Transcript: The Male Fertility Crisis | May 05, 2021

Steve sits in a room with white walls, a low slanted ceiling and several framed pictures on the walls including one of Walter Kronkite. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a pale blue shirt and a black tie.

A caption on screen reads "The male fertility crisis. @spaikin, @theagenda."

Steve says STUDIES HAVE SHOWN THAT SPERM COUNTS IN MEN LIVING IN WESTERN COUNTRIES HAVE DROPPED BY ALMOST 60 PERCENT OVER THE PAST HALF CENTURY. WHY IS THIS HAPPENING, AND SHOULD WE BE CONCERNED THAT WE'RE ON TRACK TO AN EXISTENTIAL CRISIS? WITH US TO EXPLORE THOSE QUESTIONS: IN EDINBURGH, SCOTLAND: RICHARD SHARPE, PROFESSOR AT THE MRC CENTRE FOR REPRODUCTIVE HEALTH AT THE UNIVERSITY OF EDINBURGH...

Richard is in his sixties, clean-shaven, with short gray hair. He's wearing glasses and a checkered shirt.

Steve continues IN CHAPEL HILL, NORTH CAROLINA: LINDA BIRNBAUM, FORMER DIRECTOR OF THE NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES AND NATIONAL TOXICOLOGY PROGRAM AND SCHOLAR IN RESIDENCE AT DUKE UNIVERSITY'S NICHOLAS SCHOOL OF THE ENVIRONMENT...

Linda is in her sixties, with short curly gray hair. She's wearing a pink blouse.

Steve continues AND ON MANHATTAN ISLAND, IN NEW YORK CITY, SHANNA SWAN, AUTHOR OF "COUNT DOWN: HOW OUR MODERN WORLD IS THREATENING SPERM COUNTS, ALTERING MALE AND FEMALE REPRODUCTIVE DEVELOPMENT, AND IMPERILING THE FUTURE OF THE HUMAN RACE." SHE IS ALSO A PROFESSOR OF ENVIRONMENTAL MEDICINE AND PUBLIC HEALTH AT THE ICAHN SCHOOL OF MEDICINE AT NEW YORK'S MOUNT SINAI HOSPITAL...

Shanna is in her late fifties, with short brown hair. She's wearing glasses, a red blouse and a chain necklace.
A picture of her book appears briefly on screen. The cover is orange, with an arrow that descends from the top left to the bottom right of the page forming a stair.

Steve continues IT'S A PLEASURE TO HAVE YOU THREE ON "THE AGENDA" TONIGHT. SHANNA, I'M GOING TO SPEND A FEW MINUTES WITH YOU OFF THE TOP TO SET UP THE PREMISE FOR OUR DISCUSSION, AND IN DOING SO, HERE ARE SOME NUMBERS AND A QUOTE FROM YOUR BOOK TO GET US STARTED. IN 2017, YOU EXAMINED THE FINDINGS FROM 185 STUDIES INVOLVING NEARLY 43,000 MEN THAT HAD BEEN CONDUCTED OVER A 38-YEAR SPAN, AND YOU FOUND THAT...

A slate appears on screen, with the title "A four decade long drop."

Steve reads data from the slate and says
BETWEEN THE YEARS 1973 AND 2011, SPERM CONCENTRATION... IN OTHER WORDS, THE NUMBER OF SPERM PER MILLILITRE OF SEMEN... DROPPED MORE THAN 52 percent AMONG RANDOM MEN IN WESTERN COUNTRIES AND THE TOTAL SPERM COUNT FELL BY MORE THAN 59 percent. AND YOU WRITE...

A quote appears on screen. The quote reads "The current state of reproductive affairs can't continue much longer without threatening human survival."
Quoted from Shanna Swan, "Count down." 2021.

Steve says NOW, THAT ALL SOUNDS EXTREMELY ALARMING, BUT GENUINELY, HOW CONCERNED DO YOU THINK WE OUGHT TO BE?

The caption changes to "Shanna Swan. Author, 'Count down.' ICANN School of Medicine at Mount Sinai."

Shanna says OBVIOUSLY I'M CONCERNED BECAUSE I WROTE THAT AND I FEEL THAT THE CURRENT STATE OF REPRODUCTIVE HEALTH IS REALLY PRETTY SERIOUS, AND THE NUMBER... WHEN WE LAST LOOKED AT THE SPERM CONCENTRATION, THERE WERE 47 MILLION SPERM PER MILLILITRE MEDIAN WORLDWIDE. SO THAT NUMBER, DROPPING FROM 99 IN 1973, THAT'S A HUGE DECLINE, AND WHAT THAT MEANS IS THAT AT 47 WE'RE VERY CLOSE TO 40. SO 40 MILLION SPERM PER MILLILITRE SOUNDS LIKE A LOT OF SPERM. IT IS A LOT OF SPERM. BUT IT TURNS OUT THAT WHEN A MAN'S CONCENTRATION DROPS BELOW 40, THEN A LOT OF THINGS KICK IN. HIS PROBABILITY OF CONCEIVING GOES DOWN. THE AMOUNT... THE NUMBER... OR THE PER CYCLE PREGNANCY RATE GOES DOWN, AND ACTUALLY, HE HIMSELF EXPERIENCES AN EARLIER AGE OF DEATH BECAUSE THERE'S A LIFETIME CONSEQUENCE OF THIS POOR SPERM COUNT. SO NOW THAT WE ARE ARGUABLY AT AROUND 40, BECAUSE THAT, YOU KNOW, WILL THE DECLINE CONTINUE, WHICH WE DON'T KNOW YET, THEN WE WOULD CERTAINLY BE BELOW 40 MILLION PER MILLILITRE, AND IN THAT AREA OF IMPAIRED FERTILITY. AND SO WITH A LOT OF THE WORLD IN THAT PLACE, AND SOON THE INCREASE IN ASSISTED REPRODUCTION, DECREASES IN TOTAL FERTILITY RATE, I BELIEVE WE'RE IN A SERIOUS PROBLEM.

