Niepłodność męska
Epidemiologia

Niepłodność męska stanowi istotny problem zdrowia publicznego, dotykający globalnie około 30,6-56,5 miliona mężczyzn, z częstością występowania wzrastającą o 19% (ASPR 1402,98 na 100 000 populacji w 2019 r.). Występuje znaczne zróżnicowanie geograficzne, z najwyższymi wskaźnikami w Afryce Subsaharyjskiej, Europie Wschodniej i Azji Wschodniej. Epidemiologia wskazuje na spadek średniej liczby plemników z 113 mln/ml w 1940 r. do 49 mln/ml w 2018 r., co stanowi redukcję o 51,6%. Starzenie się mężczyzn wpływa na obniżenie jakości nasienia, ze zmniejszeniem gęstości plemników i utratą komórek Sertoliego oraz Leydiga. Czynniki ryzyka obejmują palenie tytoniu (51,2%), ekspozycję na wysoką temperaturę (30,08%), spożycie alkoholu (12,49%) oraz narażenie zawodowe i środowiskowe, w tym zanieczyszczenia i pestycydy. Niepłodność pierwotna jest bardziej powszechna niż wtórna, a idiopatyczna niepłodność stanowi 30-50% przypadków. Diagnostyka opiera się na analizie nasienia, ocenie hormonalnej i badaniu fizykalnym, z uwzględnieniem czynników genetycznych i środowiskowych.

  1. Epidemiologia niepłodności męskiej
    1. Globalne rozpowszechnienie niepłodności męskiej
    2. Regionalne zróżnicowanie niepłodności męskiej
    3. Krajowe wskaźniki niepłodności męskiej
    4. Trendy czasowe w niepłodności męskiej
  2. Czynniki demograficzne i charakterystyka pacjentów z niepłodnością męską
    1. Wiek jako czynnik ryzyka niepłodności męskiej
    2. Profil pacjentów z niepłodnością męską
    3. Typy niepłodności męskiej
  3. Przyczyny i czynniki ryzyka niepłodności męskiej
    1. Główne kategorie przyczyn niepłodności męskiej
    2. Czynniki środowiskowe i styl życia
    3. Współwystępowanie chorób i niepłodność męska
  4. Diagnostyka i monitorowanie niepłodności męskiej
    1. Badania diagnostyczne w niepłodności męskiej
    2. Monitorowanie i nadzór niepłodności męskiej
    3. Wskaźniki epidemiologiczne wykorzystywane w badaniach niepłodności męskiej
  5. Wyzwania i perspektywy w epidemiologii niepłodności męskiej
    1. Ograniczenia w badaniach epidemiologicznych niepłodności męskiej
    2. Przyszłe kierunki badań i działań w zakresie niepłodności męskiej
    3. Potrzeba edukacji i świadomości w zakresie niepłodności męskiej
    4. Kolejne rozdziały

Epidemiologia niepłodności męskiej

Niepłodność jest zwykle definiowana jako niemożność zajścia w ciążę pomimo regularnego, niezabezpieczonego współżycia płciowego przez okres jednego roku. Szacuje się, że niepłodność dotyka około 13-15% par na całym świecie, co stanowi około 48,5 miliona par12. Problem ten ma charakter globalny, a jego częstość występowania różni się w zależności od regionu geograficznego. Czynnik męski jest wyłączną przyczyną niepłodności w około 20-30% przypadków, a w sumie przyczynia się do około 50% wszystkich przypadków niepłodności par12.

Globalne rozpowszechnienie niepłodności męskiej

Dokładna liczba mężczyzn dotkniętych niepłodnością na całym świecie jest trudna do ustalenia, ponieważ niepłodność męska nie jest chorobą podlegającą obowiązkowi zgłaszania, a dodatkowo metody badawcze i definicje niepłodności różnią się w poszczególnych badaniach12. Według szacunków, liczba niepłodnych mężczyzn na świecie waha się między 30,6 a 30,7 miliona1. Agarwal i współpracownicy oszacowali, że czysta niepłodność męska może dotyczyć od 2,5% do 12% światowej populacji1.

W 2019 roku globalna częstość występowania niepłodności męskiej została oszacowana na 56,53 miliona przypadków (95% UI: 31,86-90,21), co oznacza znaczny wzrost o 76,9% od 1990 roku. Ponadto, globalny wskaźnik standaryzowany według wieku (ASPR) wynosił 1402,98 (95% UI: 792,24-2242,45) na 100 000 populacji w 2019 roku, co stanowi wzrost o 19% w porównaniu z 1990 rokiem1.

Regionalne zróżnicowanie niepłodności męskiej

Występowanie niepłodności męskiej wykazuje znaczne zróżnicowanie geograficzne. Najwyższe wskaźniki niepłodności męskiej odnotowano w:

  • Afryce Subsaharyjskiej Zachodniej
  • Europie Wschodniej
  • Azji Wschodniej1

W Ameryce Północnej szacowany wskaźnik niepłodności męskiej waha się między 4,5% a 6%, podczas gdy w Australii wynosi około 9%, a w Europie Wschodniej może sięgać 8-12%12. Największe skupiska niepłodności męskiej występują w Europie Środkowej i Wschodniej (8-12%) oraz Australii (8-9%)1.

Szczególnie wysokie wskaźniki niepłodności odnotowano w regionie zwanym „Afrykańskim Pasem Niepłodności”, który rozciąga się ze wschodu na zachód przez środkową Afrykę od Gabonu do Tanzanii1. W krajach rozwijających się problem niepłodności jest zazwyczaj poważniejszy ze względu na ograniczone zasoby medyczne, wysokie koszty leczenia oraz kulturowe obawy, tabu i stygmatyzację1.

Krajowe wskaźniki niepłodności męskiej

Badania epidemiologiczne w poszczególnych krajach dostarczają szczegółowych danych na temat rozpowszechnienia niepłodności męskiej:

  • W Indiach występowanie niepłodności waha się od 3,7% w stanach Uttar Pradesh, Himachal Pradesh i Maharashtra do 15% w Kaszmirze1
  • W Pakistanie niepłodność dotyka około 21,9% populacji, z czego 3,5% to niepłodność pierwotna, a 18,5% wtórna1
  • W Nepalu występowanie niepłodności męskiej wynosi około 45% u mężczyzn w wieku 31-35 lat1
  • W Bangladeszu mężczyźni są całkowicie lub częściowo odpowiedzialni za 60% przypadków niepłodności1
  • W Iranie częstość występowania niepłodności w ciągu życia wynosi 10,9%, a aktualna niepłodność 3,3%12
  • W Polsce problemy związane z niepłodnością występują u około 19% par, w tym 4% z niepłodnością i 15% z ograniczoną płodnością1

Trendy czasowe w niepłodności męskiej

Jednym z najbardziej niepokojących trendów jest obserwowany na całym świecie spadek liczby plemników. Średnia liczba plemników wynosiła 113 milionów/ml w 1940 roku, ale spadła do 66 milionów/ml w latach 90.12. Ten trend utrzymuje się, a średnia liczba plemników zmniejszyła się o 51,6% między 1973 a 2018 rokiem1.

Szczególnie niepokojący jest fakt, że tempo spadku zwiększyło się po 2000 roku – z 1,16% rocznie po 1972 roku do 2,64% rocznie po 2000 roku1. W przeglądzie globalnych trendów liczby plemników opublikowanym w 2022 roku Levine i współpracownicy wykazali, że liczba plemników spadała średnio o 1,2% rocznie między 1973 a 2018 rokiem, z 104 do 49 milionów/ml1.

Czynniki demograficzne i charakterystyka pacjentów z niepłodnością męską

Badania epidemiologiczne dostarczają cennych informacji na temat profilu demograficznego mężczyzn z niepłodnością, co pomaga w identyfikacji grup ryzyka i opracowaniu ukierunkowanych strategii diagnostycznych i terapeutycznych.

Wiek jako czynnik ryzyka niepłodności męskiej

Starzenie się ma istotny wpływ na rozpowszechnienie niepłodności męskiej. Badania epidemiologiczne sugerują, że naturalne wskaźniki płodności są niższe, a czas do poczęcia jest dłuższy u mężczyzn powyżej 40 roku życia w porównaniu z młodszymi mężczyznami12.

