All reporting comes with a dash of propaganda.

An interesting development.  

For nearly a decade, there have been reports of a worldwide decline in male sperm counts with a claimed emerging threat to fertility.  The tone of the reporting has ranged from clinical in a few to apocalyptic in many.  It is the sort of issue which lends itself to hysteria but which is also plausible.  

In our modern complex industrial-economic consumer society, our capacity to unknowingly introduce trace chemicals into the environment which might have cumulative impacts over time is a known and plausible source of sperm count declines.  But what could happen has nothing to do with what is happening.  That is just faulty thinking.  

So I have kept the whole issue in my watch-and-see mental box awaiting confirmation that:

• It is a real phenomenon (that sperm counts are declining)
• Sperm count declines do represent a real threat to fertility
• There is a known causal mechanism by which this is happening

Good thing that I did not invest much emotional energy in this research and "expert" generated hysteria.  From The Sperm-Count ‘Crisis’ Doesn’t Add Up by Rachel E. Gross.  

Reports of a decline in male fertility rely on flawed assumptions, a new study contends.

The article confirms that we don't know if it is a real phenomenon; we don't know whether there is a causal fertility decline; and we don't understand the causal mechanisms in any reliable fashion.  

A new study countering the conclusions of an old study does not resolve the matter but it does shed some light on why the old conclusions might have been unduly alarmist.  And it also highlights some truths which had earlier been overlooked.

For example, with Covid-19 we have been wrestling with accurately counting who has died from Covid-19 from people who died with Covid-19 from individuals who possibly might have died from Covid-19.  

In 2018 there were 34,200 flu deaths in the US and roughly 50,000 died of pneumonia.  Given natural variations in death loads per year, we usually lose 75,000 to 100,000 each year to lung conditions.  

When we first started counting Covid-19 deaths, it turned up something I did not know.  Those numbers really amounted to estimates rather than confirmed diagnoses.  If someone presented with the symptoms of flu or pneumonia, they were assumed to have one or the other.  

In the scheme of things, a reasonable approach.  Diagnostic testing is expensive and time consuming and it adds complexity to an already complex system.  

It only really becomes an issue if there is a new lung inflammation contagion going around.  Such as Covid-19.  In many countries, there is a curious phenomenon where there are either no flu or pneumonia deaths or exceedingly low death rates compared to years past.  Either Covid-19 is displacing those deaths, which is possible, or Covid-19, flu and pneumonia deaths are hard to distinguish without expensive and reliable testing (recognizing that much Covid-19 testing in the beginning was especially prone to false positives.)

The whole measurement issue was a surprise to me only to the degree to which it was badly managed.  But the fact that our prior flu and pneumonia data was also so loosey-goosey was a real surprise.  I had assumed a greater diagnostic accuracy than was really the case.  

And that is not intended as a criticism.  Again, absent Covid-19, I suspect that assessment based on symptom presentation rather than detailed medical testing is reasonably reliable.  I simply misunderstood the process.

Something similar has apparently been going on with sperm count research.  It seems to be a relatively recent field of research, we don't have good measurement diagnostics, and we have no historical data from before three or four decades ago.  Whatever we think we are learning now has no context against prior data.

For nearly as long, scientists have fretted about sperm’s seemingly inevitable decline. Most recently, a series of alarming headlines — as well as a new book by an epidemiologist at Mount Sinai Medical Center in New York — warned that falling sperm counts might threaten the future of the human race. “It’s a global existential crisis,” said Shanna H. Swan, author of the book “Count Down.”

Most of these headlines can be traced to an influential 2017 meta-analysis by Dr. Swan and others, which found that sperm counts in Europe, North America, Australia and New Zealand had plummeted by nearly 60 percent since 1973. The authors screened 7,500 sperm-count studies from around the world, weeded out most of them and ultimately analyzed 185 studies on 43,000 men worldwide.

They called the decline a “canary in the coal mine” for waning male reproductive health worldwide. Today, the authors would amplify that statement. “There is clear and present alarm now,” said Dr. Hagai Levine, an epidemiologist at Hebrew University-Hadassah School of Public Health and a co-author on the 2017 review, in an email. “The canary is in trouble now.” Dr. Swan, in the same email, agreed.

Sounds pretty bad?  Well, maybe not.

