Urgent Action Needed On Rising Male Infertility Worldwide, Say Experts

Experts worldwide are calling on governments and health systems to acknowledge that male infertility may be increasing worldwide.

They have provided a first-time roadmap for urgent, global action to address the common yet serious medical condition in a consensus report that includes recommendations and is published in the journal Nature Reviews Urology.

The team of scientists compiling the report was led by the University of Melbourne, Australia.

The report highlights that patients have a right to meaningful diagnoses and targeted treatments, but owing to inadequate funding, research gaps, and non-standard clinical practices, they are currently unavailable in most cases.

The report's recommendations include a global "biobank" of tissues and clinical data from men, and their partners and children to help researchers understand genetic and environmental causes of infertility; genomic sequencing and better diagnostic tests routinely offered to men to help them understand why they are having difficulties fathering a child; rigorous tests of the impacts on men and boys of compounds such as endocrine-disrupting chemicals in everyday consumer products, the workplace, and the general environment.

Other recommendations include regulations and policies to protect men and boys from disruptive compounds, and development of safe alternatives and better training to help healthcare workers promote male reproductive health across the lifespan.

Evidence was mounting in Australia and worldwide that male reproductive health has declined over recent decades, but further research was needed, according to lead author Moira O'Bryan, Dean of Science at the university.

"Decreasing semen quality and increasing frequency of testicular cancer and congenital defects in the urogenital system indicate that, globally, male reproductive health has declined over recent decades. Research is needed to understand why, and how this trend can be reversed," said O'Bryan.

The Male Reproductive Health Initiative - a working group of the European Society for Human Reproduction and Embryology - commissioned 26 experts from Australia, Argentina, Canada, China, Denmark, Germany, Italy, Spain, the UK, and the US to produce the evidence-based roadmap that identifies key knowledge gaps, barriers, and opportunities for researchers, governments, healthcare systems, and public education.

O'Bryan said the report also highlighted that men and their partners deserve more support.

"By the time they seek medical advice, men experiencing infertility are often in emotional distress, which is made worse when their doctor can't determine the cause nor offer any treatment," she said.

Men are currently designated 'infertile' based on family history, physical examination, hormone profiles and semen analyses.

"For most infertile men, the cause of their infertility is unknown. When it is known, few targeted treatments exist. Globally, the huge economic and social burdens of male infertility are not well appreciated. The cost of treatments and the impacts of infertility on mental health, relationships, and productivity are enormous," said O'Bryan.

Medically assisted reproduction, often the default response to male infertility, fails to address the cause and pushes the burdensome and invasive procedures and associated risks onto women, according to study co-author Robert McLachlan.

"Compared to fertile men, infertile men appear to experience a higher rate of a range of chronic health disorders and even a shortened lifespan. We need more research into these issues and whether their offspring may inherit these characteristics," he said.

The World Health Organization estimates that infertility now affects one in six couples of reproductive age globally, according to a news release dated April 4, 2023.