5 December 2012 Last updated at 00:37 GMT
French sperm count 'falls by a third'
By Anna-Marie Lever
Health reporter, BBC News
The sperm count of French men fell by a third between 1989 and 2005, a study suggests.
The semen of more than 26,600 French men was tested in the study, reported in the journal Human Reproduction.
The number of millions of spermatozoa per millilitre fell by 32.3%, a rate of about 1.9% a year. And the percentage of normally shaped sperm fell by 33.4%.
The average sperm count remained within the fertile range, but experts want to see more research into possible causes.
One of the paper's authors, Dr Joelle Le Moal, an environmental health epidemiologist, said: "To our knowledge, this is the first study concluding a severe and general decrease in sperm concentration and morphology at the scale of a whole country over a substantial period.
"This constitutes a serious public health warning."
But Dr Allan Pacey, senior lecturer in andrology at the University of Sheffield, said: "The change in sperm concentration described, 73.6 to 49.9 million per millilitre [on average for a 35-year-old], is still well within the normal range and above the lower threshold of concern used by doctors which is suggestive of male infertility, 15 million per millilitre."
There has much been debate in the past 20 years over whether sperm quality has decreased, with research supporting both sides of the controversy. This latest research adds weight to the numerous European studies that suggest one in five young men has a sperm count low enough to impair fertility.
Prof Richard Sharpe, from the University of Edinburgh, said: "Something in our modern lifestyle, diet or environment like chemical exposure, is causing this.
"We still do not know which are the most important factors, but perhaps the most likely is a combination, a double whammy of changes, such as a high-fat diet combined with increased environmental chemical exposures."
The study analysed data from the French database Fivnat, which logs information from 126 assisted reproduction centres. Researchers examined semen samples provided by men aged between 18-70 whose partners were undergoing fertility treatment because of blocked or missing fallopian tubes.
As the study took place over a period of years, it is important that methods remained the same for comparison- but critics have questioned this.
Dr Pacey said: "In the paper, the authors claim that the methods for measurement of sperm concentration and motility 'have not changed noticeably during the study period', yet to me this is an odd thing to say as in my experience they have changed remarkably everywhere else in the world.
"I would argue that the 'jury is still out' on this issue."
While the study took into account factors that can affect sperm quality, such as age, researchers were unable to control for socio-economic factors, smoking or weight, which have been shown to have a major impact.
Decline in semen concentration and morphology in a sample of 26 609 men close to general population between 1989 and 2005 in France
M. Rolland1, J. Le Moal1,*,†, V. Wagner1, D. Royere2 and J. De Mouzon3
Hum. Reprod. (2012)
First published online: December 4, 2012
STUDY QUESTION Are temporal trends and values of semen quality parameters in France identifiable in partners of totally infertile women?
SUMMARY ANSWER Among a sample of 26 609 partners of totally infertile women undergoing an assisted reproductive technology (ART) procedures in the whole of France over a 17-year period, there was a continuous decrease in semen concentration of about 1.9% per year and a significant decrease in the percentage with morphologically normal forms but no global trend for motility.
WHAT IS KNOWN ALREADY A global decrease in human sperm quality is still debated as geographical differences have been shown, and many criticisms have risen concerning studies with small and biased study populations or inappropriate statistical methodology. However, growing biological, toxicological, experimental and human exposure data support the endocrine disruptors' hypothesis assuming that fetal exposure to endocrine disruptors could impair reproductive outcomes.
STUDY DESIGN, SIZE, DURATION This was a retrospective and descriptive study using data registered by Fivnat, the professional association in charge of statistics for ART in France during the 1989?2005 study period. Data were provided by 126 main ART centres over the whole metropolitan territory. The source population included 154 712 men, aged 18?70, who were partners of couples undergoing their first ART cycle and for whom semen quality indicators (concentration, total motility and percentage of morphologically normal forms), measured on fresh ejaculated semen, were available.
PARTICIPANTS/MATERIALS, SETTING, METHODS The study population was 26 609 partners of women who had both tubes either absent or blocked. The temporal trends for each indicator of semen quality were modelled using a generalized additive model that allowed for nonlinear relationships between variables and were adjusted for season and age. In-depth sensitivity analyses included the reiteration of the analysis on data from a second spermiogram available for each man and on another subsample of men diagnosed as fertile. Variables such as centre, technique (standard in vitro fertilization or intra-cytoplasmic sperm injection) and an interaction factor between technique and time were also included in the model.
MAIN RESULTS AND THE ROLE OF CHANCE There was a significant and continuous decrease in sperm concentration of 32.2% [26.3?36.3] during the study period. Projections indicate that concentration for a 35-year-old man went from an average of 73.6 million/ml [69.0?78.4] in 1989 to 49.9 million/ml [43.5?54.7] in 2005. A significant, but not quantifiable, decrease in the percentage of sperm with morphologically normal forms along the 17-year period was also observed. There was no global trend but a slight, significant increase in total motility between 1994 and 1998 was observed. The results were robust after sensitivity analysis.
LIMITATIONS, REASONS FOR CAUTION Socioeconomic status could not be controlled for. Despite universal access to medical services in France, couples undergoing ART are expected to have a higher educational level on average compared with those of the general population. Therefore, the real values in the general population could be slightly lower than those presented and the decrease possibly stronger, as the population study is less likely to smoke or be overweight, two factors known to impair semen quality.
WIDER IMPLICATIONS OF THE FINDINGS As the men were selected without a priori knowledge regarding their semen quality characteristics, the results are expected to be close to the values in the general French population. The very large sample size and the robustness of the results confer great statistical power and credibility to the results. To our knowledge, it is the first study concluding a severe and general decrease in sperm concentration and morphology at the scale of a whole country over a substantial period. This constitutes a serious public health warning. The link with the environment particularly needs to be determined.
STUDY FUNDING/COMPETING INTEREST(S) No specific funding was sought for this study. The authors have no conflict of interest to declare.
The study has been authorized by the Commission Nationale de l'Informatique et des Libertes (CNIL), the national authority for the protection of personal data collected on individuals (authorization no DE-2010-063 dated 08/09/2010).
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