Steve says THIS IS A PROBLEM IN THE DEVELOPED WORLD. IS IT ALSO A PROBLEM IN THE DEVELOPING WORLD?

Shanna says WE HAVE MUCH LESS DATA, SHALL FEWER STUDIES FROM DEVELOPING COUNTRIES. THAT'S BECAUSE THESE SPERM COUNT STUDIES TAKE A CERTAIN LEVEL OF TECHNOLOGY AND SOPHISTICATION. BUT WE'RE GETTING MORE OF THEM, AND WE'RE HOPING IN THE UPDATE THAT WE'RE DOING, WE WILL GET MORE INFORMATION. BUT THE FERTILITY DECLINE, WHICH IS THE NUMBER OF CHILDREN BORN PER WOMAN, THE TOTAL NUMBER OF CHILDREN BORN IN 1960 WAS FIVE PER WOMAN OR COUPLE WORLDWIDE AND THAT HAS DROPPED TO 2.4 WORLDWIDE IN 2019. SO THAT'S THE SAME ROUGHLY RATE OF DECLINE IN FERTILITY AND SPERM COUNT, AND IT IS WORLDWIDE FOR FERTILITY. IT'S GOING ON IN EVERY COUNTRY, AND MANY COUNTRIES... PARTICULARLY WESTERN COUNTRIES... ARE NOW BELOW REPLACEMENT. SO THIS IS NOT JUST A WESTERN PROBLEM.

Steve says THE THESIS OF THIS CONVERSATION NOW HAVING BEEN ESTABLISHED, LET'S BRING OUR OTHER TWO GUESTS IN HERE AND GET SOME REACTION FROM THEM AS TO THIS INFORMATION WE'VE JUST RECEIVED. LINDA, WHY DON'T YOU START US OFF HERE? SHANNA HAS WRITTEN THIS IS A GLOBAL EXISTENTIAL CRISIS. WHAT DO YOU THINK?

The caption changes to "Linda Birnbaum. Duke University."

Linda says I TEND TO AGREE WITH SHANNA. ABOUT 15 YEARS AGO... THERE WAS A MOVIE SOME PEOPLE MAY REMEMBER CALLED "CHILDREN OF MEN," WHICH POSITED THAT THERE WAS EXTREMELY LOW FERTILITY AND IT WAS A HUGE PROBLEM. I THINK FOR THE WORLD I'M NOT SURE OVERALL WITH WELL OVER 7 BILLION TO 8 BILLION PEOPLE ON OUR PLANET, I'M NOT SURE THAT FERTILITY IS A PROBLEM WHEN YOU LOOK AT IT THAT WAY, BUT WHEN YOU LOOK CERTAINLY AT AN INDIVIDUAL COUPLE OR INDIVIDUAL PEOPLE, IT IS A PROBLEM, AND I THINK THAT THE DATA IS GROWING AND EXTENSIVE THAT IT'S NOT ONLY MALE FERTILITY WHICH HAS DECREASED BUT ALSO FEMALE FERTILITY AS WELL.

Steve says RICHARD, WHAT SAY YOU?

The caption changes to "Richard Sharpe. University of Edinburgh."

Richard says WELL, I THINK THERE'S A MAJOR PROBLEM WITH MALE REPRODUCTIVE HEALTH FOR SURE. I THINK THAT THE GLOBAL REDUCTION IN COUPLE FERTILITY IS AN ISSUE WHERE WE HAVE TWO FACTORS AT PLAY: THE ONE THAT WE'RE CONCERNED ABOUT NOW, WHICH IS ADVERSE CHANGES IN SPERM COUNTS IN MEN, AND THAT'S IN COUPLE FERTILITY; AND SOCIETAL CHANGES, WHICH HAVE HAD A HUGE IMPACT ON COUPLE FERTILITY WHEN THEY'RE TRYING FOR CHILDREN AND ALSO HOW MANY THEY WANT TO END UP HAVING. SO IT CAN BE DIFFICULT TO DISENTANGLE THOSE TWO. BUT I THINK THAT THE BIGGEST IMPACT OF HAVING LOTS OF MEN WITH LOW SPERM COUNTS IS ANOTHER SOCIETAL CHANGE, AND THAT IS THE DELAY OF COUPLES IN TRYING FOR CHILDREN UNTIL THE FEMALE PARTNER IS IN HER 30s. THAT'S BECOMING NOW ALMOST THE MOST COMMON SITUATION. BECAUSE AT THAT TIME FERTILITY IN THE FEMALE IS MUCH REDUCED COMPARED WITH WHEN SHE'S IN HER EARLY 20s, AND THAT MEANS THAT SPERM COUNT BECOMES A MUCH BIGGER PLAYER IN TERMS OF WHETHER OR NOT SHE WILL GET PREGNANT. AND IF SPERM COUNTS ARE LOW, THEN YOU CAN SEE WHAT THE PROBLEM WILL BE.

Steve says THEY SAY IT'S ALWAYS A GOOD IDEA TO LISTEN TO YOUR UROLOGIST. SO WE ARE GOING TO HEAR FROM TWO OF THEM RIGHT NOW. DR. PAUL TURRICK SAID IN 2018...

A quote appears on screen, under the title "Will the drop stop?" The quote reads "Doctor Paul Turek: 'Over the last 100 years of industrialization, we're living better, longer, and we're certainly fatter. We're not cave men anymore. We've industrialized ourselves. We provably need less sperm.
If you're married and you're a captive audience, demand is low, and maybe you don't need it. Maybe that's what the drop is adjusting for. Maybe it's evolutionarily fine. Maybe the drop plateaus here.'"
As quoted in The New York Times. July 25, 2018.

Steve says DR. PETER SCHLEGEL, THE CHAIR OF UROLOGY AT WEILL CORNELL MEDICINE AND NEW YORK PRESBYTERIAN SAYS...

The quote changes to "Doctor Peter Schlegel: 'If you had a decrease in sperm count in the 50 to 60 percent range, we would expect the proportion of men with severe male infertility to be going up astronomically. And we don't see that."

