Lifestyle and fertility: the influence of stress and quality of life on male fertility

Background

Male infertility is a widespread condition among couples. In about 50% of cases, couple infertility is attributable to the male partner, mainly due to a failure in spermatogenesis. In recent times, the crucial role that modifiable lifestyle factors play in the development of infertility have generated a growing interest in this field of study, i.e. aging, psychological stress, nutrition, physical activity, caffeine, high scrotal temperature, hot water, mobile telephone use. Several studies have investigated associations between semen quality and the presence of lifestyle stressors i.e. occupational, life events (war, earthquake, etc.) or couple infertility; overall, these studies provide evidence that semen quality is impaired by psychological stress. In this review, we will discuss the impact of quality of life (modifiable lifestyle factors) and psychological stress on male fertility. In addition, the role that increased scrotal temperature along with inappropriate nutritional and physical exercise attitudes exert on male fertility will be presented.

Conclusion

The decline of male fertility, particularly associated with advancing age, incorrect lifestyles and environmental factors plays an important role on natality, and its consequences on the future on human population makes this an important public health issue in this century. Thus, modification of lifestyle through a structured program of educational, environmental, nutritional/physical exercise and psychological support, combined with the use of nutraceutical antioxidants can prevent infertility and therefore, may help couples to obtain better quality of life and improved possibility to conceive spontaneously or optimize their chances of conception.

     

Effects of cytoplasmic genes on sperm viability and sperm morphology in a seed beetle: implications for sperm competition theory?

Sperm competition theory predicts that sperm traits influencing male fertilizing ability will evolve adaptively. However, it has been suggested that some sperm traits may be at least partly encoded by mitochondrial genes. If true, this may constrain the adaptive evolution of such traits because mitochondrial DNA (mtDNA) is maternally inherited and there is thus no selection on mtDNA in males. Phenotypic variation in such traits may nevertheless be high because mutations in mtDNA that have deleterious effects on male traits, but neutral or beneficial effects in females, may be maintained by random processes or selection in females. We used backcrossing to create introgression lines of seed beetles (Callosobruchus maculatus), carrying orthogonal combinations of distinct lineages of cytoplasmic and nuclear genes, and then assayed sperm viability and sperm length in all lines. We found sizeable cytoplasmic effects on both sperm traits and our analyses also suggested that the cytoplasmic effects varied across nuclear genetic backgrounds. We discuss some potential implications of these findings for sperm competition theory.     

The testicular vascular cone, scrotal thermoregulation, and their relationship to sperm production and seminal quality in beef bulls

The objectives of the present study were to determine changes with age and relationships among characteristics of the testicular artery, scrotal surface temperature, scrotal circumference, testicular consistency, seminal quality and sperm production. Beef bulls aged 6 mo (n=12), 1 yr (n=12), 2 yr (n=11), and 3 yr (n=12) were used in this study. The mean length of the testicular artery as well as the length, width, and surface area of a latex cast of the testicular artery all increased between 6 mo and 1 yr of age (P<0.01). Wall thickness of the testicular artery and testicular arterial-venous distance in the spermatic cord decreased with age and with proximity to the testicle (P<0.01). Distance from the testicular vascular cone to the inner surface of the skin at the top of the scrotal neck (primarily fat) increased between 1 and 3 yr of age (P<0.01), and was associated with an increased top scrotal surface temperature (P<0.09). Increased epididymal sperm reserves were associated with an increase in testicular consistency, scrotal circumference and scrotal surface temperature gradient, and with a decrease in testicular arterial wall thickness and testicular vascular cone to skin distance. A decrease in sperm defects was associated with an increase in testicular consistency and with a decrease in the average scrotal surface temperature. Increased sperm motility was associated with increased scrotal circumference and a decreased top testicular vascular cone to skin distance. These findings emphasize the importance of thermoregulation to sperm production and seminal quality.     

