Male infertility crisis

The first uses of the term being used stem as far back as the early 1970s with suggestions it may have emerged earlier in the 1960s.[7] However, significant traction for the issue as it becomes further highlighted by the 1990s when it became more commonly studied, thus subsequent attention is paid to the issue. The term has become a catch-all term as part of the discussion of the health issues of men. There is now ongoing media coverage on the issue often being used as a common headline driver.

Research analysis has found amongst a sample of British newspapers in the 1990s there had been a recognisable discourse in the tone of a crisis.[2] In recent years, there has been substantial growth in the frequency of media coverage often coinciding and in response with releases of studies. Mass media coverage is subject to significant controversy as the use of terms such as "crisis", "apocalypse"  "timebomb" and "threat to human race" have led to arguments that it has given rise to clickbait or hysterical coverage elevating fears within the community.[7][8]

Media headlines of the male infertility crisis.

Various tabloid media agencies have published various pieces with headlines that have supported the notion of crisis. Examples include from GQ labelling it “the truth behind the shocking drop in sperm counts,” followed by a Newsweek front page cover “Who’s Killing America’s Sperm?” and with the New York Times stating it as “male infertility crisis is coming” [9][10][11]

Discussions of the usage of the terminology of male infertility crisis by the media have been evident through various comparisons. For the emphasis of the crisis, one example drew a time-series comparisons between the present-day generations and past generations i.e. fathers and grandfathers or geographic comparisons within countries or to other regions. Further stark comparisons include drawing similarities to other species notably rats and hamsters. [2] Some have compared the long term effects with the fertility collapse in dystopian fictional works such as Children of Men and The Handmaid’s Tale.[1][12]

Academia and the scientific community have agreed in consensus in favour of the use of the term.[7] 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. While others such as social commentators have argued the wide-ranging consequences that follow the male infertility crisis necessitate the use of crisis terminology.[13] Consequences include the subsequent inability to conceive a child. Thus, the effect of involuntary childlessness can be viewed as a crisis.[14]

Beginning in the 1970s & 1980s, the first studies were published that observed declines in the sperm quality and later sperm quantities of men. One of the earliest studies in a paper published in 1974 by Nelson et al. had observed decreases in the sperm quality with lower concentrations and volumes in particular increase in the percentage of observations with abnormalities in sperm.[15] Often these earlier findings have been criticised in the conduct having been cited for various faults including issues of sampling selection and various other inaccuracies in the obtaining of data.[7] There were various reports published in the 1970s & 1980s that had not found similar declines. An example is a research paper by Niecheslag et al. in 1982 concluded no decline. Instead found no parameter changes in sperm.[16] However, the claims are not completely unfounded it reflected a general shift in societal patterns changes in sexual behaviour, the prevalence drugs, preferences for later marriages and fatherhood that brought the earliest signs to attention[17]

In 1980 the World Health Organisation published its first publication, a laboratory manual for semen analysis. This set the parameters for the worldwide measurement standards in sperm quality and normality.[18]

Male infertility changes in testicular biopsy.

Limited research in the 1980s found the first signs behind the decline with links to general environmental degradation.[17]

Recent developments

By the 2010s it had become very clear, there had been significant declines with a steady decrease in sperm quality and quantity. There had now been wide-ranging publications particularly in the beginnings of the causes for the decline. In one meta-analysis study published in 2017 by Hebrew University had concluded decreases in sperm concentrations up to 52.4% and similarly a decrease of  59.3% in total sperm numbers.[22] Two follow on studies in the year 2018 presented at the Scientific Congress of the American Society for Reproductive Medicine (ASRM) had observed similar findings to find sperm counts had reduced and lower mobility of sperm during the 2000s.[7]

A 2012 paper published by French researchers and the Institute for Public Health in the Journal of  Human Reproduction studied French males between the period of 1989–2005. They concluded the sperm counts and the proportion of normal sperm fell by 32.2% and 8.1% respectively.[23][24]

Male sperm swimming

Further research had supported evidence in the role of lifestyle factors and further impact of socioeconomic status. One of the latest studies published in February 2020 journal JAMA Network Open had investigated 4 varying diets using a sample of 2935 young Danish men. It came to the conclusion men who consumed a “western diet" composed of predominantly of red meat, fried food, and sugar-sweetened drinks and desserts had the worse outcome out of the 4 diets with a sperm count ranging from 109 million to 138 million. The study had found a prudent  "healthy diet" composed of fish, chicken, fruit and vegetables. This diet had the highest sperm count with an average of 146 million to 183 million sperm. 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” [25][26]

The effects of the crisis are still being understood apart from the well-known correlated issue of directly affecting fertility rates and child birthing rates. The debate remains within the andrology community on the conclusive nature of the evidence to support the claims of crisis. Consequential reasoning for the causes of the crisis is still subject to controversy. Perspectives range on the issue with some viewing it from a biological viewpoint with the focus on causes and medical effects. The research-based in a clinical quantitative lab-based setting has been the traditional biological viewpoint.

There has been much academic research now focusing on attempts to remedy the issue. Proponents argue more needs to be done on causes, in particular, the role of lifestyle factors and a reduction of exposure to environmental chemicals.[33][6] The thought within the medical community that calls for the breaking down of the stigma that surrounds male fertility requiring a cultural shift to emphasize the importance of the issue as part of the continued decline in health outcomes.[27][34]

Advocates and proponents of the topic of male infertility have argued for modernization and reform of the health care system through improved practices and increased levels of funding. They argue the role of private health insurance and government to be potential leaders in this area.[35]

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 in male reproductive health now exist examples include Men's Health Week  and international male health awareness program of Movember.[36][37]

Within Australia, the federal government established funding for the Healthy Male a program intended to support male reproductive health and fertility. Further efforts include an award of a grant in this area of approximately $3million to Andrology Australia.[38]

Other national government responses include advice provided by the UK National Health Service (NHS) recommending a healthy lifestyle and loose-fitting underwear to improve sperm thus fertility.[39]

Organisations in the medical field have been established to address the crisis. Most notably the Male Reproductive Health Initiative a group focused on male fertility in the attempts to foster and support reform and action to address the issue to enable improvements in outcomes.[6]

• Sub-replacement fertility