W miarę starzenia się mężczyzn poziom testosteronu spada, podczas gdy poziomy estradiolu i estronu wzrastają. Badania wykazały, że wraz z wiekiem gęstość plemników zmniejsza się1. U młodych mężczyzn spermatydy są obecne w 90% kanalików nasiennych, co zmniejsza się do 50% w wieku 50-70 lat i do 10% w wieku 80 lat. Dodatkowo, 50% komórek Sertoliego zostaje utraconych do 50 roku życia, a 50% komórek Leydiga do 60 roku życia1.

Obserwowane efekty starzenia się ojca na płodność wynikają przynajmniej częściowo ze zmniejszonej jakości plemników i zwiększonych nieprawidłowości genetycznych w plemnikach1.

Profil pacjentów z niepłodnością męską

Badanie przeprowadzone wśród aktywnych członków amerykańskich sił zbrojnych w latach 2013-2017 dostarcza szczegółowych danych demograficznych dotyczących niepłodności męskiej. Wskaźniki zapadalności na niepłodność były najwyższe wśród:

  • Mężczyzn w wieku 30-34 lat (60,1 na 10 000 osobolat)
  • Osób rasy czarnej niehiszpańskiej (36,5 na 10 000 osobolat)
  • Żonatych mężczyzn (52,1 na 10 000 osobolat)
  • Starszych podoficerów (45,1 na 10 000 osobolat)
  • Osób pracujących jako piloci/załoga powietrzna (40,9 na 10 000 osobolat)
  • Osób, które miały 2 lub więcej wcześniejszych misji (44,4 na 10 000 osobolat)1

Wśród rodzajów sił zbrojnych, ogólne wskaźniki rozpoznań niepłodności męskiej były najwyższe wśród członków Armii (38,8 na 10 000 osobolat) lub Sił Powietrznych (36,6 na 10 000 osobolat), a najniższe wśród członków Korpusu Piechoty Morskiej (20,2 na 10 000 osobolat)1.

Typy niepłodności męskiej

Badania wskazują, że niepłodność pierwotna (brak wcześniejszych ciąż) jest bardziej powszechna niż niepłodność wtórna (trudności z poczęciem po wcześniejszej ciąży). W badaniu przeprowadzonym w Iranie wykazano, że 78,4% par cierpiało na niepłodność pierwotną w porównaniu do 21,6% z niepłodnością wtórną1. Podobne wyniki uzyskano w badaniu w Kuwejcie, gdzie częstość występowania niepłodności pierwotnej była znacząca (78,6%)1.

W badaniu przeprowadzonym w Iranie, częstość występowania niepłodności pierwotnej wynosiła 10,6% (95% CI 5,3-16,0), a niepłodności wtórnej 2,7% (95% CI 1,9-3,5)1.

Przyczyny i czynniki ryzyka niepłodności męskiej

Niepłodność męska może być wynikiem różnorodnych czynników, od wrodzonych nieprawidłowości po nabyte schorzenia i czynniki środowiskowe. Zidentyfikowanie przyczyn niepłodności męskiej ma kluczowe znaczenie dla opracowania skutecznych strategii leczenia.

Główne kategorie przyczyn niepłodności męskiej

Przyczyny niepłodności męskiej można podzielić na kilka głównych kategorii:

  • Idiopatyczna niepłodność męska – pozostaje najczęstszą pojedynczą jednostką diagnostyczną, choć ta klasyfikacja może się zmienić wraz z najnowszymi postępami w genetyce niepłodności męskiej1. W około 40% przypadków (zakres 30-50%) przyczyna jest uznawana za idiopatyczną1
  • Nieprawidłowości w parametrach nasienia – 90% przypadków niepłodności męskiej wiąże się z niską liczbą plemników lub złą jakością nasienia1. Około 80% mężczyzn z niepłodnością ma oligozoospermię z asthenozoospermią, ale z normalną morfologią plemników1
  • Zaburzenia hormonalne – prowadzące do nieprawidłowości w hormonach produkowanych przez przysadkę, podwzgórze i jądra1
  • Żylaki powrózka nasiennego (varicocele) – najczęstsza przyczyna wtórnej niepłodności i częsta przyczyna niepłodności pierwotnej1
  • Infekcje układu moczowo-płciowego – mogące powodować dysfunkcje w wyrzucie nasienia1
  • Czynniki genetyczne – w tym nieprawidłowości chromosomalne1
  • Azoospermia – brak plemników w ejakulacie, która może wynikać z nieobecności/znacznie upośledzonej produkcji plemników w jądrach (azoospermia nieobstrukcyjna) lub z jakiegoś rodzaju niedrożności w drogach płciowych (azoospermia obstrukcyjna)1

Czynniki środowiskowe i styl życia

Czynniki środowiskowe i styl życia odgrywają istotną rolę w epidemiologii niepłodności męskiej:

  • Palenie tytoniu – w badaniu przeprowadzonym w Kuwejcie palenie tytoniu było zgłaszane u 51,2% pacjentów z niepłodnością1
  • Ekspozycja na wysoką temperaturę – w tym samym badaniu 30,08% pacjentów było narażonych na wysoką temperaturę1
  • Spożywanie alkoholu – zgłaszane przez 12,49% pacjentów z niepłodnością1
  • Narażenie zawodowe – najczęstszy czynnik ryzyka niepłodności w niektórych badaniach1
  • Ekspozycja na substancje chemiczne, pestycydy i mykotoksyny – główne środowiskowe czynniki ryzyka niepłodności męskiej1
  • Zanieczyszczenie środowiska – rosnące dowody sugerują, że zanieczyszczenie może być przynajmniej częściowo odpowiedzialne za pogarszającą się jakość plemników1
  • Zmiany klimatyczne – mogą negatywnie wpływać na płodność męską, z kilkoma badaniami na zwierzętach sugerującymi, że plemniki są szczególnie wrażliwe na skutki wzrostu temperatur1

Współwystępowanie chorób i niepłodność męska

Mężczyźni z problemami z niepłodnością mają tendencję do posiadania większej liczby chorób współistniejących niż normalnie płodni mężczyźni1. Niepłodni mężczyźni z nieprawidłowymi parametrami nasienia mają zwiększone ryzyko raka jąder, z najwyższym ryzykiem u osób z azoospermią1.

Istnieje również zwiększone ryzyko zachorowania na raka u krewnych pierwszego i drugiego stopnia niepłodnych mężczyzn. Odwrotnie, stwierdzono, że 5-8% pacjentów z rakiem jąder ma azoospermię1.

COVID-19 wydaje się powodować nieco zmniejszoną płodność, a nawet niepłodność u niektórych wyleczonych mężczyzn, szczególnie jeśli infekcja jest ciężka12. Potrzebne są dalsze badania, aby lepiej wyjaśnić zarówno mechanizmy uszkodzeń, jak i możliwe środki zaradcze specyficzne dla niepłodności związanej z infekcją COVID-191.

Diagnostyka i monitorowanie niepłodności męskiej

Prawidłowe rozpoznanie przyczyny niepłodności męskiej jest kluczowe dla wyboru odpowiedniej metody leczenia. Ocena niepłodności męskiej obejmuje szczegółową historię medyczną, badanie fizykalne, analizę nasienia i ocenę hormonalną.

Badania diagnostyczne w niepłodności męskiej

Podstawowym badaniem laboratoryjnym w ocenie niepłodności męskiej jest analiza nasienia, która dostarcza informacji o jakości i objętości nasienia, koncentracji plemników, ruchliwości i morfologii1. Mężczyźni z prawidłową analizą nasienia rzadko mają plemniki, które przyczyniają się do niepłodności1.

Badania krwi w kierunku niepłodności męskiej są wykorzystywane do oceny hormonalnych i genetycznych przyczyn niepłodności1. Główne składniki oceny niepłodności męskiej obejmują szczegółowy przegląd historii pacjenta, badanie fizykalne, co najmniej dwie analizy nasienia i hormonalną ocenę osi podwzgórze-przysadka-gonady1.

