Male infertility crisis

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

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

This decline in male fertility is the subject of research and debate. Proposed explanations include lifestyle factors (such as diet) and environmental endocrine disruptors, such as those found in plastics.[4][6] Some scientists[7] have questioned the extent of the crisis, saying that sperm-count studies are geographically sparse, often fail to account for a subject's age, and use the single metric of sperm count as an indicator of male fertility.[8] The scientific community, however, generally acknowledges increasing male infertility as a men's-health issue.[9]

Media coverage and terminology[edit]

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 male infertility crisis, 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 said that the wide-ranging consequences of male infertility necessitate the use of crisis,[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 was a recognizable discourse about a male fertility crisis.[11] Media coverage increased during the 2010s, often coinciding with (or in response to) releases of studies and using words like "crisis", "apocalypse", "time bomb", and "threat to the human race". The mass-media coverage is controversial, since the use of such terms has led to concern that it has fostered clickbait or hysterical coverage playing on community fears.[10][14] Media coverage often uses vivid comparisons, such as sperm counts in other animals.[11] The long-term effects of male infertility have been explored in dystopian fiction such as Children of Men and The Handmaid's Tale.[1][15]

Development and history[edit]

1970s–1980s[edit]

During the 1970s and 1980s, the first studies were published which observed declines in human semen quality and, later, sperm quantity. One of the earliest studies, published in 1974, noted a reduction in sperm quality (lower sperm concentration and semen volume) and a higher percentage of abnormal sperm.[16] These early studies' methodology has been criticized for sampling bias and the inclusion of men with testicular and fertility issues.[10] Other reports published during the two decades had not found similar declines; a 1982 research paper by Niecheslag et al. concluded that there were no changes in semen quality.[17] The decline in sperm quality reflected a shift in societal patterns of sexual behaviour, widespread recreational drug use, and preferences for marriage and fatherhood later in life.[18]

The World Health Organization published its first laboratory manual for semen analysis in 1980, which sets global standard parameters for the measurement of sperm quality and normality.[19] Limited research in the 1980s found the first indications behind the decline, with links to environmental-toxin exposure and excessive heat in the genital area.[18]

1990s–2000s[edit]

The 1990s saw significant development in research on male infertility, with reliable results indicating a decline. A 1992 Danish meta-analysis, commonly known as the Carlsen study after its principal author, showed that between 1938 and 1990 a population described as healthy had experienced a significant decrease in sperm count and semen volume.[20][21] Following this study, other studies supported this thesis. During the late 1990s, the first studies of the social and psychological impact of male infertility were published.[22] Near the end of the decade, the conception technique of intracytoplasmic sperm injection (ICSI, similar to in vitro fertilisation) was introduced.[23]

2010s–present[edit]

By the 2010s, it was clear that there had been a significant, steady decline in sperm count and semen volume. In a 2017 Hebrew University meta-analysis, decreases in sperm concentration of up to 52.4 percent and 59.3 percent in sperm count were noted from 1973 to 2011.[24] Two other studies presented at the 2018 American Society for Reproductive Medicine (ASRM) scientific congress had similar findings: reduced sperm counts and motility during the 2000s.[10] A 2012 paper published by French researchers and Yeshiva University's Institute for Public Health Sciences in the Journal of Human Reproduction studied French males from 1989 to 2005 and concluded that sperm counts and the proportion of normal, motile sperm fell by 32.2 and 8.1 percent, respectively.[25][26]

Further research supported the role of lifestyle factors and the impact of socioeconomic status. A study published in the February 2020 JAMA Network Open investigated four diets with a sample of 2,935 young Danish men, concluding that men who consumed a "Western diet" (composed predominantly of red meat, fried food, and soft drinks) had worse sperm quality than the other three popular diets. The men eating a "Western" diet had sperm counts of 109 million to 138 million, and those eating a "generally healthy" diet had sperm counts of 146 to 183 million per sample. The "generally healthy" diet consisted of fish, chicken, fruit and vegetables. A co-author of the study noted the importance of a healthy diet, calling it "necessary for the production of healthy functioning sperm with high fertility potential".[27][28] Mt. Sinai Medical School epidemiologist Shanna Swan wrote in her 2021 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, "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[edit]

Male fertility issues have been overlooked in the past,[30][31] and fertility research has focused on women.[22] Sociologists studying male infertility have found that awareness has shifted societal attitudes on fertility and gender more toward men.[30]

