‘Sperm count decline is a “global crisis” threatening humanity.’
As I read this headline last year, I felt an all-too familiar existential dread.
I thought it was climate change, Covid-19 or some sort of cosmic collision that would bring about the end of humankind. But now it seems like doomsday is all in the palm of my hand – literally.
So how did it come (no pun intended!) to this?
According to a recent study, 53 countries reported declining sperm counts, but especially in North America, Europe and Australia, where there’s a 50-60% drop. This means that between 1973 and 2018, the average global sperm concentration fell from an estimated 101.2 million sperm per millilitre to just 49 million.
As for why this is happening, the study’s lead, Professor Hagai Levine, pointed to other research looking at ‘chemicals in the environment’ and ‘lifestyle choices’, like smoking, alcohol, weight and poor diet. Age plays a factor too – after turning 40.
He added: ‘We have a serious problem on our hands that, if not mitigated, could threaten mankind’s survival.’
As a result of people having babies later in life (for example, the average age for first-time mothers was 23.9 in 1973, compared to 29.1 in 2020), the fertility industry is booming.
But when it comes to conversations around the issue, Dr Gill Lockwood – fertility specialist at Fertility Family – believes women often unfairly bear the brunt of the burden.
‘After centuries in which it was assumed that infertility was a “female problem”, we now finally recognise that infertility is a shared problem,’ she tells Metro.co.uk, pointing out that it’s actually much more equal between the sexes. A third of infertility cases are caused by male reproductive issues, another third by female, and the last third by both male and female causes or by unknown factors.
To put that into perspective, an estimated 3.5 million Brits have a known fertility problem – affecting roughly one in seven couples.
As a result of this data, Dr Lockwood says more men are coming forward for fertility testing – especially from home test kits.
According to the NHS, testing for women can include a blood test to check progesterone levels (ovulation), a chlamydia test, an ultrasound, an X-ray and a laparoscopy (keyhole surgery to examine the reproductive organs).
But for men, the options are a lot more straightforward – a semen analysis and chlamydia test.
As for why this upward trend of testing is happening, Dr Lockwood explains: ‘Male partners may not feel subject to the same relentless tick of the biological clock, but “40 is the new 30” does not apply to biology. The end of lockdown, a significant re-appraisal of work-life balance and a shift to work from home have led many couples to reconsider the feasibility of starting a family.’
That’s certainly true for me. Hitting 30 during the pandemic, I started to really wonder about my own fertility.
Sure, I’d always seen myself having children in the future. As a married gay man, I was open to any and all possibilities – surrogacy, adoption and even IVF then co-parenting with another couple – but it didn’t really cross my mind that my own body could be the reason this wouldn’t happen.
I’m also one of five children in my family so my parents didn’t seem to have a problem with conceiving. I’m fairly active, eat healthily as a vegetarian, and I only really smoke on the odd night out with a few drinks – surely that wouldn’t have a huge negative effect?
Intrigued by what the answer could be, I decided to find out via London’s Lister Fertility Clinic.
I was sent a questionnaire about my medical history and lifestyle factors that could affect sperm quality, like whether I’d had previous infections, a child or been in hospital. I was also informed how to prepare for the sample collection, including refraining from sex for three days beforehand. A reasonable enough request.
Then I arranged for the sample to be collected – on an extended lunch break a few days later, which felt slightly seedy walking out of the office and telling a select few what I was about to do.
When I arrived, I was shown to a typical waiting room with pamphlets about fertility littered throughout – aimed at mostly women – and I started to imagine the types of people who’d usually be accessing this service, such as couples nervously waiting to find out why they weren’t getting pregnant.
That’s when the reality of what I was about to do hit me. I wasn’t looking to start a family anytime soon, but what if the results ended up throwing a spanner in the works for when I do? Masturbating into a cup on my lunch break suddenly didn’t feel like such a fun watercooler anecdote after that.
I was called into a little room with a chair, foot rest, sink and small sliding door hole in the wall. The latter was to place the sample in after I’d done the deed, but a miscommunication in explaining what the process was saw me poke my head through early and ask the person on the other side for clarification on what to do with the form I’d been given.
Now knowing there was someone in earshot of my money shot, the pressure intensified. Time to get the job done.
Looking at the reclining chair in front of me, I realised I didn’t really think about the logistics of collecting the sample into the cup. If there was a chair in the room, surely it was there to be used? So I sat down, whipped out the todger (if this terminology is good enough for Prince Harry, it’s good enough for me), loaded some videos on my phone and got the cup ready.
