Why Is Male Infertility So Under-Researched?

The medical advice for infertile men is 50-years old and counting. You can bet that science wouldn't have neglected the area of research if the sufferers were women.

By Neil Lyndon: “No major subject in all of medical science is more neglected than male infertility,” said the scholar. “Treatment hasn’t advanced in 50 years. It still consists largely of general health advice – wear loose pants, don’t smoke, don’t drink, don’t be overweight.”
This man and I were chatting at a gathering for a book launch. He is one of the very few academics in the West who is researching a subject solely concerned with men. His special interest is in how individual men are affected psychologically by finding themselves involuntarily childless in middle-age when they might naturally have expected to become fathers. Intrigued by the sound of that topic, I added that I knew of no studies on the psychological effects on men finding that they were infertile. He then came out with the two statements at the top of this article. 

I was so dumbfounded that I decided to investigate. Can it be true that such an obviously important field of medical research is broadly neglected?
We are constantly being told that men’s sperm levels are falling all over the developed world. Can it be possible that not enough is being done to investigate? Can it also be true that the therapy on offer to young men today is just as primitive, just as woolly as the advice that might have been given to their grandfathers?

I asked the UK’s leading medical expert, Professor Richard Sharpe of the MRC Centre for Reproductive Health at the Queen's Medical Research Institute in the University of Edinburgh. He answered: “Yes, I do agree with those two statements – for sure, the second is completely accurate. The first [is male infertility the most neglected?] is a little more subjective, but there is no doubt that it is a very much neglected area.”
Professor Sharpe sent me two papers he had written – one for the European Molecular Biology Organization (EMBO) on “Sperm Counts and Fertility in Men: a rocky road ahead” and the second for the Royal Society on “Environmental/lifestyle effects on spermatogenesis”. Reading them delivers something like the same impact as a convincing report on climate change: “If this is right,” you hear yourself thinking, “we are all is in deep trouble and haven’t even begun to wake up to the full consequences.” 
Here’s the overall picture:
The human male is, physiologically speaking, poorly designed to create sperm but, in developed countries including the UK, sperm counts in adult men halved in the period 1930-1990. Correspondingly, the percentage of sub-fertile men doubled in the same period. The figures have continued the same pattern down to the present day. Nobody knows why.
Some people suggest that environmental factors (such as chemical and diesel pollutants) may play a role, but the evidence is slender and unconvincing. Some believe that mothers who smoke and/or drink during pregnancy may diminish their sons’ fertility in the womb; but, again, there’s no certainty. Do men's increasingly sedentary lives result in too little cool air circulating around their balls? Your guess is as good as anybody’s.
What we do know is that lots of men are in trouble with this problem. Approximately one in 6.5 couples now experiences fertility problems. Fifty per cent of the problems can be ascribed to men (low sperm count/poor sperm formation and motility). If there are, say, 10 million couples of child-bearing age in this country and one in 6.5 of the men in those couples is experiencing problems with his fertility, we are talking about more than three quarters of a million men. 
Imagine the effects on each of those men of hearing a medical diagnosis that he is incapable of fathering a child. Imagine the strains on the couples who have to come to terms with that reality. How can such a grave problem that so profoundly affects the lives of so many men remain the subject of widespread, systemic neglect?
Professor Sharpe says: “The important issue is that for many cases of female infertility there are effective treatments because a defined cause can be identified whereas for male infertility there is essentially none.
"The deplorable situation with male infertility reflects 1) our ongoing ignorance about the regulation of sperm production and what can/does go wrong, 2) under-investment on the research side, and 3) female fertility is essentially a much simpler process - one egg per month - than in the male where 100 million sperm a day may be produced.”

The problem of male in/fertility is not, of course, primarily about the emotional and psychological lives of individuals. It involves a massively serious demographic issue which touches on essential questions of social and political organisation. A major crunch is coming.
Declining birth-rate inevitably creates an imbalance between the generations, with many more older people making demands of welfare services and benefits, being supported by fewer younger people of working age. Tax revenues must shrink or taxes must rise. Pressure to fill the shortfall in the native population with immigrants must inevitably increase. The shorthand for this set of circumstances spells big trouble.
As Professor Sharpe told me: “The bottom line is that the high prevalence of low sperm counts amongst young men can only ensure that more couples will experience fertility problems today and for the forseeable future, simply because the men are trying to initiate conception with older women who themselves are undergoing with age-related declining fertility.” 
If a woman in her twenties wants to get pregnant, she has an 80pc chance of succeeding. That figure drops to 50pc for women in their 30s. So many women are now deferring motherhood that, just this week, it was reported that more women over 35 than in their 20s are trying to get pregnant. Every one of those women may have sound career/lifestyle reasons for deferring motherhood but they are giving themselves dramatically reduced chances of success.
Perhaps the answer to men’s problem might be more actively sought if it were seen to a women’s problem. If the “victims” of male in/fertility were declared to be women, the world might promptly pull out its finger.
As Professor Sharpe says: “Infertile women would stand up to be counted and to demand treatment. Infertile men will just go out drinking!” 

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