Monitorowanie i nadzór niepłodności męskiej

Pomimo znaczenia epidemiologii niepłodności męskiej, jej monitorowanie jest utrudnione przez kilka czynników:

  • Niepłodność męska nie jest chorobą podlegającą obowiązkowi zgłaszania1
  • Płatność za leczenie niepłodności męskiej jest zwykle prywatna i dlatego leczenie nie jest odzwierciedlone w statystykach ubezpieczeń medycznych1
  • Szacunki częstości występowania są ograniczone przez zmienność definicji niepłodności męskiej i podejść laboratoryjnych do wykonywania analizy nasienia1
  • Brak właściwych instrumentów i danych do wykorzystania w badaniach nad zmianami jakości nasienia w czasie1

Istnieje potrzeba lepszych metod monitorowania płodności męskiej w czasie lub między różnymi populacjami1. Zrozumienie zmieniających się wzorców niepłodności męskiej w świecie, różnych regionach i różnych krajach ma kluczowe znaczenie dla oceny globalnej płodności męskiej i zdrowia reprodukcyjnego1.

Wskaźniki epidemiologiczne wykorzystywane w badaniach niepłodności męskiej

W badaniach epidemiologicznych niepłodności męskiej stosuje się różne wskaźniki:

  • Standaryzowany według wieku wskaźnik częstości występowania (ASPR) – wzrósł z 1179,22 na 100 000 populacji (95% UI: 671,86-1866,05) w 1990 roku do 1402,98 na 100 000 populacji (95% UI: 792,24-2242,45) w 2019 roku, odzwierciedlając 19% wzrost od 1990 roku1
  • Lata życia z niepełnosprawnością (YLD) – liczba YLD wzrosła z 181 947,9 (95% UI: 68 999,7-434 846,1) w 1990 roku do 321 829,1 (95% UI: 120 614,9-771 411,2) w 2019 roku, wskazując na 76,9% wzrost1
  • Czas do poczęcia (TTP) – najbardziej bezpośrednia ocena płodności, mierząca czas potrzebny do poczęcia12

Wyzwania i perspektywy w epidemiologii niepłodności męskiej

Epidemiologia niepłodności męskiej stoi przed wieloma wyzwaniami, ale istnieją również obiecujące perspektywy na przyszłość w zakresie badań, zapobiegania i leczenia.

Ograniczenia w badaniach epidemiologicznych niepłodności męskiej

Kluczowe ograniczenia metodologiczne w badaniach niepłodności męskiej obejmują:

  • Stosowanie metod antykoncepcyjnych
  • Leczenie niepłodności
  • Metoda testowania ciąży
  • Brak standardowego kwestionariusza1

Badania niepłodności są dodatkowo ograniczone przez fakt, że wymagają równej wytrwałości w próbach zajścia w ciążę oraz dość podobnych pragnień dotyczących płodności i metod planowania rodziny w porównywanych grupach1.

Na globalnym poziomie istnieje brak dokładnych statystyk dotyczących wskaźników niepłodności męskiej1. Bez dokładnych, specyficznych dla regionu danych, nie jest możliwe zidentyfikowanie i kompleksowe leczenie niepłodnych mężczyzn1.

Przyszłe kierunki badań i działań w zakresie niepłodności męskiej

Biorąc pod uwagę rosnące obciążenie niepłodnością męską, konieczne jest priorytetowe traktowanie wysiłków mających na celu poprawę płodności męskiej i zdrowia reprodukcyjnego1. Obecny stan niepłodności męskiej stanowi istotne zagrożenie dla zdrowia reprodukcyjnego i wymaga zwiększonej uwagi ze strony badaczy1.

Istnieje rosnące wezwanie do lepszego zrozumienia niepłodności męskiej i nowych podejść do jej zapobiegania, diagnozy i leczenia, a także zwiększonej świadomości pilnej potrzeby zwalczania zanieczyszczenia środowiska1.

Światowa Organizacja Zdrowia (WHO) uznaje, że świadczenie wysokiej jakości usług w zakresie planowania rodziny, w tym usług związanych z płodnością, jest jednym z podstawowych elementów zdrowia reprodukcyjnego. Uznając znaczenie i wpływ niepłodności na jakość życia i dobrostan ludzi, WHO zobowiązuje się do zajęcia się niepłodnością i opieką nad płodnością poprzez:

  • Współpracę z partnerami w prowadzeniu globalnych badań epidemiologicznych i etiologicznych nad niepłodnością
  • Wspieranie generowania danych na temat obciążenia niepłodnością w celu informowania o alokacji zasobów i świadczeniu usług
  • Opracowywanie wytycznych dotyczących zapobiegania, diagnozy i leczenia niepłodności męskiej i żeńskiej, jako części globalnych norm i standardów jakości opieki związanej z opieką nad płodnością1

Przyszłe wieloośrodkowe, randomizowane badania kontrolowane są zalecane w celu zbudowania przekonujących dowodów i poprawy ogólnej jakości życia, a także praktyki seksualnej1.

Potrzeba edukacji i świadomości w zakresie niepłodności męskiej

Edukacja w zakresie płodności jest kluczowa zarówno dla mężczyzn, jak i kobiet1. Pary powinny być edukowane na temat przyczyn niepłodności i wkładu niepłodności męskiej w ten problem1.

Historycznie płodność u par heteroseksualnych była postrzegana jako problem kobiecy, z niesprawiedliwym skupieniem badań i leczenia na kobiecie1. Jednak ostatnie kilka dekad przyniosło dramatyczny spadek jakości plemników, a obecnie wiemy, że około 30% problemów z płodnością dotyczy wyłącznie mężczyzny, według British Fertility Society1.

Istnieje dobrze udokumentowany fakt, że prawdopodobieństwo wystąpienia problemu u mężczyzny jest w przybliżeniu równe prawdopodobieństwu wystąpienia problemu u kobiety, oraz że czynnik męskiej niepłodności jest odpowiedzialny w ponad połowie przypadków, gdy para wymaga zapłodnienia in vitro1.

Pomimo tych faktów, niepłodność jest w dużej mierze i niesprawiedliwie uważana za dotykającą kobiety1. Konieczne jest zwiększenie świadomości, że niepłodność dotyka mężczyzn i kobiety w równym stopniu (50%), niezależnie od bezpośredniej przyczyny1.