Turns out it’s really difficult to aim when you’re reclined like that so some of my sample ended up accidentally missing the cup, meaning I had to try to scoop the surviving swimmers in.
I washed my hands, got myself presentable and then placed the slightly heavier cup – along with the short form I was handed upon arrival – into the hollow wall. I walked out of the room feeling slightly flustered and avoiding eye contact with everyone on my way back to the office.
Then came the wait for the results. I tried not to think about it, but it was hard to shake the idea that I might be in for some bad news. A week or so later, I had a call with Clinical Director, Dr James Nicopoullos.
He couldn’t see any major alarm bells with the questionnaire I filled out, remarking: ‘It’s the quickest history I’ll probably take all week because you’re so fit and well.’
Sufficiently reassured, he turned his attention to the main event – the sample results.
Dr Nicopoullos told me that there are a few key things they look out for – volume of fluid, concentration of sperm, motility (how efficiently it swims) and rate of abnormalities (i.e. what percentage have an oval-sized neck, as well as regular head and tail).
Reader, the next 10 minutes of the consultation were not pretty.
Even though I got slightly over the volume minimum (1.5ml), the rest wasn’t so good. I got 24% motility when 32% is considered normal and I got 10 million sperm per millilitre of fluid when 15 million is normal – the latter puts me in the low sperm count category, according to the NHS.
Then came what felt like the kicker: 98% of my little swimmers were abnormal. ‘Sorry, did you say 98%?’ I asked in disbelief.
It turns out the overwhelming majority of sperm is abnormal for everyone. In fact, anything 4% or more is considered normal. So I was a whole 2% under normal.
All in all, the doctor said there were ‘no major alarm bells ringing’ and it was ‘OK, but it could be slightly better’.
Feeling deflated, I suddenly blurted out: ‘I missed some of it in the cup! Does that have any effect on the results?’ Dr Nicopoullos explained it would obviously have an impact on total volume, but everything else would likely be around the same.
It wasn’t until we were chatting about how these scores could be improved that something clicked. When asked if I’d had Covid-19 before, I suddenly clocked that I did… literally three weeks before doing this test. I didn’t even think about this when the questionnaire asked if I’d had any infections.
The doctor couldn’t be 100% certain, but he said he’d bet if I repeated the test in four to six weeks from the last one, the results would bounce back. This is because some recent research showed Covid-19 can have a negative impact on sperm numbers.
So we agreed to test again.
Sure enough, a second test (where I stood up this time, which I would highly recommend!) came back a lot better. I’d more than doubled the volume, but also the concentration had almost tripled to 25 million per millilitre. Motility was slightly better at 25% (which is still under normal) but abnormalities were better at 97% (just 1% off normal this time).
I was told these numbers would likely get even better post-Covid infection. It wasn’t perfect, but it was better – and I was relieved.
I found the whole process incredibly reassuring, even though I didn’t initially have the best results. I had no problem asking Dr Nicopoullos any questions I had – especially about LGBTQ+ specific fertility options after finding out Lister Fertility Clinic works with Two Dads UK to talk about sperm health.
Everything was thoroughly explained and when I didn’t get the results I’d hoped for, I was advised on ways I could improve it for next time – including taking vitamins D and E, as well as zinc.
It stings a little to know that the motility and abnormality percentages aren’t really up to scratch, but it’s oddly made me feel motivated to do what I can to better that for when I’m seriously considering children whenever that happens down the line.
So was the test worth it? Even though it costs £165 compared to the home testing kits I’ve seen ranging from £18.99 up to £74.99, I’d definitely recommend it, as I couldn’t imagine getting a page of results and not being able to go through them with a qualified professional. Also, the NHS warns that home tests may ‘give you false reassurance or may suggest your sperm count is low when it’s actually perfectly normal’.
It wasn’t just a test I did, it was an explanation of next steps too.
If I decided to go ahead with using the sperm sample to have a baby, they’d conduct a barrage of extra screening tests – including for STIs like syphilis and gonorrhoea, other infections, or recessive diseases like cystic fibrosis. They’d then freeze the sperm and leave it in quarantine for around three months so they can test it again after that for biology.
On top of that, there’d be implications counselling, finding an egg donor, creating the embryos and eventually surrogacy, if that’s the route I wanted to go down.
But whether you choose to do the test at home or at a clinic, it’s still one worth doing. Just maybe practise your aim.
Lister Fertility Clinic (HCA Healthcare UK) offers ‘Fit for Fertility’, a fertility health screening package. For more information click here.
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