A ground-breaking study into current levels of male fertility has been undertaken by fertility specialists at IVI. It used the largest sample of men ever studied to date in world scientific literature. Its findings confirm what many people have suspected for some time on the basis of anecdotal evidence, and what fertility specialists working in the field have also feared was the case: that there has been a dramatic increase in levels of male infertility. The findings of the research, led by IVI Fellow Dr. Ashley Tiegs, is considered of such significance that it received the Academic Award of the Society for Male Reproduction and Urology, presented at the last edition of the ASRM, the American Society of Reproductive Medicine, held in Denver last October. In this IVI blog article, we look at the research outcomes and explore the implications arising from its findings.

What are the key findings of the IVI research into semen quality?

In summary, this study shows that the proportion of men at risk of requiring fertility treatment has increased significantly in recent years, from 12.4% in 2004 to 21.3% in 2017. This represents a 9% rise in a little more than a decade, a sudden increase that represents an alarming development in male infertility. The title of the research was “Total motile sperm count trend over time across two continents: evaluation of semen analyses from 119,972 infertile men”. It examined the total mobile sperm count (TMSC) – which is the most important parameter that predicts the probability of achieving a pregnancy – of men treated in IVI clinics spread between Spain and the United States over different periods of time in 2002- 2017.

In detail, the study method used by Dr Tiegs in her research consisted of dividing the data obtained from the sample of men into three groups. These comprised the following: men with TMSC greater than 15 million sperm per millilitre, a level that would not normally require a fertility treatment in itself; men with TMSC between 5 and 15 million, who could be at risk of requiring a simple type of assisted fertility treatment such as artificial insemination; and the final group of men with TMSC of fewer than five million, who could require assisted reproduction treatment in the form of In Vitro Fertilisation (IVF), possibly in tandem with intracytoplasmic sperm injection (ICSI), to achieve a pregnancy.

What is IVI’s role in furthering scientific research?

IVI has long taken a leading role in advancing scientific knowledge and techniques in the fields of fertility, infertility and fertility treatments. The multidisciplinary team in place at our assisted reproduction clinics is composed of highly specialised professionals whose role is the furtherance of knowledge in the field of reproduction as well as in the application of the latest techniques. This latest research into male fertility and declining sperm quality is only the latest achievement in a long history of award-winning research. IVI professionals have been awarded some of the most prestigious awards in the sector. Prominent among these are seven awards from the American Society for Reproductive Medicine, the 2002 award from the Society for Gynaecological Investigation and the Ares Serono Research Award.

In relation to this work, Dr. Nicolás Garrido, director of the IVI Foundation and co-author of the study, explains why IVI is so well placed to take this work forward. “We have a large amount of information related to infertile patients, which has allowed us to demonstrate, improving on the findings of previous studies, that this decrease in the seminal quality implies clinical connotations that have an evident effect on male fertility, which forces us to use more complex treatments to fulfil the needs of our patients, ” he explains. In layman’s terms, this simply means that in the future, unless the rising trend in male infertility is halted or reversed, there will be an increasing need for interventions. This means assisted fertility techniques at either a simple or more highly technical level.

What are the causes of declining male fertility?

This, of course, is the inevitable question that arises from the research results. The simple answer is that as yet we don’t know the exact reasons, although there is a widely held assumption that environmental and lifestyle factors are likely to play a significant role. Dr. Garrido explains:

“There is a lot of research about the adverse effects of toxic lifestyle and constant exposure to negative environmental influences on sperm quality, but it is not yet known exactly how harmful these factors are. Given that the causes of this declining trend of TMSC remains speculation, a continuous and more accurate study of these factors is required, which can negatively affect sperm quality.” In other words, more research is needed before we can be sure, but in the meantime, it would seem sensible for any man intending to become a parent to pay attention to lifestyle factors and healthy living. You probably don’t need us to tell you, but these centre around good diet, adequate exercise and sleep, and avoiding harmful substances like those present in cigarettes, alcohol and recreational drugs.

How should men check their fertility level?

Male infertility now represents half the cases treated by assisted reproduction clinics. This fact, together with the apparent decrease in the quality of semen in recent years, is our starting point. There are home sperm testing kits, but these only give a general picture of quantity, and in many cases do not give any information on the other crucial factor, sperm motility. This is why the study undertaken by IVI is so important; its sperm test measured the total mobile sperm count rather than being just a qualitative test. The best option if you need a sperm test is to get it done professionally in a fertility clinic. This is where a sample of your semen is analysed in a laboratory to check the quality and quantity of the sperm. The results are usually available within a week. If the results are abnormal, the test should be repeated to double-check them.

What treatments are available for men experiencing male infertility?

In addition to healthy lifestyle factors, what are the remedial options in cases where sub-fertility or low fertility is diagnosed? At IVI, in addition to identifying the problems, our work is focused on providing solutions. The main interventions which would be appropriate depending on whether the man has low, moderate or severe male factor infertility are artificial insemination, In Vitro Fertilisation (IVF) or IVF including the technique of ICSI: Intracytoplasmic Sperm Injection.

• Artificial Insemination

This is the simplest of all assisted reproduction techniques and is recommended for couples in which the man has slight or moderate defects in his semen in terms of concentration or motility. The objective of artificial insemination is to respect the natural environment of the gametes as much as possible, thus promoting fertilisation. This technique consists of depositing a semen sample, which has been prepared in advance in the laboratory, inside the woman’s uterus in order to increase the potential of the sperm and improve the chances of the egg being fertilised. You can see the video about artificial insemination on our IVI YouTube channel for a full explanation of how this works.

• In Vitro Fertilisation (IVF)

In Vitro Fertilisation (IVF) involves joining an egg with sperm in the laboratory – in vitro – in order to obtain fertilised embryos to be transferred to the mother’s uterus for gestation. It is often used in cases where a sperm test has indicated severe male factor infertility, because it allows a sperm sample to be prepared in the laboratory and the most viable sperm to be selected. In conventional IVF, an oocyte surrounded by prepared spermatozoa is placed in a culture plate; they are mixed together to encourage fertilisation to take place.

• Intracytoplasmic Sperm Injection (ICSI)

This technique is an additional step within the conventional IVF procedure. It is recommended in cases of severe male infertility to enable fertilisation. ICSI consists of extracting a spermatozoon from a sample of semen or by means of a testicular biopsy to select the most promising sperm. A single sperm is then injected, without causing any damage, into the oocyte. In this way ICS allows the egg and the sperm to be brought together directly, facilitating fertilisation. A sperm that has low motility or poor morphology would have greater difficulty achieving this naturally or through the technique of standard IVF. The IVI video about IVF and ICSI explains the technique.

Finding out more about options available for treatment at IVI

Our research has shown that one in five men are at risk of requiring fertility treatments. If you are or your partner is one of those affected, you are not alone; this is an issue which gives cause for concern to a wide range of people. We would encourage you to browse our website which always has the most up-to-the-minute information on treatments, techniques and results to familiarise yourself with your treatment options. It’s also a good idea to talk to your partner, family and friends about the issue; you’ll almost certainly find further reassurance that your experience is far from unusual.

When you feel ready, contact us at IVI for your first appointment. You can complete our online contact form, or give us a call on 08 000 850 035 from the UK or on +34 960 451 185 from other countries.