Is the Male Fertility Crisis Real — or Just a Numbers Game?

You have read headlines warning of a crisis in male fertility, with reports of sperm counts halving over last few decades. But does this mean men are actually less fertile today, or are we simply getting lost in a “numbers game?”

Sperm Counts: What Do They Really Tell Us?

The main way to check male fertility is by semen analysis — a test that counts & measures sperm. Strangely experts have been arguing for 100+ years about how useful these counts really are. Even now, sperm counts are quoted to support the idea of a global fertility decline. But the truth is more complicated.

Why the Numbers Keep Changing

What counts as a “normal” sperm count? That depends on which expert — & which year — you ask. Over decades, World Health Organization (WHO) has changed its definition of normal sperm counts repeatedly. One example: in the 1940s, a healthy count was 60 million sperm per milliliter. By 2010, “normal” was only 15 million! Every time these numbers drop, many men suddenly shift from abnormal to normal without any biological change.

Can We Trust the Test?

Semen analysis is far from perfect. It is not just about one test — results can swing wildly from day to day, like stock market. Some men have counts that vary by more than 300% over time. Even experts looking at the same sample often disagree due to the test’s complexity and subjectivity.

For instance, sperm described as “immotile” (not moving) may simply be “resting.” In one study, 20% started moving again after just a few minutes. Likewise, sperm shape assessment can vary a lot between different lab workers, making results hard to interpret.

Are Men Really Becoming Less Fertile?

Research does show that sperm concentrations have dropped in some places, with some studies reporting a 50% decrease since the 1970s. But here is the surprising finding: despite the decline in numbers, actual pregnancy rates have not changed much. Many men with low sperm count still become fathers, and plenty with high counts struggle.

Experts say that sperm count alone cannot predict your chance of having children. Fertility is a team effort — it depends on both partners, not just the numbers from a man’s test result.

What’s Really Going On?

So why do sperm counts seem to be falling? Possible reasons include:

• Changes in lifestyle, like poor diet, obesity, smoking, and stress.
• More exposure to environmental toxins, such as pesticides and heavy metals.
• Differences in how, where, and by whom tests are performed.

But there is no unmistakable evidence these changes are causing an actual fertility crisis. The truth is that semen analysis is not as reliable or meaningful as other medical tests. There is no universal “good” or “bad” number to guarantee or rule out pregnancy. That is why experts urge caution about dramatic headlines.

So, What Should You Do?

If you are concerned about fertility, remember:

• One semen analysis is not the whole story. Results can change.
• Lifestyle matters — healthy habits help.
• Fertility is about both partners, not just one person’s lab results.

Doctors recommend using modern testing, focusing on overall health, &, when needed, working with specialists who look at the big picture, not just one number.

The real story is not about fertility crisis — it is about measurement uncertainty. Instead of worrying about arbitrary numbers, experts now call for better research & more context, including population-based studies & tests tailored to diverse backgrounds. Male fertility is more complex than a single laboratory result, & it deserves a broader, more thoughtful look.

Daylight Saving Time — A Futile Exercise Against Nature and Logic

“Time and tide wait for no one,” goes the old saying. Yet, human beings have repeatedly tried to defy both — and in the process, have made time itself a victim of our misplaced ingenuity.

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A Century-Old Relic

Daylight Saving Time was introduced over a century ago, first in Europe and then in the United States, as a wartime measure to save fuel and optimize daylight hours. During the First World War, it was believed that adjusting clocks could conserve coal used for lighting and heating. Though the war ended, this practice stubbornly survived — spreading across continents and calendars, long after its original purpose had faded into history. Even today, countries across Europe and North America continue to “spring forward” and “fall back,” changing the clock twice a year — a ritual with no rational, scientific, cultural, religious or economic justification in the modern era. The irony is profound: in an age that values precision, data, and evidence, we continue to alter time itself without a shred of scientific support.