Steve says SHANNA, DO YOU THINK THE SPERM COUNT DROP COULD HAVE HIT A PLATEAU AND MEN WILL STILL REMAIN RELATIVELY FERTILE?

Shanna says I THINK THAT IT'S POSSIBLE THAT IT HAS PLATEAUED AND IT'S CERTAINLY NOT GOING TO GO DOWN FOREVER BECAUSE WE CAN'T HAVE A ZERO SPERM COUNT OR CONCENTRATION. HOWEVER, I WOULD TAKE ISSUE WITH THE STATEMENT THAT THE NUMBER OF INFERTILE MEN HAS NOT GONE UP DRAMATICALLY. WHEN I'VE TALKED TO PEOPLE WHO ARE RUNNING SPERM BANKS, THEY'RE REPEATEDLY REPORTING... AND THIS HAS BEEN PUBLISHED... THAT THERE ARE FEWER MEN WHO ARE ABLE TO QUALIFY WITH ADEQUATE SPERM FOR THE SPERM BANK. AND MANY SPERM BANKS HAVE ACTUALLY CLOSED. ONE I WORKED WITH IN UNIVERSITY, ROCHESTER ACTUALLY CLOSED WHEN THE NUMBER OF DONORS THAT QUALIFIED BECAME TOO LOW. SO I BELIEVE THAT WE ARE SEEING IT BECOMING MORE DIFFICULT TO GET MEN WITH ADEQUATE SPERM FOR SPERM BANKING. WE'RE SEEING IT BEING HARDER FOR MORE COUPLES GOING INTO ASSISTED REPRODUCTION AND THE NEED FOR THOSE SPERM BANKS. THOSE TWO ARE COMING TOGETHER AND CAUSING A REALLY SERIOUS PROBLEM.

Steve says RICHARD, WHAT'S YOUR VIEW ON WHETHER OR NOT THE SPERM COUNT DROP HAS FINALLY PLATEAUED?

Richard says WELL, I THINK THE BEST EVIDENCE WE'VE GOT IS FROM STUDIES IN DENMARK OF YOUNG MEN. AND THEY SUGGEST THAT IN DENMARK, WHICH HAS GOT THE LOWEST SPERM COUNTS IN THE WORLD ON AVERAGE, THAT THEY HAVE PLATEAUED OVER THE LAST 15 YEARS. THEY'RE NOT GOING ANY LOWER. SO IF DENMARK IS LEADING THE WAY, IF YOU LIKE, THEN WE CAN EXPECT THAT THINGS ARE NOT GOING TO GET ANY WORSE. BUT I DISAGREE WITH THOSE STATEMENTS, THAT THINGS ARE NOT BAD. I'M IN COMPLETE AGREEMENT WITH SHANNA HERE. BECAUSE WE KNOW THAT THERE'S, THROUGHOUT NORTHERN EUROPE, THAT ONE IN FIVE, ONE IN SIX YOUNG MEN OF REPRODUCTIVE AGE HAS A SPERM COUNT NOT 40 MILLION PER MIL BUT LESS THAN 20 MILLION PER MIL. AND WE KNOW AT THAT LEVEL, THAT IS GOING TO HAVE A VERY SERIOUS IMPACT ON HOW LONG IT TAKES TO GET THEIR PARTNER PREGNANT, IF THEY CAN DO THAT AT ALL. AND AS I SAY, IF THE FEMALE PARTNER IS IN HER 30s, THEN TIME IS NOT ON THEIR SIDE. SO YOU'RE PLAYING A VERY BAD GAME THERE. AND THAT'S WHY YOU GAIN INCREASING REFERRAL TO ASSISTED REPRODUCTION, WHICH IS VERY TRAUMATIC.

Steve says LINDA, YOUR VIEW ON THAT?

Linda says I WOULD TOTALLY AGREE WITH RICHARD AND WITH SHANNA. I THINK THAT... FIRST OF ALL, I SHOULD SAY, I'M A BELIEVER IN PREVENTION. IT'S ALWAYS BETTER THAN TREATMENT IN [indiscernible], IF YOU CAN DO IT. AND I THINK THE RAPID DECLINE OVER 50 YEARS AND EVEN IF IT HAS NOW PLATEAUED AND DOWN IN DENMARK APPROACHING 20 MILLION SPERM, I MEAN, I THINK WE'RE AT THE POINT THAT WE NEED TO THINK ABOUT WHAT CAN WE DO TO PREVENT NOT ONLY FURTHER DECLINE BUT POTENTIALLY REVERSE IT. AND I THINK IT'S IMPORTANT TO REALIZE THAT OUR GENES JUST DON'T CHANGE THAT QUICKLY. EVOLUTION WORKS OVER EONS, NOT NECESSARILY OVER A GENERATION. I DO AGREE WITH RICHARD'S COMMENT, WHICH I THINK IS REALLY IMPORTANT, THAT THE SOCIETAL CHANGES ARE MAJOR AND HAVE HAD A VERY, VERY SIGNIFICANT IMPACT, BUT, YOU KNOW, USING DENMARK AS THE EXAMPLE, I BELIEVE WELL OVER 20 percent OF PREGNANCIES IN DENMARK INVOLVE USE OF ASSISTED REPRODUCTIVE TECHNOLOGY. AND THAT USE HAS INCREASED DRAMATICALLY, NOT ONLY IN DENMARK, NOT ONLY IN NORTHERN EUROPE, BUT CERTAINLY IN THE UNITED STATES AND CANADA AS WELL. SO I THINK WE NEED TO BEGIN TO LOOK AT WHAT ARE SOME OF THE DRIVERS OF THIS... OF THIS PRECIPITOUS DROP IN SPERM COUNT AND AN INCREASE IN SOME OTHER MALE REPRODUCTIVE ABNORMALITIES AS WELL.

Steve says LET'S DO THAT RIGHT NOW. SHANNA, IN YOUR BOOK, AS WE LOOK AT WHY THIS IS HAPPENING, YOU POINT TO A CULPRIT KNOWN AS THE ENDOCRINE DISRUPTING CHEMICALS. WHAT ARE THEY?

