cited for sampling selection bias and the inclusion of men with testicular and fertility issues.[10] There were various reports published in the 1970s and 1980s that had not found similar declines. An example is a research paper by Niecheslag et al. in 1982 which concluded that there were no changes in semen quality.[17] However, the decline in sperm quality did reflect a shift in societal patterns in sexual behaviour, the prevalence of recreational drugs, and preferences for marriages and fatherhood later in life.[18]

In 1980, the World Health Organization published its first publication, a laboratory manual for semen analysis. This sets the standard parameters for the worldwide measurement of sperm quality and normality.[19] Limited research in the 1980s found the first signs behind the decline with links to exposure to environmental toxins and excessive heat in the genital area.[18]

1990s–2000s

The 1990s saw significant development in the research on male infertility where reliable results proved a decline. A 1992 Danish meta-analysis, commonly referred to as the Carlsen study after the principal author, showed that between 1938 and 1990 a population described as healthy men had experienced a significant decrease in sperm count and seminal fluid volume and thus sperm quality.[20][21] Following this study, substantial funding was given to further studies which were conducted to support this thesis to attempt to determine the causes of such a decline.

In the late 1990s, the first studies on the social and psychological impact of the crisis were published.[22]

Towards the end of the 1990s, the earliest breakthrough in the development of remedies for the male infertility crisis were found with the use of the technique known as intracytoplasmic sperm injection (ICSI).[23]

2010s–present

By the 2010s it had become clear that there had been a significant and steady decline in sperm count and seminal fluid volume. In a meta-analysis study published in 2017 by Hebrew University, decreases in sperm concentrations of up to 52.4% and a decrease of 59.3% in sperm count from 1973 to 2011 was noted.[24] A further two studies in the year 2018 presented at the Scientific Congress of the American Society for Reproductive Medicine (ASRM) had observed similar findings that sperm counts had reduced and mobility of sperm declined during the 2000s.[10]

A 2012 paper published by French researchers and the Institute for Public Health in the Journal of Human Reproduction studied French males between the periods 1989–2005. They concluded that sperm counts and the proportion of normal motile sperm fell by 32.2% and 8.1%, respectively.[25][26]

Further research had supported evidence in the role of lifestyle factors and the impact of socioeconomic status. One of the latest studies published in February 2020 in JAMA Network Open had investigated four varying diets using a sample of 2,935 young Danish men. It concluded that men who consumed a "Western diet" composed predominantly of red meat, fried food, and soft drinks had the worst sperm quality compared to the other three popular diets. The "Western" diet had a sperm count ranging between 109 million to 138 million, whereas the "generally healthy" had a count ranging between 146 and 183 million per sample. The "generally healthy" diet was composed of fish, chicken, fruit and vegetables. The co-author of the study stated the importance of diet citing it as "necessary for the production of healthy functioning sperm with high fertility potential".[27][28]

In 2021, Mt. Sinai Medical School epidemiologist Shanna Swan claimed in her book Count Down: How Our Modern World Is Threatening Sperm Counts, Altering Male and Female Reproductive Development, and Imperiling the Future of the Human Race that "If you look at the curve on sperm count and project it forward — which is always risky — it reaches zero in 2045".[29]

Impacts and responses

There is a long-standing social stigma against male fertility issues.[30][31] Thus, fertility research has traditionally focused exclusively on women.[22] Sociologists studying the topic have found that awareness of the crisis has shifted societal attitudes on fertility and gender toward more attention on men.[30]

Proponents argue that more needs to be done to remediate potential causes of male infertility, such as lifestyle factors and exposure to environmental chemicals.[32][9] They argue for modernizing the health care system through improved practices and increased funding.[33]

Social programs to alleviate the impact of the crisis have been implemented as part of a framework of men's reproductive health to address the crisis. Various awareness groups, such as International Men's Health Week and Movember, have been established to advocate for reforms needed to address the crisis.[34][35]

In Australia, the federal government established funding for the Healthy Male, a program intended to support male reproductive health and fertility, and issued a A$3 million research grant to Andrology Australia.[36] Other national government responses include advice provided by the National Health Service in the United Kingdom recommending a healthy lifestyle and loose-fitting underwear to improve fertility.[37]

Criticism

Critics of the study of the male infertility crisis have cited research that has in part led to the stigmatization of men. They argue that the crisis has inadvertently been conflated with mental health and social vulnerability of men. However, there is no direct evidence that supports claims of such stigmatization.[38] Gannon et al. (2004) argued that media coverage of the crisis has often posed it as a threat to hegemonic masculinity.[11]

Scientists disagree on the magnitude of the impact of observed fertility declines to date. Sperm counts remain above the 15 million considered to be below normal by the World Health Organization. The issue of most concern is the reduction in averages of abnormal sperm counts.[39] Health practitioners and fertility doctors who work in the field are skeptical of the notion of crisis in male fertility as they had not observed a dramatic decline from the first-hand experience. There is a disconnect between what has been studied in the published research and what is observed in public.[40]

Various andrologists have argued that not enough research has been conducted on male fertility to address the crisis in a well-informed manner.[41] Existing treatments, such as assisted reproductive technology, are difficult to access and can have severe complications.[42]

References
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See also
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