Environmental factors such as air- borne pollutants and pesticides in our foods are leading to a decline in the quality and quantity of male sperm, says Lorraine Courtney
THE infertility crisis at the heart of the recently televised The Handmaid’s Tale is the reason why Gilead’s founders staged a coup, overthrowing democracy and reclaiming fertile women, like Elizabeth Moss’ character Offred, as state property.
Channel 4’s dramatisation of Margaret Attwood’s dystopian novel got rave reviews and drew large audiences. But new research suggests that by linking infertility to environmental issues, the near-futuristic series may too far-fetched after all.
Men’s sperm counts have fallen by almost 60% since the 1970s, according to major new research which cautions that our modern world may be prompting a male fertility crisis. Over the past few years, various studies have pointed to declining sperm quality and quantity. This latest research, and the first systematic review of trends, looked at 180 studies over four decades. It concluded that total sperm counts in Western countries have fallen by 59% since 1973, with a 52% fall in sperm concentration, or the concentration of sperm in a man’s ejaculate.
“Decreasing sperm count has been of great concern since it was first reported 25 years ago,” says Dr Shanna H Swan, a professor in the Department of Environmental Medicine and Public Health at the Icahn School of Medicine at Mount Sinai, New York and study leader.
“This definitive study shows, for the first time, that this decline is strong and continuing. The fact that the decline is seen in Western countries strongly suggests that chemicals in commerce are playing a causal role in this trend.”
The chemicals he refers to range from everyday air pollutants to pesticides or even soap. So should the average man panic?
A first glance at the statistics suggests that we are faring well. Ireland had the highest birth rate among EU countries last year. 2016 saw 63,900 live births recorded according to figures from Eurostat, the EU statistics agency. That’s a super healthy rate of 13.5 births for every 1,000 of the population. Italy was the lowest with just 7.8 births for 1,000 of the population.
However, male infertility is a factor for half of the couples who seek fertility treatment here in Ireland. Azoospermia (absence of spermatozoa in the ejaculate) is a condition present in approximately 1% of males in the general population. Between 10-15% of infertile men who attend assisted reproductive technology clinics here have had a diagnosis of azoospermia. However, approximately 30% of couples present where there is suboptimal sperm count or reduced motility, impacting on the couples’ ability to conceive a child.
Tom, 41, is currently undergoing fertility treatment. “There’s less pressure on men when it comes to fertility. We see the likes of Ronnie Wood, still having babies in his seventies. I’d assumed that everything would be grand,” he says.
“My wife and I wanted to start a family, but after trying for almost two years, we went for fertility testing. The results showed that I have a low sperm count as well as poor motility and morphology, meaning that the sperm doesn’t swim well and are not the ideal shape. We are very unlikely to be able to conceive naturally.”
“I was devastated when we first got the news. I felt like I was letting my wife down and couldn’t give her the baby she wanted. Now my wife has to have IVF treatment, even though she doesn’t have a fertility problem herself. Our first treatment failed unfortunately but we’re hopeful and about to try round two.”
Dr Bart Kuczera, a consultant with Beacon Care Fertility, thinks that while we need to adopt a commonsense approach to the study’s results, environmental pollution is of major concern to everyone’s individual health, not to mention the cost in terms of healthcare bills and its contribution to declining fertility.
There’s increasing evidence that even the more mundane types of pollution, like car exhaust fumes and household cleaning products, can impact on our fertility. A 2016 University of Barcelona study concluded that outdoor air pollution affects at least one of the four semen quality parameters included in the review.
“From the food we consume to the cosmetics we use and the air we breathe we are enveloped in endocrine disruptive chemicals (such as pesticides in our fruit and vegetables) and disturbing levels of ‘particulate matter air pollution’ [particularly that from traffic and industrial sites],” says Dr Kuczera. “That said, this study shines a spotlight on the issue of declining male fertility and provides men with the information they need to make the necessary changes in their lifestyle and environment.
“We can be mindful of air pollution and live in a clean environment where possible, consuming food free from pesticides and avoiding contact with any chemicals in the environment or in the products we use,” he says.
Dr Tim Dineen, head of laboratory services at Cork’s Waterstone Clinic, says the study draws attention to a trend that doctors and scientists working in reproductive medicine have been aware of for many years.
“The decline in sperm counts is very gradual and is unlikely to prevent any individual man fathering children naturally in the short term,” says Dr Dineen.
“It is also important to point out that if a man’s sperm count is so low that natural conception is impossible, intracytoplasmic sperm injection (ICSI) treatment is able to compensate for the problem very successfully.”
Treatments, in the form of ICSI, have been very successful in overcoming male subfertility and male infertility. In the Waterstone Clinic, for those couples where the female partner is younger with good ovarian reserve, a live birth rate of at least 50% (first fresh cycle) is expected.
ICSI costs €4,750 including blastocyst and embryoscope incubator culture at the clinic, which offers a range of treatments.
“It is reasonable to assume that environmental factors are to blame but no one knows exactly which factors are involved,” says Dr Dineen. “Research is urgently required to identify the environmental causes; only then can public health initiatives be undertaken in order to address the problem.”
ANXIETY and stress may contribute to male infertility due to hormonal imbalances. “This needs further research,” he adds. “Whatever a man can do to alleviate his stress can only be beneficial, not only when trying to conceive naturally, but also following a diagnosis of infertility and as he embarks on IVF treatment.”
There is a wide range of treatment options available to infertile men. “If the patient has a low sperm count this can be stimulated for two to three months, provided that the patient’s hormonal profile is adequate. However, more often than not assisted reproduction treatment is the most suitable option,” says Dr Kuczera.
“The first line of treatment is intrauterine inseminations, where sperm is washed and concentrated prior to being placed inside the female partner’s uterus to facilitate fertilisation. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilisation. At the same time, we stimulate ovulation and monitor the female partner’s cycle to maximise the chance of success.
“Alternatively, IVF with intracytoplasmatic sperm injection can be offered. This is the best approach for most men who suffer from fertility issues and who have with their partners tried unsuccessfully to conceive for more than two years.
“Some couples adopt a wait and see approach but this is a much riskier option given that fertility declines with age for both men and women. Finally, the last option might be sperm donation.”
Age is also a factor. A study earlier this year by Harvard University found that men do have a biological clock and their fertility declines with age. The study found that women under 30 with a male partner aged 40 to 42 saw their chance of live birth after IVF fall to 46% in comparison with 73% for men aged 30 to 35.
With an eye on the future, Dr Dineen maintains that if the exact cause of the drop in sperm counts is not discovered and corrected soon, the decline will continue and major problems will arise with regard to the ability of men to father children naturally.
“It is possible that other associated male health problems, such as testicular cancer, due to pollutants and poor lifestyle could become much more common too, so it is imperative that research is funded and commenced immediately in order to address this major public health issue.”
© Irish Examiner Ltd. All rights reserved