Opinion | Friday, 1st November 2019
Focus on fertility: male infertility and the need for further awareness
As part of Fertility Week, Dr Michael Carroll discusses the decline in male fertility and why there isn’t more funding available
One in six couples face infertility in the UK and about 15% of the population globally – yet fertility is not often put at the forefront of our minds, unless it is something we are directly experiencing ourselves.
People need to be aware that infertility is a real condition. After pregnancy, it is the most common reason women in their 20s, 30s and 40s see their GP. Infertility can affect mental health, it is something which can either bring people together or tear them apart, and in parts of the world, women in particular can even be ostracised for their reproductive difficulties.
With that in mind, it is surprising that so many people are not fully aware of the factors that actually cause and impact upon fertility, which is why I believe fertility awareness is such an important issue.
Focus on male fertility
Male fertility is not the first thing that comes to mind when we think of fertility, as it is often something we associate with the female.
Yet male fertility has declined at a rapid rate in recent years. In 2017, a paper into human reproduction was published which highlighted the decline, an almost 60% decline, in the sperm count of the average male. Specifically men within Western societies.
It is believed lifestyle and environmental factors could be behind this deterioration, but nothing has been identified as a specific cause.
If environmental exposure is the cause, then these problems might even occur in the early stages of male development.
Just as a females ovaries are developed when they are a foetus, a male’s endocrine system is also set up whilst they are still in the womb. So whatever the mother is exposed to, such as chemicals like plastics and pesticides, and even smoking and alcohol exposure, this can impact upon a male’s developing reproductive system.
Studies have already shown exposure to certain things can increase the risk of problems like testicular cancer – which can directly affect fertility – including research into the chemicals found in breast milk, which were linked to the disease.
A connection between the use of protein shakes and anabolic steroids have also been linked to infertility. Here we have a paradox, men may be going to the gym trying to look more attractive for their potential mate, and yet they end up increasing their risk of becoming infertile as a result.
Likewise, the growing number of sexually transmitted infections is affecting reproductive health in both men and women. Infections like gonorrhoea and chlamydia are on the rise, especially in young people, and these diseases can cause permanent damage if not treated.
Another thing to consider when we talk about male fertility is the deterioration of sperm quality.
Men and women alike are now having children at older ages, and for some time it has been a dominant belief that men can have children at any age, with the ‘biological clock’ only ticking for women.
To an extent, this is true. However, what many people are not aware of is that older men have a higher prevalence of transferring mutations onto their offspring, which can result in lifelong health issues. So for instance, there is an increased prevalence of schizophrenia and autism in children of older men.
Stress can also have an impact. Often when two people are seriously trying to have children, a woman might be checking her ovulatory cycle and structuring their intimate moments around this. That might take away a lot of the passion, and that can affect the sperm quality. So essentially, the efforts of trying can actually end up having a negative effect.
This can be backed up by studies, which have shown that a percentage of those on the waiting list for IVF have ended up getting pregnant naturally, when the pressures of conceiving have been taken away.
Funding and infertility
Funding is an issue, fertility is not massively funded and in particular, male fertility is not hugely funded. Why? I think because fertility is not necessarily at the forefront of people’s minds.
When we have a population growth which is exponential, it is hard to consider fertility as an issue. We have seven billion people on the planet, there are the problems with resources that come with this, and some people may end up looking at infertility as a way of controlling these ever-growing populations.
However, if you think about the bigger picture, over the last 40 years there have only been eight million babies born by IVF, which is not a lot when you think how many babies will be born by even the end of today alone.
Population growth however, is not primarily a result of a birth rate increase; it is a result of an ageing population. For example, the average birth rate, globally, across all the different countries, cultures and economic backgrounds, is 2.5 children per family.
We are no longer in a time where people are having very large families and four or five children. We are becoming more educated, even in developing countries. The more educated a society, statistically, the fewer children they tend to have. Women increasingly become part of the workforce and their priorities may change.
So, the problem of infertility is not considered a major issue. Why put an emphasis on infertility when there are already lots of people?
But the truth is, for those people experiencing it, infertility is a major issue, and when you look at couples from around the globe, in certain societies, not being able to have a child can be such a severe problem, women can be ostracised for not being able to bear a child and even killed.
To say infertility does not have a massive impact is wrong. It does on those experiencing it, and there needs to be more awareness of that.
Fertility Week runs from October 28 to November 3.