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  1. 12.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Male Infertility – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK562258/
    Infertility is usually defined as the inability of a couple to conceive even after 1 year of unprotected, frequent sexual intercourse. The male is solely responsible in about 20% of cases and is a contributing factor in another 30% to 40% of all infertility cases. […] Overall, the male factor substantially contributes to about 50% of all cases of infertility. […] This activity highlights the etiology and epidemiology of male infertility. […] The prevalence of infertility is variable, and epidemiologically, male infertility has been documented less in developing countries. The burden of infertility is generally worse in the developing world due to constrained medical resources and the high cost of treatment, as well as cultural fears, taboos, and stigmas. […] Globally, infertility affects approximately 13% to 15% of all couples, while 1 in 5 couples is unable to achieve pregnancy in the first year of trying. […] In 20% to 30% of infertility cases, males can be solely responsible, with an overall contribution to infertility in couples of about 50%.
  • #1 Male Infertility – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK562258/
    With regard to male infertility, the exact prevalence is still uncertain, as male infertility is not a reportable disease. […] Agarwal et al estimated the overall pure male factor infertility could range between 2.5% and 12%. In North America, the estimated male infertility rate is between 4.5% to 6%, while it’s 9% in Australia and could be as high as 8% to 12% in Eastern Europe. […] For most practical purposes, we assume that about one-sixth of all couples worldwide have an infertility issue and that the male factor infertility is significant in about half of cases and is the only cause in about 20% to 30% of cases. […] Of great concern is the widely reported general trending, over recent decades, of reductions in sperm counts globally. […] The average sperm count in 1940 was 113 million/mL but dropped to 66 million/mL in the 1990s. […] This trend has continued worldwide as the mean sperm count declined by 51.6% between 1973 and 2018.
  • #1 A unique view on male infertility around the globe | Reproductive Biology and Endocrinology | Full Text
    https://rbej.biomedcentral.com/articles/10.1186/s12958-015-0032-1
    The largest pockets of male infertility occurred in Central and Eastern Europe (8% to 12%) and Australia (8% to 9%). […] The rates in North Africa, Sub-Saharan Africa, and Eastern Europe are close to some of the higher percentages of male infertility estimated worldwide. […] The highest numbers relate to a region known as the African Infertility Belt, which stretches east to west across central Africa from Gabon to the United Republic of Tanzania. […] Total numbers of infertile men worldwide may amount from 30,625,864 to 30,641,262. […] The main message of these findings is that male infertility is a global health issue that has not been researched or studied to truly understand its magnitude and prevalence.
  • #1 Male Infertility | Treatment & Management | Point of Care
    https://www.statpearls.com/point-of-care/23503
    Agarwal et al estimated the overall pure male factor infertility could range between 2.5% and 12%. […] In North America, the estimated male infertility rate is between 4.5% to 6%, while it’s 9% in Australia and could be as high as 8% to 12% in Eastern Europe. […] A study by Bayasgalan et al estimated the cause of infertility due exclusively to a male factor at 25.6%. […] A similar study conducted by Thonneau et al found that among the French population, a prevalence of 20% of all infertility was due exclusively to a male factor. […] Similarly, Philippov et al used a WHO questionnaire in Western Siberian to show a rate of 6.4%, while in Nigeria, Ikechebelu et al found a male infertility prevalence of 42.4%. […] For most practical purposes, we assume that about one-sixth of all couples worldwide have an infertility issue and that the male factor infertility is significant in about half of cases and is the only cause in about 20% to 30% of cases.
  • #1 Global, regional and national burden of male infertility in 204 countries and territories between 1990 and 2019: an analysis of global burden of disease study | BMC Public Health | Full Text
    https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-16793-3
    Many countries and regions have experienced male fertility problems due to various influencing factors, especially in less developed countries. […] Unlike female infertility, male infertility receives insufficient attention. Understanding the changing patterns of male infertility in the world, different regions and different countries is crucial for assessing the global male fertility and reproductive health. […] In 2019, the global prevalence of male infertility was estimated to be 56,530.4 thousand (95% UI: 31,861.590,211.7), reflecting a substantial 76.9% increase since 1990. Furthermore, the global ASPR stood at 1,402.98 (95% UI: 792.242,242.45) per 100,000 population in 2019, representing a 19% increase compared to 1990. […] The regions with the highest ASPR and ASYR for male infertility in 2019 were Western Sub-Saharan Africa, Eastern Europe, and East Asia.
  • #1
    https://journals.lww.com/apjr/fulltext/2021/10050/male_infertility__a_scoping_review_of_prevalence,.1.aspx
    Studies carried out in the Indian population indicated that infertility is broadly found among Indian states, ranging from 3.7% in Uttar Pradesh, Himachal Pradesh, and Maharashtra, to 5.0% in Andhra Pradesh, and 15.0% in Kashmir. […] The cross-sectional study carried out in Pakistan showed that infertility is a typical issue influencing about 21.9% of the Pakistani population with 3.5% primary and 18.5% secondary infertility. […] In Nepali males, the prevalence of male infertility is around 45% in men aged 31-35 years. […] Studies carried out in Bangladesh indicate that out of 60% of cases of infertility, males are found responsible fully or partially as a major contributory factor for infertility. […] The overall occurrence of sexual dysfunction was found at 5.5% in Afghanistan as evident by a clinical study. […] Data on infertility in Australia are not very clear but as per the reports available, male factor infertility in Australia contributes to 40% of total infertility. […] In Africa, 35.5% of couples had male infertility as per reports.
  • #1 Epidemiology and Etiology of Infertility in Iran, Systematic Review and Meta-Analysis
    https://www.scitechnol.com/peer-review/epidemiology-and-etiology-of-infertility-in-iran-systematic-review-and-metaanalysis-JVqd.php?article_id=1622
    Meta-analysis that was performed by using data of these studies showed heterogeneity among the studies and concluded that the total average rate of infertility in Iran is 10.9% (95% CI 7.4-14.4), primary infertility is 10.6% ( 95% CI 5.3-16.0), secondary infertility is 2.7% (95% CI 1.9-3.5) and current infertility is 3.3% (95% CI 2.7-3.8). […] Meta-analysis of the etiology of infertility among the referees to the different infertility clinics of Iran showed that 78.4% of the couples suffer from primary and 21.6% from secondary fertility problems. […] 34% of them have male factor, 43.5% female factor and 17% both male and female factors and 8.1% have no determined cause for their infertility. […] The prevalence of infertility is different between regions. […] The present meta-analysis showed that the average prevalence rate of life time infertility is 10.9% in Iran and 3.3% of the population have current infertility.
  • #1
    https://www.aaem.pl/Infertility-in-the-light-of-new-scientific-reports-focus-on-male-factor,72403,0,2.html
    Epidemiological data indicate that infertility is a problem of global proportions, affecting one-fifth of couples trying to conceive worldwide (6080 mln). […] In Poland, infertility-related issues are found in about 19% of couples, including 4% with infertility and 15% with limited fertility. […] Inability to conceive occurs equally in men and women (50%), irrespective of the direct cause. […] Although it is generally thought that reproductive issues concern women, infertility affects men and women equally. […] This study is an attempted to systematize knowledge about the role of the male factor in infertility, particularly current knowledge concerning the environmental factors of infertility.
  • #1 Male Infertility | Treatment & Management | Point of Care
    https://www.statpearls.com/point-of-care/23503
    Of great concern is the widely reported general trending, over recent decades, of reductions in sperm counts globally. […] The average sperm count in 1940 was 113 million/mL but dropped to 66 million/mL in the 1990s. […] This trend has continued worldwide as the mean sperm count declined by 51.6% between 1973 and 2018. […] Even more concerning is that the rate of decline increased after 2000, from a decline of 1.16% per year post-1972 to 2.64% annually post-2000. […] While the exact causes are not known, contributing factors are thought to be increasing long-term exposure to environmental toxins as well as improved global medical care, which paradoxically allows more men with marginal health to participate in reproductive activities. […] There may also be an increased cancer risk in first and second-degree relatives of infertile men. […] Conversely, it has been reported that 5% to 8% of patients with testicular cancer have azoospermia. […] COVID-19 appears to cause somewhat reduced fertility and even infertility in some recovered males, especially if the infection is severe.
  • #1 How pollution is causing a male fertility crisis
    https://www.bbc.com/future/article/20230327-how-pollution-is-causing-a-male-fertility-crisis
