The Sperm-Count ‘Crisis’ Doesn’t Add Up

Male scientists have lengthy waxed poetic on the contents of their testes. “Sperm is a drop of brain,” wrote the traditional Greek author Diogenes Laërtius. Leonardo da Vinci drew the penis with a sperm duct that linked on to the spinal wire. The 17th-century microscopist Antonie van Leeuwenhoek claimed that every sperm cell contained inside it a folded-up human being ready patiently to unfurl.

For practically as lengthy, scientists have fretted about sperm’s seemingly inevitable decline. Most just lately, a collection of alarming headlines — in addition to a brand new e book by an epidemiologist at Mount Sinai Medical Center in New York — warned that falling sperm counts would possibly threaten the way forward for the human race. “It’s a global existential crisis,” mentioned Shanna H. Swan, creator of the e book “Count Down.”

Most of those headlines may be traced to an influential 2017 meta-analysis by Dr. Swan and others, which discovered that sperm counts in Europe, North America, Australia and New Zealand had plummeted by practically 60 p.c since 1973. The authors screened 7,500 sperm-count research from all over the world, weeded out most of them and in the end analyzed 185 research on 43,000 males worldwide.

They known as the decline a “canary in the coal mine” for waning male reproductive well being worldwide. Today, the authors would revise that assertion. “There is clear and present alarm now,” mentioned Dr. Hagai Levine, an epidemiologist at Hebrew University-Hadassah School of Public Health and a co-author on the 2017 overview, in an e-mail. “The canary is in trouble now.” Dr. Swan, in the identical e-mail, agreed.

Now a bunch of interdisciplinary researchers from Harvard and the Massachusetts Institute of Technology contend that fears of an impending Spermageddon have been vastly overstated. In a examine printed in May within the journal Human Fertility, they re-evaluated the 2017 overview and located that it relied on flawed assumptions and failed to think about alternate explanations for the obvious decline of sperm.

In an interview, Sarah Richardson, a Harvard scholar on gender and science and the senior creator on the brand new examine, known as the conclusion of the 2017 overview “an astonishing and terrifying claim that, were it to be true, would justify the apocalyptic tenor of some of the writing.” Fortunately, she and her co-authors argue, there’s little proof that that is the case.

The 2017 authors had been “methodologically rigorous” when it got here to screening sperm-count research for high quality and consistency, Dr. Richardson and her colleagues write. However, even the information that handed muster was geographically sparse and uneven and infrequently lacked primary standards just like the age of the boys. Moreover, its authors took as a right that a single metric — sperm rely — was an correct predictor of male fertility and general well being.

The connection sounds logical: Without sperm, there may be no conception. That’s why sperm rely is likely one of the first metrics that fertility specialists measure to attempt to decide the reason for infertility in a pair. But past that truism, the science of sperm rely is surprisingly slippery.

For starters, nobody is aware of what an “optimal” sperm rely is. The World Health Organization units a variety of “normal” sperm rely as from 15 to 250 million sperm per milliliter. (Men produce about 2 to five milliliters per ejaculation.) But it isn’t clear that extra is best. Above a sure threshold — 40 million per milliliter, in response to the W.H.O. — a better sperm rely doesn’t imply a person is extra fertile.

“Doubling your sperm count from 25 to 50 million doesn’t double your chances,” mentioned Allan Pacey, an andrologist on the University of Sheffield and the editor of Human Fertility. “Doubling it from 100 to 200 million doesn’t double your chances — in fact it flattens off, if anything. So this relationship between sperm count and fertility is weak.”

Frozen sperm samples within the Cryos International Sperm Bank in Aarhus, Denmark. Although the male-fertility disaster is overstated, scientists say, the science of males’s well being has lengthy been uncared for. Credit…Thomas Fredberg/Science Source

Germaine M. Buck Louis, a reproductive epidemiologist at George Mason University who research environmental influences on human fertility, agreed that sperm rely is a poor indicator of fertility. “We don’t see it predicting much of anything, especially in the context of a partner with a healthy female pelvis,” mentioned Dr. Buck Louis, who was not concerned within the sperm-count research.

The authors of the 2017 examine inferred that decrease sperm counts equated to decrease fertility — regardless that the sperm-count declines they documented all came about throughout the “normal” vary, Dr. Richardson famous. “It’s similar to the whole conversation around testosterone — more is better, and more is manlier,” she mentioned. “That’s really a point we make, that there is no known normal or baseline for average population sperm counts.”