Shanna says I WILL ANSWER THAT QUESTION AND THEN I WANT TO INTERJECT SOMETHING. SO THOSE CHEMICALS ARE A BROAD CLASS OF CHEMICALS THAT HAVE AN ABILITY TO INTERFERE WITH OUR ENDOGENOUS HORMONES. IN MY BOOK I SAY AND RIGHT NOW I WILL SAY I CERTAINLY RECOGNIZE THAT THERE ARE MANY CAUSES FOR THIS DECLINE AND CERTAINLY THERE ARE IMPORTANT LIFESTYLE CAUSES WHICH WE CAN GO INTO, AND THESE HAVE ALSO SHIFTED OVER TIME: INCREASING OBESITY, STRESS, ALCOHOL CONSUMPTION, AND SO ON AND SO FORTH. AND THERE IS ALSO THE QUESTION OF DESIRE FOR A CHILD THAT WE WANT TO CONSIDER. BUT LET'S TURN TO ENDOCRINE DISRUPTING CHEMICALS. SO THE CLASSES THAT WE'RE THINKING ABOUT, I THINK WE COULD BROADLY CHARACTERIZE THEM AS NON-PERSISTENT AND PERSISTENT. I HAVE DONE MOST OF MY WORK WITH THE NON-PERSISTENT CHEMICALS, AND PARTICULARLY THE CHEMICALS KNOWN AS PHTHALATES, WHICH ARE CHEMICALS IN PLASTIC THAT MAKE PLASTIC SOFT AND FLEXIBLE. THEY'RE ALSO IN PERSONAL CARE PRODUCTS, AND THEY'RE ACTUALLY UBIQUITOUS IN OUR DAILY LIVES. THEN THERE'S THE PHENOLS, PARTICULARLY THE BIS PHENOLS, WHICH MAKE PLASTICS HARD, THE TRADE-OFF BETWEEN HARD AND SOFT PLASTIC. THEN WE HAVE THE BARRIERS, IF YOU WILL, THE LININGS, THE LININGS OF TIN CANS, THE WATER REPELLENTS, THE LININGS ON PAPER, THE COATINGS IN CANS. SO LININGS ALSO CONTAIN MANY OF THESE CHEMICALS. AND THEN WE HAVE THE FLAME RETARDANTS AND THE PESTICIDES. BUT, AS I SAY, MY WORK HAS BEEN PRIMARILY ON THE PHTHALATES TO SOME EXTENT ON THE PHENOLS.

Steve says LINDA, DO YOU THINK THESE ENDOCRINE DISRUPTING CHEMICALS ARE THE CAUSE FOR FAILING MALE FERTILITY?

Linda says THEY ARE A CASE. THEY ARE ONE OF MULTIPLE CAUSES. OUR HORMONE SYSTEM IS EXTREMELY IMPORTANT TO WHO WE ARE IN OUR NORMAL PHYSIOLOGY AS ADULTS FOR SURE. BUT DURING DEVELOPMENT, OUR ENDOCRINE SYSTEM IS ESSENTIAL FOR NORMAL DEVELOPMENT. AND WHEN YOU HAVE EXPOSURE THAT OCCURS IN UTERO IN EARLY LIFE STAGE, CHANGES CAN OCCUR WHICH ARE NOT REVERSIBLE. AND I THINK THAT SOME OF THE EFFECTS THAT WE ARE SEEING, ESPECIALLY FROM THESE ENDOCRINE DISRUPTORS, WHICH ACT AT EXTREMELY LOW CONCENTRATION, MANY OF THEM ARE OCCURRING BEFORE WE'RE EVEN BORN AND IN FACT THERE IS NOW EVIDENCE FOR SOME OF IT BEING IMPACTS FROM YOUR GRANDPARENTS' EXPOSURE THAT WE ARE JUST SEEING THE EFFECTS OF NOW.

Steve says RICHARD, YOUR VIEW ON THAT?

Richard says WELL, THE ONE THING THAT I FEEL STRONGLY ON IS THAT ENDOCRINE DISRUPTION IS LIKELY TO BE VERY IMPORTANT IN THE ONTOLOGY OF MALE REPRODUCTIVE DISORDERS. IN OTHER WORDS, THAT IT'S DISRUPTION OF NORMAL ANDROGEN EXPOSURE DURING FETAL DEVELOPMENT OF THE MALE, AND THAT'S LIKELY DURING THE FIRST TRIMESTER OF PREGNANCY, EARLY ON, SOMEWHERE BETWEEN 11 TO 14 WEEKS. SO IT'S FACTORS THAT AFFECT THAT PROCESS. SO WHERE I WOULD DISAGREE WITH SHANNA IS THAT I DON'T THINK THE EVIDENCE THAT PHTHALATES MAY BE HAVING AN EFFECT IN HUMANS, THEY CAN DO IT CERTAINLY IN LABORATORY ANIMALS, BUT THERE MAY BE FACTORS IN THAT PROCESS. IT MAY BE ENVIRONMENTAL CHEMICALS. IT MAY BE LIFESTYLE, DIETARY EFFECTS. IT'S EXTREMELY DIFFICULT TO STUDY BECAUSE IT'S OCCURRING WHEN THE FETUS IS LITERALLY THAT BIG AND YOU'VE GOT TO THINK THAT THAT'S THE WHOLE FETUS. SO THE TESTES ARE PRODUCING ENOUGH TESTOSTERONE TO SET UP NORMAL DEVELOPMENT. IF YOU DON'T GET ENOUGH TESTOSTERONE AT THAT STAGE, IT'S CURTAINS. YOU CAN'T REVISIT AT A LATER STAGE AND RECOVER.

Steve says JUST BEFORE I GET SHANNA TO COMMENT ON THAT, YOU USED THE WORD PHTHALATES. DO YOU WANT TO EXPLAIN WHAT THEY ARE?

