Lads, lads, lads, hate to interrupt, but how’s your ejaculate? Would you struggle to fill half a teaspoon? And your concentration, please: are we talking 20m-plus little swimmers a millilitre? And how’s that motility? Are your spermatozoa wagging their flagella as if they can’t wait to get to that ovum – or listlessly floating around like dead tadpoles in a poorly executed classroom experiment? It’s not that embarrassing, surely?
If you are hoping to fertilise a human egg someday and haven’t given much thought to these matters … well, Big Sperm reckons it is time you did. A wave of tech startups, such as ExSeed, Yo, Trak and Legacy, are offering next-generation home sperm-testing technology and – in some cases – sperm-freezing services. And even if British men aren’t quite ready to start comparing their fertility concerns yet, these are clearly lurking at the back of many minds.
“I don’t think we realised how many men are ‘just curious’ about their reproductive health,” says Greg Sommer, the chief science officer of Trak, which offers home testing kits, sperm-freezing and even sperm-training regimes. “The product is primarily targeted at couples trying to get pregnant, but about a third of our customers are using Trak while not actively trying to conceive.” In some cases, those men will have a specific concern: a past injury, say, or a history of steroid use. But others are just driven by curiosity. Sommer finds it encouraging. “In the past, men have mostly shrugged off fertility as a women’s issue. Today, men and women recognise the role that men play.”
Morten Ulsted, the CEO of the Danish company ExSeed, which launched in the UK in January, says the whole men’s health sector is “booming”. He cites the emergence of female-focused tech, such as the period-tracking app Clue or the intelligent breast pump Elvie as inspiration. “We have all seen what’s happened to ‘femtech’ in the past few years. It is predicted to be a $40bn industry by 2020, and it was nonexistent five years ago. Now the same thing is happening with male-specific issues – we just need a catchy name.”
Around one in seven British couples have difficulty conceiving, according to the NHS, and, in about 40% of cases, the problem lies with the man. But, in general, fertility tends to be framed as a women’s issue. Ulsted cites one survey that found 42% of British men had concerns about their fertility, but only 18% of men had considered a test. “Of those, 33% said they wanted the woman to test first,” he says. “But if it’s something that you’re worried about, why not just do it? And where there is stigma, tech can really help. It’s so much more comfortable to do a sperm test in the privacy of your home than it is to visit a fertility clinic.”
While a woman is born with all the eggs she will ever have, a man produces fresh sperm every 72 days or so. ExSeed works with a mail-order test you can operate via your phone; it compares results with a vast database of sperm samples to give you an analysis of volume, motility and concentration – and can then offer a personalised training programme for improving them. “People are often just told their sperm is suboptimal and they should be more healthy,” Ulsted says. “Well, great, but that’s hard to do. What we say is, here are the top two or three pieces of advice that are likely to have an impact on you. Mostly, it’s low-hanging fruit, such as drinking less and exercising a little more, plus a few supplements.”
It is possible to improve sperm count in the short term. Ulsted points to evidence that some men under professional guidance managed to improve sperm concentration by 25% and motility by 40% over a 25-week period.
One factor driving investment in this sector is the long-term decline in fertility rates among western men. A study in the journal Human Reproduction Update in 2017 found that sperm count in men from North America, Europe, Australia and New Zealand had dropped by 59.3% since 1973. If it continues to decline at this rate, soon humans will no longer be able to reproduce naturally. And, as the authors say, nobody really knows what is causing it.
Is it exposure to phthalates in plastics? There is a link between mothers being exposed to these common chemicals and decreased genital size in boys. Is it hormone-altering chemicals in sunscreen? Oestrogen in the water supply? Industrial pesticides? (Environmentalists have voiced grave concerns about sperm decline in birds and bees.) “It’s within a generation, so it’s not genetic – which means it has to be lifestyle: diet, lifestyle, stress factors,” says Ulsted, whose interest in sperm began when he read the study.
The good news is that individual men can do something about their lifestyle fairly easily and expect to see improvement within a few months. But you can’t easily remove people from western society to isolate the reasons for the long-term decline. This has become a source of great anguish on men’s rights forums, where it is sometimes seen as evidence of a feminist plot to emasculate and ultimately eliminate the western male.
