The sperm density of American males may be declining at a rate of 1.5 percent per year. Yet even amid an historic expansion of government’s role in health care, male infertility has merited little discussion in mainstream discourse. Federal and state governments are conspicuously absent in identifying the drivers of male infertility. Nor are they facilitating access to many of the most promising therapies.
Such restraint from an otherwise expanding regulatory state is intriguing—and it is particularly noteworthy given that male infertility is considered a “fundamental biomarker of overall male health” and a barometer for male outcomes in American society generally.
A meta-analysis published in the British Medical Journal determined that between 1938 and 1990, American men suffered a “genuine decline in semen quality”—results that suggest “an overall reduction in male fertility.” After the federal Centers for Disease Control and Prevention began to include men in its National Survey of Family Growth, agency surveys, based on data collected between 2006 and 2010, concluded that 12 percent of American men between the ages of 25 and 44 suffered from some form of infertility. Some 10 percent used infertility services.
And yet Obamacare, the most significant overhaul of American health care since the 1960s, was silent on federal mandates for infertility coverage. Only six states in turn have proceeded to mandate male infertility evaluation or treatment.
Three factors seem to be influencing the government’s involvement on the issue: industry influence, attitudes toward alternative medicine, and a reluctance to litigate policy choices that are jeopardizing male wellbeing.
Industry Lobbies and Agency Capture: BPA as a Case Study
To understand the government’s role in the male-infertility saga, one must dig into the most common cause of male infertility—problems in sperm production, maturation, and fertilization. Experts continue to debate the precise reasons behind declining sperm quality, but a common suspect in the literature is the endocrine-disrupting chemical bisphenol-A (BPA.)
BPA is difficult to regulate because the toxin is everywhere. Introduced into commercial use in the 1950s, BPA is a plastic additive that allows a wide array of goods to be produced at low costs. The BPA industry, on track to cross $20 billion in revenues by 2020, has already put the chemical in hundreds of household objects including plastic containers, eyeglasses, and canned foods and beverages. BPA was found in the urine of 93 percent of a survey population tested by the CDC between 2003 and 2004.
While BPA toxicity is a threat to the population generally, it may be a particular concern for male fertility. According to some experts, males may be more sensitive to environmental factors—and BPA specifically, as Dr. Theo Colborn, a pioneer in the field, discovered, tends to inflict the most damage on the young. Consistent with other animal and human studies, a 2011 study in the journal Fertility and Sterility found that, when compared to men without detectable urine BPA levels, “men with environmental BPA exposure at levels comparable with those in the U.S. population” had:
- “more than three times the risk of lowered sperm concentration and lower sperm vitality”
- “more than four times the risk of lower sperm count” and
- “more than twice the risk of lower sperm motility”
These and other studies suggest that while nearly all American males, compared to past generations, may be at greater risk for BPA-related declines in sperm quality, the threat is particularly acute for those with heightened environmental exposure and/or predisposing factors.
Dogged by questions since the 1970s about BPA’s safety, industry groups, backed by corporations such as Alcoa, Coca-Cola, and Del Monte Foods, have undertaken a sophisticated lobbying effort to thwart regulatory limitations on their products. Their playbook is modeled on past efforts by big tobacco and is being carried out by the same “product defense consultants” who went to bat for asbestos and Agent Orange. Between 2005 and 2011, the American Chemistry Council spent more than $9.4 million on lobbying efforts in California alone, and donated an additional $50,000 in direct contributions to state lawmakers’ campaign accounts.
The BPA industry is overseeing a long-term strategy, rallying against bills even when BPA is not directly implicated. The goal is twofold. One is to preempt precedents that could galvanize a consumer safety movement directed at BPA exposure. Another is to establish an unreachable standard of proof that, by discrediting specific testing methods, effectively undermines the entire process of safety testing.
In these battles, the BPA lobby has found a convenient if unsurprising ally: the Food and Drug Administration (FDA). As evidence of BPA’s safety, the industry has invoked the “FDA’s authority” and the “scientific assessment” of its experts. Why? Under existing FDA guidelines, academic research often gets “second billing to industry and government studies.” In the name of vague “data quality standards,” cutting-edge academic research is frequently disregarded while studies in labs financed by the BPA industry are used to inform government safety assessments.
Suspicions that FDA officials cater to the BPA industry have grown under recent administrations. In 2008, the Milwaukee Journal Sentinel discovered that an FDA report affirming the safety of BPA was “written largely by the plastics industry and others with a financial stake” in the chemical. The FDA findings were, let’s just say, debatable. While about 90 percent of the more than 100 independently funded experiments on BPA at the time saw “evidence of adverse health effects at levels similar to human exposure,” all 14 industry-funded studies reached the opposite conclusion.
The Sentinel report prompted legislative hearings. Iowa’s Republican Sen. Chuck Grassley accused the FDA of being a “business partner with industry,” while Michigan’s Democratic congressman John Dingell lashed out at the “supposedly reputable scientists” getting “paid to cast doubt on valid scientific data that raise public-health concerns about everyday products.” Still, despite the fact that Congress, under the 1996 Food Quality Protection Act, had mandated the FDA to screen endocrine-disrupting chemicals, the agency refused to screen even one chemical.
Little changed in 2014 when the FDA, under the oversight of President Obama’s Commissioner Margaret Hamburg, vetted 161 new studies on the potential health effects of BPA. The agency ultimately deemed only four studies to be compelling enough to consult in setting safety standards. Not one of them acknowledged harmful effects from small doses of BPA. FDA officials meanwhile routinely left government to accept jobs at the very industries they once regulated. According to Dr. Michael Carome of Public Citizen, the FDA consistently “succumbed to industry and political pressures.”
