19 October 2023
Male infertility and reproductive health issues are a serious growing global problem. Declining male fertility and reproductive health matters not just to individuals but to societies as well. It is resulting in fewer natural conceptions and greater uptake and reliance on assisted reproductive technologies. It is leading to fewer births and birth rates falling below population replacement levels, causing wider societal pressures and challenges. It can also indicate other serious and chronic health problems and reduced lifespans.
How big a problem is male infertility?
Infertility affects one in every six couples. It is defined as an inability by a couple to conceive a child after one year of regular unprotected sexual intercourse. Male infertility factor is now understood to be a substantial contributory factor in half of all infertility cases; solely responsible in around 20 percent of cases and a contributing factor in 30 to 40 percent of cases where both male and female infertility co-exist.
It is also of concern that we are seeing continued declining trends in male sperm counts. It is reported that worldwide sperm counts declined by 51.6 percent between 1973 and 2018 among men from North America, Europe and Australia; with the rate of decline doubling after 2000 from 1.16 percent post-1972 to 2.64 percent annually post-2000 (1).
You can read more in our previous blog “Global Decline in Sperm Counts: Do I Need To Be Concerned?”.
What causes male infertility?
There are many different causes of male infertility, some treatable and some which are currently untreatable. Male infertility causes can include:
- Endocrine disorders – which can be caused by hormonal imbalances, genetic factors or tumours.
- Genetic disorders and diseases – such as cystic fibrosis, Klinefelter syndrome (where a male has an extra X chromosome),Young syndrome (characterised by damaged airways in the lungs and obstructive azoospermia), Kallmann syndrome (hormonal disorder that delays or prevents puberty).
- Congenital abnormalities – including undescended testes, ejaculation issues, defects in tubes that carry sperm.
- Acquired urogenital abnormalities – including varicocele (a swelling of veins that drains the testicle), blocked tubes transporting sperm.
- Infection – which can impact healthy sperm production or cause scarring that blocks sperm movement.
- Medications and drugs – whether prescribed in the treatment of diseases (e.g. chemotherapy) or taken for lifestyle reasons.
- Toxins in the environment – including smoking, excess alcohol, pesticides, microplastics.
What needs to change?
Current knowledge and research gaps remain a barrier to effectively addressing male infertility and reproductive health issues. This needs to change and more targeted research and studies are needed to increase understanding and develop new strategies and treatments. In turn, this will help alleviate:
- Emotional distress and poor mental health caused by infertility in both men and women.
- The additional medical burden for women in undergoing invasive fertility treatment (e.g. egg collection, IVF, ICSI).
- The financial costs associated with undergoing assisted reproductive technologies and fertility treatment.
- Declining male sperm counts.
- Serious health conditions by virtue of earlier diagnosis, predictive and preventative treatment of cancer and metabolic diseases.
- Rising ages at conception and birth and trends in later life parenthood.
- Falling birth rates.
- Declining workforces generating taxes to sustain societies and care for increasingly aging populations.
Increasing use and integration of genomic sequencing will also aid the diagnosis and treatment of male infertility and reproductive health issues. This will help identify and predict genetic disorders and diseases and deliver precision healthcare to promote and improve male health and where possible overcome infertility. To effectively achieve this will require continued advancements in genomic technology, increased training and more skilled geneticists, scientists and genomic medicine specialists, as well as integrated genomic law reform and approaches to reproductive health and (in)fertility.
Advisory, Consultancy and Specialist Fertility and Family Law
Fertility is precious and fragile. Given the increasing global challenges associated with male reproductive health and infertility, it has never been more important to preserve and maximise individual fertility and adopt proactive approaches to family formation, genomics and healthcare, assisted reproductive technologies and fertility treatment. Specialist advisory and consultancy or individually tailored fertility and family law strategies help inform approaches to (in)fertility and reproductive health, as well as plan and project manage family building journeys. They inform and proactively navigate a range of legal and practical issues and risks, place family building and life on a firm foundation to achieve the best outcomes. In doing so, they address:
- Complex personal and family situations.
- Legal and practical aspects of fertility preservation.
- Family building options and issues due to impaired fertility/infertility, cancer diagnosis or other illness, unsuccessful conception attempts, change in gender, change in personal circumstances, delayed parenthood.
- Posthumous conception with the eggs, sperm and embryos of a deceased loved one (e.g. due to illness or accident).
- Legal and practical aspects of assisted conception with a known donor, anonymous/identity-release donor or co-parent (e.g. legal parentage, parental rights, financial responsibility and dispute mitigation).
- Legal and wider aspects of international surrogacy or a UK surrogacy arrangement.
- Legal parentage issues and disputes (e.g. concerning DNA testing, direct-to-consumer genetic testing, rectification of birth certificate, declaration of parentage, step-parent adoption, recognition of overseas adoption, parental order).
- Care and upbringing of children following a dispute with an ex-partner, parent, donor or surrogate (e.g. contact, residence, financial arrangements, parental responsibility, specific issue or prohibited steps).
- Issues with importing frozen gametes and embryos into the UK for use in fertility treatment and surrogacy (e.g. due to anonymous and commercially obtained gametes and embryos which engage UK public policy restrictions).
- Issues exporting frozen gametes and embryos abroad for use in fertility treatment and surrogacy (e.g. consent and storage term difficulties).
- Expert witness fertility, surrogacy and donor conception law services.
Need Advisory or Consultancy? Alternatively, if you need to put in place effective legal and practical strategies to navigate pre-conception, assisted reproductive technologies, fertility treatment, global family building and inclusive parenting contact Louisa Ghevaert by email louisa@louisaghevaertassociates.co.uk or telephone +44 (0)20 7965 8399.
Footnote
- “Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries”, Levine H, Jørgensen N, Martino-Andrade A, Mendiola J, Weksler-Derri D, Jolles M, Pinotti R, Swan SH. Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries. Hum Reprod Update. 2023 Mar 1;29(2):157-176. doi: 10.1093/humupd/dmac035. PMID: 36377604.
