October 10, 2017

expert reaction to an editorial on trends in male fertility

An editorial, published in The BMJ, calls for urgent action to investigate disturbing trends in men’s reproductive health.

Prof. Darren Griffin, Professor of Genetics, University of Kent, said:

“The decline is sperm quality is now so well reported from a number of different perspectives that it is hard to ignore.  We have a problem that, if the trend continues, might have significant effects on our existence.  What is causing it? We have only clues.

“IVF is a world-leading innovation, giving joy to many couples but, as a means of alleviating a world problem like this, it is a little like shutting the door after the horse has bolted. IVF and ICSI (Intracytoplasmic sperm injection) can only deal, as best it can, with the fall out of this problem and addressing it at source is far more important.

“It is time for the government funding bodies, the companies interested in fertility, and the medical charities to get their heads together and pump more resource into basic research in the causes of this phenomenon and how to reverse it.”

Prof. Sheena Lewis, Emeritus Professor of Reproductive Medicine, Queen’s University (QUB), said:

“This brings together the accumulating evidence that both the numbers and quality of sperm are decreasing.  These are indications of serious threats to male health in terms of infertility and male cancers. We must take notice and act to  source the dangers and safeguard our men’s’ health.”

Prof. Allan Pacey, Professor of Andrology, University of Sheffield, said:

“This is a useful editorial that highlights the potential threats to male reproductive health and calls for urgent research to be conducted in this area. As a researcher in male fertility issues (Andrology) with 25 years’ experience, I first have a number of comments to make about how we conduct this kind of research:

“Firstly, it has often been difficult to convince funders of medical and scientific research that studies in male fertility issues were of value, when we are forced to bid competitively for a limited pot of money alongside colleagues working in other areas such as cancer, diabetes or cardiology. Secondly, we have not really achieved a joined up approach with regard to research into male fertility in the UK (or indeed within Europe) with research teams working in isolation rather than collaborating on big projects that will help answer some of the significant questions in this area. Thirdly, to tackle some of the important questions, it will be necessary to devise large longitudinal studies of large numbers of couples and then follow the reproductive health of their sons over many, many years, to better understand the risk factors for poor male reproductive health. This will take considerable investment.

“One of the central arguments of Skakkabaek’s editorial are that we should be concerned by the potential decline in sperm counts that were suggested by a recent meta-analysis as well as one done 25 years ago by his research group. I have made my views known previously about these data (see http://www.sciencemediacentre.org/expert-reaction-to-meta-analysis-of-sperm-count-among-men-in-western-countries/) and by itself I am not convinced that this is evidence enough of a potential public health issue.

“However, I am very convinced by the year on year increase in the rates of testicular cancer in many post-industrial countries around the world. Whilst, thankfully, this has been accompanied by increased survival rates as medical treatments for testicular cancer have improved, it does suggest that something significant is happening with the testicular development of young men compared to their fathers and grandfathers. This is worthy of further investigation and is the most convincing argument I have heard for why we should be concerned.

“Unfortunately, in his article, Professor Skakkabaek argues that the decline in fertility rates below replacement levels, and an increased reliance on assisted conception and use of donor sperm, are important indicators of a male reproductive health problem. However, for me, this simply reflects changes in society brought about through economic development and social choice by couples about how many children to have and when to have them. In my opinion this is the weakest evidence for a potential male reproductive health problem caused by external environmental effects.”

* ‘Sperm counts, testicular cancers, and the environment’ by Skakkebaek published in The BMJ at 23:30 UK time on Tuesday 10 October.

Declared interests

Prof. Darren Griffin: No conflicts of interest.

Prof. Sheena Lewis: Sheena is CEO of Lewis Fertility Testing Ltd, a university spin-out company marketing a test for male infertility: www.spermcomet.com.

Prof. Allan Pacey: “Chairman of the advisory committee of the UK National External Quality Assurance Schemes in Andrology, Editor in Chief of Human Fertility and Trustee of the Progress Educational Trust (all unpaid).  Also, recent work for the World Health Organisation, British Broadcasting Corporation, Purple Orchid Pharma (paid consultancy with all monies going to University of Sheffield).  Co-applicant on a research grant from the Medical Research Council (ref: MR/M010473/1).”