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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