Stefan Chmelik talked to India Sturgis in The Telegraph about the decline in male fertility and what can be done about it. Her article is reproduced below.
Modern medicine has long presumed fertility to be the dominion of women, a space ruled by gynaecologists and invasive procedures explained by softly pink pamphlets. But that is only half the story. Possibly even less, according to mounting evidence. Male fertility is dipping, and fast. Sperm may prove to be the greatest casualty of modern life.
Last summer, scientists at the Hebrew University of Jerusalem found that male sperm counts had fallen by almost 60 per cent in 40 years. In what was the largest study of its kind, they analysed data from 43,000 men from North America, Europe, Australia and New Zealand, taking in 185 studies from 1973 to 2011. Its lead author, Dr Hagai Levine, decreed the result an ‘urgent wake-up call’.
Sperm studies have historically been piecemeal and played second fiddle to female fertility research, but warning signs have been flashing for years. In 2012 a study of more than 26,000 French men found sperm counts fell by a third between 1989 and 2005. In the UK, a 2007 report published in the Journal of Andrology found that in one British city, sperm counts had declined by 29 per cent in 13 years between 1989 and 2002.
So, what on earth is going on? Could it be that we’re on the cusp of a major social and biological disaster? Are the stats misleading, or have we been distracted by fears of overpopulation, when in fact spermageddon – a fertility time bomb – has been sneaking up on us all along?
Stefan Chmelik, an integrated healthcare practitioner and the founder of Harley Street’s New Medicine Group, is quite clear in his predictions. ‘There are scant mainstream medical treatments for male fertility and, at current rates of sperm decline, the human race will be infertile in 50 years. I’m beginning to see IVF babies of IVF babies. While I’m certainly not judging, it’s hard not to wonder what happens when we see tenth-generation IVF children.’
He believes there are many reasons for the problem. ‘No generation of human being has ever lived under the type of stress that people are now experiencing in developed countries. We’re not stressed about not having a roof over our heads any longer – it’s about too many emails, work deadlines and home commitments. The result being your brain can’t distinguish between physiological and psychological threat and it only has one response, which is to release adrenalin’ (which has a detrimental effect on sperm production).
It’s estimated that around one in six couples have problems conceiving and, of those, the split between male and female cause is roughly 50:50. Twenty five per cent of cases of infertility in the UK are unexplained. Male infertility is a result of too few sperm being produced (a low count), poor motility (swim-ability), morphology (size and shape) or a man possessing no sperm at all, a condition known as azoospermia.
It can be caused by testicular damage, congenital defects, hypogonadism (low levels of testosterone) and ejaculation disorders, among other things. Right from the start, on a sperm’s long journey to fertilisation, the odds are against it. Out of some 200 million sperm that a man ejaculates, only about 10,000 get anywhere near a fallopian tube. To be successful, they must swim 15cm from the vagina to the egg, avoiding vaginal acids that will kill them if they’re not quick enough.
We know that lifestyle factors such as alcohol, smoking, stress, obesity and antidepressants can also act as barriers to men hoping to father a child, but there is evidence that sunscreen (containing endocrine-disrupting UV filters) and non-stick frying pans (that use poly- and perfluoroalkyl substances in the manufacturing process) may affect sperm too.
Not to mention tight pants, oestrogen in our waterways from the contraceptive pill and electromagnetic radiation from Wi-Fi routers. Recently, ibuprofen has been called into question; a study this year published in the Proceedings of the National Academy of Sciences showed that those taking high doses of the drug over long periods had disrupted production of male sex hormones.
Many are also concerned about links between male infertility and chemical additives in food, or endocrine-disrupting pesticides and industrial pollutants. Even water-based paints have been found to contain glycol ethers associated with a low-motile sperm count.
In among this cacophony of modern interference, doom and general confusion, one thing is certain: reported changes in fertility are occurring too quickly to be a direct result of genetics. In other words, they are down to our changing lifestyles and/or environment. And although this sounds alarming, it could be good news, because small changes such as reducing stress, eating a better diet of raw fruit and vegetables and less meat, giving up smoking and getting more sleep might be all that’s needed.