Richard says THEY'RE ONE OF THE COMPOUNDS THAT SHANNA REFERRED TO THAT SHE HAS STUDIED. THEY ARE A PLASTICIZER. THEY ARE IN OUR ENVIRONMENT. WE ARE EXPOSED WHETHER WE WANT TO BE OR NOT. AND OUR DIET. OUR DIET IS ANOTHER IMPORTANT EXPOSURE OR MEANS OF EXPOSURE TO PHTHALATES.

Steve says SHANNA, DO YOU WANT TO COME BACK ON THAT?

Shanna says I AGREE WITH WHAT RICHARD JUST SAID. I THINK WHERE WE DISAGREE IS ON THE ABILITY OF THEM TO ALTER MALE REPRODUCTION IN UTERO. I HAVE SHOWN IN REPEATED STUDIES, AS HAVE OTHER PEOPLE, THAT MEASURED LEVELS IN THE WOMAN'S URINE, THAT IS URINE METABOLITE LEVELS THAT ARE KNOWN TO BE ANTI-ANDROGENS, ARE SIGNIFICANTLY ASSOCIATED WITH END POINTS WHICH RICHARD AND OTHERS IN HIS FIELD HAVE CALLED THE PHTHALATES SYNDROME. SO IN OUR STUDIES FIRST IN 2005, 2008, 2015, AND OTHER STUDIES FOR OTHER PHTHALATES, PARTICULARLY IN SWEDEN, THERE IS A RELATIONSHIP BETWEEN THE MOTHER'S EXPOSURE TO THESE CHEMICALS AND CHANGES IN THE MALE GENITALS, INCLUDED SHORTENED DISTANCE, WHICH IS A MARKER OF THE SYNDROME, THE PERINEUM LENGTH, THE SIZE OF THE TESTES, SO THESE STUDIES ESTABLISH THE EXISTENCE OF THE PHTHALATES SYNDROME IN HUMANS.

Steve says RICHARD, DO YOU SEE A LINK BETWEEN THE PLASTICS AND THE PROBLEM WE'RE TALKING ABOUT HERE?

Richard says BASED ON ANIMAL STUDIES WHICH WE'VE BEEN PROBABLY THE LEADING LAB IN THE WORLD ON, THEN YOU WOULD SAY THAT SHANNA IS COMPLETELY CORRECT TO BE CONCERNED. BUT TO INDUCE PHTHALATES SYNDROME IN RATS, YOU NEED TO EXPOSE THEM BY 10 TO 100,000 TIMES THE LEVEL TO WHICH YOU AND I ARE EXPOSED. IF YOU EXPOSE AT HUMAN EXPOSURE LEVELS, YOU GET NO EFFECTS. YOU CAN ONLY INTERFERE WITH TESTOSTERONE AT VERY HIGH LEVELS. IF YOU LOOK AT HUMAN FETAL TESTES AND ASK THE QUESTION DO THE PHTHALATES INTERFERE WITH THE DEVELOPMENT OF THOSE TESTES, THEY DO NOT. WE COME BACK TO SHANNA'S EPIDEMIOLOGICAL STUDIES, OF COURSE IT CAN NEVER PROVE CAUSE AND EFFECT. SO MY WAY OF LOOKING AT IT IS THAT THERE IS SOMETHING ELSE THERE WHICH IS HAVING THE EFFECTS THAT SHANNA IS INTERESTED IN, THE REPRODUCTIVE EFFECTS AND REDUCTION IN DISTANCE AND ALSO INCREASING EXPOSURE TO PHTHALATES. BUT I DON'T THINK THEY ARE CAUSING THE EFFECTS.

Steve says I THINK, LINDA, I'VE HEARD YOU SAY IN THE PAST THAT YOU CAN'T SAY THIS CAUSES THIS. YOU CAN SAY THIS IS ASSOCIATED WITH THIS. HAVE I GOT THAT RIGHT? THAT YOU'RE NOT SEEING A DEFINITIVE CRYSTAL-CLEAR LINK AS WELL?

Linda says I WOULD SAY THAT I DISAGREE WITH RICHARD AND AM MORE SUPPORTIVE OF SHANNA'S STUDIES. I THINK... FIRST OF ALL, NATURE IS INHERENTLY CONSERVATIVE. WHEN IT WORKS SOMETHING OUT IN OTHER SPECIES, WE TEND TO SEE THE SAME THING IN PEOPLE. I WOULD SAY THAT THE PHTHALATES EFFECT IS NOT ONLY SEEN IN RATS AND MICE, IT HAS BEEN OBSERVED IN OTHER ANIMAL SPECIES AS WELL. I THINK THE EXPOSURE ISSUE IS ONE THAT IS OFTEN NOT FULLY UNDERSTOOD. YOU ALWAYS HAVE TO EXPOSE SMALL LITTLE ANIMALS, LIKE A RAT OR A MOUSE, TO A MUCH HIGHER DELIVERED DOSE THAN YOU WOULD IN PEOPLE IN ORDER TO GET THE SAME INTERNAL, WHAT WE CALL BODY BURDEN, OR IN THIS CASE, WE MIGHT SAY CONCENTRATION IN THE FETAL TESTES, FOR EXAMPLE. I THINK THERE ARE SOME... THERE ARE... NOT CRITERIA BUT CONSIDERATIONS THAT ARE OFTEN USED TO DECIDE WHETHER THERE IS ACTUALLY A CAUSE-EFFECT RELATIONSHIP IN EPIDEMIOLOGICAL STUDIES, THEY ARE KNOWN AS THE BRADFORD-HILL CONSIDERATIONS. WHEN MANY OF THEM ARE SATISFIED, SUCH AS BIOLOGICAL PLAUSIBILITY, WHICH CAN BE PROVIDED BY BOTH HECK NICE PARTICULAR ANIMAL STUDIES OR HUMAN STUDIES, LIKE RICHARD MENTIONED, THAT CAN OCCUR USING HUMAN FETAL TESTES, FOR EXAMPLE. AND YOU SEE... FOR EXAMPLE, SHANNA'S EPIDEMIOLOGY HAS LOOKED AT SOME PROSPECTIVE LONGITUDINAL KIND OF STUDIES. YOU'RE NOT LOOKING AT THE LEVELS FOR EXAMPLE OF PHTHALATES IN THE MOTHER WHEN THE BABY IS BORN, YOU'RE LOOKING DURING KEY WINDOWS OF SUSCEPTIBILITY THAT OCCUR DURING GESTATION. I SHOULD SAY, DO I THINK PHTHALATES ARE THE ONLY SOURCE OF THE DECREASED SPERM COUNTS THAT WE'RE SEEING? AND THE ANSWER TO THAT WOULD BE: NO, I DON'T THINK SO. I THINK THERE ARE MULTIPLE KINDS OF COMPOUNDS THAT HAVE BEEN SHOWN TO IMPACT QUALITY AND QUANTITY OF SPERM. SOME OF THEM ARE THINGS THAT WE TRADITIONALLY THINK OF AS SOME OF THE ENDOCRINE DISRUPTORS OR THINGS LIKE SOME OF THE PCBs OR DIOXINS, BUT WE NEED TO UNDERSTAND THERE ARE MULTIPLE KINDS OF COMPOUNDS THAT MAY BE IMPACTING ON MALE FERTILITY AT THIS POINT IN TIME.

