Why is it so Difficult to Establish the Prevalence of Male Infertility?

Male infertility is definitely a taboo subject. Whilst it is becoming increasingly common for women to dissect all aspects of their physical, emotional and hormonal health with their gynaecologist; the topic of male fertility rarely gets mentioned.

This is wrong.

Infertility is not solely a woman’s issue and as a couple it is something you should face together. Not least, because in approximately 20% of infertility cases, the problem will involve both parties and in 30% of cases the problem will lie with just the male.

The problem

It has, however, proven difficult to answer the question of how prevalent male infertility actually is. In fact, in constructing their guidelines, the World Health Organisation states that it is not possible to report an unbiased prevalence of male infertility across the general population.

Why is this?

Well, there are a number of reasons. Firstly, there are geographical variations in how acceptable male infertility is. For example, in Africa and the Middle East, many men are unwilling to undergo testing as they consider it emasculating. This results in underreporting of male infertility cases in these regions.

Other issues relate to what actually constitutes infertility. The most widely accepted definition includes all couples who have not fallen pregnant, despite taking no preventative measures for at least 12 months. However, in some cases, couples who experience miscarriages are included in this figure, meaning there is an inconsistency in the way infertility is assessed across different studies. Another problem is that only couples who are actively trying to conceive will seek assistance; this means that a proportion of both men and women who have never tried to conceive will, unknowingly, be infertile. This means that prevalence rates for male and female are likely to be an underestimation.

So, how is prevalence estimated?

Infertility is estimated to affect 15% (48.5 million) of couples globally. The best estimates put the incidence of male infertility at between 2.5% and 12%. However, for the reasons listed above, this figure is likely to be a conservative estimate. It has also involved extrapolating the results from geographical locations such as Europe and Northern America, where men are more likely to seek assistance, to the rest of the world.

Until the stigma of male infertility is lifted, it will not be possible to accurately identify global trends and differences.

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Sources:

• Agarwal, A, et al. “A Unique View on Male Infertility around the Globe.” Reproductive Biology and Endocrinology, vol. 13, 26 Apr. 2015, p. 37., doi:10.1186/s12958-015-0032-1.
• Barratt, C L R, et al. “The Diagnosis of Male Infertility: an Analysis of the Evidence to Support the Development of Global WHO Guidance—Challenges and Future Research Opportunities.” Human Reproduction Update, vol. 23, no. 6, 1 Nov. 2017, pp. 660–680., doi: 10.1093/humupd/dmx021.