Current global status of male reproductive health

Abstract

Background: The widespread interest in male reproductive health (MRH), fueled by emerging evidence, such as the global decline in sperm counts, has intensified concerns about the status of MRH. Consequently, there is a pressing requirement for a strategic, systematic approach to identifying critical questions, collecting pertinent information, and utilizing these data to develop evidence-based strategies. The methods for addressing these questions and the pathways toward their answers will inevitably vary based on the variations in cultural, geopolitical, and health-related contexts. To address these issues, a conjoint ESHRE and Male Reproductive Health Initiative (MRHI) Campus workshop was convened.

Objective and rationale: The three objectives were: first, to assess the current state of MRH around the world; second, to identify some of the key gaps in knowledge; and, third, to examine how MRH stakeholders can collaboratively generate intelligent and effective paths forward.

Search methods: Each expert reviewed and summarized the current literature that was subsequently used to provide a comprehensive overview of challenges related to MRH.

Outcomes: This narrative report is an overview of the data, opinions, and arguments presented during the workshop. A number of outcomes are presented and can be summarized by the following overarching themes: MRH is a serious global issue and there is a plethora of gaps in our understanding; there is a need for widespread international collaborative networks to undertake multidisciplinary research into fundamental issues, such as lifestyle/environmental exposure studies, and high-quality clinical trials; and there is an urgent requirement for effective strategies to educate young people and the general public to safeguard and improve MRH across diverse population demographics and resources.

Limitations reasons for caution: This was a workshop where worldwide leading experts from a wide range of disciplines presented and discussed the evidence regarding challenges related to MRH. While each expert summarized the current literature and placed it in context, the data in a number of areas are limited and/or sparse. Equally, important areas for consideration may have been missed. Moreover, there are clear gaps in our knowledge base, which makes some conclusions necessarily speculative and warranting of further study.

Wider implications: Poor MRH is a global issue that suffers from low awareness among the public, patients, and heathcare professionals. Addressing this will require a coordinated multidisciplinary approach. Addressing the significant number of knowledge gaps will require policy makers prioritizing MRH and its funding.

Study funding/competing interests: The authors would like to extend their gratitude to ESHRE for providing financial support for the Budapest Campus Workshop, as well as to Microptic S.L. (Barcelona) for kindly sponsoring the workshop. P.B. is the Director of the not-for-profit organization Global Action on Men's Health and receives fees and expenses for his work, (which includes the preparation of this manuscript). Conflicts of interest: C.J.D.J., C.L.R.B., R.A.A., P.B., M.P.C., M.L.E., N.G., N.J., C.K., AAP, M.K.O., S.R.-H., M.H.V.-L.: ESHRE Campus Workshop 2022 (Travel support-personal). C.J.D.J.: Cambridge University Press (book royalties-personal). ESHRE Annual Meeting 2022 and Yale University Panel Meeting 2023 (Travel support-personal). C.L.R.B.: Ferring and IBSA (Lecture), RBMO editor (Honorarium to support travel, etc.), ExSeed and ExScentia (University of Dundee), Bill & Melinda Gates Foundation (for research on contraception). M.P.C.: Previously received funding from pharmaceutical companies for health economic research. The funding was not in relation to this work and had no bearing on the contents of this work. No funding from other sources has been provided in relation to this work (funding was provided to his company Global Market Access Solutions). M.L.E.: Advisor to Ro, Doveras, Next, Hannah, Sandstone. C.K.: European Academy of Andrology (Past president UNPAID), S.K.: CEO of His Turn, a male fertility Diagnostic and Therapeutic company (No payments or profits to date). R.I.M.: www.healthymale.org.au (Australian Government funded not for profit in men's health sector (Employed as Medical Director 0.2 FET), Monash IVF Pty Ltd (Equity holder)). N.J.: Merck (consulting fees), Gedeon Richter (honoraria). S.R.-H.: ESHRE (Travel reimbursements). C.N.: LLC (Nursing educator); COMMIT (Core Outcomes Measures for Infertility Trials) Advisor, meeting attendee, and co-author; COMMA (Core Outcomes in Menopause) Meeting attendee, and co-author; International Federation of Gynecology and Obstetrics (FIGO) Delegate Letters and Sciences; ReproNovo, Advisory board; American Board of Urology Examiner; American Urological Association Journal subsection editor, committee member, guidelines co-author Ferring Scientific trial NexHand Chief Technology Officer, stock ownership Posterity Health Board member, stock ownership. A.P.: Economic and Social Research Council (A collaborator on research grant number ES/W001381/1). Member of an advisory committee for Merck Serono (November 2022), Member of an advisory board for Exceed Health, Speaker fees for educational events organized by Mealis Group; Chairman of the Cryos External Scientific Advisory Committee: All fees associated with this are paid to his former employer The University of Sheffield. Trustee of the Progress Educational Trust (Unpaid). M.K.O.: National Health and Medical Research Council and Australian Research Council (Funding for research of the topic of male fertility), Bill and Melinda Gates Foundation (Funding aimed at the development of male gamete-based contraception), Medical Research Future Fund (Funding aimed at defining the long-term consequences of male infertility). M.H.V.-L.: Department of Sexual and Reproductive Health and Research (SRH)/Human Reproduction Programme (HRP) Research Project Panel RP2/WHO Review Member; MRHI (Core Group Member), COMMIT (member), EGOI (Member); Human Reproduction (Associate Editor), Fertility and Sterility (Editor), AndroLATAM (Founder and Coordinator).