Steve says RICHARD, SINCE YOU'RE ON THE DOWNSIDE OF THIS 2-1 SCORE HERE, MAYBE I SHOULD GIVE YOU THE LAST WORD ON JUST THIS PART OF OUR SEGMENT. WHAT ARE YOU APPARENTLY NOT SEEING THAT THE OTHER TWO ARE SEEING?

Richard says WELL, ONE OF THE WAYS THAT I LOOK AT IT IS TO ASK AND SAY: WHEN WE LOOK AT THE WORLD AROUND US AND THE HEALTH CHANGES THAT OCCURRED OVER THE TIME SPAN THAT WE'RE INTERESTED, SO SAY THE LAST 50 TO 70 YEARS, WHAT HAS BEEN THE DRIVER FOR THE MAJOR HEALTH CHANGES? AND THE ANSWER IS UNEQUIVOCALLY CHANGES IN OUR DIET, PARTICULARLY EATING TOO MUCH, EATING TOO MUCH OF THE WRONG THINGS, AND NOT EATING ENOUGH OF THE GOOD THINGS. SO IF YOU WERE GOING TO ASK, AS SPERM COUNTS HAVE GONE DOWN, WHAT IS THE MOST LIKELY FACTOR TO HAVE IMPACTED THAT? I WOULD START WITH DIET. I WOULDN'T START WITH CHEMICALS WHICH WE ARE EXPOSED TO AT VERY, VERY LOW LEVELS. I'M NOT SAYING THAT THEY'RE NOT PLAYING A ROLE. BUT WHAT WE'VE DONE IS TO DO IT THE OTHER WAY AROUND. SO I DON'T THINK WE'VE BEEN LOOKING ENOUGH AT DIET. AND WE KNOW THAT IN HUMANS, THE WAY THAT REPRODUCTIVE DEVELOPMENT IS SET UP AND DRIVEN IN HUMANS IS FUNDAMENTALLY COMPLETELY DIFFERENT TO WHAT IT IS IN RODENTS. WE'RE ALL USING ANDROGENS, TESTOSTERONE TO DO IT, BUT WHAT DRIVES THE TESTOSTERONE IN A LABORATORY ANIMAL IS COMPLETELY DIFFERENT FOR WHAT DRIVES IT IN A HUMAN. AND WHAT DRIVES IT IN A HUMAN COMES FROM THE PLACENTA AND WE KNOW THAT CAN BE IMPACTED BY LIFESTYLE, DIET, AND OTHER FACTORS. SO I WOULD SIMPLY MAKE A PLEA: LET'S LOOK MORE AT THAT, PLEASE. BECAUSE WHAT WE DON'T WANT TO DO IS SPEND A HUGE AMOUNT OF MONEY IN RESEARCH BANNING CHEMICALS, FOR EXAMPLE, AND TO FIND THAT THERE'S NO BENEFIT. SO WE NEED TO ACTUALLY GET THE RIGHT GUY IN JAIL, NOT THE WRONG GUY. SO THAT'S MY VIEW.

Steve says OKAY. LET'S MOVE ON TO ANOTHER ANGLE HERE, AND I WANT TO MOVE... I GUESS SORT OF FROM EPIDEMIOLOGY TO PSYCHOLOGY, BECAUSE MANY PEOPLE CONNECT LOW TESTOSTERONE COUNT WITH BEING LESS MASCULINE. IT MIGHT NOT BE FAIR, BUT PEOPLE DO THAT. SHANNA, TO YOU FIRST. WHAT PSYCHOLOGICAL EFFECT DO YOU THINK ALL OF THIS IS HAVING ON MEN TODAY?

Shanna says WELL, SO YOU'RE SAYING LOW TESTOSTERONE COUNT IS ASSOCIATED WITH FEELINGS OF LESS... YOU KNOW, BEING LESS MASCULINE, CERTAINLY. MOST MEN DO NOT KNOW THEIR TESTOSTERONE COUNT. THEY CAN KNOW THEIR SPERM COUNT. UNFORTUNATELY, MOST MEN DON'T KNOW THAT, WHICH, BY THE WAY, I THINK THEY SHOULD. BUT ANY EVIDENCE THAT THEY NEED A TESTOSTERONE REPLACEMENT, THEY NEED TO GO TO A.R.T. AND SO ON, IS DEFINITELY... ASSISTED REPRODUCTION... THAT THEY FEEL LESS A MAN. AND FOR THIS REASON, BY THE WAY, I THINK MEN HAVE NOT OWNED UP TO THEIR ROLE IN THE DIFFICULTIES THAT A COUPLE MAY BE HAVING CONCEIVING. THEY HAVEN'T OWNED UP TO THEIR ROLE IN MULTIPLE MISCARRIAGES WHEN THEY DO PLAY A ROLE. AND I THINK, EVEN THOUGH IT'S DIFFICULT, MEN HAVE TO STEP UP AND SAY, "WE ARE EQUAL PARTNERS IN THIS PROBLEM." MEN AND WOMEN BEAR RESPONSIBILITY EQUALLY, IF YOU WILL, AND THE WOMAN SHOULD NOT BE BLAMED, AS SHE HAS BEEN, BY THE WAY, FOR CENTURIES, BEEN BLAMED FOR THE INABILITY TO CONCEIVE.

