Fertility. Few things evoke stronger basic human instincts than the primal urges to satisfy the biological imperative of reproduction. The images of a child's birth and the beginning of a family are commonly seen as significant rites of passage within our society. Many couples take for granted that this process will happen seamlessly. Difficulties encountered in conceiving a child are challenging to an ever-increasing number of couples, contributing to relationship stressors and potential feelings of inadequacy.  

‍

Common causes of infertility:

• Sperm disorders
• Hormonal contributions - men with low testosterone can impact their fertility
• Medications - young men taking testosterone are often unaware that it impairs fertility
• Anatomic contributions - physically dilated veins (varicoceles) and blockages

‍

A large percentage of men have idiopathic infertility. Idiopathic means no obvious factor has been identified that is causing the problem. In short, the root of the problem is unknown or poorly understood. 

‍

Part of my everyday conventional urologic practice involves counseling couples dealing with infertility. While some men do present with the common causes listed above, many do not.  I have observed this nebulous aspect of my practice increase over time in terms of the volume of patients reporting these concerns. I started “connecting the dots” within some of the clinical information that these couples provided. Not so surprisingly, these patients often share many contributing risk factors overlapping across diverse backgrounds. As I explored these themes further, a bigger picture unfolded. This was not a local problem; this seemed to be impacting the US and the world as a whole.

‍

Many factors are favored to contribute to this decline, including:

   1- Worsening rates of obesity - worsening metabolic health, a core priority for HolSpan

   2- Environmental exposures - endocrine disrupting compounds (EDC) that are impacting testosterone/sex hormones‍

• The National Institute of Environmental Health Sciences defines endocrine-disrupting compounds as follows: “Endocrine-disrupting chemicals (EDCs) are natural or human-made chemicals that may mimic, block, or interfere with the body’s hormones, which are part of the endocrine system.” These chemicals are associated with a wide array of health issues.

   3- Genetic contributions - some that can be screened for, but many that we cannot test well for currently 

‍

HolSpan places a large emphasis on the importance of lifestyle factors in young individuals/couples seeking to conceive a child. Many of the approaches that are foundational to sexual health are also very applicable to reproductive health. Foundational lifestyle changes made to be daily habits hold the promise to improve the health of the current generation along with future generations. 

‍

Sources:

• Urology Care Foundation. (n.d.). Male Infertility. Urology Care Foundation. [Online]. Available at: Link to the article
• World Health Organization (WHO). (2023, April 4). 1 in 6 people globally affected by infertility: WHO. [Online]. Available at: Link to the article‍
• National Institute of Environmental Health Sciences (NIEHS). (n.d.). Endocrine Disruptors. Health & Education. The National Institute of Environmental Health Sciences. [Online]. Available at: Link to the article