New Recommendations For Addressing Rising Male Infertility Rates

Infertility now affects one in six couples of reproductive age according to the World Health Organisation, and a leading expert on male infertility says environmental factors are a leading cause. About half of the time, infertility in couples originates from men.

Université de Montréal Professor Sarah Kimmins, a researcher at the CHUM Research Centre (CRCHUM), and colleagues believe that men have a right to meaningful diagnoses and targeted treatments. Unfortunately, these are unavailable in most cases at present.

Currently, the lack of knowledge regarding the causes of male infertility and in combination with limited clinical tools, has resulted in treatment focused on women, and burdensome and risky invasive procedures for male infertility.

A report titled ‘Frequency, morbidity and equity — the case for increased research on male fertility’ published in the journal Nature Reviews Urology, twenty-five  scientists led by Moira O’Bryan, Dean of Science at the University of Melbourne, offered ten  recommendations that could improve the health of men and their children, and decrease the burden on their female partners. Professor Kimmins said of the report, “The rapid decline in male fertility cannot be explained by genetics, and studies indicate that environmental factors are a driving force. These include increased exposure to hormone-disrupting chemicals that exist in our daily lives and persist in the environment.”

“Other factors include the rise in overweight and obese men, poor diet, stress, cannabis use, alcohol and smoking or vaping. Unfortunately, men are generally unaware of these factors,” she added.

The report also recommends a public awareness campaign that centers on the hazards to male fertility posed but the aforementioned practices. “As it takes months to make sperm, men should consider adopting a healthy lifestyle well before planning their families,” said co-author Dr. Jacquetta Trasler at the Research Institute of the McGill University Health Centre.

In a 2009 paper published in Endocrine Reviews, the authors of 'Endocrine-Disrupting Chemicals: An Endocrine Society Scientific Statement', wrote:

"The group of molecules identified as endocrine disruptors is highly heterogeneous and includes synthetic chemicals used as industrial solvents/lubricants and their byproducts [polychlorinated biphenyls (PCBs), polybrominated biphenyls (PBBs), dioxins], plastics [bisphenol A (BPA)], plasticizers (phthalates), pesticides [methoxychlor, chlorpyrifos, dichlorodiphenyltrichloroethane (DDT)], fungicides (vinclozolin), and pharmaceutical agents [diethylstilbestrol (DES)].

"Natural chemicals found in human and animal food (e.g., phytoestrogens, including genistein and coumestrol) can also act as endocrine disruptors. These substances, whereas generally thought to have relatively low binding affinity to ERs, are widely consumed and are components of infant formula (1,2). A recent study reported that urinary concentrations of the phytoestrogens genistein and daidzein were about 500-fold higher in infants fed soy formula compared with those fed cow’s milk formula (3). Therefore, the potential for endocrine disruption by phytoestrogens needs to be considered."

Men are currently designated infertile based on family history, physical examination, hormone profiles, and a simple semen analysis that has not changed for more than 50 years. “As health professionals, going forward, we need more funding of research that will allow us to offer men sensitive and accurate tests of sperm health,” said Trasler.

 “The clinic is poorly equipped to properly diagnose and treat male reproduction. Current methods are based on outdated techniques,” said co-author Géraldine Delbès, a researcher at Institut National de la Recherche scientifique.

Based on years of research, Kimmins founded HisTurn: a company that will be the first genomic diagnostic to offer personalized medical approach to male infertility. It is now being clinically validated for eventual use in fertility clinics. It may save couples money and time, while also improving success rates of fertility treatment.

“Decreasing semen quality and increasing frequency of testicular cancer and congenital defects in the urogenital system indicate that, globally, male reproductive health has declined over recent decades. Research is needed to understand why, and how this trend can be reversed. Urgent, worldwide action to implement our recommendations is critical,” said O’Bryan.

HisTurn’s test will provide an individual fertility prediction score associated with clinical treatment outcomes that takes into account potentially reversible lifestyle factors (cannabis use, toxicant exposure, and obesity) that, if addressed, may improve fertility status and treatment outcomes. The goal is to provide clinicians and patients with personalized treatment recommendations that have the most potential for success. 

Currently Kimmins and colleagues are validating the accuracy of the test, and they aim to commence clinical trials in 2024. Kimmins is clear about wanting to ensure the best possible version of the test is ready to be put on the market when the time comes. 

“We want to put out a gold standard,” explained Kimmins who added, “There are a lot of tests in the fertility space with questionable use and accuracy and so we really want to put out a test that is going to be reliable, that's accurate, that can actually guide treatment.”