Reversibility of the reproductive toxicity of gossypol in peripubertal bulls

Gossypol has been shown to impair sperm production in male ruminants. The purpose of this study was to determine if the adverse effects of gossypol on spermatogenesis in peripubertal bulls were reversible. Twenty-eight crossbred Angus bulls were allocated into treated and control groups at 11 months of age. For 8 weeks, treated bulls were fed a ration containing 8 mg of free gossypol per kilogram of body weight per day while control bulls were fed a soybean meal ration free of gossypol. At 28-days intervals, scrotal circumference was measured and semen collected to assess sperm motility and morphology. Seven control and seven treated animals were castrated 56 days after the start of the experiment and the testes were examined histologically. The remaining bulls were fed a gossypol-free diet for 210 days prior to castration. There were significant increases in primary and secondary sperm abnormalities in treated bulls 28 and 56 days after gossypol feeding. The number of sperm with proximal droplets was significantly higher in gossypol-treated bulls, suggesting testicular degeneration. There was no significant effect on the sperm motility, scrotal circumference, or histopathological characteristics of the testes. Four weeks after the end of gossypol feeding, primary and secondary abnormalities were still increased in gossypol-treated bulls, however in subsequent collection periods the percentage of abnormalities were similar between groups. At 210 days, there was no treatment effect on scrotal circumference, and histological characteristics of the testes were not different between groups. The deleterious effects of gossypol on the morphological characteristics of spermatozoa were reversible. Gossypol (8 mg/kg per day for 56 days) increased sperm abnormalities but the effects were reversible.     

Reproductive melanization may protect sperm from harmful solar radiation

Animal pigmentation is incredibly diverse, serving a variety of functions. However, the function of the pigmentation that surrounds the testes of some vertebrates is unknown. Why are the tissues surrounding the testes (scrotum, tunica vaginalis and/or tunica albuginea) melanized in some species but not others? We examined this question in bats, where there is extensive species-specific variation in the presence of darkly pigmented (melanized) tissues surrounding the male gonads, as well as diversity in their ecologies, mating systems, and physiologies. Using data from 136 species of bats, we found that melanin surrounding the testes and epididymis is associated with more exposed roosting sites (presumably with greater sun exposure- and UV radiation), and with the occurrence of long-term male sperm storage. These findings suggest that scrotal melanin may protect mature sperm from UV damage, and from oxidative damage in species with male sperm storage. We found no evidence of an association between group size or mating system with reproductive melanin, or that phylogeny explains the distribution of pigmentation. Although our study suggests that scrotal melanin may protect sperm, the mechanism remains unknown. We outline several avenues for future work on reproductive pigmentation aimed at investigating additional roles of reproductive melanization in male bats.     

Effect of lifestyle exposures on sperm aneuploidy

Lifestyle exposures including cigarette smoke, alcohol, and caffeine have all been studied in relationship to male reproductive health. Over the years the focus has primarily been on semen quality and/or fertility. More recently, literature evaluating direct adverse effects of lifestyle exposures on sperm chromosomes and chromatin has grown due to concern that induced damage could be transmitted to offspring causing transgenerational health effects. In this paper we present a new analysis that summarizes published studies of smoking effects on sperm chromosome number and demonstrates a statistically significant increase in sperm disomy among smokers compared to nonsmokers (P < 0.001). In addition, new data on the effect of alcohol intake on sperm chromosome number are presented showing a rate ratio of 1.38 (95% CI 1.2, 1.6) for XY frequency in sperm of alcohol drinkers compared to nondrinkers.     

Sperm Competition in Humans: Mate Guarding Behavior Negatively Correlates with Ejaculate Quality

In species where females mate with multiple males, the sperm from these males must compete to fertilise available ova. Sexual selection from sperm competition is expected to favor opposing adaptations in males that function either in the avoidance of sperm competition (by guarding females from rival males) or in the engagement in sperm competition (by increased expenditure on the ejaculate). The extent to which males may adjust the relative use of these opposing tactics has been relatively neglected. Where males can successfully avoid sperm competition from rivals, one might expect a decrease in their expenditure on tactics for the engagement in sperm competition and vice versa. In this study, we examine the relationship between mate guarding and ejaculate quality using humans as an empirical model. We found that men who performed fewer mate guarding behaviors produced higher quality ejaculates, having a greater concentration of sperm, a higher percentage of motile sperm and sperm that swam faster and less erratically. These effects were found independent of lifestyle factors or factors related to male quality. Our findings suggest that male expenditure on mate guarding and on the ejaculate may represent alternative routes to paternity assurance in humans.     

