Human semen quality in the new millennium: a prospective cross-sectional population-based study of 4867 men

Abstract

Objectives

Considerable interest and controversy over a possible decline in semen quality during the 20th century raised concern that semen quality could have reached a critically low level where it might affect human reproduction. The authors therefore initiated a study to assess reproductive health in men from the general population and to monitor changes in semen quality over time.

Design

Cross-sectional study of men from the general Danish population. Inclusion criteria were place of residence in the Copenhagen area, and both the man and his mother being born and raised in Denmark. Men with severe or chronic diseases were not included.

Setting

Danish one-centre study.

Participants

4867 men, median age 19 years, included from 1996 to 2010.

Outcome measures

Semen volume, sperm concentration, total sperm count, sperm motility and sperm morphology.

Results

Only 23% of participants had optimal sperm concentration and sperm morphology. Comparing with historic data of men attending a Copenhagen infertility clinic in the 1940s and men who recently became fathers, these two groups had significantly better semen quality than our study group from the general population. Over the 15 years, median sperm concentration increased from 43 to 48 million/ml (p=0.02) and total sperm count from 132 to 151 million (p=0.001). The median percentage of motile spermatozoa and abnormal spermatozoa were 68% and 93%, and did not change during the study period.

Conclusions

This large prospective study of semen quality among young men of the general population showed an increasing trend in sperm concentration and total sperm count. However, only one in four men had optimal semen quality. In addition, one in four will most likely face a prolonged waiting time to pregnancy if they in the future want to father a child and another 15% are at risk of the need of fertility treatment. Thus, reduced semen quality seems so frequent that it may impair the fertility rates and further increase the demand for assisted reproduction.

Article summary

Article focus

• A paper by Carlsen et al 20 years ago ( BMJ 1992;305:609–13) raised controversy with evidence of a decline in semen quality, and several studies on semen quality in human populations have followed.

• There has been a lack of larger, prospectively collected quality-controlled data on semen quality in the general population.

Key messages

• This study brings good and bad news.

• Fifteen years monitoring of semen quality in men of the general population indicated a slight increase in both median sperm concentration and total sperm count.

• However, still only a fraction of the men (23%) had optimal sperm concentration and sperm morphology, and the median percentage of abnormal spermatozoa was as high as 93% with no sign of improvement during the study period.

• Approximately 15% of the men had a sperm concentration at a level that would indicate a high risk of needing future fertility treatment if they want to father a child, and another 27% of the men will be at risk of a prolonged waiting time to pregnancy.

Strengths and limitations of this study

• Large prospective study of semen quality among men of the general population unselected with regard to fertility.

• Standardised inclusion and investigation procedures.

• Lack of historical, directly comparable data.