Sperm concerns: Now and then

Recently I came upon a complex article about the alarmingly low sperm counts and sperm concentrations of some of the 43 000 men measured between 1971 and 2013.[1] Using various statistical methods, the data were compiled from over 750 abstracts and close to 2500 articles published over 42 years. Laboratory results from men from North America, Europe, New Zealand, and Australia (called the Western group) were compared and contrasted with results from men from South America, Asia, and Africa. Over this 42-year span there were no significant changes in the sperm volume of men in either group. In the South America, Asia, and Africa group there were no significant changes in sperm concentrations or total sperm counts either. However, in the Western group there was a sperm concentration decline of 52% and sperm count decline of 60%.

Sperm was first observed in 1677 by Antonie van Leeuwenhoek when he peered at his own specimen through his newly invented microscope. At the time the sperm cell was thought to contain a miniaturized fully developed human form. It took another 150 years before Claude Francois Lallemand (1790–1854), a famous French physician of the time, focused medical attention on the volume of seminal fluid and its relationship to health. Believing that a man had a finite volume of semen, he reported on 150 cases in which nocturnal seminal discharges were thought to be the cause of various disorders and even death. 

In 1843 W.H. Ranking, MD Cantab., physician to the Suffolk General Hospital, published the first English language alarm about the dangers of spermatorrhoea,[2] the involuntary expenditure of seminal fluid. His concept was that abuse of the genital organs made a man “infested with seminal emissions during sleep.” Dr Ranking reported that “discharges upon the genital economy is soon evidenced: the mind becomes enfeebled and incapable of protracted attention . . . the body gradually emaciates . . . digestion is impaired . . . the bowels are almost invariably costive . . . and resist the most powerful cathartics.”

Spermatorrhoea was taken very seriously by nineteenth-century physicians across Europe and America. Doctors used drugs to decrease libido, recommended that family members hold vigil over the disordered individual, waking him up repeatedly during the night in the hope of preventing nocturnal emissions. Various mechanical and electric devices were marketed that would wake the person up when penile erection was about to occur. Strangely, in the late 1800s, the use of vibrators was prescribed to women with the diagnosis of hysteria, yet self-stimulation by men was thought to be a main cause of spermatorrhoea, as well as a likely cause of insanity.

The 2017 report[1] does not indicate a significant decrease in the volume of ejaculate, the very threat that so worried physicians of the past. Measurements of sperm count and concentration are essentially laboratory findings to which physicians of the distant past had no access.

Authors of the 2017 study do not offer answers to the cause of the reported sperm-count decline in the Western group of patients, nor do they propose any solutions. In their view the low sperm counts are of public health importance because of the societal consequences of male infertility, the potential association of low sperm count with other forms of morbidity, and the possibly harmful but perhaps preventable impacts of the modern environment. 

As is the case so often in medical research, more studies are needed.
—George Szasz, CM, MD

1.    Levine H, et al. Temporal trends in sperm count: A systematic review and meta-regression analysis. Hum Reprod Update. 2017;23:646-659.
2.    Ranking WH. The spermatorrhoea alarm. Accessed 12 March 2019. www.thomas-morris.uk/the-spermatorrhoea-alarm.

This post has not been peer reviewed by the BCMJ Editorial Board.

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