Lower temperature of the cauda epididymidis facilitates the storage of sperm by enhancing oxygen availability

The temperature coefficients for the oxygen consumption rate of sperm from the rat, mouse, bull, and sea urchin were measured to be within a range of 2.7 to 3.0. For a reduction in temperature from 37°C to 30°C, the respiration rate of mammalian sperm declined by a factor of approximately 2.1. Hence, the availability of oxygen to sustain these sperm substantially increased over this temperature range. In addition, the solubility of oxygen in cauda epididymidal fluid increased by 7.6% for a decline in temperature from 37°C to 30°C. The increased availability of oxygen to sperm at the lower temperature is related to the increased storage capacity of the cauda epididymidis in scrotal mammals. In this context, it is suggested that the evolutionary migration of the cauda epididymidis to a cooler, extra-abdominal location may have been influenced by the increased availability of oxygen to sperm and hence resulted in an increased capacity to sustain and thereby store more sperm per unit volume of duct.     

Effect of age and genetic group on characteristics of the scrotum,testes and testicular vascular cones,and on sperm production and semen quality in AI bulls in Brazil

The objectives were to determine the effects of age and genetic group on characteristics of the scrotum, testes and testicular vascular cones (TVC), and on sperm production and semen quality in 107 Bos indicus, B. taurus and cross-bred bulls at three artificial insemination (AI) centers in Brazil. In addition, predictors of sperm production and semen quality were identified. In general, scrotal circumference (SC), scrotal shape score, scrotal neck perimeter, and testicular size (length, width and volume) increased (P < 0.05) with age. Although there were no significant differences among genetic groups for SC or testicular size, B. indicus bulls had the least pendulous scrotal shape, the shortest scrotal neck length, and the greatest scrotal neck perimeter (P < 0.05). Fat covering the TVC was thinner (P < 0.05) in bulls < or = 36 months of age and in B. taurus bulls than in older bulls and B. indicus bulls, respectively. Age and genetic group did not affect testicular ultrasonic echotexture. B. indicus bulls tended (P < 0.1) to have the lowest average scrotal surface temperature (SST). In general, ejaculate volume, total number of spermatozoa and number of viable spermatozoa increased (P < 0.05) with age. However, there was no significant effect of age on sperm concentration, motility, major and total defects. The proportion of spermatozoa with minor defects was highest (P < 0.05) in bulls 37-60 months of age. B. indicus bulls had higher (P < 0.01) sperm concentration, total number of spermatozoa and number of viable spermatozoa than B. taurus bulls, with intermediate values for cross-bred bulls. Increased sperm production was associated with increased testicular volume, SC, TVC fat cover, and SST top-to-bottom gradient. Decreased semen quality was associated with increased SC and bottom SST, and decreased scrotal shape, scrotal neck perimeter and vascular cone diameter. In summary, age and genetic group affected the characteristics of the scrotum, testes, and TVC, sperm production and semen quality. In addition, characteristics of the scrotum, testes and TVC were associated with sperm production and semen quality in bulls and could be assessed for breeding soundness evaluation.     

Testicular migration, spermatogenesis, temperature regulation and environment of the sheath-tail bat, Taphozous georgianus

The testes of the common sheath-tail bat of tropical Australia undergo a seasonal migration between the abdomen and the scrotal pouches, while each cauda epididymidis is permanently maintained in the scrotal pouch. Straps of smooth muscle attach to both the cranial and caudal poles of the testes, and these extend cranially to the diaphragm and caudally to the cauda epididymidis. The testicular arteries are not coiled. Among the environmental factors investigated, maximum temperature correlated most significantly with testicular descent, and the number of spermatogonia per bat also correlated most significantly with maximum temperature. Body temperature of a captive bat ranged from 25 to 38 degrees C and this was closely related to body weight and ambient temperature. It seems likely that the scrotal pouch provides a temperature slightly below that of the body and so facilitates sperm storage in the permanently scrotal cauda epididymidis. Migration of the testes probably serves to ameliorate the seasonal temperature fluctuations to which they are exposed while the relatively high correlation between maximum environment temperature and spermatogonial numbers suggests that temperature may be a proximate influence on reproduction in the sheath-tail bat.     