In East Putney, a short stroll from the Thames, sits Concept Fertility Clinic, an organisation offering ‘a unique and bespoke service’, including fertility testing, IVF, ICSI (in which an individual sperm cell is injected into an egg) and egg and sperm freezing. There is a pastel-pink wall covered in framed photographs of smiling babies successfully produced here – it’s a motivational reminder of what can be achieved with a Petri dish and a bit of luck. Business is booming.
The clinic’s medical director, Mr Kamal Ojha, a consultant gynaecologist and lecturer at St George’s Hospital specialising in subfertility, has noticed a substantial rise in ‘male factor’ walk-ins. They boast ‘probably’ the biggest ‘male production’ room in the country – a barren, forensically clean area containing only a television set, a copy of Hustler, a basin and a wipe-clean chair where visitors are left to make their deposit next to a small hatch with a bell.
The panic around the Zika virus, which can cause birth defects, during the 2016 Olympics in Brazil saw an upsurge in visitors to the clinic who wanted to freeze their sperm as a precautionary measure. More recently, they’ve had men as old as 70 enquire about sperm freezing. However, as Mr Ojha, and many others, see it, infertility starts before birth – in the mother’s womb.
‘During the first trimester of pregnancy a baby’s seminal organs are growing. At that stage, whatever you consume is going to have an impact on the foetus. That is where the damage is being done. To change that, you have to change a woman’s behaviour during early pregnancy, between six and 12 weeks.’
So it’s back to the woman again for an explanation of the problem. He cites a case in Italy where the sons of women exposed to high levels of toxic dioxins during pregnancy, as a result of an industrial accident at a pesticide-manufacturing plant in 1976, were found to have low sperm counts. Men exposed to dioxins in adulthood showed no such effect.
In Norway, a 2016 study exposed female mice to daily levels of persistent organic pollutants, equivalent to that which humans unwittingly eat. When the same mice reproduced, their offspring had a significantly lowered ability to produce sperm, and the sperm they did produce had high levels of DNA damage.
Exposure to phthalates, in food containers and wrappings, has also been shown to reduce male offspring fertility, and four years ago the Royal College of Obstetricians & Gynaecologists issued a paper recommending women avoid low-level chemical exposure and minimise the use of personal-care products such as certain shower gels. But for new guidance to be issued, hard science is needed – and this is currently lacking.
Allan Pacey, former chairman of the British Fertility Society and currently professor of andrology at the University of Sheffield, is adamant that we shouldn’t run for the hills just yet. He attributes falling sperm counts to shifting parameters and the ways that science has collected sperm over the decades, and he sees age as the decisive factor.
‘The bigger problem is couples waiting until they are older before trying for a baby. It’s rubbish that the male sperm count continues indefinitely. When a man gets older he might produce the same number of sperm but they become less good. When you leave it too long, it flushes out all manner of problems.’
Whatever Mick Jagger and Rod Stewart – who welcomed their eighth babies at 73 and 66 respectively – might have us believe, semen quality can deteriorate in the mid-20s, and a male biological clock does exist. The partners of men over the age of 40 carry a much higher risk of miscarriage, regardless of their own age, and are half as likely to get their partner pregnant as those under 25.
Older fathers are also more likely to have children with schizophrenia, autism and ADHD, which is one reason NHS regions in England can withhold access to IVF if male partners are over 40; UK guidelines suggest sperm donors should not be above that age.
‘We tend to slap older fathers on the back and yet look down our noses at older women who have children,’ admonishes Pacey. ‘We don’t think about it fairly as a society at all.’
Dr Kevin Smith, senior genetics lecturer at Abertay University in Dundee, has gone further, calling for the NHS to start freezing the sperm of 18-year-olds to counter the risks of genetic mutation later down the line.
No matter the date on your birth certificate, the emotional repercussions of male infertility can be as devastating as they are far-reaching, as 31-year-old Gareth Down knows only too well. The mechanic from Weymouth, Dorset, had been trying for a child for 18 months with his wife, Natalie, 33, before a GP told him tests showed that he had azoospermia. ‘He just phoned me at work and said, “You’ve got no sperm.” We couldn’t believe it.’
He believes it was down to an operation he had when younger to remove benign lumps on his testes, although he could have been born with no sperm. There’s no way of knowing. Over the next eight years the couple endured nine cycles of treatment, including three rounds of IVF using a sperm donor, costing tens of thousands of pounds, followed by four miscarriages.
