Men’s Fertility: Is it on the Decline?

Lola MagazineDr. Jared Moss, Health and Beauty, Lola Shreveport

In 2022, a review article reported that, globally, male fertility was on the decline. Sperm counts decreased by approximately 1.2% from years 1973 to 2018. Specifically, sperm counts decreased from an average of 104 million sperm/mL to 49 million sperm/mL. The decline was thought to be from a combination of lifestyle and environmental factors. This was clearly an alarming finding, especially since infertility is on the rise. Approximately 1 in 6 couples now experience infertility! Unfortunately, this is a sensitive subject and many couples do not feel comfortable discussing their struggles publicly. This sadly leads to couples feeling alone and helpless during a very tough period in life. Fortunately, there is a lot that we CAN do to help improve and treat infertility.

According to another recent article, male infertility contributes to approximately half of all cases of infertility and affects approximately 7% of men. It is very important to have both partners evaluated simultaneously if there are infertility concerns. Typically, most reproductive doctors recommend trying for at least one year of having unprotected sex prior to having an evaluation for infertility. It is also fine to shorten this period to 6 months of trying if there are obvious infertility concerns or risk factors, such as a prior history of cancer, female age over 35, irregular menstrual cycles or a prior history of surgeries that place the reproductive tract at risk.

Female patients will typically see their OB/GYN for a fertility evaluation, and men will normally see a urologist. In order to fully evaluate a male patient for infertility a few pieces of information will be needed. First, the urologist will need to take a good reproductive history and perform a physical exam. The male genitalia do need to be examined at some point to make sure there are no abnormalities, but this is a very quick exam and not painful. It will also be important to check male hormones that could cause infertility. Testosterone and follicle stimulating hormone (FSH) are two hormones that can easily be checked with a blood test. Testosterone is the male hormone that is important for sex drive, muscle mass and sperm production. FSH is produced by the brain and is very important for sperm production. Importantly, if the testosterone is low, you do NOT want to take supplemental testosterone such as injections. Supplemental testosterone is very bad for your fertility. The testicles are an organ that is responsible for making sperm and testosterone, and when men inject testosterone, the body becomes dependent on it and the testicles stop producing testosterone and sperm! In order to prevent this situation, urologists often prescribe estrogen blockers such as clomiphene citrate. This is an oral medication taken daily and is fertility friendly. It helps to increase natural production of testosterone from the testicles and can also improve fertility.

Semen testing is also a very important part of evaluating men for infertility. There are many ways to get this test done. Testing ranges from labs that allow you to collect a semen specimen on site versus companies that allow you to collect one in the privacy of your own home. These at-home tests include a liquid preservative, and the specimen is shipped overnight to a lab for testing. A man will want to abstain from sex for at least 3 days prior to testing to ensure accurate results.

Varicoceles are a common cause of infertility in men. These are dilated veins around the testicle inside the scrotum. They can cause pain, low testosterone and low sperm counts. Approximately 15% of men have varicoceles, but the good news is that most of them are small and do not cause issues. For the men that do have a varicocele that causes fertility issues, there is a minor outpatient surgery to correct this, and it is covered by insurance. Men cycle their sperm production every 72 days, so, unfortunately, it can often take up to 6-9 months before a man sees improvement in his semen parameters after surgical repair.

Sexual dysfunction is also a big part of infertility for men. Approximately 1 in 4 men experience sexual dysfunction associated with infertility. As time passes, the couple typically may feel increased stress and anxiety surrounding the problem. Men in this situation can often experience issues with erectile dysfunction or trouble reaching climax. This situation only compounds the couple’s infertility struggles as sex often must be scheduled and repeated around the female’s ovulation cycles. Thankfully, there are medications and counseling that can help greatly with this situation and the prognosis is very good. Low dose tadalafil or sildenafil, which are both generic and very affordable, can be extremely helpful in this situation.

It is also important to discuss lifestyle changes that can improve men’s fertility without medications or surgery. We know that obesity negatively impacts male fertility and losing weight through diet, exercise or a combination can greatly improve testosterone and sperm counts. We also know that smoking tobacco or THC (marijuana) can impair sperm production. Smoking cessation can be difficult, but it is possible. Excessive alcohol use is problematic for overall male health, but the occasional drink does not appear to hurt men’s fertility. There are also over the counter male fertility supplements that help to improve fertility. Patients must be careful to find ones that are affordable, as there is no difference in how well they work (regardless of what the bottle claims!).

Male and female infertility is an increasing problem and there are multiple factors that account for it. The obesity epidemic and environmental factors are certainly major contributors, but couples are also, understandably, delaying having children to focus on establishing their careers first. As a society, we must get better about discussing infertility, so our friends and patients are not suffering alone. Thankfully there are many things that we can do to help couples during this difficult time.

Jared Moss, MD, is a Clinical Assistant Professor of Urology at LSU Health Shreveport practicing at Ochsner LSU Health Shreveport – Regional Urology.

Dr. Moss is a fellowship-trained urologist with a focus in men’s health, male fertility, low testosterone, erectile dysfunction and sexual dysfunction. To learn more or schedule an appointment, call 318-683-0411.