Radiations and male fertility

During recent years, an increasing percentage of male infertility has to be attributed to an array of environmental, health and lifestyle factors. Male infertility is likely to be affected by the intense exposure to heat and extreme exposure to pesticides, radiations, radioactivity and other hazardous substances. We are surrounded by several types of ionizing and non-ionizing radiations and both have recognized causative effects on spermatogenesis. Since it is impossible to cover all types of radiation sources and their biological effects under a single title, this review is focusing on radiation deriving from cell phones, laptops, Wi-Fi and microwave ovens, as these are the most common sources of non-ionizing radiations, which may contribute to the cause of infertility by exploring the effect of exposure to radiofrequency radiations on the male fertility pattern. From currently available studies it is clear that radiofrequency electromagnetic fields (RF-EMF) have deleterious effects on sperm parameters (like sperm count, morphology, motility), affects the role of kinases in cellular metabolism and the endocrine system, and produces genotoxicity, genomic instability and oxidative stress. This is followed with protective measures for these radiations and future recommendations. The study concludes that the RF-EMF may induce oxidative stress with an increased level of reactive oxygen species, which may lead to infertility. This has been concluded based on available evidences from in vitro and in vivo studies suggesting that RF-EMF exposure negatively affects sperm quality.     

Testicular heat stress,a historical perspective and two postulates for why male germ cells are heat sensitive

Herein, we compare the different experimental regimes used to induce testicular heat stress and summarise their impact on sperm production and male fertility. Irrespective of the protocol used, scrotal heat stress causes loss of sperm production. This is first seen 1–2 weeks post heat stress, peaking 4–5 weeks thereafter. The higher the temperature, or the longer the duration of heat, the more pronounced germ cell loss becomes, within extreme cases this leads to azoospermia. The second, and often underappreciated impact of testicular hyperthermia is the production of poor-quality spermatozoa. Typically, those cells that survive hyperthermia develop into morphologically abnormal and poorly motile spermatozoa. While both apoptotic and non-apoptotic pathways are known to contribute to hyperthermic germ cell loss, the mechanisms leading to formation of poor-quality sperm remain unclear. Mechanistically, it is unlikely that testicular hyperthermia affects messenger RNA (mRNA) abundance, as a comparison of four different mammalian studies shows no consistent single gene changes. Using available evidence, we propose two novel models to explain how testicular hyperthermia impairs sperm formation. Our first model suggests aberrant alternative splicing, while the second model proposes a loss of RNA repression. Importantly, neither model requires consistent changes in RNA species.     

Post-Meiotic Intra-Testicular Sperm Senescence in a Wild Vertebrate

There is growing interest in sperm senescence, both in its underlying mechanisms and evolutionary consequences, because it can impact the evolution of numerous life history traits. Previous studies have documented various types of sperm senescence, but evidence of post-meiotic intra-testicular sperm senescence in wild animals is lacking. To assess such senescence, we studied within-season changes in sperm motility in the common toad (Bufo bufo), where males produce all sperm prior to the breeding season. We found that males exposed to experimentally induced re-hibernation at the start of the breeding season, that is to experimentally lowered metabolic rates, stored sperm of significantly higher motility than males that were kept under seminatural conditions without females throughout the breeding season. This finding indicates that re-hibernation slows normal rates of sperm ageing and constitutes the first evidence to our knowledge of post-meiotic intra-testicular sperm senescence in a wild vertebrate. We also found that in males kept in seminatural conditions, sperm motility was positively related to the number of matings a male achieved. Thus, our results suggest that post-meiotic intra-testicular sperm senescence does not have a genetically fixed rate and may be modulated by temperature and possibly by mating opportunities.     

Sperm mobility determines the outcome of sperm competition in the domestic fowl

The aim of this study was to establish whether the mobility of sperm of the domestic fowl, as measured by an in vitro assay, predicted the outcome of sperm competition. Thirteen pairs of New Hampshire roosters, comprising one male categorized as having high-mobility sperm and the other as having average-mobility sperm, were used. Each male provided 25 x 10(6) sperm, which were mixed and artificially inseminated into between four and seven New Hampshire hens, each of which produced 2-11 offspring. The experiment was conducted twice, such that the same pair of males inseminated the same females. Paternity was assigned by using microsatellite markers. There was a clear effect of sperm-mobility phenotype on the outcome of sperm competition: in all 13 pairs the high-mobility male fathered the majority of offspring (75.3% overall; p < 0.0001). The proportion of offspring fathered by the high-mobility male within pairs varied significantly between male pairs (p < 0.0005). This effect was associated with the difference in sperm-mobility scores between males within pairs; there was a significant positive relationship between the proportion of offspring fathered by the high-mobility male and the ratio of mobility scores between males (p < 0.05). In addition, compared with their success predicted from the non-competitive situation, in the competitive situation high-mobility males were disproportionately successful in fertilizing eggs compared with average-mobility males. This may occur because female sperm storage is limited in some way and a greater proportion of high-mobility sperm gain access to the female's sperm storage tubules. There was no evidence that female effects accounted for any of the variation in paternity.     

