Male Infertility: The West's Hidden Pandemic

Across the Western world, the number of men unable to have children without medical intervention is growing. Health specialists are raising the alarm and scientists are struggling to find the cause, while politicians are ignoring the issue.

Male infertility is rising at an alarming rate and research in the Western world
Benedikt Schwan

BERLIN — For many people, having a child signifies the hope, or perhaps even the certainty, that life will continue even after they are dead. Many men find it difficult to come to terms with discovering that they are infertile, it can make them feel they've lost a part of their future. In Germany, hundreds of thousands of men are affected.

Male infertility is both a hidden and a modern pandemic. In many countries across the Western world, the concentration of sperm cells is decreasing, a phenomenon that has resulted in a declining birth rate and increased demand for fertility treatment. But little is known about the causes of this change — and there is not enough research being done in the area. Politicians have also not been paying attention to this growing problem.

Men's sperm count in Western countries has dropped by 52%.

When a couple is having trouble conceiving, doctors traditionally assume the issue lies with the woman. Fertility clinics are almost exclusively geared toward women, who are prescribed hormones and subjected to invasive procedures, taking on the lion's share of the treatment. For many men, all they have to do is provide sperm and, if that doesn't work, a sperm donor can be found.

However, it has been clear for some years now that the problem often actually lies with the man's fertility —or lack of. In 2017, Israeli epidemiologist Hagai Levine gave the world of fertility a big wake-up call. Levine and his team brought together numerous studies carried out since the 1970s, which collected data on sperm count and health through so-called spermiograms: 185 studies with 244 evaluations of the concentration and total number of sperm cells provided enough good data for the team to carry out a valid statistical analysis. The results were shocking: Over the last four and a half decades, men's sperm count in Western countries has dropped by 52%.

Problems sometimes begin in the womb

The search for the cause of this dramatic drop is complicated. Levine speculates that for a long time now people in the West have been exposed to the chemical revolution: pesticides, plastics and other potentially harmful substances are everywhere.

Sometimes problems begin in the womb, where the organs responsible for producing semen fail to develop properly. This has far-reaching consequences, not only in terms of fertility. Levine refers to studies that have shown infertile men are more likely to get cancer. But little is known about any direct connection between the two. Levine advises all those affected to have regular check-ups.

A recent study by Italian researchers has suggested that worldwide around 7% of men of reproductive age are infertile. In over half of cases where a couple is experiencing difficulties conceiving, the problem now lies at least partially with the man. According to experts, this is only the tip of the iceberg, as there has not been enough data collected about the issue.

Across the Western world, the concentration of sperm cells is decreasing — Photo: Bobjgalindo

In Germany, there are still no reliable statistics about how widespread male infertility is, as men don't go for regular check-ups. There are no systematic examinations of boys as they enter puberty. A simple spermiogram could show how many men are producing too few or no sperm cells. But since military service was abolished, and men no longer have to undergo medical examinations as standard, it's rarer for doctors to identify abnormalities in men's sex organs or other physiological problems.

Frustratingly, many of those affected could be helped, if the reduced fertility that often accompanies certain diseases was discovered and treated earlier.

The cause is often never identified

There is one widespread form of male infertility that is the subject of research in Germany: azoospermia. This is when there is no sperm present in an ejaculation, meaning that affected men cannot fertilize an egg. In many cases, the cause is never identified. It may be hereditary, or have physiological causes.

Frank Tüttelmann, a reproductive geneticist at the University of Münster, has carried out a wide-ranging study in the area, seeking to identify genes that could be responsible for male infertility. Tüttelmann says it's a relief for men if they find out the possible cause.

Men can be very affected when they discover that they have reduced fertility. "Many say that they don't feel like real men if they can't have children," says fertility therapist Petra Thorn. She often hears them say things like, "I'm worried that other people will question my masculinity and my sexual potency."

Thorn is one of very few specialists in male infertility. She has a practice in Frankfurt and says men often find it difficult to come to terms with their infertility.

