Male fertility is broken down by the ejaculate. This is broken into the overall mass and the concentration of the mass of ejaculate, and the motility or activity profile of the spermatozoa, namely are they moving around actively or listlessly floating. Male fertility also makes up around a third of the causes of infertility issues in couples, while a further thirty percent are a mix of both male and female infertility.
Male fertility issues are considered as an overall good biomarker for an individual's health. If a male has a low sperm count, they are often found to have an increased risk of having or developing other health conditions. As well, the age-related decline of male-fertility sees contraception with a male partner over 45 leading to increased risk of miscarriage and an increased risk of children born with neurological disorders, even with a younger partner.
The growing awareness around male fertility has seen startups come to develop products and make fertility more accessible and affordable.
As a cause for concern, studies done in 1992 by Carsen et al., and a 2017 literature review have suggested a decline in overall sperm counts for males living in North America, Europe, Australia, and New Zealand (males studied in South America, Asia, and Africa showed no significant trend in sperm counts). The 2017 study was a systematic review and analysis for trends in sperm counts measured by sperm concentration and sperm count based on semen samples provided by 42,935 men from 1973 to 2011. The study showed a decline in sperm count and total sperm count of 1.4 percent per year with an overall decline of 52.4 percent between 1973 to 2011.
The decline in sperm count has been linked to multiple causes. The trend has been seen as generational, which has lead to the suggestion that the decline is linked to lifestyle, including diet, exercise, and stress factors.
There are suggested environmental components, including the potential link between phthalates - which are in products such as flexible plastics, industrial solvents, and personal care products - and decreased genital size in baby boys; the link between chemical ultraviolet light filters often found in sunscreen products and their disruptive effect on sperm function; the use of pesticides which have been suggested to directly damage spermatozoa, alter cell function, and disrupt the endocrine function in any stage of hormonal regulation; and there has been a suggested link between estrogen-led decline in sperm count, however there is little evidence for this in studies performed.
The 1992 paper by Carlsen et al. has been criticized by D J Handelsman in his study on the possible impact of estrogen in falling sperm counts. D J Handelsman found this study had flaws, including heterogeneity of component studies and a data analysis based on arithmetic mean rather than median, which did not show significant changes over time.
Further, Allan Pacey, a professor of andrology at the University of Sheffield and advisor to Legacy (a sperm testing company), is skeptical about the claims of declining sperm counts based on possible bias, improved study techniques, and an improved understanding of the margins of error since those studies have been conducted. Further, Allan Pacey has pointed out that the decline is from normal to normal, meaning concentration levels have gone from 99m sperm a milliliter to 47m, and anything above 20m is fine.
Male fertility testing works to test the concentration and motility in male ejaculate. In the case of fertility issues in couples, the National Health Service (NHS) in the United Kingdom suggests 40 percent of infertility cases are caused by male infertility. Further surveys done by the NHS have found 42 percent of British men had concerns about fertility, but only 18 percent of those men with concerns considered a test. The suggestion from these studies is that either men prefer women to take fertility firsts, as often fertility issues are framed as a women's issue, or they face a stigma around traditional fertility clinics.
Companies such as Legacy, Dadi or ExSeed offer at-home testing kits to help with the stigma around visiting fertility clinics. A lot of the home testing kits are also less expensive than those provided by fertility clinics. In the case of ExSeed, they offer a mail-order test which a user can operate with their phone. The company compares the sperm sample against a database of sperm samples and provide an analysis and a further personalized program for improving the users sperm count and motility. ExSeed is capable of offering at-home analysis through the same software used at andrology labs with a correction algorithm and an optical optimization algorithm to draw the data from the phone.
Whereas Legacy and Dadi offer a more traditional version of sperm collection, with a kit sent to a persons home to collect a sperm sample, and the kit is returned to the company for a full fertility report and both offer further fertility lifestyle recommendations based on the sperm. However, neither Dadi nor Legacy are able to offer what is legally considered medical advice, and in the case of results which indicate a problem, the companies refer those customers to fertility specialists.
While increased fertility testing for men is considered a benefit by the larger medical community, there are still some questions about how much sperm concentration affects fertility among men. And in the traditional fertility clinics, the results of male fertility assessments can vary greatly between clinics. To try and solve this problem, Mojo Diagnostics is developing a computer vision tool to automate sperm analysis and improve the overall analysis.
