meFERTILITY AFFECTS one in six couples, and for half of these, the problem lies with the male partner. Sperm is in decline. Their concentration and count—the number of sperm per milliliter of semen and the total number of sperm in an ejaculate—has fallen by more than 50% on average in Western countries since the 1970s. No one knows why for sure, but rising obesity rates, lifestyle factors such as smoking and physical inactivity, and exposure to endocrine-disrupting chemicals such as BPA and phthalates, are the main theories. The “Spermpocalypse,” a scenario in which future men have little or no sperm, is unlikely. For now, spermatozoa meet the basic requirements for human reproduction. But poor quality sperm is not only linked to the deterioration of men’s overall health, it also negatively affects women and children.
Men’s health is a disaster. Their life expectancy is on average five years shorter than that of women and they are diagnosed with more chronic diseases. Sperm quality is a biomarker for a man’s overall health and, when abnormal, can indicate serious diseases such as tumors, cancer, diabetes and general morbidity. However, sperm is rarely talked about. Its first researcher, the Dutch scientist Antonie van Leeuwenhoek, was hesitant to share his discovery of the strange “animalcules” in his semen with the scientific world in 1677, worried that his “observations might displease or scandalize scholars.” Four centuries later, some still squirm over sperm.
I’ve interviewed fertility experts around the world and discovered how little most people know about this topic. Fertility industry marketing only targets women and reminds them of their biological clocks, in part because the word sperm is banned from many advertising platforms. But men also experience an age-related decline in fertility after age 35. Every year of a man’s life beyond 35, sperm motility (their movement) decreases, morphology (the percentage of sperm with normal size and shape) decreases, and DNA fragmentation increases, causing of recurrent miscarriages and birth defects. Increasing paternal age puts pregnant women at greater risk of gestational diabetes and preeclampsia. Women contribute only a quarter of the age-related genetic mutations to a future child. The risk of schizophrenia, Down syndrome, bipolar disorder, autism, childhood leukemia and other cancers in future children increases with paternal age. So does the risk of premature birth, seizures and disabilities such as congenital heart disease and cleft palate.
Women’s lifestyle choices—what we eat, drink, do, and use in our bodies—are examined from conception through pregnancy. The same factors influence sperm. Unlike eggs that, once chromosomally abnormal, remain that way, sperm can be improved. Producing healthier sperm is simple: avoid hot tubs and saunas, stop cycling, smoking and recreational drugs (including cannabis), eat less processed food, drink less alcohol, stop fizzy drinks, keep -get active, get more sleep and avoid chemicals that disrupt hormones. in household products for three months before trying to conceive. However, men rarely receive this guidance.
Boys receive even less reproductive health education than girls, and are often told that men don’t complain about health problems. The result is that many men avoid seeking help until a problem is too big or painful to ignore, and male fertility problems go untreated because, more often than not, the symptoms are mild. Urology deals with the urinary tract and andrology deals with infertility, but there is no medical specialty that proactively manages men’s reproductive health like gynecology does with women.
Preconception dating is also unusual, so potential side effects of drugs on male fertility are rarely communicated to patients and, unlike pregnancy risks, are not universally listed on drug labels. warning Metformin, for example, is prescribed to more than 150 million people to treat type 2 diabetes. A recent study suggests it lowers sperm count and quality and has another insidious effect: the children of parents who took it in the three months after conception they are more likely to have genital birth defects. When couples seek help for infertility, 25% of American men are not even seen by doctors. Ultimately, women must undergo invasive, expensive, and sometimes unnecessary fertility treatments when all that may be required is a semen analysis, a physical exam, and lifestyle adjustments.
I am tired of seeing the physical and emotional burden of infertility on women’s shoulders. I am also a mother of two young boys and worry about their future if male fertility continues to decline. I don’t particularly want to give sperm freezing as a graduation gift, but if nothing changes, I may have no choice. Raising informed and respectful men who understand their sexual health while reproductive health care is at stake feels more critical than ever.
So, men, the future is in your hands. Don’t want to go to the doctor? Do a semen analysis at home – it’s an indicator of your overall health, even if babies aren’t on your mind. Thinking about conception? Prepare your body to create a human by improving your lifestyle and reviewing your medications. Governments and policy makers should fund youth education programs that give boys the tools to take better care of their minds and bodies. As a bonus, the same groups should launch a preventive health initiative for men that includes semen analysis. This alone could reduce the number of unnecessary fertility treatments and rates of chronic disease.
To everyone else: Have an honest talk with your child, parent or partner about reproductive health. It’s time we embrace these tiny, miraculous cells that are half the source of human survival for their other superpower: the ability to improve and even save lives. ■
Leslie Schrock is a healthcare and technology entrepreneur and investor. She is the author of “Bumpin’: The Modern Guide to Pregnancy” (2019) and “Fertility Rules” (2023). She is an investor in reproductive health companies such as Maven, Legacy and Oath, and serves on the board of advisors for the Moody School of Communication at the University of Texas at Austin.
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