Neither Science nor Sense

Numerous studies have examined the supposed benefits of DST — reduced energy use, improved productivity, and better public safety. The results are, at best, inconclusive, and often outright negative. Modern electricity consumption patterns differ vastly from those in 1916; energy saved on lighting is often lost to heating or air-conditioning. More concerning are the health effects. Disruptions to the body’s circadian rhythm — our natural biological clock — are well documented. Sleep researchers have associated DST transitions with increased risks of heart attacks, depression, workplace injuries, and road accidents. In truth, what we gain in one hour of light, we lose in well-being and mental balance.

A Global Patchwork of Confusion

There is not even global uniformity in this exercise. Some countries observe it; others do not. Even within countries, regions differ — a logistical nightmare for business, travel, broadcasting, and global communication. In an era of digital synchronization and atomic precision, forcing millions to adjust their clocks twice a year borders on absurdity.

A Futile Habit That Refuses to Die

I have been intrigued by this practice for over forty years, ever since I first encountered it in England. Over the decades, I have discussed it with innumerable individuals — scientists, citizens, and administrators alike. Not one has provided a convincing explanation as to why this practice began and why it continues. In my quest for clarity, I even wrote to the past Presidents of the United States, and to the Prime Ministers of the United Kingdom, Canada, New Zealand, and Australia — seeking a rationale. I also wrote to Science and The New York Times, hoping that someone, somewhere, might illuminate the reasoning. None did. Perhaps that silence speaks louder than any justification.

A Call for Common Sense

Daylight Saving Time is not merely outdated; it is a relic of wartime anxiety that has outlived its purpose. It offers no measurable benefit — only confusion, inconvenience, and subtle harm to public health. In a world that prides itself on evidence-based policy and scientific progress, it is astonishing that such a non-productive, disruptive, and irrational practice endures. Surely, in nations that have produced countless Nobel laureates, we can find the wisdom to let nature — and time — take their own course. I hope that this year marks the end of this antiquated ritual. Let us stop turning the clock back and forth in the name of tradition and instead move forward — with one standard time throughout the year. After all, time belongs to nature, not to human legislation.

For centuries, the timeline of motherhood was largely dictated by nature. Today, it’s a landscape of conflicting pressures.

The human body has not changed with changing socio-cultural milieu. A woman’s fertility, peaks in her twenties, faces a significant decline by her mid-30s. This is an unyielding biological fact. Yet, simultaneously, the age of marriage & childbearing has progressively increased due to education, career ambitions, & economic shifts.

This creates a painful paradox: women are building their lives in ways society encourages, only to find their biological capacity diminished when they are ready for motherhood. The result, is an “epidemic of infertility,” where age is a primary factor.

The “Older Mother”: Two Profiles, One Deep Desire

The term “older mother” often conjures a single image, but in clinical practice, we see two distinct, powerful narratives:

1. The Woman Chasing a Basic Biological Instinct: These are women in their late 30s & 40s who, aware of their “diminishing fertility,” still seek to fulfill a “highly cherished desire.” They face not just medical challenges but also huge “peer pressure on women to achieve motherhood, sometimes, almost at any cost.” 2. The Post-Menopausal Woman: Altruism or Last Chance: This group includes women using donor eggs or acting as surrogates. To condemn them, we argue, is cruel. “Grandmothers do not reproduce for fun… they do it to help others or to attend to their basic biological need.” ,

The Unassailable Right to Reproduce

The 1994 International Conference on Population and Development in Cairo stated: “To be able to reproduce & raise a family is one of the fundamental rights of every individual.”

This is not just a medical issue; it is an ethical one. Should the criteria for motherhood be age alone, or physical fitness, or a combination? Is it just to deny a fit & healthy 50-year-old woman the chance to be a mother, when an unfit 30-year-old faces no such barriers?

The argument that an older mother may not live to see her child into adulthood is, as we called it, a “specious argument.” Even a decade of a mother’s love is a profound gift. “Many women who were denied motherhood for medical reasons are now going through successful pregnancies and deliveries… The advancement in medical management has offered motherhood for these women.” Why should a healthy old women be excluded from this progress?