The majority of semen analysis is done through microscopic inspection and computer-assisted semen analysis (CASA). But the available tests for male fertility can, but do not necessarily, include sperm penetration assays, perm agglutination, oxidative stress analysis, and DNA fragmentation technique. Those latter techniques are generally performed through fertility clinics and andrology labs.
Another area of growth in the male fertility market is sperm freezing. Doctors traditionally have traditionally suggested sperm banking to men with specific complications that could impact fertility, including:
- Those going through cancer treatments
- Those about to have a vasectomy
- Those going through gender reassignment surgery
- Those on certain forms of medication (including SSRI-type antidepressants, anti-epileptics, and anti-diabetics)
- Those working with pesticides, plastics, and heavy metals
- Those sitting for long periods in confined spaces (such as taxi drivers or long-haul truck drivers)
- Those with general health problems from alcohol, recreational drugs, poor diet, and sedentary lifestyle
Sperm freezing is also being marketed towards those men who know they want to have children, but do not necessarily want children in their twenties or thirties, similar to women freezing their eggs. Studies have shown that when a male partner is over 45 years the risk of miscarriage is twice as high and there is an increased risk of children being born with neurological disorders, even when the partner is much younger. Sperm freezing is being promoted as a solution to all of these problems.
Doctors have suggested that males outside of the communities of men with conditions which put their fertility at-risk do not need to freeze their sperm, nor that sperm freezing is a solution to all of these problems. Allan Pacey, professor of andrology at the University of Sheffield and advisor to Legacy, also points out that frozen sperm will not remain intact over time, but that often it can be depleted and most who freeze their sperm will end up relying on in vitro fertilization and other assisted reproductive technologies.
For those who find they are dealing with fertility issues, companies offer supplements, training programs, and other products to help increase fertility over the 72 day sperm cycle. Many of the fertility testing companies offering at-home kits, along with offering sperm freezing and storage services, they offer supplements to help increase male fertility, as well as supplements for hair loss, overall health, and erectile dysfunction.
Companies offering sperm analysis often offer lifestyle advice for increasing the total sperm count, also known as sperm training programs. A lot of these programs include drinking less alcohol, exercising more often, stop smoking, eat a healthier diet, vitamin supplements, ensuring a person is not sitting for long periods of time, and keep the temperature of their genitalia cooler to support the sperm production. Beyond these general advice points, any further analysis into the problems in a persons sperm and medical advice into what can be done to increase the sperm count and motility are directed towards healthcare and fertility clinics.
There is also a growing market for companies selling new products to help with fertility issues and erectile dysfunction. Coolmen is one such company, developing wearable technology which is attached to the testicles to cool them down for eight hours a day and help promote healthy sperm production. Comphya, a Swiss company, is developing an implanted neuro-simulator in the pelvic cavity, switched on and off by a remote, for those for whom Viagra and other oral treatments do not work. And a company such as CDLP develops men's underwear intended to breathe and cool the genitalia although not specifically for the purpose of increasing male fertility.
A more lab and clinic focused part of male and female fertility technology, assisted reproductive technology includes any technology used to treat fertility. Most of these treatments include the handling of both a female's egg and a male's sperm and mixing them to make embryos which are returned to the female's body. In vitro fertilization (IVF) is the most common and effective type of assisted reproductive technology. Some companies, such as Baby Home Kit, offer assisted reproductive products for use at home to help couples conceive; though this is a small segment, with most procedures still done in clinics and still very expensive.
Compared to the range of options that are available to women, there have been very few developments in the area of male contraceptives. As of 2021, there are only two contraceptive methods that are available to men: condoms—a barrier form of contraception that stops sperm from reaching and fertilizing an egg, and a vasectomy—a small but usually permanent surgical procedure that stops sperm from reaching the ejaculated semen.
Male contraceptive researchers are optimistic that a safe, effective and nonpermanent pill method could one day become a reality. One such pill-based method currently being researched is dimethandrolone undecanoate (DMAU), a once-daily pill that works by suppressing two types of male hormones: follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones simultaneously decrease production of testosterone without causing symptoms of low-testosterone. While DMAU is not currently available for use by the public, the pill passed the first round of clinical testing in 2019.
Other proposed male contraceptive methods being studied include a gel method that could feasibly lower testosterone to levels that could prevent pregnancy while not interfering with sex drive or libido. In June of 2020, UC Davis Health began clinical trials on a reversible male contraceptive gel study funded by the National Institutes of Health (NIH). The gel, which had advanced to Phase 2 testing, was developed by the Population Council and NIH's Eunice Kennedy Schriver National Institute of Child Health and Human Development (NICHD).