    Sperm quality appears to be declining around the world but is a little discussed cause of infertility. […] Male infertility contributes to approximately half of all cases of infertility and affects 7% of the male population. […] Research suggests the problem may be growing. Factors including pollution have been shown to affect men’s fertility, and specifically, sperm quality with potentially huge consequences for individuals, and entire societies. […] There is mounting evidence that pollution may be at least partly behind declining sperm quality and sperm counts. […] At the same time, there may also be a decline in a different kind of fertility, known as fecundity meaning, a person’s physical ability to produce offspring. […] In 2022, Levine and his collaborators published a review of global trends in sperm count. It showed that sperm counts fell on average by 1.2% per year between 1973 to 2018, from 104 to 49 million/ml.
  • #1 Causes of male infertility – UpToDate
    https://www.uptodate.com/contents/causes-of-male-infertility
    Impact of aging — Aging affects the prevalence of male infertility. Overall, the studies indicate that paternal age >40 years adversely affects couples’ fertility, but this effect is small compared with the effect of maternal age >35 years. […] Epidemiologic studies suggest that natural fertility rates are lower and time to conception is longer for men over age 40 years than younger men. […] The observed effects of paternal aging on fertility are at least partially due to decreased sperm quality and increased genetic abnormalities in sperm.
  • #1 Male Infertility: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/436829-overview
    The effect of aging on fertility is unclear. As men age, their testosterone levels decrease, while estradiol and estrone levels increase. Studies have shown that, as men age, their sperm density decreases. Young men have spermatids present in 90% of seminiferous tubules, which decreases to 50% by age 50-70 years and to 10% by age 80 years. Additionally, 50% of Sertoli cells are lost by age 50 years, and 50% of Leydig cells are lost by age 60 years. Despite this, aging men may achieve fertility rates similar to those in younger men, although conception often takes longer.
  • #1 Brief Report: Male Infertility, Active Component, U.S. Armed Forces, 2013–2017 | Health.mil
    https://health.mil/News/Articles/2019/03/01/Male-Infertility?type=Fact+Sheets
    Compared to their respective counterparts, crude overall rates of incident infertility diagnoses were highest among service men aged 3034 years (60.1 per 10,000 p-yrs), non-Hispanic blacks (36.5 per 10,000 p-yrs), those who were married (52.1 per 10,000 p-yrs), senior enlisted service men (45.1 per 10,000 p-yrs), those working as pilots/air crew (40.9 per 10,000 p-yrs), and those who had 2 or more prior deployments (44.4 per 10,000 p-yrs). Across the services, overall rates of male infertility diagnoses were highest among Army (38.8 per 10,000 p-yrs) or Air Force members (36.6 per 10,000 p-yrs) and lowest among Marine Corps members (20.2 per 10,000 p-yrs). […] Annual rates of incident diagnoses of total male infertility decreased slightly from 35.2 per 10,000 p-yrs in 2013 to 30.3 per 10,000 p-yrs in 2017. Rates of diagnoses of male infertility, unspecified showed a steady decrease over the course of the 5-year period. Annual rates of infertility due to extratesticular causes remained relatively low and stable during 20132015.
  • #1 Epidemiology and Etiology of Infertility in Iran, Systematic Review and Meta-Analysis
    https://www.scitechnol.com/peer-review/epidemiology-and-etiology-of-infertility-in-iran-systematic-review-and-metaanalysis-JVqd.php?article_id=1622
    This meta-analysis showed that 78.4% of the couples in Iran suffered from primary infertility compared to 21.6% for the secondary infertility. […] The etiologic cause of infertility for 43.5% of the couples was a female factor. […] Some etiologic factors for infertility are more dominant in special geographic areas. […] Evidence shows that male fertility has decreased in some populations. […] The average rate of unexplained infertility calculated in this meta-analysis was 8.1% (95% CI 5.6-11.5). […] The prevalence rate of life time infertility was 10.9% and current infertility was 3.3% in Iran. Male factor was responsible for 34.0%, female factor for 43.5%, both factors for 17.1% and 8.1% were unexplained.
  • #1
    https://journals.lww.com/urol/fulltext/2020/12040/a_population_based_study_of_the_epidemiology_and.4.aspx
    The prevalence of primary male infertility was remarkable (78.6%), which is inconsistent with a previously published study of 289 patients, whereas only 10.4% of the patients had primary male infertility due to either chromosomal anomalies or Y chromosome microdeletions. […] Smoking is an influential risk factor of male infertility and has been reported in 51.2% of the patients included in our study. […] Varicocele is a common predisposing factor to male infertility since it causes impairment of testicular function and infertility. […] According to our results, 86% of the patients had varicocele: 43% as left-sided varicocele and 42.1% as bilateral varicoceles. […] In the present study, semen abnormalities among our patients revealed that 91.8% of the cases had abnormal semen tests such as oligoasthenospermia. […] Our results revealed that only 21.5% had high FSH, 11.69% had high LH, and 15.95% had low testosterone. […] Future multicenter random controlled studies are recommended to build conclusive evidence and improve the overall quality of life as well as sexual practice.
  • #1 Epidemiology and etiology of Male Infertility | Stony Brook Medicine
    https://www.stonybrookmedicine.edu/patientcare/urology/Epidemiology_info
    Idiopathic male infertility remains the most common single diagnostic entity, although this classification may be changed with recent advances in the genetics of male infertility. […] The common causes of male infertility are varicocele, accessory gland infection, immunological factor, congenital abnormalities; obstructive azoospermia; iatrogenic systemic and endocrine causes.
  • #1 Male infertility | Radiology Reference Article | Radiopaedia.org
    https://radiopaedia.org/articles/male-infertility?lang=us
    Male infertility is the inability to conceive due to factors in the male partner. […] Precise numbers vary, but generally, male factors are estimated to play a role in up to half of infertility cases. […] Risk factors for male infertility include lifestyle factors, e.g. smoking, alcohol, non-medical drug use, obesity, psychological stress, advanced paternal age, and toxin exposure, e.g. pesticides, heavy metals. […] There is a wide range of both congenital and acquired causes of male infertility, although ~40% (range 30-50%) are considered idiopathic.
  • #1 Male Infertility: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/436829-overview
    An estimated 10-15% of couples are considered infertile, defined by the World Health Organization (WHO) as the absence of conception after at least 12 months of unprotected intercourse. In US men, the risk correlates to approximately 1 in 25. Low sperm counts, poor semen quality, or both account for 90% of cases; however, studies of infertile couples without treatment reveal that 23% of these couples conceive within 2 years, and 10% more conceive within 4 years. Even patients with severe oligospermia ( 2 million sperm/mL) have a 7.6% chance of conception within 2 years. […] Patterns of male infertility vary greatly among regions and even within regions. The highest reported fertility rates are in Finland, while Great Britain has a low fertility rate. A combination of social habits, environmental conditions, and genetics is suspected to contribute to this variation.
  • #1
    https://step2.medbullets.com/renal/120712/male-infertility
    10-15% of reproductive-aged couples in the US […] 12% of men are infertile […] 80% of men with infertility have oligozoospermia with asthenozoospermia, but with normal morphology of sperm […] more common in those over 40-years-old […] often unable to determine etiology […] more common in developing countries.
  • #1
    https://www.who.int/news-room/fact-sheets/detail/infertility
    Infertility affects millions of people and has an impact on their families and communities. Estimates suggest that approximately one in every six people of reproductive age worldwide experience infertility in their lifetime. […] In the male reproductive system, infertility is most commonly caused by problems in the ejection of semen, absence or low levels of sperm, or abnormal shape (morphology) and movement (motility) of the sperm. […] Infertility may occur due to male, female or unexplained factors. […] In the male reproductive system, infertility may be caused by: obstruction of the reproductive tract causing dysfunctionalities in the ejection of semen. This blockage can occur in the tubes that carry semen (such as ejaculatory ducts and seminal vesicles). Blockages are commonly due to injuries or infections of the genital tract; hormonal disorders leading to abnormalities in hormones produced by the pituitary gland, hypothalamus and testicles hormones such as testosterone regulate sperm production. Example of disorders that result in hormonal imbalance include pituitary or testicular cancers; testicular failure to produce sperm, for example due to varicoceles or medical treatments that impair sperm-producing cells (such as chemotherapy); and abnormal sperm function and quality. Conditions or situations that cause abnormal shape (morphology) and movement (motility) of the sperm negatively affect fertility.
  • #1 Male Infertility – American Urological Association
    https://www.auanet.org/meetings-and-education/for-medical-students/medical-students-curriculum/male-infertility
    Many anatomic, hormonal, and genetic abnormalities can cause male infertility. […] Azoospermia refers to the absence of sperm in the ejaculate. Azoospermia can result from absent/markedly impaired sperm production within the testicle, known as non-obstructive azoospermia, or it can result from some type of obstruction within the genital tract, known as obstructive azoospermia. […] A varicocele refers to the abnormal dilation of the veins of the pampiniform plexus. This is the most common cause of secondary infertility and also a common cause of primary fertility. […] Unfortunately, many men seen for infertility and abnormal semen analyses have no obvious cause for their condition. […] The cornerstone of a male infertility workup is the semen analysis. […] Blood testing for male factor infertility is used to evaluate for hormonal and genetic causes of infertility. […] Treatment for male factor infertility varies based on the underlying cause.
