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  • Review Article
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Semen quality in the 21st century

Nature Reviews Urology volume 14, pages 120–130 (2017)Cite this article

Subjects

Key Points

  • Downward trends in sperm concentrations have been described in several geographical areas during this century

  • In several countries, sperm concentration of a considerable proportion of young men has been described to be on a level that has been associated with prolonged time to pregnancy

  • Longitudinal studies suggest that almost full sperm production capacity is achieved around the age of 20 years, which points to the importance of earlier developmental phases in establishment of spermatogenic capacity

  • Environmental factors are likely to have contributed to the declining trends in sperm concentrations; however, identifying the most important factors causing adverse effects remains a challenge

Abstract

Although semen quality is an important determinant of fertility, defining clear thresholds for normal ranges has proven difficult. According to 'time to pregnancy' studies, fecundity starts to decline when sperm concentrations fall below 30–55 × 106/ml, whereas the WHO criterion for normal values is currently 15 × 106/ml. Multiple studies over the past 15 years have reported median sperm concentrations of 41–55 × 106/ml in young men (mean age 18–21 years) from the general population, suggesting that many of them have suboptimal semen quality. Sperm numbers remain fairly constant between 19 and 29 years of age, which points to the importance of developmental effects. Discussion on whether population semen quality has declined has continued for decades, as regional differences in trends have been noted. The reasons for poor semen quality and adverse trends are not well established, but some associations suggest a causal relationship, for example, with maternal smoking during pregnancy. The role of chemical exposures leading to endocrine disruption and detrimental reproductive effects has been in the focus of research during the past 20 years. Identification of exposures that affect fertility could provide opportunities for effective prevention of reproductive health problems.

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Figure 1: Median sperm concentration of young men in different geographical areas in studies using similar study protocols.
Figure 2: Median sperm concentration of fertile men in different geographical areas in studies using similar study protocols.

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Acknowledgements

The authors thank Dr. Wiwat Rodprasert for drawing the figures and Ms. Johanna Järvi for technical assistance with this article. This work was supported by the European Commission (FP7), the Academy of Finland, Sigrid Juselius Foundation, Novo Nordisk Foundation, Turku University Hospital Special Governmental Research Fund, and The Research Fund of Rigshospitalet (grant no. R42-A1326).

Author information

Authors and Affiliations

  1. Department of Physiology, Institute of Biomedicine, University of Turku, Kiinamyllynkatu 10, Turku, 20520, Finland

    Helena E. Virtanen & Jorma Toppari

  2. University Department of Growth and Reproduction and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, Blegdamsvej 9, Copenhagen, DK-2100, Denmark

    Niels Jørgensen & Jorma Toppari

  3. Department of Paediatrics, Turku University Hospital, Kiinamyllynkatu 4 – 8, PL 52, Turku, 20521, Finland

    Jorma Toppari

Authors
  1. Helena E. Virtanen
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  2. Niels Jørgensen
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  3. Jorma Toppari
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Contributions

All authors researched data for article, made substantial contributions to discussion of content, wrote the article, and reviewed and edited the manuscript before submission.

Corresponding author

Correspondence to Jorma Toppari.

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Competing interests

J.T. has received honoraria for speaking and acted as a consultant for Merck and Mylan. The other authors declare no competing interests.

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Virtanen, H., Jørgensen, N. & Toppari, J. Semen quality in the 21st century. Nat Rev Urol 14, 120–130 (2017). https://doi.org/10.1038/nrurol.2016.261

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