Low sperm count is an indicator of the presence of disease
THE WEEK|May 23, 2021
Dr Shanna Swan, professor of environmental medicine and public health, Icahn School of Medicine at Mount Sinai, New York City
POOJA BIRAIA JAISWAL

Shanna Swan’s recent book has a comprehensive name: Count Down: How our Modern World Is Threatening Sperm Counts, Altering Male And Female Reproductive Development And Imperiling The Human Race. “It is no longer business as usual when it comes to human reproduction,” she writes. “We are living in an age of reproductive reckoning that is having reverberating effects across the planet.” In 2017, the environmental and reproductive epidemiologist documented how the average sperm count among men in the west had more than halved in nearly 40 years.

In her book, she talks about how chemicals in our environment are endangering the sexual health of both men and women, thereby affecting their ability to conceive naturally. In recent years, she explains, we have witnessed an increasing number of babies born with smaller penises, higher rates of erectile dysfunction, and girls hitting puberty early. This is just the beginning, she says. Excerpts from an interview:

Q/Your study on low sperm count and your book have created quite a stir. Did it lead to any policy overhaul on chemical exposure in the US?

A/ No. It is difficult, but not impossible. There are many companies now that are expressing commitment to making safer products. We need more public pressure to press for change and move away from these hazardous chemicals. We need chemicals that are not hormonally active and this is difficult because there are many hormones in the body and testing the chemicals to be free of hormonal action is difficult. But I think we can do it.

Q/You say that the sperm count could hit zero by 2045.

A/ What we know is that sperm count concentration has been decreasing dramatically, and hypothetically it could hit zero in 2045. However, hitting zero would mean that the median sperm count would be zero in 2045. Now, is that possible? No, because we cannot have negative sperm [count], which means we can come arbitrarily close to it but we cannot go below it. In western countries, at the end of the study period, the median sperm count was 47 million per millilitre. This is extremely low and it is about 52 per cent lower than it was 39 years ago. So, it is showing evidence of slowing down. The way you look at that is you go back by each decade and if decade after decade it is slowing down, then it should become less till it flattens, and I believe that will happen. Also, 47mpm is very low because it is close to 40mpm, which is the point at which it takes longer and longer to get pregnant. As the sperm concentration drops below 40mpm, the couple will not be able to conceive without assisted reproduction.

Q/Can your meta-analysis on sperm count be applied to Asian countries as well?

A/ When we did this study… there were very few non-western studies. First, because [of the size, demography] of the population. Second, the infrastructure required to carry out these studies. Nevertheless, I am sure India has got the knowledge and the ability to count sperm. But they have not published many studies. That is the problem. But I am sure that just as in the west, men in India do not get their sperm count tested and do not know what their sperm count is. Also, there is a lack of awareness. Sperm count is not just an indicator of reproductive health, but a low sperm count is an indicator of the presence of disease—heart disease, diabetes and reproductive cancers. And, they die younger. So, just like one finds out one’s cholesterol and blood pressure levels, one must get his sperm count routinely checked.

Q/You speak of endocrine-disrupting chemicals (EDCs), specifically phthalates that are added to plastics, cosmetics, cookware coatings and food wrappers. You also speak of bisphenols and pesticides. We are exposed to these in India as well. How can such exposure make us infertile?

A/ They are not chemically bound to the products. That means they can leave. For example, if you look closely at premature babies in a hospital or a pediatric ward, their food comes in through tubes; oxygen too. You can show that the number of tubes to which a baby is connected is directly related to the amount of phthalates in her urine. This is proof that phthalates in the tube leave the tube, enter the nutrients going into the baby and go into the urine, because these are water-soluble and you can measure it. That is an example of how food gets contaminated.

Another way… is when an expecting mother eats food that has phthalates in it…. It goes into her bloodstream, crosses the placental barrier and gets into the foetus and affects its development…. And we have shown that by measuring what is in the woman’s urine, we know how much phthalates or bisphenols or pesticides are in her body and we know that level of these chemicals in her body affect the development of the child at birth and after wards. And we can show that link.

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