Characterization of the semen quality of postpuberal boars with spontaneous unilateral abdominal cryptorchidism on the right side.

In recent studies, we found that the ectopic testis from postpuberal boars with unilateral abdominal cryptorchidism does not produce sperm. Therefore, in these males, the seminal characteristics can be used as indicators of the activity of the scrotal testis and its epididymis and also the accessory glands. The semen quality (ejaculate volume, cell-rich fraction volume, sperm concentration, sperm vitality, sperm motility, sperm morphology and cephalic stability of spermatozoa) was evaluated in healthy postpuberal boars and in postpuberal boars with unilateral abdominal cryptorchidism on the right side. In comparison with the healthy boars, the unilateral abdominal cryptorchid boars showed a significant decrease of the ejaculate volume, sperm concentration and sperm motility. The low sperm concentration indicated that unilateral abdominal cryptorchidism severely impairs the sperm production of the scrotal testis. The decrease of ejaculate volume was attributed to an abnormal activity of the accessory glands. The alterations in sperm motility develop as a result of dysfunctions in the epididymal epithelium and/or the accessory glands. The sperm vitality, sperm morphology and cephalic stability of spermatozoa maintained normal values; therefore, at testicular level, despite the low sperm production, the germ cell differentiation is not disturbed. At epididymal level, the morphological maturation of spermatozoa is not altered.     

Mating success of male guppy <Emphasis Type="Italic">Poecilia reticulata</Emphasis> in the wild

To understand how the diversity among male sexual traits is maintained despite directional female choice for attractive traits, it is important to study male reproductive success in each reproductive episode. Male reproductive success is indeed the comprehensive result of several processes such as mate choice, mating, and fertilization. In this study, male mating success was estimated in a wild guppy Poecilia reticulata population of Hiji River, Okinawa Island, in southern Japan. The mating success of males was estimated as the percentage of sperm transferred in relation to the total sperm reserve. In a preliminary experiment, it was confirmed that the sperm reserves of males were partly replenished after 12 h and fully replenished after 72 h, when all sperm were released. In addition, the results of investigation in the wild population revealed that approximately 20% of males had no sperm reserves at all, although their sperm reserves should have been replenished by sexual isolation. Male sexual traits such as body size or color pattern did not affect the percentage of sperm transferred. Results from this study provide important insights into male sperm transfer ability and sperm production in this population. However, the high frequency of male sperm-transfer success estimated in this study should to be taken with caution, and whether it is due to differences between wild and laboratory conditions, sex ratio or the rates of multiple matings by females in the wild population remain to be fully explored.     

Reproductive patterns of stray male dogs in the tropics

Two studies were performed to determine annual reproductive patterns in stray male dogs in the tropics. In Study 1, four dogs housed individually outdoors were monitored once monthly for 12 months, including collection and assessment of semen, measurements of scrotal width, and determination of serum testosterone and prolactin concentrations. In Study 2 (conducted concurrently), a single blood sample (for serum testosterone concentration) was collected from 220 clinically healthy dogs, and after euthanasia, scrotal width and morphology of epididymal sperm were determined. The year was divided into three seasons: warm-dry (March to June); warm-humid (July to October) and fresh-humid (November to February). In Study 1, scrotal width, ejaculate volume, sperm count and motility were significantly lower during the fresh-humid season and sperm midpiece abnormalities were significantly more common during the warm-humid and fresh-humid seasons. Serum testosterone concentrations remained constant during the year. Prolactin concentrations did not differ significantly among seasons, but had a well-defined increase from the beginning of March to the end of August. In Study 2, sperm morphology was similar to in Study 1 and serum testosterone concentrations varied nonsignificantly during the year. Environmental factors, e.g. daylength may have influenced circannual changes in prolactin secretion. Seasonal variations in some reproductive tract and seminal traits were significant but of small magnitude and the percentage of morphologically normal sperm did not vary significantly among seasons. In conclusion, healthy male dogs constantly produced sperm and were apparently fertile throughout the year.     