Where Do We Draw the Line? The Problem with Legislation

The urge to legislate an age limit is understandable but ultimately flawed. As we stated, “To legislate on these issues would be futile,” often leading to a public backlash and drives desperate couples to “falsify their age to seek treatment elsewhere.”

The responsibility, therefore, cannot rest with the community or a rigid law. It must be a shared decision between the individual, their family, and their doctor. “The ultimate responsibility should be that of the individual centre/doctors and the patient.”

A Final Thought: Recalibrating Our Priorities

Most poignant insight is a societal one: “There is a confusion & conflict between education, career & childbearing.” We must recognize that for many women, “the first & most important career… is childbearing; education & career are secondary… but childbearing must be done at the right time for optimal results.”

Yet, for those for whom the “right time” comes later in life, our role is not to judge but to support. The question is not “How old is too old?” but “Is this individual, with her unique circumstances, physical health, & profound desire, prepared for the journey of motherhood?”

Denying her that chance based on a number alone is to ignore the very purpose she holds dear: that “we all live to reproduce; reproduce & continue to live through our children.”

The Unforgiving Clock: A Biological Perspective on Age, Reproduction, and Modern Dilemmas

We are in a race against our own biology, and understanding the science is the first step to making informed choices. Let us begin with a few fundamental truths, as seen through the lens of biology.

All life is connected. Life begets life. We, Homo sapiens, are but one branch on the vast, intricate tree of evolution — a tree that grew by default, not by design. And on this one-way street of evolution, one thing seems inevitable: aging. It may be delayed, but it cannot be denied.This immutable truth lies at the very heart of human reproduction.

The Law of Life in a Modern World

Reproduction is the law of life and a fundamental biological right. Yet, in a few short decades, we have witnessed a profound shift. The global fertility rate has plummeted — from 6.1 children per woman in the 1950s to 2.6 today. In India, the decline is equally stark.

This is not happening in a vacuum. The delinking of sex from reproduction, driven by contraception and assisted reproductive technologies (ART), has granted us unprecedented freedom. But this freedom comes with a complex biological catch.

The Female Biological Timeline: A Story of Ovarian Reserve

For women, the relationship between age and fertility is not a gentle slope; it is a steep and irreversible decline. The reason is ovarian reserve.

A female is born with her lifetime supply of eggs — a staggering 6–7 million at 20 weeks of gestation. This number is her biological fortune, and it can only be spent, not earned.

· At birth: 1–2 million

· At puberty: 300,000–400,000

· At menopause: Merely 1,000

This process of follicular atresia (natural degeneration) is continuous and unrelenting. Age is the single most crucial factor influencing this reserve. While genetics and ethnicity play a role in the rate of depletion, the overall trajectory is universal.

The Data Doesn’t Lie:

· Early 20s: 1–2% incidence of infertility

· Late 20s: 16%

· Mid-late 30s: 25%

· Early 40s: Over 50%

Fertility is highest for women under 25. After 35, the decline accelerates, and by 45, natural conception becomes a biological rarity.

Why Are We Having Children Later?

The reasons are social, not biological:

· Prioritizing education and career.

· Financial instability.

· The shift to nuclear families and the pursuit of self-fulfillment.

As the data shows, there is a strong correlation: as women’s education increases to match men’s, the fertility rate declines from six children to two. We are making rational choices for our lives, but they often run counter to our biological reality.

The Illusion of a Safety Net: ART and “Social Oocyte Banking”

This is where modern medicine enters the picture, offering what seems like a solution: egg freezing and In Vitro Fertilization (IVF). Pregnancies in older women are rising, leading some to ask: Is age no longer a barrier?

The data from clinics like Chettinad Fertility Services provides a sobering answer:

Maternal Age and Pregnancy Rate via Assisted Reproduction

Under 35 — 30.4%

35 and Above — 18.6%

The hard truth is that ART cannot overcome the decline in age-related fecundity. The goal is not just achieving a pregnancy; it is achieving a live birth. With advanced maternal age comes a cascade of increased risks:

· Prolonged time to pregnancy (TTP) and infertility.

