The reason why The Handmaid's Tale gave me sleepless nights...

I’d love to say I’ve read the book. But only because that’s what everyone loves to say! Instead I’ve read a different book and one in which the author shares my growing concerns. Until now I thought I was the only one who was worried by the rapid decline in sperm health, plummeting by 50% over the last 40 years. But finally researchers are starting to piece the evidence together. Professor Shanna Swan, one of the world’s leading environmental and reproductive epidemiologists provides disturbing statistics which makes me question whether The Handmaid’s Tale is not a work of fiction but more a glimpse into the very alarming future. 

For the last few years, while everyone else has been talking about climate change, I’ve been worrying about a different threat. But this one seems to get way less traffic when it comes to the global stage. There’s no Sperm Summit for instance. Yet research shows that sperm health is rapidly declining with no signs of levelling off and it is predicted that by 2050 everyone will need to use assisted reproduction (IVF) to have a baby. 

So how have we dealt with this? Thank goodness for the World Health Organisation who very cleverly stepped in to resolve the problem. In the 1940s the WHO considered an adequate sperm count to be 60 million/mL. In 1980 they lowered this to 20 million/mL and by 2010 it was further reduced to 15 million/mL. Phew! 

By the 1980s they’d figured out what to do. “Male factor infertility is the only medical situation that’s treated by administering a painful procedure to a woman because of a problem that afflicts her male partner.” (Swan) This is in the form of assisted reproduction (AR), which to any who are unfamiliar, involves the woman injecting herself with hormones to stimulate egg production where ovaries swell to the size of grapefruits so that she might ripen anywhere from 5 to 20 eggs (in a natural cycle only 1 to 2 eggs would ripen and release every month). These eggs are extracted under general anaesthetic, mixed with sperm that has been extracted the ‘easy way’, before being implanted back into the woman’s uterus without the use of any anaesthetic at all. They’re told it’s like an “uncomfortable smear”, but for some it’s excruciating. 

You might be under the illusion that this is the only way to make a baby when the sperm isn’t up to scratch and therefore an unfortunate necessity. It’s not. TESA (Testicular Sperm Aspiration) is exactly what it says on the tin. A needle is inserted into the testicles and sperm are aspirated out. Yet despite this radically improving the outcome of AR I have only known two men in my entire career who were willing to have the procedure. “The pregnancy rate using testicular [TESA] and ejaculated [the old fashioned way] spermatozoa was 44% and 6%, respectively.” (Zini & Agarwal) The lack of uptake for men having TESA is in part due to them being unaware it exists. It is not something offered in most fertility clinics despite them having the ability to perform the procedure. To add to this, men are rarely given any dietary, lifestyle or supplementation advice, even if they have a poor sperm assay. Instead women are told to cut out alcohol, reduce their BMI and take pre-conception vitamins when actually obesity and alcohol affect sperm quality far more than in female reproductive health. “Alcohol damages chromatin integrity and increases DNA fragmentation in sperm”. (Zini & Agarwal) Correct supplementation in men is shown to markedly improve overall sperm quality by 48.9% in three months and 80.9% in six months. (Gvozdjáková A et al, 2015) Yet I’m eternally gobsmacked that this type of useful information isn’t disseminated down to the patient. Are we so afraid that men can’t handle the truth? That they might be solely responsible for being unable to start a family and that THEY might want to do something about it. In my experience most men would do a whole lot about it given the information by a medical fertility consultant. I have certainly come across men who have said that if their fertility consultant isn’t bothered by their sperm assay then why should I be? You can imagine my frustration! The fact is the goal posts have been moved. What equates to a “good” sperm result today would be considered exceptionally poor as little as 10 years ago. 

So why do women suffer unnecessarily, take the hormones, go on diets, etc and are totally willing to do whatever it takes? Because the pull for a baby is often far stronger than defending any female rights. Some women will do almost anything to have a baby, and herein lies the problem. It’s not a fault, merely a hormonal and innate urge to procreate and nurture a child. But in this way we can be manipulated into almost anything for the promise of a child. The same can be true of men too. (Of course it’s not just women who suffer.) My point here is that the subject of fertility is emotive and can make people do crazy things.