Much better understood are the risk factors for fathers hoping to conceive later in life. “We talk about women’s age and fertility all the time, as if they’re the only thing that matter,” says Geeta Nargund, the medical director of Create fertility clinics. “The main difference is that women’s fertility stops, but men’s declines over time. And the risk factors increase. Not only can it take five times as long to conceive when the male partner is over 45; the risk of miscarriage is twice as high, even when the partner is much younger. Then there is an increased risk of children being born with neurological disorders, such as autism and attention deficit hyperactivity disorder.”
American entrepreneurs increasingly promote sperm-freezing as a solution to these problems. It is already fairly common among men who are about to undergo cancer treatment, have a vasectomy or go through gender reassignment surgery. But it is only recently that men have been encouraged to do so as an “insurance policy”, as Sommer puts it.
“I think the idea of men freezing their sperm ‘just because’ is quite new, but we certainly welcome it,” he says. “It speaks to the growing awareness and engagement men have with their health. It also shows that men are embracing and prioritising fatherhood as part of their life goals.” He points out that it is easier for men to freeze their sperm than it is for women to freeze their eggs: “So why not?” But it takes a little planning. “Just as you should try to optimise your sperm count when trying to conceive, you should also optimise it before freezing it. That sample you collect for freezing is an important one – best to give it your best shot.” (The temptation to pun in his industry must be overwhelming, I remark. “It gets hard,” he agrees.)
People who work in the fertility industry in the UK are more sceptical. Nargund sees egg- and sperm-freezing as “drastic solutions” to problems that would better be solved by increased fertility awareness. In some high-risk cases, it may be worth considering. Certain forms of medication affect sperm count, notably SSRI-style antidepressants, some anti-epileptics and anti-diabetics. People who work with pesticides, plastics and heavy metals, as well as taxi drivers and long-distance lorry drivers – because they sit for long periods in confined spaces – are at risk. And reproductive health is inextricably linked with general health: alcohol, recreational drugs, poor diet and sedentary lifestyles all pose potential problems. But, as new sperm is produced every three months or so, men who make the right sort of changes in their lifestyle often see significant improvements.
“What I wouldn’t want is for men and women to freeze their sperm and then cease to worry about it,” says Nargund. “The minute you freeze sperm, you are reliant on other forms of reproductive science, such as IVF. So you are outsourcing your reproduction to a clinic, and that will be expensive. It may not work the first time. And I’m also opposed to women being exposed to unnecessary treatments.”
Moreover, the potential complications of later-life paternity don’t end with conception. “Let’s say you freeze your sperm at 30 to have a child at 50. We have to think of the welfare of the child, too. A man of 50 will be 65 by the time the child is 15. It might be younger sperm, but still there are other issues to consider. We should encourage men and women to start families when they are younger when it is possible.” She concedes that this isn’t what men will want to hear, even if it’s the sort of message women have been getting for years.
Allan Pacey, a professor of andrology at the University of Sheffield who has advised Legacy on its sperm-testing technology, wonders why we are so reluctant to heed these dangers. “There’s a lot of evidence about the male-age impact on children. The data has been around for 20 or 30 years. But we tend to ignore it, as it bucks what society wants. Nature tells us to have children in our late teens and early 20s – it doesn’t really want us to have children in our mid-to-late 30s.” He, too, doesn’t see sperm-freezing as much of a solution, particularly in the UK. “It’s not like heating up a frozen pie from Tesco. You can freeze perfectly good sperm and take it out and it can be depleted.” While some couples may find success using their defrosted sperm “in a turkey-baster kind of way”, most won’t, and will end up reliant on IVF.
He is sceptical about claims of a western sperm crisis. “Yes, the graphs show a striking decline, but looking at measures of sperm quality over time is fraught with potential for bias. Techniques have changed and our understanding of the margins of error have changed. I tend to go with the Carl Sagan view that if you’re going to make an extraordinary claim, you need extraordinary evidence.”
The decline is, as he points out, from “normal to normal”: concentration levels have gone from 99m sperm a millilitre to 47m, and anything above 20m is fine. It is true we’re having fewer children in Europe, and that’s not the case in Africa, say. But it’s hard to disentangle this from socioeconomic factors. “Wealth tends to be a good contraceptive,” Pacey says – as GDP rises, people tend to have fewer children.
“All the same, I do wonder why male fertility is not higher up the political and healthcare agenda,” he says. “Why do we still see this through a female prism? Half the time when couples can’t conceive, it is to do with male fertility issues. That is why I welcome the innovation. Whatever healthcare providers and scientists like me have been saying, it isn’t working. So I wonder if these tech startups will be able to disrupt things in a good way.”