They switched jobs to make time for hospital appointments and moved 15 miles away – far from family and newborn nieces and nephews who were too painful to see. ‘You bottle up your feelings,’ says Down. ‘You can’t help but blame yourself. Fundamentally there was nothing wrong with Natalie, so having to watch her go through all those injections, hormone treatments and procedures was awful. You think, “She wouldn’t have to go through all this if she was with someone else.”’
Down felt increasingly isolated. ‘Friends avoided the subject once they knew; they didn’t know how to broach it. Once you explain what you’re going through, they disappear. It’s not something a man can comfortably discuss unless they’ve gone through it themselves.’
To prevent the same happening to others, he has set up Men’s Fertility Support, a male-only Facebook group, and 19 months ago Natalie gave birth to a son, Reece, using IVF and donor sperm. The pressure such a diagnosis can place on a relationship is also immense. Raj Baksi, 45, a fire-safety training officer from Brighton, had been with his wife for 20 years and married for 10 before they started trying for a baby in their mid-30s.
A year passed and tests showed he had Klinefelter syndrome, a genetic disorder affecting around one in 600 men in which males are born with an extra X chromosome, which can cause infertility. ‘My wife became very depressed. She carried on, but deep down there was scarring and it had a significant impact.’
It would eventually cause such a rift between the pair that Baksi moved out, and his now ex-wife had a baby with another man. ‘It was heartbreaking. I had to end the life I knew. After lots of soul-searching, I concluded it was OK not to have children. Once I got over that, life became easier.’
Far harder to brush off, paradoxically, has been the stigma attached to male infertility. ‘People come out with the most insensitive remarks as jokes, offering me their sperm or offering to have sex with my wife. They don’t realise the impact it can have. Some men have massive anxiety and depression over this. It’s about feeling less of a man.’ Baksi, vice chair of the Klinefelter’s Syndrome Association(KSA), is now in a relationship with a woman who has an 11-year-old daughter, and is becoming used to fatherhood of a different sort.
In all of this, the disconcerting fact is how little we know about what’s really going on. Last year the World Health Organization admitted knowledge of male infertility was ‘very low’, and calls have been issued for more funding. ‘The bottom line is we don’t understand sperm,’ says Dr Sarah Martins Da Silva, a clinical lecturer in reproductive medicine specialising in subfertility investigation, at the University of Dundee.
‘We don’t know why some sperm just don’t work, and we don’t know how to treat the problem. Male fertility is a bit of an orphan, a niche area that’s not at all well funded. So, by default, couples go down the routes of IVF or ICSI treatment, which is essentially treating the woman to tackle the man’s problem. When it’s successful, it’s fantastic, but it’s a big undertaking and a medicalised way of achieving pregnancy. It would be better if we could find other ways.’
She recommends high doses of vitamin C and antioxidant-rich diets to strengthen sperm, and dreams of a magic pill that will one day be able to improve sperm count. ‘We’ve got some promising compounds but so much relies on funding. I hope in my lifetime to see major differences in treatment options available to men.’
Failing that, stem-cell research could provide the key to lab-made sperm and eggs. Last year, scientists at Cambridge created the world’s first artificial embryo using two types of mice stem cells. Still, Da Silva is hopeful for a less ethically questionable solution.
‘The tide is turning slowly. Men are being more open and honest. The more it is on the agenda, the more people realise it is a common issue and that it doesn’t need to be shameful. This is an eye-opening moment where people are realising there’s a demand for greater knowledge and treatments. There is a lot of work that needs to be done.’
Fertility by numbers
- 59.3 per cent: The decline in sperm count of Western men from 1973 to 2011, according to a study by Hebrew University of Jerusalem
- Men contribute to 50 per cent of cases of infertility
- 1 in 6 couples will experience a problem conceiving
- 15 per cent of young men across Northern Europe have a sperm count low enough to impair fertility
- 25 per cent of cases of infertility remain unexplained in the UK
- 1 in 50 babies in the UK are born as a result of IVF treatment
- A normal sperm count, according to the World Health Organization, is 15 million per millilitre or above