· Increased miscarriages and ectopic pregnancies.

· Higher risk of pregnancy complications (diabetes, pre-eclampsia).

· Increased chance of chromosomal abnormalities like Down Syndrome.

· Preterm births and stillbirths.

A patient who passed away after childbirth remarked: “No regrets,”

Reproduction

For decades, public health discussions centered on controlling fertility — contraception, family planning, and population policies. But there’s another, quieter side of reproduction — infertility. While millions try not to conceive, millions of others struggle because they can’t.

The World Health Organization defines infertility as a disease of the reproductive system. It is often treated as a private sorrow, not a public concern. Couples spend years & savings “chasing a phantom pregnancy,” moving from one clinic to another, often in silence & shame.

1. Health and Human Rights

The WHO defines health as “a state of complete physical, mental, and social well-being — not merely the absence of disease.”

Infertility threatens health on all fronts. If health is a right, & reproduction is essential to health, then shouldn’t reproduction itself be a right?

Reproductive rights don’t stop at contraception; they include the right to have children, Infertility care remains inaccessible or unaffordable in much of the world.

2. The Ethical Crossroads of Modern Science

IVF, ICSI, surrogacy, egg freezing, and even mitochondrial replacement therapy have given hope where once there was none.

New technologies raise profound questions:

Should reproduction be considered a right, regardless of cost or circumstance?

• Do these rights extend to same-sex couples, single individuals, or post-menopausal women?
• How do we balance reproductive freedom with ecological and population concerns?

These are not just scientific issues — they are moral and social ones. Rights come with responsibilities. Science must serve compassion, not commerce.

3. Infertility Care as a Matter of Justice

If society funds contraception and abortion services, shouldn’t it also support infertility care?

Recognizing infertility as a public health issue means:

• Making diagnosis and basic treatment available through public hospitals.
• Offering insurance coverage or subsidies.
• Providing counseling to handle the emotional toll.
• Ensuring ethical regulation of assisted reproduction.

The goal isn’t to promise everyone a child — but to ensure that no one is abandoned in their desire to become a parent.

4. A Right with Boundaries

Reproduction unlike most other rights, affects not just the individual, but future generations and the planet.

Some nations face declining birth rates, while others struggle with overpopulation. The right to reproduce must therefore be balanced with social and ecological responsibility.

5. The Human and Emotional Side

Infertility isn’t just a medical diagnosis — it’s a deep emotional wound. In many cultures, childlessness carries stigma, especially for women. It can lead to depression, isolation, or marital breakdown.

Empathy, counseling, and public awareness are as important as medical treatment.

Societies must stop viewing infertility as a failure and recognize it as a shared human challenge.

6. The Way Forward

Infertility is a health issue that affects millions across all economic & cultural boundaries.

Public policy must evolve — to make infertility care accessible, ethical, & humane. Laws must protect the rights of parents, donors, surrogates, and children born through these technologies.

Reproduction is more than biology. It is an affirmation of life, continuity, & belonging. Denying infertility care is not just denying treatment — it is denying people their wholeness.

Reproduction is indeed a fundamental right — but one guided by responsibility & compassion. The desire to create life is not a luxury — it is part of what makes us human.

Success is a journey, not the destination. The path continues beyond the peak.

We are all taught how to handle failure. We learn to rise when we fall, to correct mistakes, to be resilient. Entire volumes are devoted to grit, perseverance, and recovery. Yet very few ever teach us how to handle success. And paradoxically, success can be harder to manage than failure.

Success brings light — recognition, joy, new opportunities. But it also casts shadows: complacency, envy, the pressure to repeat achievements, and the danger of losing perspective. Shakespeare captured it perfectly in Henry IV: “Uneasy lies the head that wears the crown.”