Steve says GOES BACK TO HENRY VIII, IF NOT BEFORE.

Shanna says EXACTLY.

They laugh.

Steve says LINDA, LET ME GET YOU ON THAT, THE PSYCHOLOGICAL EFFECT ON MEN, DO YOU THINK, BY ALL OF WHAT WE HAVE BEEN TALKING ABOUT HERE?

Linda says I THINK MOST MEN ARE UNAWARE OF IT. AS SHANNA SAID, YOU GO TO YOUR DOCTOR AND YOU GET YOUR CLINICAL CHEMISTRY DONE. TESTOSTERONE IS NOT SOMETHING THAT'S OFTEN DONE. I THINK IF MEN FIND OUT AND WHEN THEY DO FIND OUT THAT THEIR TESTOSTERONE MAY BE, SAY, AT THE LOW END OF NORMAL OR BELOW THE NORMAL RANGE, I THINK THAT CONCERNS MANY MEN, AND I THINK THAT THERE HAS BEEN AN INCREASE OVERALL IN MALE REPRODUCTIVE ISSUES, AND I THINK THAT CLEARLY HAS A PSYCHOLOGICAL EFFECT ON MEN.

Steve says RICHARD, YOUR VIEW?

Richard says WELL, I THINK MEN ARE INHERENTLY VERY INSECURE. YOU KNOW, WE'RE DESIGNED TO BE COMPETITIVE AND SUCCESSFUL, AND I THINK THAT ANYTHING THAT APPEARS TO INTERFERE WITH THAT IS BAD NEWS AS FAR AS MEN'S SECURITY AND THEIR OWN FEELINGS OF SELF-WORTH COME ALONG. SO THE IDEA OF HAVING A LOWER SPERM COUNT, THAT YOU'RE INFERTILE, GOD FORBID HAVE LOWER TESTOSTERONE, THEN I THINK WE JUST DO NOT HANDLE THAT WELL. WE WILL NOT COME OUT AND TALK ABOUT IT. YOU DON'T SEE MANY MEN PUTTING UP THEIR HANDS AND SAYING, "I'VE GOT A FERTILITY PROBLEM." WHEN WOMEN HAVE A FERTILITY PROBLEM, THEY SEEK HELP ABOUT IT. MEN WON'T EVEN ADMIT IT. SO I THINK IT'S A CRISIS FROM THAT POINT OF VIEW. WE NEED A FUNDAMENTAL CHANGE IN THE WAY THAT MEN CONFRONT THIS ISSUE AND ALL ASPECTS TO DO WITH MASCULINITY, ET CETERA. AND WE ARE BEGINNING TO DEAL WITH THAT FOR OTHER REASONS, METOO AND THINGS LIKE THAT, BUT THIS IS PART OF THE SAME STORY TO MANY EXTENT.

Steve says SHANNA, LET ME FOLLOW UP WITH YOU. DO YOU SEE A CONNECTION BETWEEN LOWER TESTOSTERONE LEVELS AND PEOPLE IDENTIFYING AS GENDER FLUID OR NON-BINARY?

Shanna says WELL, THAT'S A REALLY DIFFICULT QUESTION, STEVE, ISN'T IT? IT'S SOMETHING THAT I DON'T THINK WE CAN REALLY... THE PREMISE IS DIFFICULT. THE PREMISE THAT MORE PEOPLE ARE IDENTIFYING AS GENDER FLUID... I'M NOT SURE THAT'S TRUE BECAUSE WE DON'T HAVE HISTORICAL RECORDS. PEOPLE DID NOT COME UP AND RAISE THEIR HAND TO BE COUNTED IN THE PAST AND THEY DON'T TODAY. SO WE REALLY DON'T KNOW THE PREVALENCE, WE DON'T KNOW THE HISTORICAL PREVALENCE. THERE APPEARS TO BE MORE. LET ME JUST BACK UP AND SAY THAT ENVIRONMENTAL CHEMICALS CAUSE PROBLEMS OF SEXUAL DEVELOPMENT IN ANIMALS. THAT CAN BE SHOWN IN THE LABORATORY. THAT CAN BE SHOWN IN THE WILD. FROGS WITH OVARIES AND TESTES IN THE SAME ANIMAL CAN BE PRODUCED BY EXPOSURE AND SO ON. SO THERE'S NO QUESTION THAT CHEMICALS IN THE ENVIRONMENT CAN CAUSE THESE PROBLEMS... IN THESE PROBLEMS IN HUMANS. BUT WE'RE NOT REALLY TALKING ABOUT PROBLEMS OF SEXUAL DEVELOPMENT. WE'RE TALKING ABOUT SOMETHING IN YOUR MIND. DO I FEEL LIKE I'VE BEEN BORN IN THE WRONG BODY? DO I FEEL LIKE, THOUGH I HAVE A BIOLOGICAL SEX, A GENETIC SEX OF XY, I REALLY SHOULD HAVE BEEN ASSIGNED XX. THIS IS A DIFFERENT PROBLEM. AND I DON'T THINK THIS IS A PROBLEM THAT ANIMALS CAN HELP US WITH BECAUSE WE CAN'T ASK THEM WHAT'S IN THEIR MIND. WE CAN'T ASK THEM WHAT GENDER WOULD THEY PREFER TO BE. SO I'M NOT SURE WE'RE GOING TO GET HELP FROM RICHARD'S EXPERIMENTS OR FROM ANY EXPERIMENTS ON THIS. SO I THINK WE NEED A NEW SET OF KIND OF SCIENCE TO ADDRESS THIS, AND I DON'T THINK WE'RE THERE YET.

