Is Male Infertility On the Rise?

As always, there was a flurry of information released from the annual meeting of the European Society of Human Reproduction & Embryology (ESHRE), held during June this year in Copenhagen. While it can be exciting to hear about new advances in diagnosis and treatment, some of the information can be easily misinterpreted through the media, sometimes leading to unwarranted concern by understandably confused consumers.

An ESHRE committee that monitors IVF data in Europe recently issued a statement that more men than women may be affected by infertility. It's long been known that, when it comes to diagnosed cases of infertility, the root of the cause is about equally divided among male factors and female factors. However, according to this committee's well-publicized report, male infertility is slowly but surely closing in as the leading cause.

Is this true? Is it time for men to panic and make drastic changes to stop the rise in incidence of male infertility?

Probably not, says Dr. Michael Slowey of Reproductive Medicine Associates of New Jersey. He explains that, as in many cases, the alarm that's being heard is a matter of data interpretation. In this case, the data in question is the increasing rate of intracytoplasmic sperm injection (ICSI) procedures being performed -- and why.

"The findings presented at the ESHRE meeting are simply indicating that more ICSI is being done," explains Dr. Slowey. "The use of ICSI has revolutionized the treatment of male infertility; however, this increased utilization does not necessarily indicate that male infertility is on the rise."

ICSI is an assisted reproductive technique that's been in use since 1992. The primary advantage that the procedure grants to users is that only one good sperm cell per egg is required for fertilization. When you consider the usual odds for unassisted conception and even some assisted cases, such as intrauterine insemination (IUI), ICSI is clearly a shortcut down the path to pregnancy for some.

In fact, ICSI is so targeted a procedure, even men with a zero sperm count (called azoospermia) can become biological fathers via several different sperm extraction/aspiration techniques. Just one good sperm...

The ESHRE committee found in their analysis that "the proportion of ICSI has been rising steadily" since they first began collecting data, and in 2002 ICSI accounted for 52 percent of all treatments in the 24 European countries reporting. The committee went on to speculate about the possible causes of this increase in ICSI, citing as one potential reason an overall decline in sperm quality around the world, perhaps resulting from the observed interaction between environmental factors and the human endocrine system.

Dr. Stephen Somkuti of Abington Reproductive Medicine downplays the theory of a lower overall sperm count, saying "There've been sporadic reports over the last couple of decades connecting human exposure to estrogens and lower counts, but there really hasn't been a significant lowering proven."

Somkuti, who has a special interest in environmental effects on reproduction, adds "Even with all the FDA and EPA testing done, there are a lot of unknowns out there to be sure -- but you can't avoid the normal, daily exposure to chemicals that are in things like plastic wrap, IV tubing, pacifiers..."

The bottom line, Somkuti says, "is that you can argue that there are risk factors out there to be aware of, but fortunately and ultimately, there's a lot of redundancy in the male reproductive system. Men can regenerate their reproductive capacity throughout their lifespan."

So while attention-getting headlines -- "Infertility may be becoming more of a man's problem than a woman's problem" and even More males than females suffering from infertility" -- call attention to that one speculation by the committee, there are other possible reasons for the rise in ICSI use.

Dr. Somkuti agrees with the ESHRE committee's other proposal that a combination of increased skill in using the ICSI technique plus heightened consumer awareness of its availability are contributing to the data.

"ICSI has become an extremely routine and safe procedure," says Somkuti. "We've had patients come in and request ICSI right up front because they feel it offers them more of what they need."

Dr. Slowey concurs and elaborates that as technical skill has increased, there has been an expansion in the indications for its use. "While abnormal semen parameters are the major indication for using ICSI, there are others such as prior poor fertilization at IVF, prior failed IVF, advanced age of the woman, increased thickness of the zona pellucida and preimplantation genetic diagnosis (or PGD)."

PGD is an even newer assisted reproductive technology that allows patients using IVF to screen embryos before transferring them into the woman's uterus. Dr. Slowey explains, "PGD can be used to detect genetic diseases, as well as to assist patients who've experienced recurrent pregnancy loss, those who are of advanced maternal age, and for those who've had multiple IVF failures. ICSI is necessary in PGD in order to prevent contamination with extra sperm."

So there are numerous possible reasons for the increase in ICSI use, and so far, the existing data and analysis simply do not provide support for some of the alarming headlines.

"Certainly, this trend bears watching and more detailed evaluation," Dr. Slowey allows, "but we need to be rigorous in our interpretation of the data so that we remain open to any safety or health issues that might be suggested, without creating unnecessary concern."

Dr. Michael Slowey -- Reproductive Medicine Associates of New Jersey

Dr. Stephen Somkuti -- Abington Reproductive Medicine