Male fertility has been in decline across the planet for several years, but the problem remains poorly understood and it is important to tackle it as quickly as possible, argues a group of international researchers to which a Montreal scientist belongs.
This lack of knowledge has the effect of shifting the burden onto the woman, who will have to undergo invasive and risky assisted reproduction procedures in the hope of becoming pregnant, deplore the authors in the medical journal Nature Reviews Urology.
“The main problem is that we do not know the causes of male infertility, and current diagnosis and treatments are not based on the causes,” lamented Sarah Kimmins, who is a professor at the University of Montreal and a researcher at CHUM research center. It’s a “one size fits all” approach. »
If you are infertile, and if you are a man, she added, there are “few treatment options and the diagnosis is really out of date, virtually nothing has changed in over 50 years. So the treatment falls on the woman, whether the fertility problem belongs to her or him. »
However, studies suggest that behavioral and environmental factors play a leading role in male infertility. Growing exposure to endocrine disruptors; the increase in the number of overweight or obese men; poor nutrition; the stress ; consumption of cannabis or alcohol; and smoking and vaping are all factors that must be taken into account, Ms. Kimmins listed.
A group of 25 scientists led by Moira O’Bryan, the dean of science at the University of Melbourne, made ten recommendations that could improve the health of men and their children and reduce the burden on their female partners.
Chief among these: more public education campaigns to educate men about the behaviors and lifestyle habits they should adopt (or avoid) to maximize their chances of being able to start a family in the coming years .
“We would like boys to receive this education in a school environment, when they are young,” said Ms. Kimmins. They must be taught to protect their fertility, shown what they should avoid to reduce the risk of infertility later. Doctors should also raise these factors that can negatively impact fertility with their male patients. »
Doctors too often consider that there is a relatively easy solution to infertility, she laments, in the form of in vitro fertilization. However, they forget that the entire burden of this procedure falls on the woman’s shoulders, even if it may have nothing to do with her couple’s fertility problem.
“It’s really unfair and it’s really inequitable that there’s nothing available to treat the couple better,” Kimmins said.
Prevention is all the more crucial, continues the researcher, as we still do not know whether the damage that may have been caused is permanent or whether it is reversible. Men whose occupation increases their risk of infertility, such as those who work with chemicals, should therefore be made aware of the possibility of freezing their sperm before it is too late, Kimmins said.
Many men are also unaware that it takes months to produce sperm. Their next ejaculation has been in preparation for several weeks.
Those thinking about starting a family should therefore eliminate factors that could harm their fertility as much as possible, for example by eating better, exercising and sleeping well for as long as possible.
“They should look at how they live their lives in their 20s before thinking about having a family in their 30s,” Kimmins warned. Their behaviors could have a negative impact on their choice to have a family. It might not even be an option for them anymore. It’s not just a matter of improving my fertility health a month before (conception). It’s a lifelong responsibility. »
It’s not just about starting a family either. For example, growing scientific evidence shows that infertile men are sicker and tend to die younger than fertile men. The incidence of cancer and cardiovascular disease would therefore be higher in this group.
And beyond fertility, quality sperm can also protect the health of children, and even grandchildren, by reducing the risk of transmitting epigenetic changes to them which could result in a multitude of health problems, obesity to neurodevelopmental disorders.
Paradoxically, an infertile man could even transmit his infertility to his descendants during medically assisted fertilization.
“Men (so) have the burden of protecting their health, protecting their fertility, but also the health of future generations,” Kimmins said.
The World Health Organization estimates that one in six couples is affected by infertility, and that men are to blame in half of the cases.