The BPA industry is only one of many suspected drivers of male infertility that aggressively lobby legislatures and pursue agency capture. Governments face similar obstacles in investigating and regulating other products linked to male infertility, among them: alcohol, beef, electromagnetic fields, fluoride, heavy metals, pesticides, soy, pharmaceutical drugs, and xenoestrogens.
Ignorance and Regulation of Promising Alternative Therapies
Even if the government is unwilling to battle powerful industries, why isn’t it facilitating access to innovative treatments? Part of the reason may be that the most promising therapies for male infertility appear to be in the realm of alternative rather than allopathic medicine. Efforts to expand access to integrative treatments, however, tend to provoke resistance from a medical establishment that has generally remained ignorant and/or skeptical of alternative approaches.
A notable example is traditional Chinese medicine. It was only in 1986 that large-scale clinical trials for male infertility, reported in Chinese medical journals, began in large numbers to be abstracted into English. Even today, translations of whole articles are generally obtained by request from translators, a process that perhaps would be less cumbersome if government agencies and the health-care industry took more interest in these studies.
Obamacare was sold in part on the assumption that it would expand coverage of wellness-based therapies. It did indeed allow health-insurance plans to cover alternative medicine. But since the passage of Obamacare, only six states have recognized acupuncture as an Essential Health Benefit. In Washington State, which has expanded coverage for alternative medical services, businesses, carriers, and state medical associations are pursuing persistent challenges to this regime, outspending advocates of natural health. Practitioners of alternative medicine throughout the country meanwhile face inconsistent licensure and credentialing rules that restrict the care they can provide.
At least in the realm of male infertility, government’s lack of interest in alternative medicine seems outdated. Over the past two decades, a variety of placebo-controlled studies and case reports have demonstrated the ability of acupuncture and moxibustion to produce improved sperm quality. Herbology, according to clinical studies, leads to pregnancy or restored fertility in 70 percent of both male and female infertility cases. And homeopathic therapy has shown in studies and case reports significant improvements in critical sperm markers.
Yet under the Dietary Supplement Health and Education Act of 1994, it is illegal to claim that the supplements used in these practices “diagnose, cure, mitigate, treat or prevent illness.”
Alternative strategies are by no means without risk, but when they do work, they’re generally far less intensive and costly than standard fertility care. With mainstream modalities, 64 percent of patients spend over $15,000 and 16 percent spend over $50,000. Acupuncture treatments, by contrast, typically require twice-weekly sessions for less than two months while periodic use of herbs usually restores fertility within six to twelve months among patients in the United States.
Misguided Public Policy for Young Men?
The government’s attitude toward alternative medicine is one facet of a broader tendency to avoid grappling with male infertility in a holistic paradigm. Allopathic approaches tend to view male infertility as an obstruction of the reproductive ductal system—a condition to be managed with microsurgery or expensive reproductive technologies. Artificial insemination, in vitro fertilization, and intracytoplasmic sperm injections do not aim principally to improve patients’ underlying sperm quality or address the root causes of their suboptimal health. Alternative medical practitioners are more inclined to view male infertility as a symptom of systemic imbalances in the emotional and physical wellbeing of patients. The fact that sperm quality, in some studies, is negatively correlated with occupational psychological stress, psychosocial distress, fear, and fright arguably lends credence to a more holistic perspective.
Skepticism is warranted as to whether governments ultimately have an incentive to view male infertility from a holistic perspective. For doing so could raise uncomfortable questions about the consequences that bipartisan policy choices have had for young and middle-aged men.
Consider developments since the last CDC report on male infertility in 2010. Economic uncertainty for American men has been a major factor in driving the male median age of marriage to nearly 29 years. According to Brigham Young University professor Jason Carroll, the time is “quickly approaching” when that number will cross 30. Those men who intend to delay fatherhood until marriage—a demographic increasingly confined to the college-educated—face a precarious path forward:
- At age 26, a possible positive association between age, sperm damage, and declining ejaculate volume;
- At age 30, gradual drops in rapid progressive motility and normal sperm morphology; and
- After age 34, drops in total sperm numbers leading to “a declining likelihood of pregnancy.”
The twenties and thirties are increasingly years of emotional difficulty for men. Men in this age group, for example, are resorting in unprecedented numbers to mental health medications, oblivious perhaps to correlations between SSRIs and adverse effects in sperm DNA integrity.
Acknowledging that male infertility could be an outgrowth of broader policy failures could spell trouble for the political class. Public suspicion that a whole array of political, economic, and social policies is contributing to a transgenerational epidemic in male infertility could exacerbate challenges against an already beleaguered establishment.
Insofar as government watchdogs must weigh in on public-health matters, they should at least bring credible information to the fore. Pervasive crony capitalism, however, renders this almost impossible. And litigating longstanding biases against alternative medicine, as well as the policy decisions that have left young men in a perilous state, is, optimistically speaking, a generational challenge.
It is too soon to tell what impact, if any, the Trump administration will have on the male-infertility issue. Trump has criticized specifically the FDA’s “inspection overkill” of farm-production hygiene and food-packaging rules, some of which involve regulation of infertility-related chemicals. His deregulatory approach is reflected in the administration’s proposed budget, which would eliminate the Endocrine Disruptor Screening Program responsible for monitoring BPA and other chemicals. Trump’s nominee for FDA commissioner does embody the corrupt revolving door between the agency and the pharmaceutical industry. But in a context in which government agencies have proven unable to excise themselves from corporate capture, President Trump’s deregulation agenda may, over the long run, diminish industry influence over government inquiries into male infertility.
Regardless, reliable information and effective treatments for male infertility are most likely found outside our corporate-government nexus.