Global action needed to tackle declining male fertility

Male infertility needs improved options for diagnosis and treatment, as well as wider investment in research, social awareness, and education, according to an international consortium.

Concern that male fertility may be declining globally led the Male Reproductive Health Initiative working group within the European Society for Human Reproduction and Embryology (ESHRE) to commission an expert international panel, led by Professor Moira O'Bryan, from the University of Melbourne, Australia.

'Decreasing semen quality, 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' said Professor O'Bryan.

She and 25 other experts from countries across Europe, plus the USA, Canada, China and Argentina, have published their findings in Nature Review Urology.

As well as declining fertility, the panel address how infertility in men is as common as in women, but the cause of infertility in male patients is often unknown, and usually goes uninvestigated as fertility treatments such as ICSI are used as a workaround. Because of this, very few targeted treatments for male infertility are available.

The panel also considered research suggesting that unexplained infertility could be a marker for other undiagnosed health conditions in men, such as cancer or metabolic diseases. However, without research into underlying mechanisms, opportunities to use this as an early warning sign are lost.

One of the UK participants on the panel, PET trustee, Professor Allan Pacey from the University of Manchester said: 'For far too long, the science and medicine which deals with male reproductive health has been in the shadows. If we are truly to understand the risks to male reproductive health, and know how to deal with them, we need a major step change in how this happens'.

To accomplish this, the panel have published ten recommendations which together form a roadmap for standardised global healthcare for male infertility.

Recommendations include more diagnostic tests, including genome sequencing for men with infertility, to find a cause where possible; establishment of a global biobank to support research into genomic and environmental effects on fertility; training and education for healthcare workers; and acknowledgement by government and healthcare providers that male infertility is a common and serious medical issue deserving of meaningful diagnosis and treatment.