James and Davina D’Souza fell in love and tied the knot in their 20s. 3 years later they bought a home on a quiet street in London and decided to start a family. Davina was 29 and James was 33.
After trying for a year without success, Davina underwent invasive tests including a transvaginal scan of her uterus to rule out fibroids, and an HSG test, which involves dyeing the reproductive system and then using an X-ray to visualise its internal structure. All of Davina’s tests came back normal and it was only then that anyone thought to test James. He, however, wasn’t so lucky; 99% of his sperm were formed abnormally and this number would rise to 100% over the next two years.
James felt helpless and isolated. In his own words, “No one was talking about this stuff. You’d go online and there was no male conversation. I’d Google ‘problems having a baby’ or ‘fertility issues’, and the websites that came up were all pink. I’d post in a forum and women would respond on behalf of their husbands. There was nothing for men.”
Men across the Western world are grappling with infertility. In a seminal 2017 study, professor Hagai Levine, of the Hebrew University of Jerusalem, showed that between 1973 and 2011, sperm counts plummeted by nearly 60% among men from Europe, North America, and Australia. More specifically, sperm concentration declined by 52.4%, while total sperm count declined by 59.3% in men with and without known fertility issues.
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A follow-up to this study yielded similar results and found that in fact, sperm counts were declining even faster than was previously thought, throughout all parts of the world. While it’s been a few years since these studies were published, a recent report by the World Health Organisation (WHO), that found one in six people around the world experience infertility, has restarted the conversation.
The decline in fertility, however, seems to have occurred only for men; female infertility has remained relatively constant at about 7% for the last 2 decades. Overall, infertility affects approximately 8-12% of couples worldwide and around half of all cases are due to “male factor” infertility. The CDC estimates that 9.4% of all American men are infertile and plummeting sperm counts have led some commentators to suggest that humanity could soon become extinct.
But why are sperm counts falling so fast, and what – on a personal level – can men do about it?
What is causing fertility issues in men?
A complete understanding of the underlying causes of declining sperm counts remains a mystery. Many theories, however, have been proposed to try and explain what’s happening. These include exposure to endocrine-disrupting chemicals (EDCs), rising rates of obesity, and delayed parenthood. They also include other fixtures of modern life including cell phones, drugs – including nicotine and cannabis, and alcohol, all of which are known to negatively affect sperm production.
Exposure to environmental toxins and EDCs like pesticides, phthalates, bisphenol A (BPA), and heavy metals has surged in recent decades, affecting hormonal balance and sperm function. A 2014 study by Buck Louis et al. found that couples with higher urinary concentrations of EDCs took longer to conceive.
The study monitored 501 couples trying for a baby between 2005 and 2009 and tested urine samples of both partners to measure BPA and 14 phthalate metabolites. Despite accounting for factors like age, BMI, and research site, the study concluded that higher levels of specific phthalates in men’s urine led to a longer time to achieve pregnancy and some male phthalate exposures were associated with a 20% decrease in fertility.
Obesity, modern life and infertility
Obesity has risen just as sperm counts have fallen and the condition now affects over a third of the global population. The connection between obesity to heart disease, diabetes, and cancer, is well known. But less well-known is that it also causes accelerated ageing, erectile dysfunction, reduced semen quality, and prostate inflammation in men.
Obesity-related factors including high insulin and leptin levels, chronic inflammation, and oxidative stress harm male fertility by disrupting hormonal balance, testicular function, and metabolism, while epigenetic changes brought on by obesity have the potential to impact any children that are conceived.
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Other hallmarks of modern life don’t bode well for spermatogenesis either. Inactivity, increased screen time, poor diet, and processed food consumption, also contribute to suboptimal sperm production and function, while high-stress levels lead to mental health issues that can also impair male fertility.
As with women, male fertility also declines with age, even if the decline isn’t as pronounced. This means that the modern trend of delayed parenthood is also a potential contributing factor to the rising tide of male infertility.
Other infertility factors
Polluted air is already known to increase the risk of low birth weight and premature birth. A study of over 10,000 couples in China found that air pollution also increases the risk of infertility. Exposure to small-particle pollution, which can cause inflammation in the body, raises the risk of not becoming pregnant within a year of trying by 20%.
And according to a separate study of over 1300 women, air pollution also reduces the ovarian reserve, or the number of viable eggs in a woman’s ovaries, by as much as 50%.
Other factors are also thought to contribute to male infertility. While trends in their use can’t necessarily be mapped exactly to reflect the trend in declining fertility, their effects are nevertheless well known, which makes them worth mentioning.
They include smoking, alcohol and drug use. They also include unsuspecting lifestyle habits like placing laptops in your lap while using them, wearing tight clothing, and sitting for long periods of time, the last of which can raise the scrotal temperature, impairing sperm production and function.
Some even believe that climate change may also play a role given how sensitive the production of sperm is to even minor changes in temperature, but little to no evidence currently exists to back this up.
What can we do about it?
Tackling male infertility begins with identifying the underlying cause. Provided that the man in question isn’t completely sterile, potential treatments for tackling infertility range from hormone therapy, medications like estrogen receptor blockers, and surgical interventions, to assisted reproductive technologies like intrauterine insemination (IUI) and in-vitro fertilisation (IVF).
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Better lifestyle choices, including regular exercise, stress reduction, a nutrient-rich diet, avoidance of environmental toxins and endocrine disruptors, and quitting smoking, drug use and alcohol, can also help enhance fertility. For men looking to have children, managing heat exposure to the testicles, seeking timely medical advice, and addressing underlying health conditions is also essential to further optimise fertility outcomes.
The story of James and Davina highlights the growing issue of male infertility, a problem that demands attention and action. By understanding the contributing factors and implementing positive lifestyle changes, future fathers can (hopefully) take charge of their reproductive health and break the cycle of declining fertility.