Research sheds light on our understanding of male infertility and how we may better treat this in the future. By Kim Bell
The statistics on rising male infertility are alarming says Christopher Barratt, professor of reproductive medicine at the University of Dundee in Scotland, with an estimated one in 10 young men today having sperm counts low enough to impact conception.
The rising male infertility rate is alarming
Barratt was recently in Hong Kong, the keynote speaker at the 9th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE). He believes this is an issue of concern and feels the world has not “woken up” to the impact of male infertility, and “its longer-term economic and societal consequences”.
As the former director of the World Health Organization’s Male Fertility Expert Working Group, Barratt knows what he’s talking about. He believes assisted reproductive technology is a highly newsworthy, multi-billion dollar enterprise to assist the one in six couples struggling to achieve their dream of having a baby.
However, he shares: “The perception from the outside is that all is well in the world of male reproduction, but this is an illusion.” He adds that the lack of research and data about male infertility and how to treat it, often means boosting a couple’s chance of having a baby involves costly and invasive intervention for the female partner. “In a world in which we claim to be addressing inequalities between men and women, the fact that the female partner often has to bear the burden of male infertility is an infringement of basic human rights and dignity.”
Barratt adds that sperm counts have been steadily declining for the past 40 years. While environmental factors have been sited as the cause, he adds that the specific reasons are currently only “educated guesswork”.
We need to invest into a men’s health strategy
There has been extensive research in some Scandinavian countries. The Australian Government also recently announced that it was investing millions of dollars into a men’s health strategy, which includes research into both the causes and prevention of male infertility. However, Barratt has raised concerns that in other parts of the world, including Africa, Asia and South America, there is “little definitive data on male infertility”.
Barratt adds: “We must engage medical professionals to develop the drive and energy to deal with this global health issue. Now is the time for an urgent wake-up call. The first step is to galvanise the professions into action and also to get a groundswell from patients pushing for this to be done.” He says, “This should involve, in part, better promotion of positive lifestyle issues to help men make more informed choices about their reproductive health.”
One of the areas that could assist is ensuring quality semen analysis be part of the strategy of action. “We now know for sure that semen samples analysed in different laboratories give different results, hence diagnostic and prognostic information.”
There is hope: A UK-study presented recently at the European Association of Urology Congress in Barcelona has shed some light on our understanding of male infertility and provides insight into how this can be better treated in the near future.
The researchers found that sperm DNA from the testicles of many infertile men may be as good a quality as ejaculated sperm in fertile men.
The scientists found that sperm can become damaged on the journey from the testicles, along the series of ducts, before reaching the end target. Some of this damage is due to oxidative stress.
Consultant Urologist at the Imperial College, London, and one of the researchers, Jonathan Ramsay explains: “When we looked at ejaculated sperm, we found that the extent of sperm DNA damage was much higher in infertile men than in fertile men, with roughly 15 % in fertile men, but 40% in infertile men. It wasn’t a surprise to see greater DNA damage in ejaculates of infertile men. What we didn’t expect was the consistency in these results when we looked at sperm taken directly from the testicles of infertile men, we found that it was of similar quality to that of ejaculated, fertile sperm.
The majority of DNA damage caused in transit from testicles to ejaculate is caused by oxidative stress, which causes DNA single but not double strand breaks. This occurs when the sperm is subjected to poor lifestyle habits such as poor diet, sitting at a laptop all day or smoking. Diseases such as Crohn’s disease and Type 2 Diabetes also cause oxidative stress”.
The researchers believe this could lead to interventions where sperm is taken directly from the testes of those men who have damaged sperm upon ejaculation. DNA integrity plays a large role in fertilisation rates in assisted reproduction, and this could help in the decision-making process, whether or not to resort to testicular sperm aspiration rather than using ejaculated sperm in those men with signs of DNA damage. Using sperm from the testes could lead to an improvement in male fertility.
Kim Bell is a wife, mother of two teenagers and a lover of research and the way words flow and meld together. She has been in the media industry for over 20 years, and yet still learns more about life from her children everyday. You can learn more about Kim Bell here.