Now a group of interdisciplinary researchers from Harvard and the Massachusetts Institute of Technology contend that fears of an impending Spermageddon have been vastly overstated. In a study published in May in the journal Human Fertility, they re-evaluated the 2017 review and found that it relied on flawed assumptions and failed to consider alternate explanations for the apparent decline of sperm.

In an interview, Sarah Richardson, a Harvard scholar on gender and science and the senior author on the new study, called the conclusion of the 2017 review “an astonishing and terrifying claim that, were it to be true, would justify the apocalyptic tenor of some of the writing.” Fortunately, she and her co-authors argue, there is little evidence that this is the case.

The 2017 authors were “methodologically rigorous” when it came to screening sperm-count studies for quality and consistency, Dr. Richardson and her colleagues write. However, even the data that passed muster was geographically sparse and uneven and often lacked basic criteria like the age of the men. Moreover, its authors took for granted that a single metric — sperm count — was an accurate predictor of male fertility and overall health.

So sperm research is just about as prone to error as the notorious field of psychology where some 70% or more of the more famous findings eventually fail to replicate.  They display the same sets of systemic failures

• Poor data collection practices
• Sparse and non-random data sets
• Inadequate methodology pre-registration 
• Misunderstanding of causal mechanisms of fertility
• Inability to eliminate alternate causal mechanisms 
• Failure to define measures and ranges 
• Inattention to plausible alternative explanations
• No baseline for comparison 
• Failure to take into account that improvements in measurement mechanisms may be generating the false appearance of a real effect

I am glad for the update.  I can't help but note, though, the non-scientific reporting style.  This is a science issue.  One would hope that one could get reporting that is focused and reportorial and not ideological.  Here is one of the offending passages.

There was one point that every author agreed on: Men’s reproductive health matters. And until now, it has been surprisingly neglected.

Male infertility contributes to at least half of all cases of infertility worldwide. Yet historically, women have shouldered most of the blame for the inability to conceive. And with the rise of reproductive technologies like in vitro fertilization, women’s bodies are the ones that have been meticulously measured and tracked by reproductive medicine.

As a result, science still lacks basic knowledge when it comes to sperm, said Rene Almeling, a sociologist of medicine and author of “GUYnecology: The Missing Science of Men’s Reproductive Health.”

Weasel word red flags - "Male infertility contributes to at least half of all cases of infertility"?  If it was more than half, that is what they would report.  The "at least" wording seems superfluous.  Why is it there?

More importantly is the reporting as fact that which seems like speculation - "Yet historically, women have shouldered most of the blame for the inability to conceive."  Is that true?

With four decades of broad science reading, no example leaps to mind of anyone blaming women for being the primary cause of infertility.  Where does that wording come from?  It seems to be from a paper by a couple of Yale professors which Gross links to at least twice.  

Although male infertility contributes to more than half of all cases of global childlessness, infertility remains a woman's social burden. 

The paper is focused on global infertility and yet Gross's reporting is largely USA targeted.  Probably there is an issue arising from the mismatch of scope.  US fertility issues are likely handled far differently than cultures elsewhere.  Is there really blame here?

And separate from that, what even are the facts.  In writing this post, I have held off doing any research in order to better identify my own priors.  From high school biology and from four decades of catholic science reading with no particular focus on fertility but encompassing a lot of biology I would guess that there is a likelihood of women being slightly more the source of infertility than men based on the following reasoning.

I have always understood the female reproductive system to be far more complex and therefore prone to possible perturbations than males.  Males simply produce and deliver sperm.  Their sperm may be too low in count, insufficiently motile, or in some other way deformed in a fashion which precludes insemination but the production and delivery is a relatively simple chain of events over the course of at most a couple of weeks.  Females on the other hand have a limited lifetime production of eggs, a finely timed egg delivery process, a nine month gestation period, a vastly complex hormonal transition for their bodies to adapt to in order carry foreign matter, and a prolonged period of exposure to possible food toxins to the fetus.  On balance, I would guess that women's set of fertility risk exposures amounts to probably 2/3rds of cases of infertility.

Which would have to be offset against some considerations regarding male infertility.  While sperm production is comparatively straightforward, men are far more likely to work in environments of extreme chemical or heat exposure which can have an impact.  With external genitalia, males must also have a greater disruption exposure than females, especially regarding the heat environment of the testes.  Taking these factors into account, I adjust the estimate and guess that perhaps 55% of cases of infertility are due to female conditions and 45% due to male conditions.  