It seems unlikely that there will be a better understanding of the causes any time soon. In the summer of 2020, a group of respected German experts in reproductive health presented a call to arms: the Essen Manifesto, calling for the German government to allocate sufficient funds to research in this area so that they can establish the causes of rising infertility. However, the funds have not been made available so far. "We are greatly concerned to see that the number of research posts specializing in clinical reproduction and reproductive health is being reduced."

Without research, we can't gain a better understanding of the problem.

The number of university-based fertility clinics that combine treatment and research is also decreasing. Last year the Aachen University Clinic was shut down. Fertility clinics are often privately run — but, although they offer treatment, they don't conduct research. According to the Essen Manifesto, there is little awareness of reproductive health among the general public, certainly far less than its importance in society would merit.

Professor Jörg Gromoll from the Centre of Reproductive Medicine and Andrology at the University of Münster, who is one of the manifesto's main authors, says there is a further problem: The assisted conception techniques currently in use are an ongoing experiment "whose consequences will only become clear over the next few generations." These techniques and medicines are no longer subject to independent scientific evaluation. Fertility clinics see their purpose above all as helping couples to conceive. They don't research the causes of infertility. Without research, Gromoll says, we can't gain a better understanding of the problem.

There's an urgent need to strengthen university research into reproductive health in Germany. According to Gromoll, scientists have made an initial approach to health ministers, who did not seem to have any awareness of the issue. "There is both a big communication problem and an awareness problem."

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La Sagrada Familia Delayed Again — Blame COVID-19 This Time

Hopes were dashed by local officials to see the completion of the iconic Barcelona church in 2026, in time for the 100th anniversary of the death of its renowned architect Antoni Guadí.

Work on La Sagrada Familia has been delayed because of the pandemic

By most accounts, it's currently the longest-running construction project in the world. And now, the completion of work on the iconic Barcelona church La Sagrada Familia, which began all the way back in 1882, is going to take even longer.

Barcelona-based daily El Periodico daily reports that work on the church, which began as the vision of master architect Antoni Gaudí, was slated to be completed in 2026. But a press conference Tuesday, Sep. 21 confirmed that the deadline won't be met, in part because of delays related to COVID-19. Officials also provided new details about the impending completion of the Mare de Déu tower (tower of the Virgin).

El Periódico - 09/22/2021

El Periodico daily reports on the latest delay from what may be the longest-running construction project in the world.

One tower after the other… Slowly but surely, La Sagrada Familia has been growing bigger and higher before Barcelonians and visitors' eager eyes for nearly 140 years. However, all will have to be a bit more patient before they see the famous architectural project finally completed. During Tuesday's press conference, general director of the Construction Board of the Sagrada Familia, Xavier Martínez, and the architect director, Jordi Faulí, had some good and bad news to share.

As feared, La Sagrada Familia's completion date has been delayed. Because of the pandemic, the halt put on the works in early March when Spain went into a national lockdown. So the hopes are dashed of the 2026 inauguration in what would have been the 100th anniversary of Gaudi's death.

Although he excluded new predictions of completion until post-COVID normalcy is restored - no earlier than 2024 -, Martínez says: "Finishing in 2030, rather than being a realistic forecast, would be an illusion, starting the construction process will not be easy," reports La Vanguardia.

But what's a few more years when you already have waited 139, after all? However delayed, the construction will reach another milestone very soon with the completion of the Mare de Déu tower (tower of the Virgin), the first tower of the temple to be completed in 44 years and the second tallest spire of the complex. It will be crowned by a 12-pointed star which will be illuminated on December 8, Immaculate Conception Day.

Next would be the completion of the Evangelist Lucas tower and eventually, the tower of Jesus Christ, the most prominent of the Sagrada Familia, reaching 172.5 meters thanks to an illuminated 13.5 meters wide "great cross." It will be made of glass and porcelain stoneware to reflect daylight and will be illuminated at night and project rays of light.

La Sagrada Familia through the years

La Sagrada Familia, 1889 - wikipedia

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