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<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Pardon any cross-posting (thanks to Jolie
from HCWH for forwarding this to that list serve). </span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> </span></font></p>
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<p style='margin-bottom:12.0pt'><font size=2 color=navy face="Times New Roman"><span
style='font-size:10.0pt;color:navy'>Laurie <br>
<br>
<br>
</span></font></p>
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<p class=MsoNormal><b><font size=2 face=Tahoma><span style='font-size:10.0pt;
font-family:Tahoma;font-weight:bold'>From:</span></font></b><font size=2
face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma'> Jolie Patterson
Rosst [mailto:jprosst@hcwh.org] <br>
<b><span style='font-weight:bold'>Sent:</span></b> Wednesday, May 03, 2006
12:43 PM<br>
<b><span style='font-weight:bold'>To:</span></b> hcwh<br>
<b><span style='font-weight:bold'>Subject:</span></b> [hcwh] male fertility and
pregnancy rates</span></font></p>
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<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'> </span></font></p>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>(hcwh@lists.hcwh.org)</span></font></p>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Article on <a href="http://www.slate.com/">www.slate.com</a> by Liza
Mundy of the Washington Post on decreasing fertility – mentions CHE,
phthalates, widespread chemical use, etc… My husband happens to be the
organizer of the National Day to Prevent Teen Pregnancy so this article is of
great interest to us. </span></font></p>
<p><b><font size=6 face="Times New Roman"><span style='font-size:24.0pt;
font-weight:bold'>What's Really Behind the Plunge in Teen Pregnancy?</span></font></b>
<br>
<b><font size=5><span style='font-size:18.0pt;font-weight:bold'>It's time to
look at boys' contributions.</span></font></b> <br>
By Liza Mundy<br>
Posted Wednesday, May 3, 2006, at 10:20 AM ET<br>
<br>
<b><span style='font-weight:bold'>Today, May 3</span></b><b><font face=Tahoma><span
style='font-family:Tahoma;font-weight:bold'>—</span></font>in case you
didn't know it</b><b><font face=Tahoma><span style='font-family:Tahoma;
font-weight:bold'>—</span></font>is "National Day To Prevent Teen
Pregnancy."</b> In the past decade, possibly no social program has been as
dramatically effective as the effort to reduce teen pregnancy, and no results
so uniformly celebrated. Between 1990 and 2000 the U.S. teen pregnancy rate
plummeted by 28 percent, dropping from 117 to 84 pregnancies per 1,000 women
aged 15-19. Births to teenagers are also down, as are teen abortion rates. It's
an achievement so profound and so heartening that left and right are eager to
take credit for it, and both can probably do so. Child-health advocates
generally acknowledge that liberal sex education and conservative abstinence
initiatives are both to thank for the fact that fewer teenagers are ending up
in school bathroom stalls sobbing over the results of a home pregnancy test. </p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>What,
though, if the drop in teen pregnancy isn't a good thing, or not entirely? What
if there's a third explanation, one that has nothing to do with just-say-no
campaigns or safe-sex educational posters? What if teenagers are less fertile
than they used to be?</span></font></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>Not the
girls</span></font><font face=Tahoma><span style='font-family:Tahoma'>—</span></font>the
boys? It's a conversation that's taking place among a different and
somewhat less vocal interest group: scientists who study human and animal
reproduction. Like many scientific inquiries, this one is hotly contested and
not likely to be resolved anytime soon. Still, the fact that it's going on
provides a useful reminder that not every social trend is the sole result of
partisan policy initiatives and think-tank-generated outreach efforts. It
reminds us that a drop in something as profound as fertility, in human
creatures of any age, might also have something to do with health, perhaps even
the future of the species.</p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>The great
sperm-count debate began in 1992, when a group of Danish scientist published a
study suggesting that sperm counts declined globally by about 1 percent a year
between 1938 and 1990. This study postulated that "environmental
influences," particularly widely used chemical compounds with an impact
like that of the female hormone estrogen, might be contributing to a drop in
fertility among males. If true, this was obviously an alarming development,
particularly given that human sperm counts are already strikingly low compared
to almost any other species. "Humans have the worst sperm except for
gorillas and ganders of any animal on the planet," points out Sherman
Silber, a high-profile urologist who attributes this in part to short-term
female monogamy. Since one man's sperm rarely has to race that of another man
to the finish, things like speed and volume are less important in human sperm
than in other animals, permitting a certain amount of atrophy among humans. </span></font></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>The
Danish study set an argument in motion. Other studies were published showing
that sperm counts were staying the same; still others showed them going up. In
the late 1990s, however, an American reproductive epidemiologist named Shanna
Swan published work confirming the Danish findings. In a well-respected study
published in<i><span style='font-style:italic'> Environmental Health
Perspectives</span></i>, Swan, now at the University of Rochester Medical
Center, found that sperm counts are dropping by about 1.5 percent a year in the
United States and 3 percent in Europe and Australia, though they do not appear
to be falling in the less-developed world. This may not sound like a lot, but
cumulatively</span></font><font face=Tahoma><span style='font-family:Tahoma'>—</span></font>like
compound interest<font face=Tahoma><span style='font-family:Tahoma'>—</span></font>a
drop of 1 percent has a big effect. Swan showed, further, that in the United States there appears to be a regional variation in sperm counts: They tend to be
lower in rural sectors and higher in cities, suggesting the possible impact of
chemicals (such as pesticides) particular to one locality. </p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>Swan is
part of a group of scientists whose work suggests that environmental changes
are indeed having a reproductive impact. Under the auspices of a women's health
group at Stanford University and an alliance called the <a
href="http://www.healthandenvironment.org/"
title="http://www.healthandenvironment.org/">Collaborative on Health and the
Environment</a>, some of these scientists met in February 2005 at a retreat in Menlo Park, Calif., to discuss their findings. Among the evidence presented are several
trends that seem to point to a subtle feminization of male babies: a worldwide
rise in hypospadias, a birth defect in which the urethral opening is located on
the shaft of the penis rather than at the tip; a rise in cryptorchidism, or
undescended testicles; and experiments Swan has done showing that in male
babies with high exposure to compounds called phthalates, something called the
anogenital distance is decreasing. If you measure the distance from a baby's
anus to the genitals, the distance in these males is shorter, more like that of
… girls.</span></font></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>Wildlife
biologists also talked about the fact that alligators living in one
contaminated Florida lake were found to have small phalli and low testosterone
levels, while females in the same lake had problems associated with abnormally
high levels of estrogen. In 1980 the alligators' mothers had been exposed to a
major pesticide dump, which, some believe, was working like an estrogen on
their young, disrupting their natural hormones. A report later published by
this group pointed out that similar disruptions have been found in a "wide
range of species from seagulls to polar bears, seals to salmon, mollusks to frogs."