Sperm rely has different limitations as a metric. It takes round two months for stem cells within the testes to become new sperm, that means that any single rely is merely a snapshot of an evolving panorama.

“Something that’s going on in a man’s body one month may be totally different from what’s happening the next month, and the effects on sperm count might be changing also,” mentioned Meredith Reiches, an creator on the 2021 paper and a organic anthropologist on the University of Massachusetts, Boston

It additionally overlooks a significant piece of the infertility puzzle: ladies. Focusing solely on the male metric leaves out key interactions between sperm, the feminine reproductive tract and the egg. “It’s very important, actually, to look at the couple,” mentioned Dr. Bradley D. Anawalt, a reproductive endocrinologist on the University of Washington School of Medicine.

In her e book, Dr. Swan means that sperm counts have plummeted largely as a result of rise of endocrine disruptors, a category of hormone-mimicking chemical compounds present in all the things from shampoo to TV-dinner packaging. (She additionally cites life-style elements like weight problems, alcohol, and smoking.) Dr. Swan has proven in earlier research that publicity to those chemical compounds in utero can alter female and male sexual improvement.

Dr. Richardson and her co-authors instructed an alternate clarification: Perhaps sperm ranges naturally rise and fall over time and inside populations. The query has not been explored by reproductive researchers and can’t be answered simply, as world sperm counts earlier than 1970 are largely unknown.

There are different attainable explanations, as effectively. Sperm-counting is a tough enterprise and notoriously vulnerable to human error, Dr. Pacey mentioned. (“I say it from the point of view of someone who spent 30 years counting sperm and knows how difficult it is,” he added.) In a 2013 overview article, he famous that as methodologies for counting had improved and been standardized for the reason that 1980s, sperm counts had appeared to fall. In different phrases, it could merely be that earlier scientists had been overcounting sperm.

Dr. Swan and Dr. Levine agreed that exploring these various hypotheses was vital, in order that threats to reproductive well being might be established and prevented. “We showed evidence for decline, and raised alarm,” Dr. Levine wrote in an e-mail. “We need to study the causes, including the unlikely possibility of non-pathological decline.”

There was one level that each creator agreed on: Men’s reproductive well being issues. And till now, it has been surprisingly uncared for.

Male infertility contributes to no less than half of all instances of infertility worldwide. Yet traditionally, ladies have shouldered a lot of the blame for the lack to conceive. And with the rise of reproductive applied sciences like in vitro fertilization, ladies’s our bodies are those which were meticulously measured and tracked by reproductive medication.

As a outcome, science nonetheless lacks primary data in the case of sperm, mentioned Rene Almeling, a sociologist of drugs and creator of “GUYnecology: The Missing Science of Men’s Reproductive Health.” For occasion, simply this 12 months, researchers reported for the primary time that sperm swim in a corkscrew movement, quite than undulating like eels.

“We have built up such a medical infrastructure around the fertility and reproductivity of women’s bodies that we haven’t asked some of the basic questions about men’s reproductive health,” Dr. Almeling mentioned. “There is just so, so much basic research still to be done about sperm.”

The principal qualities of sperm that infertility specialists take a look at these days — what number of, what form and the way they swim — haven’t modified prior to now 40 years, mentioned Dr. Abraham Morgentaler, a urologist and founding father of Men’s Health Boston.

Dr. Morgentaler, who labored at a semen evaluation lab at Beth Israel Deaconess Medical Center within the 1980s, attributes this stagnation to the rise of I.V.F. and different reproductive applied sciences, which have turn into frontline remedies for nearly any male issue fertility drawback. “It almost doesn’t even matter what’s wrong with the sperm,” he mentioned.

These data gaps radiate out to all our bodies. In reality, Dr. Swan mentioned a part of her motivation for writing the e book was that she wished to see the general public — women and men — turn into extra proactive about their reproductive well being.

“It’s invisible,” she mentioned. “People don’t talk about it. You talk about, ‘Oh, I’ve got a high cholesterol measure,’ or ‘My blood pressure’s up.’ But you never would say, ‘My egg count is down,’ or ‘My sperm count is down.’”

Dr. Richardson agreed that the impression of reproductive toxins on fertility deserved additional investigation. “To say that we think these are alarmist and apocalyptic claims, and they’re not well founded, is not to say that we think it isn’t an important research agenda,” she mentioned. “There is a need to center on men’s reproductive health and understand their bodies as reproductive and as porous to the environment as anyone’s bodies.”