To thrive, we must remember that success is a journey, not the destination. Even more, we must accept that success and failure are conjoint twins, two sides of the same coin. One inevitably follows the other, eventually.

Success and Failure: Conjoint Twins

In clinical practice, a new treatment or surgical technique often feels like a triumph. A patient recovers, families rejoice, colleagues congratulate. Yet every doctor knows that early success demands vigilance. Complications may arise. Long-term outcomes must be tracked. In medical research, too, a published paper brings recognition, but it also brings scrutiny. Others will try replication. Critics will probe your methods. A celebrated finding becomes the foundation for the next round of questions, not the end of inquiry.

History echoes this truth. Thomas Edison, often hailed for inventing the light bulb, reframed his countless failed attempts as essential steps: “I have not failed. I have just found 10,000 ways that will not work.”

Lesson: Success and failure are not enemies but twins. Each success carries within it the seeds of future setbacks, and each failure holds the lessons that make future victories possible.

Success Is a Beginning, Not a Destination

One of the greatest conquerors in history, Alexander the Great, wept in his twenties because there were “no more worlds left to conquer.” His victories came so swiftly that success itself became a burden. What he thought was the end turned into a void.

The truth is, every success is a starting point, not a finish line. Winning a gold medal, publishing a landmark paper, or launching a popular product may feel conclusive. But the world keeps moving, and the journey continues.

In modern times, companies like Kodak and Blockbuster remind us of the danger of resting too long on your laurels. They mistook their market dominance for permanence, not adapting when the next chapter arrived. Their success blinded them to change.

Lesson: Treat every victory as a milestone on a continuing road. Celebrate it — but then ask, what comes next?

Humility: The Anchor of Achievement

Success often brings applause, and applause can intoxicate. The antidote is humility.

Humility does not mean pretending achievements do not matter. It means recognizing that they were never achieved alone. Behind every success lies a team..

Consider Marie Curie, the first person ever to win Nobel Prizes in two sciences. Despite her unprecedented recognition, she lived modestly, devoted to her laboratory, and never patented her process for isolating radium, believing that science should serve humanity. Her humility kept her achievements in perspective.

In medicine, too, success is rarely solitary. A successful surgery depends on anesthetists, nurses, and technicians. A research breakthrough relies on data collectors, statisticians, and peer reviewers. Acknowledging this network keeps arrogance at bay and preserves the human ties that make future success possible.

Guard Against Complacency

Failure naturally drives us to work harder. Success, ironically, tempts us to relax. Complacency is the most dangerous shadow cast by achievement.

Disclaimer: This is an opinion podcast for educational purposes only and does not constitute medical advice. Readers should consult their healthcare providers before making any decisions about diagnosis or treatment.

What is Endometriosis? Endometriosis happens when tissue like the lining of the womb (uterus) grows in places it does not belong — like on the ovaries, the fallopian tubes, or other parts of the pelvis. In rare cases, it can even show up in places far from the womb, like the lungs or surgical scars.

This tissue behaves like it would inside the womb — it reacts to monthly hormonal changes, swells, and bleeds during periods. But because it is trapped outside the womb, it can cause pain, swelling, and sometimes scar tissue.

Why Does It Happen? Doctors are not completely sure why endometriosis develops. One main theory is retrograde menstruation — where some menstrual blood flows backward into the pelvis instead of out of the body. These cells then stick to other tissues and grow.

We also know that: — It mostly affects women who are having regular periods and have working ovaries. — Pregnancy and breastfeeding often ease symptoms because periods stop for a while. Endometriosis usually goes away after menopause when periods stop permanently.

How Common is It? We do not know the exact number because many women have no symptoms.

But it is estimated that: — Around 1 in 3 women with endometriosis have trouble getting pregnant. Around 1 in 3 women with fertility problems have endometriosis. — In India alone, over 40 million women may have it.