  • #1 Causes and risk factors for male infertility | IJGM
    https://www.dovepress.com/causes-and-risk-factors-for-male-infertility-a-scoping-review-of-publi-peer-reviewed-fulltext-article-IJGM
    Despite the evidence of declining sperm counts worldwide and the increasing prevalence of male infertility, there has been limited documentation of the potential causes and risk factors for male infertility. […] Understanding the causes and risk factors will enable the identification of primary prevention methods, as well as effective methods for the primary treatment of male infertility. […] The results indicate limited knowledge of the actual causes of male infertility in published studies. […] The gaps in knowledge that need to be bridged to enable a fuller understanding of the actual causes of male infertility were highlighted. […] The major biological factors associated with male infertility identified in this review were genetic factors, uro-genital infections, and varicoceles.
  • #1 Epidemiology and occupational risk factors of male infertility based on 3,025 patients in Eastern Morocco during 2021-2023: a cohort study | Scilit
    https://www.scilit.com/publications/80068407bc09803a72be60aa918386bf
    Epidemiology and occupational risk factors of male infertility based on 3,025 patients in Eastern Morocco during 2021-2023: a cohort study […] The objective of our study was to characterize the sperm parameters of men consulting for infertility in our fertility center. The study included 3,025 patients investigated from September 2021 to July 2023. Demographic data, infertility risk factors, and the primary or secondary nature of infertility were recorded for each patient. The sperm parameters were analyzed according to World Health Organization (WHO) criteria (2021). The average age of the patients was 40 years. The average duration of infertility was 5.5 years. Primary infertility was noted in 2,736 patients (88.97%). The most common risk factors for infertility were occupational exposure, followed by varicocele. Lifestyle factors associated with male infertility included smoking (24.29%), alcohol consumption (12.49%), and high temperature exposure (30.08%). Spermogram abnormalities were observed in 78.71% of cases. Spermocytogram abnormalities were found in 63.1% of cases. Sperm count, morphology, total motility, and vitality below WHO (2021) reference values were found in 29.07%, 34.13%, 32.29%, and 62.46% of the analyzed samples, respectively. Seminal fluid analysis revealed oligozoospermia in 29.07% of cases, asthenozoospermia in 24.68%, and azoospermia in 17.56%. Oligo-astheno-necrospermia was the most frequently observed combined abnormality (10.0%). This study showed a high rate of abnormal semen quality in male partners of infertile couples. Male infertility is often multifactorial and results in quantitative and/or qualitative sperm abnormalities.
  • #1 Causes and risk factors for male infertility | IJGM
    https://www.dovepress.com/causes-and-risk-factors-for-male-infertility-a-scoping-review-of-publi-peer-reviewed-fulltext-article-IJGM
    The major environmental risk factors for male infertility identified in this review were exposures to chemicals, various pesticides, and mycotoxins. […] The results of this review indicate a substantial deficit of information required to confirm specific causes for male infertility. […] While some associations have been identified, there is a need to establish causation with purposefully designed studies.
  • #1 How pollution is causing a male fertility crisis
    https://www.bbc.com/future/article/20230327-how-pollution-is-causing-a-male-fertility-crisis
    Levine argues this acceleration could be down to epigenetic changes, meaning, alterations to the way genes work, caused by environmental or lifestyle factors. […] „This [declining sperm count] is a marker of poor health of men, maybe even of mankind,” says Levine. „We are facing a public health crisis and we don’t know if it’s reversible.” […] Individual lifestyle changes may not be enough to halt the decline in sperm quality. Mounting evidence suggests there is a wider, environmental threat: toxic pollutants. […] Climate change may also negatively impact male fertility, with several animal studies suggesting that sperm are especially vulnerable to the effects of increasing temperatures. […] There is a growing call for greater understanding of male infertility and new approaches for its prevention, diagnosis and treatment as well as an increased awareness of the urgent need to tackle pollution.
  • #1 Male Infertility – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK562258/
    Men with infertility issues tend to have more health-related comorbidities than normally fertile males. […] Infertile men with abnormal semen parameters have an increased risk of testicular cancer, with the highest risk in azoospermic individuals. […] COVID-19 appears to cause somewhat reduced fertility and even infertility in some recovered males, especially if the infection is severe. […] Further investigations are needed to better elucidate both the mechanisms of damage and possible remedies specific to COVID-19 infection-related infertility.
  • #1 Male Infertility: An Overview of the Causes and Treatments
    https://www.uspharmacist.com/article/male-infertility-an-overview-of-the-causes-and-treatments
    Semen analysis is the fundamental laboratory test in the evaluation of male infertility. It provides information about semen quality and volume, sperm concentration, motility, and morphology. These results may be compared with reference ranges and used to identify men with abnormal semen parameters who may benefit from ART such as intrauterine insemination (IUI) or in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI). Men with normal semen analyses rarely have sperm that contribute to infertility. […] Some infertile men will have medically or surgically correctable causes, making natural conception possible with appropriate intervention. Treatment is dependent on the underlying etiology and thus requires an accurate diagnosis for proper treatment. If a treatable or correctable infertility factor is identified, it should be corrected using appropriate medical or surgical therapies. Men with uncorrectable, untreatable, or unknown etiologies may benefit from ART. […] Advances in ART have improved outcomes for severely infertile couples, but further research is needed to better understand unknown causes of male infertility and to develop more effective treatments.
  • #1 Male Infertility: An Overview of the Causes and Treatments
    https://www.uspharmacist.com/article/male-infertility-an-overview-of-the-causes-and-treatments
    The American Urological Association (AUA) recommends an initial screening evaluation of the male partner of an infertile couple if pregnancy has not occurred within one year of regular, unprotected intercourse. An earlier evaluation is reasonable if a known infertility factor exists or a male doubts his fertility potential. A previous history of fertility does not exclude the possibility of secondary infertility. Men with secondary infertility are evaluated in the same manner as men who have never initiated pregnancy. The female partner should also undergo evaluation during this time period. […] The basic components for the evaluation of male infertility include a detailed review of patient history, physical examination, at least two semen analyses, and hormonal assessment of the HPG axis.
  • #1 Male Infertility | Treatment & Management | Point of Care
    https://www.statpearls.com/point-of-care/23503
    The prevalence of infertility is variable, and epidemiologically, male infertility has been documented less in developing countries. The burden of infertility is generally worse in the developing world due to constrained medical resources and the high cost of treatment, as well as cultural fears, taboos, and stigmas. It is much more challenging to identify and manage infertility in areas where medical resources for basic health care are already strained. […] Globally, infertility affects approximately 13% to 15% of all couples, while 1 in 5 couples is unable to achieve pregnancy in the first year of trying. […] In 20% to 30% of infertility cases, males can be solely responsible, with an overall contribution to infertility in couples of about 50%. […] With regard to male infertility, the exact prevalence is still uncertain, as male infertility is not a reportable disease. Furthermore, payment for male infertility treatment is usually private, and hence, treatments are not reflected in medical insurance statistics.
  • #1 Causes of male infertility – UpToDate
    https://www.uptodate.com/contents/causes-of-male-infertility
    INTRODUCTION […] EPIDEMIOLOGY […] Definitions and prevalence — Infertility in a couple is often defined as the inability to achieve conception after one year of frequent, unprotected intercourse, but epidemiological studies are inconsistent on the application of this definition. […] The distribution of male and female causes of infertility has not been well defined. In a 1982 to 1985 World Health Organization (WHO) multicenter study, 20 percent of cases were attributed to male factors, 38 percent to female factors, 27 percent to both, and 15 percent not clearly attributed to either. […] While other studies have reported a prevalence of male fertility of approximately 10 to 15 percent, a WHO systematic review suggested that estimates of prevalence are limited by variability in definitions of male infertility and laboratory approaches to performing semen analyses.
  • #1 SciELO Brazil – Measuring male infertility: epidemiological aspects Measuring male infertility: epidemiological aspects
    https://www.scielo.br/j/rhc/a/jDstyYFdDkhGzZyyNjZYPFc/
