MONTREAL — Male fertility is on the decline worldwide, and an international group of researchers says the poorly understood issue needs to be tackled as soon as possible.
In a new paper published in the medical journal Nature Reviews Urology, researchers warn that this lack of lack knowledgeoftenresults in the burden of male fertility falling on women, who are subject to invasive assisted reproduction procedures.
"The major problem is that we don't know the causes of male infertility, and current diagnoses and treatment (are) not causal-based," said Sarah Kimmins, a Université de Montréal professor and member of the research group. "It's a one size fits all."
If you're an infertile man, she added, there are few treatment options, "and the diagnosis is really outdated. It has not changed for more than 50 years."
"So the treatment really falls on the woman, whether it's her fertility issue or his."
The World Health Organization estimates that infertility affects one in six couples, and that men compose half of all cases. Studies suggest that behavioural and environmental factors play a major role in male fertility. Among them, says Kimmins, are an increasing exposure to hormone-hindering chemicals known as endocrine disruptors; a rise in obesity; poor diet; stress; cannabis use; alcohol consumption; and smoking and vaping
The new paper by a group of 25 scientists — led by Moira O'Bryan, dean of the faculty of science at the University of Melbourne — offers 10 recommendations to improve the health of men and their children and reduce the onus on women to bear the brunt of a couple's fertility problems.
Chief among them is a call for public campaigns to educate men about the behaviour and lifestyle habits they should adopt — or avoid — to maximize their chances of producing offspring.
"We'd really like that boys and young men receive this education in the school setting, when they're young," said Kimmins. "That their fertility is something (to be) protected and (what) to avoid to lessen the risk of having infertility later in life."
There is also a role for family doctors to discuss with their male patients factors that can reduce fertility. Too often, she said, doctors see in vitro fertilization as a relatively easy solution to male infertility. They forget, however, that the onus of the procedure falls on women, even though the root fertility problem may not be theirs.
"It's really unfair and inequitable that we don't have something available to better treat the couple," Kimmins said.
Prevention is all the more crucial, she continued, because it's still unclear whether fertility compromised by external factors is permanent or reversible. Men whose occupations increase their risk of infertility, such as those who work with chemicals, should therefore be informed of the possibility of freezing their sperm before it's too late, Kimmins said.
Those thinking of starting a family should try to minimize factors that could harm their fertility by eating better, exercising and sleeping well, for example. "It's not just a matter of, 'I've got to improve ... my fertility health in the month before (conception).' It's that men need to be thinking about this as a lifetime responsibility."
A growing body of scientific evidence shows that infertile men are more prone to disease and tend to die younger than fertile men. The incidences of cancer and cardiovascular disease are also higher among infertile men.
And beyond fertility, quality sperm can also protect the health of children, and even grandchildren, by reducing the risk of passing on lifestyle-influenced genetic changes that can result in a host of health problems, from obesity to neurodevelopmental disorders. An infertile man could even pass on his infertility to his offspring during medically assisted fertilization.
So men "bear the burden of protecting their health, protecting their fertility, but also the health of future generations," Kimmins stressed.
This report by The Canadian Press was first published Oct. 13, 2023.
Jean-Benoit Legault, The Canadian Press