As evidence that a parent's exposure to toxicants can powerfully affect the
development of offspring, the example of DES, or diethylstilbestrol, was also,
of course, offered. Widely given to pregnant women beginning in the late 1930s
under the mistaken assumption that it would prevent miscarriage, DES left the
women unaffected but profoundly affected their female fetuses, some of whom
would die of cancer, others of whom would find their reproductive capacity
compromised. The consensus was that the so-called chemical revolution may well
be disrupting the development of reproductive organs in young males, among
others. This research is controversial, certainly, but accepted enough, as a
hypothesis, that it appears in developmental-biology textbooks. </span></font></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>Tellingly,
the U.S. government is also taking this conversation seriously. Together, the
National Institutes of Health and the U.S. Centers for Disease Control are
sponsoring a longitudinal effort to study the effect of environment on
fertility. This <a href="http://www.lifestudy.us/"
title="http://www.lifestudy.us/">study</a> will track couples living in Texas and Michigan, following their efforts to become pregnant. The aim is to determine
whether toxicants are affecting the reproductive potential of female and male
alike.</span></font></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>It will
be welcome information. In the United States, good statistics about infertility
are strikingly hard to come by. There is no government-sponsored effort to
track male fertility rates, even though male-factor problems account for half
of all infertility. Even among women, who are regularly interrogated about
reproductive details, it's difficult to get a good handle on developments. For
years, government researchers included only married women in the category of
"infertility," creating a real problem for demographers and
epidemiologists looking for trends. The <a href="http://www.cdc.gov/nchs/"
title="http://www.cdc.gov/nchs/">National Center for Health Statistics</a>
created a second category called "impaired fecundity," which includes
any woman, of any marital category, who is trying to get pregnant and not
having luck. </span></font></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>And the
"impaired fecundity" category contains findings that may have a
bearing on the are-young-men-more-infertile-than-their-fathers question. In the
United States, "impaired fecundity" among women has seen, over
several decades, a steady rise. And while much attention has focused on older
women, the most striking rise between 1982 and 1995 took place among women
under 25. In that period, impaired fecundity in women under 25 rose by 42
percent, from 4.3 percent of women to 6.1 percent. Recently published data from
2002 show a continued rise in impaired fecundity among the youngest age cohort.</span></font></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>In a 1999
letter to<i><span style='font-style:italic'> Family Planning Perspectives</span></i>,
Swan sensibly proposed "that the role of the male be considered in this
equation." If sperm counts drop each year, then the youngest men will be
most acutely affected, and these will be the men who are having trouble
impregnating their partners. In 2002, Danish researchers published an opinion
piece in<i><span style='font-style:italic'> Human Reproduction</span></i>
noting that teen pregnancy rates (already much lower than in the United States) fell steadily in Denmark between 1985 and 1999. Unlike in the United States, in Denmark there have been no changes in outreach efforts to encourage responsible
behavior in teens: no abstinence campaigns, no big new push for condom
distribution. Wider social trends notwithstanding, they note that "it
seems reasonable also to consider widespread poor semen quality among men as a
potential contributing factor to low fertility rates among teenagers." </span></font></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>Among
other things, the sperm-count debate reminds us that we should not be smug
about the success of teen-pregnancy prevention efforts. We may not want today's
teenagers to become pregnant now, but we certainly want them to become pregnant
in the future, providing they want to be. If nothing else, the sperm-count
hypothesis shows that when it comes to teenagers and sexual behavior, there's
always something new to worry about.</span></font></p>
<p><i><font size=3 face="Times New Roman"><span style='font-size:12.0pt;
font-style:italic'>Liza Mundy, a staff writer for the</span></font></i>
Washington Post<i><span style='font-style:italic'>, is writing a book about
reproductive technology and its impact that will be published next year.</span></i></p>
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