Call for global action to address declining male fertility

Urgent, global action is needed to address male infertility, according to a new report from an international consortium.

Writing in Nature Reviews Urology, the experts have called for governments and health systems to acknowledge that male infertility is a common and serious medical condition that may be increasing worldwide.

The Male Reproductive Health Initiative – a working group of the European Society for Human Reproduction and Embryology – commissioned 26 experts from Australia, Argentina, Canada, China, Denmark, Germany, Italy, Spain, the UK and USA to produce the evidence-based roadmap that identifies key knowledge gaps, barriers, and opportunities for researchers, governments, healthcare systems, and public education.

The report, the first of its kind, says patients have a right to meaningful diagnoses and targeted treatments, but these are currently unavailable in most cases due to inadequate funding, research gaps, and non-standard clinical practices.

Among its recommendations are: the creation of a global “biobank” of tissues and clinical data from men, and their partners and children to help researchers understand genetic and environmental causes of infertility; routine offer of genomic sequencing and better diagnostic tests to men to help them understand why they are having difficulties fathering a child; and the rigorous tests of the impacts on men and boys of compounds such as endocrine-disrupting chemicals in everyday consumer products, the workplace, and the general environment.

Lead author Professor Moira O’Bryan, from the University of Melbourne, Australia, said: “Urgent, worldwide action to implement our recommendations is critical.

“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.”

Co-author Professor Allan Pacey from the University of Manchester, UK, added: “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.

“In this paper our working group has proposed its top 10 recommendations which it hopes can help kick-start research and education in male reproductive health around the globe.”

Prof O’Bryan said the report also highlights that men and their partners deserve more support.

“By the time they seek medical advice, men experiencing infertility are often in emotional distress, which is made worse when their doctor can’t determine the cause nor offer any treatment,” she said.

“For most infertile men, the cause of their infertility is unknown. When it is known, few targeted treatments exist. Globally, the huge economic and social burdens of male infertility are not well appreciated. The cost of treatments and the impacts of infertility on mental health, relationships, and productivity are enormous.”

Frequency, morbidity and equity — the case for increased research on male fertility. Nature Reviews Urology 12 October 2023


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