Believers that male infertility has reached crisis proportions say that more must be done to remediate potential causes of male infertility, such as lifestyle factors and exposure to toxic environmental chemicals.[32][9] They advocate modernizing health care with improved practices and increased funding.[33]

Social programs to alleviate the impact of the crisis have been implemented as part of men's reproductive health. Events such as International Men's Health Week and Movember advocate reforms to address the crisis.[34][35]

The Australian federal government funded the Healthy Male, a program to support male reproductive health and fertility, and issued a A$3 million research grant to Andrology Australia.[36] Other national-government responses include recommendations by the UK's National Health Service for a healthy lifestyle and loose-fitting underwear to improve fertility.[37]

Criticism[edit]

Critics of labeling male infertility a crisis have cited research which has partially stigmatized men, and say that male infertility has inadvertently been conflated with mental health and social vulnerability. However, no direct evidence supports such stigmatization.[38] Gannon et al. wrote in 2004 that media coverage of the crisis has posed it as a threat to hegemonic masculinity.[11]

Scientists disagree on the impact of observed fertility declines to date, and sperm counts remain above the 15 million considered to be below normal by the World Health Organization. The issue of most concern is reducing average abnormal-sperm counts.[39] Health practitioners and fertility doctors who work in the field are skeptical about a crisis in male fertility, since they had not observed a dramatic decline first-hand; a disconnect exists between what has been observed in published research and what is seen in clinical practice.[40]

Andrologists have said that not enough research has been conducted on male fertility to address the crisis effectively.[41] Existing treatments, such as assisted reproductive technology, are difficult to access and may have severe complications.[42]

See also[edit]

References[edit]

