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Sperm quality appears to be declining around the world but is a
little discussed cause of infertility. Now scientists are narrowing
in on what might be behind the problem.
"We can sort you out. No problem. We can help you," the doctor told Jennifer
Hannington. Then he turned to her husband, Ciaran, and said: "But there's not
much we can do for you."

The couple, who live in Yorkshire, England, had been trying for a baby for two
years. They knew it could be difficult for them to conceive as Jennifer
has polycystic ovarian syndrome, a condition that can affect fertility. What they
had not expected was that there were problems on Ciaran's side, too. Tests
revealed issues including a low sperm count and low motility (movement) of sperm.
Worse, these issues were thought to be harder to treat than Jennifer's – perhaps
even impossible.

Hannington still remembers his reaction: "Shock. Grief. I was in complete denial. I
thought the doctors had got it wrong." He had always known he wanted to be a
dad. "I felt like I'd let my wife down."

Over the years, his mental health deteriorated. He began to spend more time
alone, staying in bed and turning to alcohol for comfort. Then the panic attacks set
in.

"I hit crisis point," he says. "It was a deep, dark place."

Male infertility contributes to approximately half of all cases of infertility and

affects 7% of the male population. However, it is much less discussed than
female infertility, partly due to the social and cultural taboos surrounding it. For
the majority of men with fertility problems, the cause remains unexplained – and
stigma means many are suffering in silence.

Research suggests the problem may be growing. Factors including

pollution have been shown to affect men's fertility, and specifically, sperm quality
– with potentially huge consequences for individuals, and entire societies.

A hidden fertility crisis?

The global population has risen dramatically over the past century. Just 70 years
ago – within a human lifetime – there were only 2.5 billion people on Earth. In
2022, the global population hit eight billion. However, the rate of population
growth has slowed, mainly due to social and economic factors.

Birth rates worldwide are hitting record low levels. Over 50% of the world’s
population live in countries with a fertility rate below two children per woman
– resulting in populations that without migration will gradually contract. The
reasons for this decline in birth rates include positive developments, such as
women's greater financial independence and control over their reproductive
health. On the other hand, in countries with low fertility rates, many couples would
like to have more children than they do, research shows, but they may hold off
due to social and economic reasons, such as a lack of support for families.

At the same time, there may also be a decline in a different kind of fertility, known
as fecundity – meaning, a person's physical ability to produce offspring. In
particular, research suggests that the whole spectrum of reproductive problems in
men is increasing, including declining sperm counts, decreasing testosterone
levels, and increasing rates of erectile dysfunction and testicular cancer.

Swimming cells

"Sperm are exquisite cells," says Sarah Martins Da Silva, a clinical reader in
reproductive medicine at the University of Dundee and a practicing gynaecologist.
"They are tiny, they swim, they can survive outside the body. No other cells can do
that. They are extraordinarily specialised."

Seemingly small changes can have a powerful effect on these highly specialised
cells, and especially, their ability to fertilise an egg. The crucial aspects for fertility
are their ability to move efficiently (motility), their shape and size (morphology), and
how many there are in a given quantity of semen (known as sperm count). They
are the aspects that are examined when a man goes for a fertility check.

"In general, when you get below 40 million sperm per millilitre of semen, you start
to see fertility problems," says Hagai Levine, professor of epidemiology at the
Hebrew University of Jerusalem.

Sperm count, explains Levine, is closely linked to fertility chances. While a higher
sperm count does not necessarily mean a higher probability of conception, below
the 40 million/ml threshold the probability of conception drops off rapidly.

In 2022, Levine and his collaborators published a review of global trends in

sperm count. It showed that sperm counts fell on average by 1.2% per year
between 1973 to 2018, from 104 to 49 million/ml. From the year 2000, this rate of
decline accelerated to more than 2.6% per year.

We are facing a public health crisis and we don't know if it's

reversible – Hagai Levine
Levine argues this acceleration could be down to epigenetic changes, meaning,
alterations to the way genes work, caused by environmental or lifestyle factors. A
separate review also suggests epigenetics may play a part in changes in sperm,
and male infertility.

"There are signs that it could be cumulative across generations," he says.

The idea that epigenetic changes can be inherited across generations has not
been without controversy, but there is evidence suggesting it may be possible.

"This [declining sperm count] is a marker of poor health of men, maybe even of
mankind," says Levine. "We are facing a public health crisis – and we don't know if
it's reversible."

Research suggests that male infertility may predict future health problems,
though the exact link is not fully understood. One possibility is that certain lifestyle
factors could contribute to both infertility, and other health problems.

"While the experience of wanting a child and not being able to get pregnant is
extraordinarily devastating, this is a much bigger problem," says Da Silva.

Individual lifestyle changes may not be enough to halt the decline in sperm quality.
Mounting evidence suggests there is a wider, environmental threat: toxic
pollutants.