Abstract
Currently, most men with infertility cannot be given an aetiology, which reflects a lack of knowledge around gamete production and how it is affected by genetics and the environment. A failure to recognize the burden of male infertility and its potential as a biomarker for systemic illness exists. The absence of such knowledge results in patients generally being treated as a uniform group, for whom the strategy is to bypass the causality using medically assisted reproduction (MAR) techniques. In doing so, opportunities to prevent co-morbidity are missed and the burden of MAR is shifted to the woman. To advance understanding of men’s reproductive health, longitudinal and multi-national centres for data and sample collection are essential. Such programmes must enable an integrated view of the consequences of genetics, epigenetics and environmental factors on fertility and offspring health. Definition and possible amelioration of the consequences of MAR for conceived children are needed. Inherent in this statement is the necessity to promote fertility restoration and/or use the least invasive MAR strategy available. To achieve this aim, protocols must be rigorously tested and the move towards personalized medicine encouraged. Equally, education of the public, governments and clinicians on the frequency and consequences of infertility is needed. Health options, including male contraceptives, must be expanded, and the opportunities encompassed in such investment understood. The pressing questions related to male reproductive health, spanning the spectrum of andrology are identified in the Expert Recommendation.
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Acknowledgements
Thanks goes to R. Agnew, E. Heighton and A. Mergo from The University of Dundee for their assistance with data collection for Fig. 1. Thanks also goes to A. O’Connor from the University of Melbourne for assistance with referencing. This research was supported in part by funding by the National Health and Medical Research Council of Australia to M.K.O., R.I.M. and J.A.V. (APP1120356); S.K. is a Canada Research Chair in Epigenomics, Reproduction and Development and funding for this study is provided by the Canada Research Chairs program, and the Canadian Institutes of Health Research grants (DOHaD Team grant 358654 and Operating grant 350129). The authors thank ESHRE for financial and logistical support of the MRHI.
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All authors researched data for the article. S.K., R.A.A., C.L.R.B., C.J.D.J. and M.K.O. contributed substantially to discussion of the content. All authors wrote the article. S.K., R.A.A., C.L.R.B., H.M.B., S.R.C., C.J.D.J., G.D., M.L.E., N.G., N.J., C.K., A.L., R.I.M., S.M., T.M., A.P., L.P., S.S., J.T., L.T., F.T., M.H.V.-L., J.A.V., F.Z. and M.K.O. reviewed and/or edited the manuscript before submission.
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C.L.R.B. is supported in part by the Bill and Melinda Gates Foundation in the area of contraceptive development, Chief Scientist Office (Scotland), NHS and Genus Healthcare. C.L.R.B. has received fees from Cooper Surgical for lectures on scientific research methods outside the submitted work and Ferring for a lecture on the future of male reproductive health. M.L.E. is an adviser to Ro, Doveras, VSeat, and Next. R.A.A. reports grants and personal fees from Roche Diagnostics, personal fees from Ferring Pharmaceuticals, IBSA, Merck Serono, outside the submitted work. S.K. is an inventor on a Provisional patent 14647-P68337CA00 10 June 2022: Methods for identifying epigenetic modifications in sperm, diagnosing infertility, and identifying treatment strategies. A.P. has undertaken paid consultancy for Cryos International, Cytoswim Ltd, Exceed Health, Meals Group, and Merck Serono in the last 2 years, but all monies have been paid to the University of Sheffield (former employer). M.K.O. is supported in part by the Bill and Melinda Gates Foundation in the area of contraceptive development. All other authors declare no competing interests.
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Related links
Australian Male Infertility Exposure Study: http://www.mcri.edu.au/research/projects/australian-male-infertility-exposure-amie-study
European Society of Human Reproduction and Embryology: http://www.eshre.eu/Specialty-groups/Special-Interest-Groups/Andrology/MRHI
Family Planning 2030: https://fp2030.org/
Male Contraceptive Initiative: http://www.malecontraceptive.org
NordFertil: https://nordfertil.org
United Nations Sustainable Development Goals 3 and 5: https://sdgs.un.org/goals
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Kimmins, S., Anderson, R.A., Barratt, C.L.R. et al. Frequency, morbidity and equity — the case for increased research on male fertility. Nat Rev Urol 21, 102–124 (2024). https://doi.org/10.1038/s41585-023-00820-4
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DOI: https://doi.org/10.1038/s41585-023-00820-4
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