Radio Review: Inside Health – Sperm counts

The question of whether sperm counts are falling seems like it should have a simple yes or no answer, based on our ability to measure this by carrying out semen analysis. This episode of BBC Radio 4's Inside Health challenges that illusion.

Delivered in two parts, the podcast starts by exploring personal experiences, discussing the way individual sperm counts are measured and what they mean. The podcast then switches its focus, presenting a wider, global debate and the complexities within the science.

At first, I didn't enjoy the seemingly disjunctive delivery of the podcast. I questioned whether separating the different styles (personal and anecdotal compared with scientific debate) was too stark a contrast for the listener, instead of weaving them together throughout. However, by the end, I thought it provided a comprehensive scope of the question at hand, so stick with it!

The beginning dives straight into the real-life experience of presenter, James Gallagher, having a semen analysis test. While his personal and anecdotal style has been heard before in many Inside Health podcasts, this experience is particularly intimate (and also as he says, intimidating) for a journalist. The dialogue between Gallagher and the healthcare professionals he engages with in the process of providing a sperm sample and receiving the results, captured my imagination from the get-go, and lent itself well to anyone with curiosities about the process.

After receiving his results, Gallagher introduces a couple, Suzanne and Richard, who discuss their fertility journey. This felt more like scripted actors than the natural dialogue we had heard beforehand, however, they provide a first-hand account of their feelings when they discovered that Richard's semen analysis results showed a sperm count that was so low that there was almost zero chance of conceiving.

Many questions about the causes of male infertility are answered when Gallagher meets with Professor Sheryl Homa from Andrology Solutions and the University of Kent, who has at least 30 years of experience with sperm. Professor Homa discusses Gallagher's test results, and explains in great detail the parameters and their significance. Here, the podcast becomes incredibly informative, while managing to keep the style personal when we hear what seems like Gallagher's genuine reaction to his own semen analysis results.

They discuss how lifestyle factors or infections that contribute to the heating of the testes can be detrimental to sperm quality. However, it isn't always lifestyle. Moving on from Gallagher's results personally and discussing male infertility more generally, Professor Homa introduces the leading known cause of male infertility – varicocele: a clump of varicose veins in the testes causing engorgement of blood flow that leads to the testes heating up. To his own surprise as well as my own, this was a revelation to Gallagher. I wondered how a man, with so much scientific and health knowledge, could be unaware of a condition that if untreated, could have such a significant impact on life.

Back to the couple, Suzanne and Richard, and their happy ending! Richard describes how a bag of frozen peas, alongside an operation over in the 'blink of an eye' to remove his varicocele (which he was aware of but had ignored) resulted in a naturally conceived baby! Susan describes the varicocele as 'a bag of worms with one particular large worm under the skin', a helpful description to raise awareness of the poorly diagnosed condition.

Cue the second half of the podcast, with the debate on global falling sperm counts. Gallagher is joined by Professor Allan Pacey from the University of Sheffield, also a Progress Educational Trust trustee, and Professor Richard Sharpe from the University of Edinburgh.

So, are sperm counts falling? I'll skip to the end here: Professor Sharpe describes this as 'a question we will always be debating but never resolve'. By integrating their subtly different opinions, the professors unpack the nuances within the debate that bring them to their inconclusive conclusions.

They acknowledge the literature, and one paper in particular published in the Human Reproduction Update (see BioNews 1168), indicates a global trend for falling sperm rates with stark numbers reported, but is it all it seems? Changes in measurement techniques over time, a question of whether sperm count measurements are the be-all and end-all in the wider debate of male reproductive health and increasing concern in the modern context of ageing mothers are discussed.

Richard's experience from the first half of the podcast may leave a listener who has concerns about infertility feeling hopeful. If I cool down my testes, I may be ok… Prepare for a reality check when Gallagher brings current lifestyle changes into the debate. Professor Pacey provides caution about the strength of evidence for the effect that changing lifestyle habits could have, with Professor Sharpe discussing how male infertility may be totally beyond the control of the man himself, due to processes that may have gone wrong during their own fetal development. It doesn't match the hopeful story from the first part of the podcast, but it's a theory that deserves attention as it challenges our perception of the correct timeline for interventions to tackle male infertility.

Overall, this podcast is incredibly informative, and balances personal stories with global trends that paint the bigger picture. It may not conclusively answer the question of whether sperm counts are falling, but it generates much-needed attention to many aspects of male reproductive health.