  1. ^ a b McKie, Robin (2017-07-29). "The infertility crisis is beyond doubt. Now scientists must find the cause". The Guardian. Retrieved 2018-10-10.
  2. ^ Levine, Hagai; Jørgensen, Niels; Martino-Andrade, Anderson; Mendiola, Jaime; Weksler-Derri, Dan; Mindlis, Irina; Pinotti, Rachel; Swan, Shanna H (2017-07-25). "Temporal trends in sperm count: a systematic review and meta-regression analysis". Human Reproduction Update. 23 (6): 646–659. doi:10.1093/humupd/dmx022. ISSN 1355-4786. PMC 6455044. PMID 28981654.
  3. ^ Davis, Nicola (2017-07-25). "Sperm counts among western men have halved in last 40 years – study". The Guardian. Retrieved 2018-10-10.
  4. ^ a b Johnston, Ian (25 July 2017). "Western men's sperm counts plunge 60% in 40 years due to 'modern life'". The Independent. Retrieved 2018-10-10.
  5. ^ Chen, Zi-Jiang; Wang, Li; Zhang, Lin; Song, Xiao-Hui; Zhang, Hao-Bo; Xu, Cheng-Yan (2017). "Decline of semen quality among Chinese sperm bank donors within 7 years (2008-2014)". Asian Journal of Andrology. 19 (5): 521–525. doi:10.4103/1008-682x.179533. PMC 5566843. PMID 27345004.
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  10. ^ a b c d e Fetters, Ashley (2018-10-12). "Sperm Counts Continue to Fall". The Atlantic. Retrieved 2020-05-28.
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  15. ^ "Why the male infertility crisis could be good news for women". New Scientist. Retrieved 2018-10-10.
  16. ^ Nelson, C.M. Kinloch; Bunge, Raymond G. (1974). "Semen Analysis: Evidence for Changing Parameters of Male Fertility Potential". Fertility and Sterility. 25 (6): 503–507. doi:10.1016/S0015-0282(16)40454-1. PMID 4835605.
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  18. ^ a b Bouton, Katherine (1982-06-13). "Fighting Male Infertility". The New York Times. ISSN 0362-4331. Retrieved 2020-05-28.
  19. ^ "Aktuelles". Praxis. 92 (20): 978. 2003. doi:10.1024/0369-8394.92.20.978. ISSN 0369-8394.
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  21. ^ Carlsen, E.; Giwercman, A.; Keiding, N.; Skakkebaek, N. E. (1992-09-12). "Evidence for decreasing quality of semen during past 50 years". BMJ (Clinical Research Ed.). 305 (6854): 609–613. doi:10.1136/bmj.305.6854.609. ISSN 0959-8138. PMC 1883354. PMID 1393072.
  22. ^ a b Webb, Russell E.; Daniluk, Judith C. (1999). "The End of the Line: Infertile Men's Experiences of Being Unable to Produce a Child". Men and Masculinities. 2 (1): 6–25. doi:10.1177/1097184X99002001002. ISSN 1097-184X. S2CID 73326269.
  23. ^ Endocrine disruptors : effects on male and female reproductive systems. Naz, Rajesh K. (2nd ed.). Boca Raton: CRC Press. 2005. ISBN 0-8493-2281-2. OCLC 55634444.{{cite book}}: CS1 maint: others (link)
  24. ^ Levine, Hagai; Jørgensen, Niels; Martino-Andrade, Anderson; Mendiola, Jaime; Weksler-Derri, Dan; Mindlis, Irina; Pinotti, Rachel; Swan, Shanna H. (1 November 2017). "Temporal trends in sperm count: a systematic review and meta-regression analysis". Human Reproduction Update. 23 (6): 646–659. doi:10.1093/humupd/dmx022. ISSN 1460-2369. PMC 6455044. PMID 28981654.
  25. ^ "Countdown". The Economist. ISSN 0013-0613. Retrieved 2020-05-28.
  26. ^ Rolland, M.; Le Moal, J.; Wagner, V.; Royère, D.; De Mouzon, J. (2013). "Decline in semen concentration and morphology in a sample of 26 609 men close to general population between 1989 and 2005 in France". Human Reproduction. 28 (2): 462–470. doi:10.1093/humrep/des415. ISSN 1460-2350. PMC 4042534. PMID 23213178.
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  28. ^ Nassan, Feiby L.; Jensen, Tina K.; Priskorn, Lærke; Halldorsson, Thorhallur I.; Chavarro, Jorge E.; Jørgensen, Niels (2020-02-21). "Association of Dietary Patterns With Testicular Function in Young Danish Men". JAMA Network Open. 3 (2): e1921610. doi:10.1001/jamanetworkopen.2019.21610. ISSN 2574-3805. PMC 7043196. PMID 32083688.
  29. ^ Walsh, Bryan (2021-02-24). "A new book blames chemicals for growing problems in human reproduction". Axios. Retrieved 2021-06-21.{{cite web}}: CS1 maint: url-status (link)
  30. ^ a b Petok, William D. (2015). "Infertility counseling (or the lack thereof) of the forgotten male partner". Fertility and Sterility. 104 (2): 260–266. doi:10.1016/j.fertnstert.2015.04.040. PMID 26048155.
  31. ^ Ravitsky, Vardit; Kimmins, Sarah (2019-11-21). "The forgotten men: rising rates of male infertility urgently require new approaches for its prevention, diagnosis and treatment". Biology of Reproduction. 101 (5): 872–874. doi:10.1093/biolre/ioz161. ISSN 0006-3363. PMC 6877781. PMID 31553040.
  32. ^ Berry, Sarah (2017-07-26). "'We are not in crisis yet': 60 per cent drop in sperm count can be reversed". The Sydney Morning Herald. Retrieved 2020-05-28.
  33. ^ "Opinion: Impending fertility crisis requires urgent action". Montreal Gazette. Retrieved 2020-05-28.
  34. ^ "Home". Men's Health Week. Retrieved 2020-05-28.
  35. ^ "Movember". Movember. Retrieved 2020-05-28.
  36. ^ "$19.7 million National Men's Health Strategy". Greg Hunt MP. Retrieved 2020-05-28.
  37. ^ "Why tomato puree might improve male fertility". BBC News. 2019-10-09. Retrieved 2020-05-28.
  38. ^ Hanna, Esmée; Gough, Brendan (2015-12-23). "Experiencing Male Infertility: A Review of the Qualitative Research Literature". SAGE Open. 5 (4): 215824401561031. doi:10.1177/2158244015610319. ISSN 2158-2440.
  39. ^ "expert reaction to meta-analysis of sperm count among men in Western countries | Science Media Centre". Retrieved 2020-05-28.
  40. ^ Belluz, Julia (2018-09-17). "Sperm counts are falling. This isn't the reproductive apocalypse — yet". Vox. Retrieved 2020-05-28.
  41. ^ "Tackling the stigma around male infertility". Raconteur. 2018-04-23. Retrieved 2020-05-28.
  42. ^ Ravitsky, Vardit; Kimmins, Sarah (2019-11-21). "The forgotten men: rising rates of male infertility urgently require new approaches for its prevention, diagnosis and treatment". Biology of Reproduction. 101 (5): 872–874. doi:10.1093/biolre/ioz161. ISSN 0006-3363. PMC 6877781. PMID 31553040.