    The most important limitation in fertility studies is that the design requires equal persistency in trying to become pregnant and rather similar fertility desires and family planning methods in the groups to be compared. […] Measures of male infertility are needed if we want to monitor the biological capacity of males to reproduce over time or between different populations. […] The debate concerning a possible decline in sperm values over time has clearly demonstrated our lack of proper instruments and data to be used in this research. […] The major determinants for indications of deteriorating male reproductive health are probably related to social factors and access to safe contraceptive methods rather than reduced biological capacity to reproduce. […] Fertility as a measure of changes in fecundity over time and between countries, however, is not a good indication for male fecundity.
  • #1 SciELO Brazil – Measuring male infertility: epidemiological aspects Measuring male infertility: epidemiological aspects
    https://www.scielo.br/j/rhc/a/jDstyYFdDkhGzZyyNjZYPFc/
    Evidence suggests that human semen quality may have been deteriorating in recent years. […] Measures of male infertility are needed if we want to monitor the biological capacity for males to reproduce over time or between different populations. […] We also need these measures in analytical epidemiology if we want to identify risk indicators, risk factors, or even causes of an impaired male fecundity that is, the male component in the biological ability to reproduce. […] The most direct evaluation of fecundity is to measure the time it takes to conceive. […] A prolonged time required to produce pregnancy may therefore be due to a failure to conceive or a failure to maintain a pregnancy until clinical recognition. […] Studies that focus on quantitative changes in fecundity (that does not cause sterility) should in principle be possible in a pregnancy sample.
  • #1 Global, regional and national burden of male infertility in 204 countries and territories between 1990 and 2019: an analysis of global burden of disease study | BMC Public Health | Full Text
    https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-16793-3
    The burden of male infertility in the High-middle SDI and Middle SDI regions exceeded the global average in terms of both ASPR and ASYR. […] The global burden of male infertility has exhibited a steady increase from 1990 to 2019, as evidenced by the rising trends in ASPR and ASYR, particularly in the High-middle and Middle SDI regions. […] Notably, the burden of male infertility in these regions far exceeds the global average. […] Given these findings, it is imperative to prioritize efforts aimed at improving male fertility and reproductive health. […] The prevalence number of male infertility increased by 76.9%, from 31,952 thousand (95% UI: 18,08950,104.9) in 1990 to 56,530.4 thousand (95% UI: 31,861.590,211.7) in 2019. […] The ASPR of male infertility rose from 1,179.22 per 100,000 population (95% UI: 671.861,866.05) in 1990 to 1,402.98 per 100,000 population (95% UI: 792.242,242.45) in 2019, reflecting a 19% increase since 1990.
  • #1 Global, regional and national burden of male infertility in 204 countries and territories between 1990 and 2019: an analysis of global burden of disease study | BMC Public Health | Full Text
    https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-16793-3
    In terms of YLD, the number of YLD increased from 181,947.9 (95% UI: 68,999.7434,846.1) in 1990 to 321,829.1 (95% UI: 120,614.9771,411.2) in 2019, indicating a 76.9% rise. […] The burden of male infertility coexists with high fertility needs. […] The current status of male infertility poses a substantial threat to reproductive health and necessitates heightened attention from researchers.
  • #1 SciELO Brazil – Measuring male infertility: epidemiological aspects Measuring male infertility: epidemiological aspects
    https://www.scielo.br/j/rhc/a/jDstyYFdDkhGzZyyNjZYPFc/
    Fecundity will decline over time as a result of these changes in population selection. […] Several reports in the literature have suggested a possible decline in human semen quality during the last 50 to 60 years. […] A systematic analysis of 61 studies was undertaken by Carlsen in 1992. […] These results have been discussed in the literature and have stimulated extensive research. […] When these observations are brought together with the increasing incidence of testicular cancer in all the countries in which it is measured, and with the reported increased incidence of cryptorchidism and of hypospadias, the existence of a single syndrome, the „testicular dysgenesis syndrome” (TDS), that would associate these 3 elements, seems likely. […] The most direct evaluation of fecundity is to measure the time it takes to conceive.
  • #1 A unique view on male infertility around the globe | Reproductive Biology and Endocrinology | Full Text
    https://rbej.biomedcentral.com/articles/10.1186/s12958-015-0032-1
    Infertility affects an estimated 15% of couples globally, amounting to 48.5 million couples. Males are found to be solely responsible for 20-30% of infertility cases and contribute to 50% of cases overall. […] On a global level, there is a lack of accurate statistics on rates of male infertility. […] Our calculated data showed that the distribution of infertility due to male factor ranged from 20% to 70% and that the percentage of infertile men ranged from 25% to 12%. Infertility rates were highest in Africa and Central/Eastern Europe. […] According to our results, at least 30 million men worldwide are infertile with the highest rates in Africa and Eastern Europe. […] Without accurate, region-specific data, it is not possible to identify and comprehensively treat infertile men. […] The calculated global data shows that the percent of infertility that is attributable to males ranged between 20-70%.
  • #1
    https://www.who.int/news-room/fact-sheets/detail/infertility
    While assisted reproduction technologies (ART) have been available for more than three decades, with millions of children born worldwide from ART interventions such as in vitro fertilization (IVF), these technologies are still largely unavailable, inaccessible and unaffordable in many parts of the world, particularly in low and middle-income countries (LMIC). […] WHO recognizes that the provision of high-quality services for family-planning, including fertility care services, is one of the core elements of reproductive health. Recognizing the importance and impact of infertility on peoples quality of life and well-being, WHO is committed to addressing infertility and fertility care by: collaborating with partners to conduct global epidemiological and etiological research into infertility; supporting the generation of data on the burden of infertility to inform resource allocation and provision of services; developing guidelines on the prevention, diagnosis and treatment of male and female infertility, as part of the global norms and standards of quality care related to fertility care.
  • #1 Male infertility: “It’s not just about having a few extra tests. It’s about the right emotional and medical support.” | HFEA
    https://www.hfea.gov.uk/about-us/our-blog/male-infertility-it-s-not-just-about-having-a-few-extra-tests-it-s-about-the-right-emotional-and-medical-support/
    By missing opportunities for further tests and not investigating the man more thoroughly, we run the risk of putting women through unnecessary treatment. […] It seems crazy to go into something as invasive, expensive and emotionally charged as IVF without investigating both parties fully, yet this is happening regularly. […] Fertility education is crucial for both men and women, and its time we helped men get a better understanding of their fertility and the choices they have, because there is so much more out there for them if they know where to look. […] Good education and more thorough testing are needed, and if men were to be offered more comprehensive tests from the very beginning, it could completely change the treatment pathway for many couples. […] This starts with a clear referral pathway from GPs, which currently only exists in extreme cases, as well as a focus on the research into the impact sperm have on fertility outcomes, and a push to recruit or train more Urologists with male fertility expertise.
  • #1
    https://www.ijrcog.org/index.php/ijrcog/article/view/12456
    Approximately 10% to 15% of couples in developing countries are infertile. Male infertility is responsible for 20-43% of infertility cases and contributes to another 12-20% of cases. […] Aims and objectives of current study was to analyze the epidemiology and clinical factors of male infertility in Central India and identify its risk factors. […] All semen abnormalities were more common among businessmen and also more prevalent among smokers. […] Couples should be educated about infertility causes and the contribution of male infertility to it. Multifactorial analysis along with clinicopathological analysis should contribute to accurate diagnosis of the cause of male infertility and proposal of adequate measures.
  • #1 Male infertility: “It’s not just about having a few extra tests. It’s about the right emotional and medical support.” | HFEA
    https://www.hfea.gov.uk/about-us/our-blog/male-infertility-it-s-not-just-about-having-a-few-extra-tests-it-s-about-the-right-emotional-and-medical-support/
    Historically, fertility in heterosexual couples has been thought of as a female issue, with the focus of testing and treatment sitting unfairly on the woman. […] The last couple of decades have seen a dramatic decline in sperm quality, and we now know that around 30% of fertility issues sit purely with the man, according to the British Fertility Society. […] It is well documented that the likelihood of the issue sitting with the man is roughly equal to that of it sitting with the woman, and that male factor infertility is responsible in more than half of cases where a couple requires IVF. […] Although still an area of debate among some fertility clinicians, there are further tests and examinations that could be considered for men, some of which show promising data in male infertility aetiology diagnosis.
  • #1 What people really know about male infertility – Fertility Europe
    https://fertilityeurope.eu/what-people-really-know-about-male-infertility/
