The indicators that Spain is on its way to being a subfertile country according to WHO parameters are coming one after the other. A work published at the end of last year with studies from more than fifty countries that compared sperm records between 1973 and 2018 of healthy men pointed to the fact that the quality of the semen had been reduced by half during that period. And reports from assisted reproduction clinics point in the same direction. A study by the IVI group on samples of 120,000 patients from the last two decades concludes that the risk of men needing fertility treatments to become fathers has grown by 9%. And the analysis of the 5,000 samples examined over the last five years by the Bernabeu Institute (IB) shows a decrease of 16% in sperm concentration and 12% in motility.
And the worst semen quality is not detected only in the cases of men who go with their partners to consultations for fertility problems. They also appreciate it among sperm donor candidates, who are supposedly healthy young men aged between 18 and 35. The Bernabeu Institute reported a few days ago that, in 5 years, the donor acceptance rate for the sperm bank has gone from 15% to 8%. And eight out of ten rejected were due to low semen quality.
The acceptance rate provided by other sperm banks consulted is a little higher – 10%, according to IVI Valencia, or 20%, from the Puigvert Foundation – but they all agree that the main reason of rejection is that the candidate’s semen does not meet the required quality standards. It is clear that the seminal quality parameters asked of donors are more demanding than those set by the WHO to consider a man subfertile. “They are asked, for example, three to four times the amount of sperm per milliliter than is considered normal because the samples will be frozen and thawed, and in the process there is a loss of seminal quality,” explains Gabi Adalid, Andrology nurse and coordinator of the Puigvert Foundation’s semen donation program.
However, the scientific director of the genetics laboratory of the IB, Belén Lledó, assures that 40% of the donor candidates who are rejected due to poor semen quality “do not meet the WHO criteria, are subfertile and are advised let them go to the urologist”.
What causes the drop in semen quality? “It is difficult to attribute the problem we have with fertility to a specific cause, because many factors influence it and they are interrelated”, answers the president of the Spanish Fertility Society, Juan José Espinós. Lluís Bassas, andrologist and director of the Puigvert Foundation’s semen bank, assures that the negative view on the evolution of semen quality is affected by methodological changes when analyzing it to advances in genetics which cause more candidates to be rejected, in addition to the delay in the age at which people are encouraged to become fathers or mothers.
But, as Rocío Rivera, director of the andrology laboratory at IVI Valencia, explains, what they see in the samples from young donors indicates that it is not only a matter of age, but rather of lifestyle. “What has changed the most in recent years is the way we live: a more sedentary life, more exposure to pollutants, a more unbalanced diet, more obesity, more toxic consumption, more stress… And all this conditions not only the person in question, but also to the offspring due to epigenetics”, summarizes Dr. Espinós.
And among all the changes, fertility experts are clear about the one that clearly affects many men’s semen: body worship. “The gym effect reaches fertility consultations; the substances that many men take to improve sports performance destabilize the hormonal system and this affects the formation of gametes, the quality of semen and fertility”, sums up Lledó.
“Anabolics are extremely harmful to male fertility and the effect is immediate; and there are many men who consume them, who take steroids to stimulate strength, improve resistance to exercise and physical appearance; we see it in the consultation, because the drop in sperm produced by these substances is very exaggerated, but many deny that they take them because they are ashamed, because they have become addicted to them, or because they don’t even know what the gel they put on does on the skin because it was recommended by someone at the gym”, emphasizes Dr. Bassas.
“It is very common: muscular patients in whom you know that it is impossible for the infertility to be due to another cause and they deny that they are taking anything… The problem is that these are products that escape the control of the health authorities, which are sold as a a positive thing to be more handsome, to have more muscles…, and no one explains to these boys that it can have a negative effect in terms of sperm production”. But anabolics are not the only way by which the cult of the body slows down the quality of the semen. “Treatments for baldness and hair implants have become popular and the drug that is taken, finasteride, increases the levels of testosterone in the body and this deregulates the hormones that cause sperm to be produced,” explains Dr. Rivera, from IVI Valencia.
It is clear that both in the case of anabolics and in the case of hair treatments, the effects on the sperm are temporary. “When you stop taking them, the hormones return to their levels and you recover your fertility, but sometimes it takes months,” says Bassas.