Keywords: andrology; contraception; economics; education; epigenetics; fertility; genetics; male infertility; male reproductive health; policy.

Figure 1.

The impact of global prosperity on human fertility. As nations become more socio-economically developed, primary healthcare improves, infant mortality rates decline and family sizes decrease. In parallel, women use the freedom they have gained from the reduction in family size to become educated and pursue a professional career. This frequently leads to a delay in initiating a family, which further compromises fertility owing to advanced maternal age. In parallel, the increased urbanization associated with modern industrialized societies further challenges our fertility, as a result of the increased availability of contraception, the decline in available living space and the increased cost of housing and child raising. In the longer term, the environmental pollution associated with urban living impacts fertility, reducing sperm counts and increasing the risk of miscarriage and stillbirth. Such pollutants, as well as the global increase in paternal age at conception, may also increase both the genetic, epigenetic, and mutational load carried by the offspring. Finally, in modern societies that have gone through the demographic transition, there is no longer intense selection pressure for high-fertility genes, with the result being that human fertility will inevitably decline. Furthermore, the increasing use of medically assisted reproduction preserves poor fertility genes in the population. This complex interplay of social, economic, cultural, and biological factors is serving to drive down global fertility rates in our species to below replacement levels. These trends will carry long-term implications for governments, national health service providers, and the populace at large. GDP, gross domestic product.

Figure 2.

Targets of contraception in the male reproductive tract. Schematic of the male reproductive system showing the main targets areas for novel contraceptive approaches (red text and arrows), specifically the endocrine approach resulting in suppression of GnRH and LH/FSH, approaches targeting spermatogenesis, and post-testicular approaches targeting the epididymis and vas deferens. Adapted from Reynolds-Wright JJ, Anderson R. BMJ Sex Reprod Health. 2019; 45: 236–242.

Figure 3.

Results of the Male Reproductive Health Initiative questionnaire about male infertility. In a 1-year period, 1171 men aged 20–59 years responded to the questionnaire. Collectively, men 30–39 (60.8%) and 40–49 (23.9%) years of age made up 85% of the age demographic. Patients responded to: how they feel about their infertility; what motivated them to seek health care; how likely are they to talk with others about their infertility; their awareness of male infertility support groups; what their primary source for information is regarding male infertility; and has an infertility specialist recommended herbal supplements to you as a treatment for your infertility? The questionnaire remains open to collect data and can be accessed using the following link: https://fertilityeurope.eu/male-infertility-questionnaire-participate-now/.