    Epidemiology of male infertility. […] Infertility is largely and unfairly thought to affect women. […] When a couple has trouble conceiving, it is often assumed that the issues lie with the female partner. However, male infertility plays a role in many cases. […] Infertility within a couple is defined as the inability of a sexually active, non-contracepting couple to become pregnant in one year and is believed to affect at least one in every six young couples. […] It is estimated that the cause of infertility can be explained by issues relating to the female partner in 38% of cases, and the male partner in 20% of the time. […] As with female infertility, male infertility isn’t anyone’s fault. However, in light of these statistics we should remember that in up to 50% of cases in which couples can’t have babies naturally, the male partner could be contributing towards the underlying cause of infertility.
  • #2 A unique view on male infertility around the globe | Reproductive Biology and Endocrinology | Full Text
    https://rbej.biomedcentral.com/articles/10.1186/s12958-015-0032-1
    Infertility affects an estimated 15% of couples globally, amounting to 48.5 million couples. Males are found to be solely responsible for 20-30% of infertility cases and contribute to 50% of cases overall. […] On a global level, there is a lack of accurate statistics on rates of male infertility. […] Our calculated data showed that the distribution of infertility due to male factor ranged from 20% to 70% and that the percentage of infertile men ranged from 25% to 12%. Infertility rates were highest in Africa and Central/Eastern Europe. […] According to our results, at least 30 million men worldwide are infertile with the highest rates in Africa and Eastern Europe. […] Without accurate, region-specific data, it is not possible to identify and comprehensively treat infertile men. […] The calculated global data shows that the percent of infertility that is attributable to males ranged between 20-70%.
  • #2 Azthena logo with the word Azthena
    https://www.news-medical.net/health/Male-Infertility-Epidemiology.aspx
    Infertility issues plague nearly 15% of couples in the world. […] Of these cases nearly 30% are due to male infertility issues. […] There is no way to accurately pinpoint cases of male infertility across the globe, but recent studies conducted on a region and country basis by different organizations have made it possible to gain a better understanding of the disorder. […] The estimated number of infertile men in the world ranges between 30,625,864 and 30,641,262. […] The highest concentration of male infertility was found in Europe. […] The study concluded that nearly 50% of infertility cases rest with women while 30% are caused due to male infertility issues.
  • #2 Causes of male infertility – UpToDate
    https://www.uptodate.com/contents/causes-of-male-infertility
    INTRODUCTION […] EPIDEMIOLOGY […] Definitions and prevalence — Infertility in a couple is often defined as the inability to achieve conception after one year of frequent, unprotected intercourse, but epidemiological studies are inconsistent on the application of this definition. […] The distribution of male and female causes of infertility has not been well defined. In a 1982 to 1985 World Health Organization (WHO) multicenter study, 20 percent of cases were attributed to male factors, 38 percent to female factors, 27 percent to both, and 15 percent not clearly attributed to either. […] While other studies have reported a prevalence of male fertility of approximately 10 to 15 percent, a WHO systematic review suggested that estimates of prevalence are limited by variability in definitions of male infertility and laboratory approaches to performing semen analyses.
  • #2 Male Infertility | Treatment & Management | Point of Care
    https://www.statpearls.com/point-of-care/23503
    Agarwal et al estimated the overall pure male factor infertility could range between 2.5% and 12%. […] In North America, the estimated male infertility rate is between 4.5% to 6%, while it’s 9% in Australia and could be as high as 8% to 12% in Eastern Europe. […] A study by Bayasgalan et al estimated the cause of infertility due exclusively to a male factor at 25.6%. […] A similar study conducted by Thonneau et al found that among the French population, a prevalence of 20% of all infertility was due exclusively to a male factor. […] Similarly, Philippov et al used a WHO questionnaire in Western Siberian to show a rate of 6.4%, while in Nigeria, Ikechebelu et al found a male infertility prevalence of 42.4%. […] For most practical purposes, we assume that about one-sixth of all couples worldwide have an infertility issue and that the male factor infertility is significant in about half of cases and is the only cause in about 20% to 30% of cases.
  • #2 Epidemiology and Etiology of Infertility in Iran, Systematic Review and Meta-Analysis
    https://www.scitechnol.com/peer-review/epidemiology-and-etiology-of-infertility-in-iran-systematic-review-and-metaanalysis-JVqd.php?article_id=1622
    This meta-analysis showed that 78.4% of the couples in Iran suffered from primary infertility compared to 21.6% for the secondary infertility. […] The etiologic cause of infertility for 43.5% of the couples was a female factor. […] Some etiologic factors for infertility are more dominant in special geographic areas. […] Evidence shows that male fertility has decreased in some populations. […] The average rate of unexplained infertility calculated in this meta-analysis was 8.1% (95% CI 5.6-11.5). […] The prevalence rate of life time infertility was 10.9% and current infertility was 3.3% in Iran. Male factor was responsible for 34.0%, female factor for 43.5%, both factors for 17.1% and 8.1% were unexplained.
  • #2 Male Infertility: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/436829-overview
    Debate has occurred in the literature regarding a poorer semen quality, decreased sperm counts (113 million/mL in 1940 compared with 66 million/mL in the 1990s), and decreased fertility in men today compared with fertility 50 years ago. Investigators hypothesize that environmental conditions and toxins have led to this decline; however, others argue that this is solely because of differences in counting methods, laboratory techniques, and geographic variation. […] Isolated conditions of the female are responsible for infertility in 35% of cases, isolated conditions of the male in 30%, conditions of both the male and female in 20%, and unexplained causes in 15%. Even if one partner has an obvious cause for the infertility, a thorough evaluation of both partners for completeness is prudent. In addition, both partners may be aided by evaluation of their sexual practices.
  • #2 Male Infertility: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/436829-overview
    The effect of aging on fertility is unclear. As men age, their testosterone levels decrease, while estradiol and estrone levels increase. Studies have shown that, as men age, their sperm density decreases. Young men have spermatids present in 90% of seminiferous tubules, which decreases to 50% by age 50-70 years and to 10% by age 80 years. Additionally, 50% of Sertoli cells are lost by age 50 years, and 50% of Leydig cells are lost by age 60 years. Despite this, aging men may achieve fertility rates similar to those in younger men, although conception often takes longer.
  • #2 Male Infertility | Treatment & Management | Point of Care
    https://www.statpearls.com/point-of-care/23503
    Of great concern is the widely reported general trending, over recent decades, of reductions in sperm counts globally. […] The average sperm count in 1940 was 113 million/mL but dropped to 66 million/mL in the 1990s. […] This trend has continued worldwide as the mean sperm count declined by 51.6% between 1973 and 2018. […] Even more concerning is that the rate of decline increased after 2000, from a decline of 1.16% per year post-1972 to 2.64% annually post-2000. […] While the exact causes are not known, contributing factors are thought to be increasing long-term exposure to environmental toxins as well as improved global medical care, which paradoxically allows more men with marginal health to participate in reproductive activities. […] There may also be an increased cancer risk in first and second-degree relatives of infertile men. […] Conversely, it has been reported that 5% to 8% of patients with testicular cancer have azoospermia. […] COVID-19 appears to cause somewhat reduced fertility and even infertility in some recovered males, especially if the infection is severe.
  • #2 SciELO Brazil – Measuring male infertility: epidemiological aspects Measuring male infertility: epidemiological aspects
    https://www.scielo.br/j/rhc/a/jDstyYFdDkhGzZyyNjZYPFc/
    Fecundity will decline over time as a result of these changes in population selection. […] Several reports in the literature have suggested a possible decline in human semen quality during the last 50 to 60 years. […] A systematic analysis of 61 studies was undertaken by Carlsen in 1992. […] These results have been discussed in the literature and have stimulated extensive research. […] When these observations are brought together with the increasing incidence of testicular cancer in all the countries in which it is measured, and with the reported increased incidence of cryptorchidism and of hypospadias, the existence of a single syndrome, the „testicular dysgenesis syndrome” (TDS), that would associate these 3 elements, seems likely. […] The most direct evaluation of fecundity is to measure the time it takes to conceive.

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koncentracja plemników narażenie zawodowe komórki Leydiga morfologia plemników varicocele azoospermia nieobstrukcyjna oś podwzgórze-przysadka-gonady ekspozycja na wysoką temperaturę komórki Sertoliego analiza nasienia niepłodność pierwotna rak jądra liczba plemników infekcja układu moczowo-płciowego kanalik nasienny niepłodność niepłodność wtórna jakość nasienia azoospermia obstrukcyjna podwzgórze czynnik męski niepłodności niepłodność męska choroby współistniejące jądro ruchliwość plemników zaburzenie hormonalne żylaki powrózka nasiennego przysadka mózgowa