I am not claiming this is an accurate assessment.  All I claim is that that is what my high school biology and broad science reading would lead me to conclude.  Now for some quick googling to discover how far astray I might be.

First research discovered is from 2015 and with a pretty high 1,108 citation account.  

Infertility affects an estimated 15% of couples globally, amounting to 48.5 million couples. Males are found to be solely responsible for 20-30% of infertility cases and contribute to 50% of cases overall. However, this number does not accurately represent all regions of the world. Indeed, on a global level, there is a lack of accurate statistics on rates of male infertility. Our report examines major regions of the world and reports rates of male infertility based on data on female infertility.

Hmm.  20-30% male source of infertility versus at least half?  Sounds like perhaps Gross should have dug a little deeper.  Especially given that "on a global level, there is a lack of accurate statistics on rates of male infertility."  Gross's preferred research paper is only cited 854 times even though published in the same year.  

From the National Institute of Child Health and Human Development:

About 9% of men and about 11% of women of reproductive age in the United States have experienced fertility problems.

In one-third of infertile couples, the problem is with the man.

In one-third of infertile couples, the problem can't be identified or is with both the man and woman.

In one-third of infertile couples, the problem is with the woman.

Studies suggest that after 1 year of having unprotected sex, 12% to 15% of couples are unable to conceive, and after 2 years, 10% of couples still have not had a live-born baby.  (In couples younger than age 30 who are generally healthy, 40% to 60% are able to conceive in the first 3 months of trying.)

Fertility declines with age in both men and women, but the effects of age are much greater in women. In their 30s, women are about half as fertile as they are in their early 20s, and women's chance of conception declines significantly after age 35.  Male fertility also declines with age, but more gradually.

So 9% male source and 11% female source.  Not a huge differential but let's go to the numbers.  9/(9+11) = 45% of infertility issues accorded to males and therefore 11/(9+11) = 55% are due to female.  Hot dang, I always like it when an experiment with a Fermi Estimation Problem works out.  

But to be fair, it is clear that the measurement process is not a male:female binary.  One, other, or both at least.  

So the fifty percent infertility cases due to male infertility at least seems ill founded and lifted from that single paper.  

I click through another half dozen studies and they are all consistent with the above.  They do highlight one other factor that I overlooked in my estimation.  Males and Females both have declines in their fertility as they age but the female decline is much more rapid.  In addition, there is a terminal fertility rate with menopause for women which does not occur with males.  Given increasing age at first child, that is another factor that I should have taken into account.

So Gross inadequately sourced her reporting, depending too much on a single study and reported on global conditions when she was actually most focused on the US.  

What about the claim that women are societally blamed for infertility more than men.  Possibly at the global level.  But in the US?  

I googled "are women blamed for infertility more than men?" to see if there was any data to support the assertion.  All I came up with were opinion pieces asserting that to be the case but with no data to support the assertion.  Indeed, half of the first twenty results seem to point to the claim of "women are blamed for infertility more than men" as an article of theory in feminist theory.

In other words the hackneyed claim did not belong in Gross's article, particularly when the binary of 45:55% is so close and when the more refined (33% male, 33% female, 33% joint or indeterminable causes) seems to be the standard knowledge.  

Error or ideology?

The mind goes to Obama's Ben Rhode's infamous characterization of modern journalists:

“All these newspapers used to have foreign bureaus,” he said. “Now they don’t. They call us to explain to them what’s happening in Moscow and Cairo. Most of the outlets are reporting on world events from Washington. The average reporter we talk to is 27 years old, and their only reporting experience consists of being around political campaigns. That’s a sea change. They literally know nothing."

Is Rachel E. Gross a 27 year-old know-nothing?  Part of the academia-mainstream media bubble?   

Well, pretty much.  29 years-old.  Berkley and Northwestern graduate.  Her entire career has been in mainstream media primarily in Washington, D.C.  She has a book forthcoming in 2022, VAGINA OBSCURA, which seems to argue a more than passing familiarity with feminist theory.

Gross's article is useful in that it calls into question suspect research over the past decade.  Kudos for that.  But the introduction of ideological assumptions and claims is jarring.  If the New York Times still had control over the newsroom or fact-checkers or editors, they could have averted this marred reporting.  But those are no longer, regrettably, parts of their business model.  

All reporting comes with a dash of propaganda.  It is up to the reader to catch it.