Average sperm count has more than halved among Western men in the past 40 years, according to a comprehensive study published by the Hebrew University of Jerusalem. Several other studies have reached similar conclusions – and what is clear is that men are facing a fertility crisis. Yet until recently, the focus of both fertility experts and research scientists has been overwhelmingly on women’s bodies.
“Infertility affects one in seven couples, and up to 50 per cent of it is due to a male factor,” according to Professor Suks Minhas, a consultant urologist at Imperial College London, and expert in male fertility. “If there is a fertility problem, women are referred for IVF treatments or assisted reproductive technologies, which isn’t wrong, but often the approach has been, ‘Look, let’s get the sperm and the egg together, we’ll see what happens’. There are some takeaways that are important to know as we better understand what is going on with male infertility.”
What causes it?
“We don’t fully understand about 25 to 30 per cent of male infertility,” Professor Minhas said. We do know, however, that 1 per cent of men don’t have any sperm; it doesn’t sound like a high number, but in terms of the male population, that is a lot of people.
“We also know that some male infertility is down to damaged DNA sperm, which is due to various environmental factors: diet, smoking, alcohol, recreational drug usage. More and more men are also using anabolic steroids or bodybuilding drugs, which could affect fertility.
“It can also be down to hormone problems, genetic issues, immune problems or infections. Then, of course, there are men who might have had chemotherapy or radiotherapy treatments, all of which can affect fertility.”
Male infertility as a marker of health
“It’s emerging that male fertility might be a barometer of general health. About a third of men with lower sperm counts have low testosterone,” Professor Minhas said.
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“Testosterone itself is linked long term to cardiovascular disease, so now when we see a man with low sperm count, we begin to realise that in the long-term these patients might be at increased risk of cardiovascular disease as well as various types of cancer and respiratory problems,” Professor Minhas said. “So it’s not only about fertility, but also about managing health in general.”
Evolving research
Professor Minhas said that there are more evolving treatments for male infertility. He added: “There is also more understanding about how damaged sperm DNA can be down to oxidative stress, which is related to an imbalance of chemicals in the bloodstream.
“Looking at this is important because previously tests might have shown up everything being normal and sent the woman for IVF, but we are beginning to realise that this damaged sperm DNA might be why a couple can’t conceive naturally. In many cases, this damage can be reduced by changes in lifestyle and antioxidant treatment.
“Another area to look at is the role of genetics, and inherited diseases and mutations that can account for fertility issues.”
Professor Minhas will be speaking at The Fertility Show on 7 May