James Lefanu
Do lower sperm counts really threaten our species?
There is certainly no suggestion that men today are having greater difficulty in conceiving
Gratifyingly, medical experts are showing definite signs of anxiety-mongering fatigue. There has been a notable decline in recent times in those ubiquitous health scares implicating, improbably, virtually every aspect of our daily lives in some dire disease or other: mobile phones (brain tumours), gas cookers (asthma), electric toasters (leukaemia), cat ownership (multiple sclerosis), wearing dentures (Alzheimer’s), and so drearily on, ad nauseam.
What, then, to make of the most apocalyptic warning of all, resurrected last week, that the human species faces extinction from declining male fertility? The statistics certainly seem clear enough, with a fall in the “average” sperm count by almost half, from 99 to 47million (per millilitre) over the past four decades.
But this supposedly comprehensive analysis of almost 200 studies on which these figures are based contains several significant anomalies. This trend, perplexingly, is confined to the Western world and is not evident in Asian or African countries. Further, several investigations from the United States, Denmark and Sweden have revealed, on the contrary, a significant increase in sperm count over the same period. Meanwhile, there can apparently be a marked variation within a single country where, compared to Parisians, men in Caen and Toulouse have respectively a higher and lower sperm count.
Then, contra to the alarmist claims, there is certainly no suggestion that men are having greater difficulty in conceiving than in the past, as even 40million sperm are more than enough (three times, in fact) for fertilisation to occur.
As to possible explanations, the authors of the report maintain it has been “plausibly” linked to an unhealthy lifestyle, or exposure to pollutants such as oestrogenic chemicals or pesticides present (in infinitely small amounts) in the water supply. Not so.
The propagation of such spurious speculations is scarcely helpful for those who must deal with what is, as Robert Clothier described in this paper last week, a distressing condition and its adverse psychological consequences.
It is more important for people to know, as it is not widely appreciated, that several commonly prescribed drugs (notably, calcium-blocking antihypertensives and the acid suppressant Cimetidine) may, as a side-effect, suppress production of sperm.
Leg weakness causes
The plight of the woman in her late seventies whose legs weaken after 20 minutes on her feet but improve after a short rest is suggestive, as several have pointed out, of spinal stenosis, where arthritic changes in the lower lumbar vertebrae compress and cut blood flow to the nerves as they exit the spinal canal.
This usually presents as pain and numbness of the legs on walking and relieved by sitting, though Oxford family doctor David Wise reports that, for two of his patients, weakness was the only symptom. Similarly, while narrowing of the blood vessels to the legs is usually experienced as pain in the calves on exertion (intermittent claudication) relieved by rest, it too may present, as a reader described it, as “the legs giving way”. The several other possibilities include statin-induced inflammation of the upper thigh muscles or an abnormal potassium level in the blood, also usually druginduced.
Finally, the combination of weakness and unsteadiness may be due to cerebral vascular disease (or mini-strokes) – a condition known as higher cortical gait failure – for which there is no specific treatment, though it can be ameliorated by use of a shopping trolley or motorised wheelchair.
Itchy ear issue
This week’s medical query comes courtesy of Mr CW from Bolton, troubled by a painful, red itchiness of the top outer edge of both ears that, rather oddly, is most marked in the late afternoon. His family doctor attributes this to dryness of the skin, but the regular application of moisturisers has not improved matters. All suggestions will be gratefully received.