What Are the Symptoms? Some women have no symptoms at all. For others, endometriosis can cause: — Very painful periods — Pain during or after sex — Difficulty getting pregnant — Pain when passing stools or urine (especially during periods) — Ongoing pelvic pain

Does It Cause Infertility? This is still debated. In some cases, scar tissue or adhesions from endometriosis can block the fallopian tubes or affect the ovaries, making pregnancy harder. But in many women, the link between endometriosis and infertility is unclear. Some experts even suggest infertility can sometimes lead to endometriosis rather than the other way around.

How is it Diagnosed? The only sure way to confirm endometriosis is through a small surgical procedure called laparoscopy — where a tiny camera is inserted into the abdomen. Even then, samples are taken and usually checked under a microscope to be sure.

Scans like ultrasound can detect endometriomas (a type of cyst caused by endometriosis), but they can miss smaller or hidden spots.

Treatment Options: Treatment depends on whether the main problem is pain, infertility, or both.

1. Hormonal treatments (such as birth control pills, progestins, or hormone-blocking injections) can relieve pain but usually prevent ovulation, making them unsuitable for those trying to conceive. — Surgery can remove endometriosis patches, but symptoms can return. Surgery is advised when there’s severe pain, bowel or urinary blockage, or suspicion of cancer.

2. For infertility, mild cases may be addressed with fertility treatments such as ovulation stimulation and intrauterine insemination (IUI). — For more severe cases or if other treatments fail, IVF is usually the best choice. — Removing endometriomas before IVF does not usually improve success rates and may reduce egg numbers, so it is often avoided unless necessary.

Living with Endometriosis: Endometriosis can be frustrating & unpredictable — symptoms can be mild, severe, or even disappear on their own. The key is to tailor treatment to the woman’s main concerns — pain, fertility, or both — and avoid unnecessary delays in trying for pregnancy when that is the goal.

Disclaimer: This is an opinion podcast for educational purposes only and does not constitute medical advice. Listeners should consult their healthcare providers before making any decisions about diagnosis or treatment.

Fertility Add-Ons: Hope, Hype, and Hard Truths

Quick Look:

Add-ons are optional extras in IVF promising better success. Most lack strong evidence for improving live birth rates and often add only cost, risk, and complexity.

What Are Add-Ons?

Add-ons are drugs, procedures, or lab techniques added to standard IVF hoping to improve outcomes. Examples include additional drugs (DHEA, growth hormone), lab innovations (time-lapse imaging, embryo glue), and procedures (endometrial scratching). Today's routine (like ICSI) was often yesterday's add-on, reminding us that today's fashion may be tomorrow's history.

The Vulnerability of Patients

The emotional burden of infertility makes patients vulnerable and willing to try anything. History shows the dangers of untested interventions (e.g., Thalidomide, DES). Embryos are highly sensitive, and add-ons may carry hidden long-term risks.

Do Add-Ons Really Work?

Most fail to improve live birth rates:

· Androgens/Growth Hormone: May increase eggs retrieved but not proven to improve live births.

· Antioxidants: Can improve sperm quality, but link to live birth is weak.

· Aspirin/Heparin: Evidence does not support routine use.

· Metformin: Useful for PCOS to reduce risk but doesn’t clearly raise live births.

· Endometrial Scratching/Assisted Hatching/ERA: Strong trials show little to no benefit for most.

The Herd Effect & Problem with "Evidence"

Medicine is not immune to fashion. Unproven add-ons become mainstream as patients request them and clinics offer them to stay competitive. Supporters often cite weak evidence like meta-analyses of small studies or statistically significant but clinically meaningless p-values. Fertility treatment demands the strongest evidence.

What This Means for Patients

· Ask: “Is it proven to help someone like me achieve a live birth?”

· Weigh the significant financial costs.

· Understand potential side effects and unknown long-term risks.

The Hard Truth

Most add-ons do not increase your chance of a baby. They reliably add cost, confusion, and complexity. Innovation must continue but with caution, protecting patients.

Final Takeaway

Until solid evidence proves they increase live births without harm, add-ons remain optional extras—not essentials.