Maternal inheritance,epigenetics and the evolution of polyandry

Growing evidence indicates that females actively engage in polyandry either to avoid genetic incompatibility or to bias paternity in favor of genetically superior males. Despite empirical support for the intrinsic male quality hypothesis, the maintenance of variation in male fitness remains a conundrum for traditional "good genes" models of sexual selection. Here, we discuss two mechanisms of non-Mendelian inheritance, maternal inheritance of mitochondria and epigenetic regulation of gene expression, which may explain the persistence of variation in male fitness traits important in post-copulatory sexual selection. The inability of males to transmit mitochondria precludes any direct evolutionary response to selection on mitochondrial mutations that reduce or enhance male fitness. Consequently, mitochondrial-based variation in sperm traits is likely to persist, even in the face of intense sperm competition. Indeed, mitochondrial nucleotide substitutions, deletions and insertions are now known to be a primary cause of low sperm count and poor sperm motility in humans. Paradoxically, in the field of sexual selection, female-limited response to selection has been largely overlooked. Similarly, the contribution of epigenetics (e.g., DNA methylation, histone modifications and non-coding RNAs) to heritable variation in male fitness has received little attention from evolutionary theorists. Unlike DNA sequence based variation, epigenetic variation can be strongly influenced by environmental and stochastic effects experienced during the lifetime of an individual. Remarkably, in some cases, acquired epigenetic changes can be stably transmitted to offspring. A recent study indicates that sperm exhibit particularly high levels of epigenetic variation both within and between individuals. We suggest that such epigenetic variation may have important implications for post-copulatory sexual selection and may account for recent findings linking sperm competitive ability to offspring fitness.     

Sperm dumping in a haplogyne spider

The present study shows that females of Silhouettella loricatula (Arachnida: Araneae: Oonopidae) manage to process sperm in an unusual and previously unknown way. The male ejaculate consisting of spermatozoa and globular secretion is enclosed in a secretory sac. This may avoid the mixing of sperm from different males and at least severely limit sperm competition. The process of sperm enclosure occurs within the female's sperm storage site (receptaculum) as the ejaculate is not surrounded by a sac inside the male's sperm-transferring organs (palpal bulbs). The secretion forming the sac is produced by glands adjoining the receptaculum. The possibility that globular secretions in the male palpal bulbs partly contribute to the sac cannot be ruled out completely. It is suggested that in S. loricatula , the main function of sperm enclosure in a sac is enabling females to dump the ejaculate of a male. The present study represents the first report on sperm dumping in the family Oonopidae. During five first and three second copulations in the laboratory, the dumping of a sac was observed. One dumped sac was sectioned and contained spermatozoa. Two couples were flash-fixed with liquid nitrogen early during copulation, which revealed the mechanism of the sac dumping. By muscle contractions, the receptaculum is bent backwards and the sac moved into the genital opening. The actual sac dumping occurs most probably in cooperation with the male, which moves his pedipalps rhythmically during the entire copulation. Extensions and furrows on the emboli suggest that they may additionally be used as copulatory courtship devices. The enclosure of sperm from the current male in secretion takes place during or immediately following copulation as all mated females sacrificed after copulation had a new sac containing spermatozoa in the receptaculum. Dumping sperm of a previous male during the next copulation may allow females to bias sperm precedence.     

Changing Male Reproductive Health: A Review of the Clinical Evidence?

Several lines of circumstantial evidence suggest that we may be seeing adverse changes in male reproductive health. A possible decline in semen quality has attracted most attention, but there are stronger indications of a rising incidence of testicular cancer, with increases observed in both Europe and the USA. There are striking geographic variations in both the incidence of testis cancer and in the observed rate of increase, and it is noteworthy that testis cancer is much more common in Denmark, where low sperm counts have been reported, than in Finland, where semen quality seems to be better. Another cause for concern is the rising incidence of congenital malformations of the male genital tract — cryptorchidism and hypospadias. In the UK, for example, rates of cryptorchidism have increased by as much as 65 to 77%. The data are harder to interpret on semen quality. In a meta-analysis, Carlsen et al. (1992) identified significant decreases over time in sperm concentration, corresponding to a fall of almost 50% between 1940 and 1990. Several groups have since examined secular trends in semen quality, with some reporting a downward trend and others no change. However, evidence has emerged of striking regional differences in semen quality, whether due to ethnic, genetic, environmental, or lifestyle factors remains to be determined.