‘Man Up’: the importance and strategy for placing male reproductive health centre stage in the political and research agenda

Abstract

Approximately 1 in 20 young men today have sperm counts low enough to impair fertility, whereas this may not have been the case historically. The cause(s) of such a decline in male reproductive health is unknown, despite it being a global health issue. Concomitantly, little progress has been made in answering fundamental questions in andrology or in developing new diagnostic tools or alternative management strategies to ICSI in infertile men. We advocate formulation of a detailed roadmap for male reproductive health to facilitate development of a research agenda that highlights the present unmet needs and key unanswered questions, and seeks to deliver effective funding and investment to address them. This vision we term ‘a Male Reproductive Health Ecosystem’.

Cap‐Score™ prospectively predicts probability of pregnancy

“…It is widely appreciated that our reliance on semen analysis—either to diagnose male infertility or to assess a functional response to treatment of male infertility—is inadequate (Barratt et al, ). Assays proposed over the years to fill these needs have not demonstrated efficacy at prospectively predicting the clinical outcome of generating a pregnancy (Barratt et al, ), and are often found to correlate with the traditional semen analysis parameters (Aitken, ; Giwercman et al, ; Hazary, Chaudhuri, & Wishart, ; Zini et al, ).…”

“…It is widely appreciated that our reliance on semen analysis—either to diagnose male infertility or to assess a functional response to treatment of male infertility—is inadequate (Barratt et al, ). Assays proposed over the years to fill these needs have not demonstrated efficacy at prospectively predicting the clinical outcome of generating a pregnancy (Barratt et al, ), and are often found to correlate with the traditional semen analysis parameters (Aitken, ; Giwercman et al, ; Hazary, Chaudhuri, & Wishart, ; Zini et al, ). Prospective data presented here strongly demonstrate that the Cap‐Score, a measure quantifying the percentage of sperm that can capacitate and undergo acrosome exocytosis (Cardona et al, ; Moody et al, ; Ostermeier et al, ), successfully predicted low or high success at achieving pregnancy in three or fewer attempts at IUI.…”

“…It is widely appreciated that our reliance on semen analysis-either to diagnose male infertility or to assess a functional response to treatment of male infertility-is inadequate (Barratt et al, 2018).…”

“…Male fertility is a serious and growing concern globally. Yet, the field of andrology faces critical gaps in diagnostic technologies and knowledge, affecting scientific advancement as well as clinical management by both reproductive endocrinologists and urologists (Barratt, De Jonge, & Sharpe, ). The extent of the problem is staggering: 10–15% of couples have difficulty conceiving (Sharma, Biedenharn, Fedor, & Agarwal, ); 40–60% of these couples have a contributing male factor component (Agarwal, Mulgund, Hamada, & Chyatte, ); and sperm counts and concentration in Western societies have shown marked declines of over 50% since 1973 (Levine et al, ).…”

“…Conversely, those with poorly functioning sperm might be able to avoid the emotional, physical, and financial costs associated with repeated IUI attempts that have little chance of success, by being guided to procedures such as intracytoplasmic sperm injection (ICSI). However, as has been pointed out (Barratt et al, 2018), approaches such as ICSI are not treatments of poor male fertility; they instead seek to overcome it. Therefore, the third application for a test that quantifies male fertilization competence would be as a metric for urologists attempting to treat underlying factors contributing to male infertility.…”