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While much of the traffic and news surrounding infertility and IVF treatment focuses on female infertility, male infertility actually accounts for about 50 percent of infertility cases.

Male infertility has been on the rise for decades. Globally, we’ve seen a decline in sperm counts, semen quality, and other markers of male reproductive health since the 1970s.

According to a recent study by Oxford Academic, male sperm count declined by 62.3 percent between 1973 and 2018. As the first study to survey men from South America, Central America, Asia, and Africa, the data suggests that this worldwide decline in male fertility has been accelerating throughout the 21st century.

Geographic elements, changes in genetics, diets, environmental conditions– a lot of possible factors are thought to be contributing to this decline, with isolated studies showing the negative effects of air pollution on male fertility.

The rise in overall infertility rates has resulted in fertility rates in many countries sinking below the replacement level of 2.1. Male infertility plays a central role in this storm. So why, outside of academic circles, is nobody talking about it?

A Pervasive Lack of Awareness about Male Fertility

When couples seek fertility treatment and discover that male infertility is the reason they’re unable to conceive, the news often takes them completely by surprise.

The lack of awareness about male infertility is staggering. If asked to draw a graph depicting the change in male infertility as it relates to age, most medical students I’ve encountered– who in theory should know a lot about infertility– produce varying and inaccurate results.

Overwhelmingly, the general public focuses on women’s ability to conceive. A focus informed, at least in part, by the lack of media coverage on the male half of the equation.

Additionally, because male fertility doesn’t drop off a cliff with age, people don’t regard male fertility as a time-sensitive issue. Female fertility undergoes a significant drop when women enter their 30s and will ultimately reach zero. Existing evidence shows that while male fertility decreases with age, it doesn’t eventually reach zero which has led to the generally accepted idea that men can have children in their 70s whereas women can’t.

However, age actually does have a multifactorial effect on male fertility. It affects a libido, ejaculatory frequency, intercourse, spermatic genesis, number of sperm, and sperm mobility.

Aging also damages DNA– there’s increasing data about the health of the children fathered by a man of advanced paternal age, particularly regarding the prevalence of autism spectrum disorders.

The Limited Treatment Available for Male Infertility

When it comes to treating infertility, men don’t have many options. There’s no pill or remedy that can increase sperm counts or sperm mobility. Unlike women, who can take fertility drugs and hormone treatments before pursuing IVF, intracytoplasmic sperm injection (ICSI)– a specific type of IVF procedure– is the only available treatment for male infertility.

Because ICSI is also used to treat infertility cases with unknown causes, embryologists employ this technique frequently. However, ICSI hasn’t evolved much since its creation in the 1990s. It remains a highly technical and difficult procedure that requires a lot of training for embryologists to be able to perform it successfully.

Male Infertility and the Looming Fertility Crisis

While male infertility rates are rising, demand for IVF treatment is outstripping supply for a number of reasons.

The trend of women seeking IVF treatment at an older age puts pressure on the system as the older the women, the more time it takes to to get pregnant.

At the same time, countries, such as Scotland, Israel, and Denmark, now fund IVF treatment because declining population rates have incentivized governments to remove the cost barrier for people who need to attempt IVF to have children, resulting in more people seeking treatment.

For a variety of reasons, parts of Africa, South America, and India are experiencing growing demand for fertility treatment that can’t be met with the services currently available.

The combination of people not wanting children and those who want children being unable to access fertility services has resulted in a fertility crisis: people are not having enough children.

We can already see the problem unfolding. Researchers can map birth and death rates. In Glasgow, the birth rate is less than one when the needed birthrate for replacement is 2.1 In the near future in China, a generation of 800 million people will be trying to support a generation of 1 billion.

Academics and scientists have begun talking about the fertility crisis, but these conversations haven’t yet entered the mainstream. To address this crisis, we need more IVF clinics as well as a greater number of employees to staff them. We need governments to invest in the research and development of new fertility technologies as well as the training the staff required to implement these technologies and treat patients.

In tandem, we need to increase awareness about male infertility, a task that is not without its challenges. In general, men are not as proactive about treating health issues as women. Men resist going to the doctor for check-ups and instead only attend for urgent medical problems. A survey as part of the Cleveland Clinic’s ‘MENtion it’ campaign revealed that 72 percent of respondents would rather perform household chores, such as cleaning toilets, than go to the doctor. Sixty-five percent of respondents reported that they avoid going to the doctor as long as possible.

Moreover, in the minds of much of the general public, fertility remains wrongfully associated with virility. As a result, discussions about male infertility are sensitive and commonly avoided. Many men are reluctant to talk about infertility, and they view questions about fertility as an assault on their manhood. Changing this perception will take time, education, and effort.

Nonetheless, there are reasons to be hopeful. Male celebrities, athletes, and leaders are increasingly taking to social media to talk about their mental health and well-being, which helps to normalize the topic and break down society’s traditional ideas about masculinity.

We likewise need to talk about male infertility. Otherwise, we risk ignoring half of the problem.

Prof. Christopher Barratt

Head of the Reproductive Medical Group at University of Dundee