If you’ve not come round to my way of thinking, that The Handmaid’s Tale might be a prediction of the future, let’s consider what happens with the ageing process and fertility. Up until fairly recently we thought only women had a biological clock but it is clear now that men’s fertility also decreases steadily from age 35 onwards in the form of Sperm DNA Fragmentation. (You can read more about this is my blog article “Could it be Sperm DNA Fragmentation?”) “Studies suggest that for men ages forty and older, their partner has a 60 percent increased risk of experiencing miscarriage, compared to partners under thirty.” (Swan) Young eggs can accommodate older sperm and “make good” sperm that would not be viable if it was paired with an older egg. I predict that as sperm rates decline, younger, fertile women will become a commodity. We’ve already seen this with the rate of surrogacy rising in popularity. Couples seeing their only hope of starting a family by renting a uterus. I understand it. I can see how being unable to have a child can make you do some unorthodox things; I am a fertility acupuncturist after all!

And then, in the television series, there’s the issue of toxins and chemicals having created this unhealthy and infertile environment with barren Handmaid’s being sent to the “colonies” to finish their miserable lives. For anyone who hasn’t seen it this place depicts areas of contaminated, radioactive wasteland. Not too dissimilar to some parts of the UK! Bristol scores particularly high on the air pollution rankings with The Guardian reporting “Air pollution kills five people in Bristol each week, study shows”. (guardian.com) 

Today, the rise in male factor infertility is thought largely to be due to environmental pollutants. Baby boys exposed to high levels of phthalates (found in plastics) in the womb were shown to have diminished fertility in adulthood. The trend continues if the exposure carries on through adulthood. Despite the overwhelming evidence that phthalates (among other chemicals) are responsible for such a downward turn in male fertility they are still widely used. Worse still, chemicals that have been shown to be “harmful” are replaced by chemicals that haven’t been tested and the replacements tend to be no better than their predecessors. “In essence, this takes advantage of the public’s misperception that the replacement is inherently safe.” (Swan) 

In my blog article, Chemical Warfare, I speak about the issues of chemicals affecting our health. “There are around 70,000 to 85,000 chemicals in use today, with around 2,000 new chemicals coming onto the market each year. It is estimated that around 1% of these chemicals have been tested as Environment Protection Agencies struggle to keep up with the growing volume of new chemical compositions.” The fact of the matter is, we know they are not safe, yet we continue to use them as there just isn’t an alternative. What would we do without plastics?! 

So, we know male fertility is rapidly declining. We know this is largely due to environmental exposure to chemicals and toxins that baby boys are exposed to in and outside of the womb. We know that with fewer young people we will not be able to support the older generation. “What will happen in the future - will sperm count reach zero? Is there a chance that this decline would lead to extinction of the human species? Given the extinction of multiple species, associated with man-made environmental disruption, this is certainly possible.” (Levine) 

So realistically, I’m not sure if we’ll ever see the types of tyrannical characters and restrictions we see in The Handmaid’s Tale. But certainly we will see infertility becoming a global problem that will require radical intervention. Indeed male infertility IS a global problem but sssssh… don’t for goodness sake’s tell anyone!

For more information on the subject and to read a fantastic book packed full of research and statistics on the problems we face both in male and female infertility please read: Countdown: How our modern world is threatening sperm counts, altering male and female reproductive development, and imperilling the future of the the human race by Shanna H. Swan, PhD. I highly recommend it. And if you have sons it is your duty to read this book!

https://blackwells.co.uk/bookshop/product/9781982113667?gC=5a105e8b&gclid=CjwKCAjw07qDBhBxEiwA6pPbHqdkoKjL34w-whsCpMYs8SqcrQzxpK_Gim-lM_SXroxCXozirPoI-xoC8ugQAvD_BwE

​References:
Swan, Countdown: How our modern world is threatening sperm counts, altering male and female reproductive development and imperilling the future of the human race, 2020

Zini and Agarwal, A Clinician's Guide to Sperm DNA and Chromatin Damage, 2018

Laville, Air pollution kills five people in Bristol each week, study shows,  18 November 2019, https://www.theguardian.com/environment/2019/nov/18/air-pollution-kills-bristol-health [Accessed on 8th April 2021]

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