Steve says OKAY. IN OUR REMAINING MOMENTS HERE, LINDA, START US OFF ON THIS. DO YOU THINK ANYTHING CAN BE DONE ABOUT THIS?

Linda says IF BY "THIS," YOU MEAN PROBLEMS IN MALE FERTILITY.

Steve says YES.

Linda says I WOULD HOPE SO. BECAUSE I THINK IF YOU ARE AGREEING WITH THE LINEAR TREND WHICH IS SHOWING CONTINUED DECREASES, WE ARE GETTING MEN INTO A HUGE AREA WITH FERTILITY. WE DON'T HAVE ALL THE DATA FROM THE DEVELOPING WORLD, BUT THE LIMITED DATA THAT WE HAVE SUGGESTS THAT THAT DATA IS SUPPORTIVE OF WHAT WE'RE SEEING IN THE DEVELOPED WORLD. I THINK THAT ENVIRONMENTAL CHEMICALS HAVE... AND ENDOCRINE DISRUPTORS ARE UBIQUITOUS. WE ARE ALL EXPOSED ALL THE TIME TO A SOUP OF THESE. IT IS NOT ONE CHEMICAL AT A TIME. AND I DO BELIEVE THAT THEY ARE HAVING AN IMPACT ON OUR HEALTH. I TOTALLY AGREE WITH RICHARD THAT OUR DIET IS A MAJOR COME POUNDER OF WHAT... CONFOUNDER OF WHAT WE'RE TRYING TO SAY. FIRST OF ALL, THESE CHEMICALS AND ADDED EXPOSURE IS OFTEN THROUGH THE DIET. AND, AGAIN, IT'S NOT ONE; IT'S A PLETHORA OF COMPOUNDS TO WHICH WE'RE EXPOSED. ONE POINT I WOULD LIKE TO MAKE, JUST AS SOMETHING TO THINK ABOUT, IS WHEN WE TALK ABOUT PHTHALATES, THEY ARE NOT ONLY MALE REPRODUCTIVE INTOXICANTS. THEY CAN AFFECT FEMALES. SOMETHING WE HAVEN'T TALKED ABOUT AT ALL HERE IS THEY ARE IMPACTING THE BRAINS OF OUR CHILDREN. AND I THINK THAT IS ANOTHER PROBLEM THAT WE NEED TO BE ADDRESSING.

Steve says RICHARD, DO YOU THINK GOVERNMENTS ARE SEIZED ENOUGH OF THIS ISSUE TO BE PREPARED TO DO ANYTHING ABOUT IT?

Richard says I DON'T THINK SO, NO. I THINK THAT LARGELY MALE OR COUPLE INFERTILITY IS VIEWED AS A PROBLEM SOLVED, AND IT'S BEEN VIEWED THAT WAY EVER SINCE WE DEVELOPED EFFECTIVE MEANS OF ASSISTED REPRODUCTION. AND I SHOULD SAY THAT THOSE EFFECTIVE MEANS, THEY'RE ONLY EFFECTIVE FOR THE MINORITY OF PEOPLE WHO SEEK HELP. SO THEY'RE NOT THAT SUCCESSFUL. BUT I THINK THAT THAT'S WHAT THEY'VE DONE IS ENGENDERED THE VIEW THAT WE'VE GOT IT ALL SOLVED. IF YOU'VE GOT A FERTILITY PROBLEM, IF HE'S GOT A LOW SPERM COUNT, WE JUST GET THEM TOGETHER, WE GET THE SPERM, WE INJECT IT INTO THE EGG, AND THERE'S YOUR PROBLEM SOLVED. THAT IS NOT THE REALITY. ASSISTED REPRODUCTION IS TRAUMATIC AND EXPENSIVE AND IT'S NOT HUGELY SUCCESSFUL FOR THE MAJORITY. SO I THINK THAT YOU GET WHAT YOU PAY FOR. WE HAVEN'T PUT ENOUGH MONEY INTO MALE REPRODUCTIVE RESEARCH FOR SURE. LOTS OF REASONS FOR THAT, INCLUDING MALE RELUCTANCE TO PUT THEIR HANDS UP BUT YOU GET WHAT YOU PAY FOR AND THAT'S WHAT WE'RE SEEING AT THE MOMENT.

Steve says YOU GET WHAT YOU PAY FOR. YOU COULD SAY THAT FOR SO MANY THINGS. SHANNA, I'M GOING TO GIVE YOU THE LAST WORD ON THIS. WHAT CAN BE DONE?

Shanna says OKAY. I THINK THE FIRST THING THAT HAS TO BE DONE IS THAT PEOPLE HAVE TO REALLY FACE THIS PROBLEM, AND PARTICULARLY MEN HAVE TO RECOGNIZE THAT THEY ARE PLAYING A ROLE AND THAT THEY SHOULD CONSIDER THE POSSIBILITY OF THEIR LOW SPERM COUNTS, GET TESTED. IF NECESSARY, BANK SPERM, FREEZE EGGS. BECAUSE I THINK THIS IS REALLY A SERIOUS PROBLEM THAT PEOPLE HAVE TO ACT ON PERSONALLY. THEN GOVERNMENTS HAVE TO TEST THESE CHEMICALS. THEY ARE CURRENTLY, IN THE UNITED STATES, NOT TESTED BEFORE THEY GO INTO MARKET, LARGELY. AND WE HAVE TO TEST ALL THOSE LEGACY CHEMICALS THAT WE LET IN BECAUSE THEY HAVE BEEN USED FOREVER. THEY'RE NOT TESTED. AND WE HAVE TO TEST IN THE WAYS THAT PEOPLE ARE EXPOSED. AS RICHARD POINTED OUT, ANIMALS ARE EXPOSED TO VERY HIGH DOSES IN TESTS. WE ARE EXPOSED TO LOW DOSES. SO THAT'S WHAT WE SHOULD BE TESTING. SO ADEQUATE TESTING. ADEQUATE MONITORING. AND AWARENESS OF PEOPLE, THAT THIS IS A PROBLEM, SO THAT THEY CAN DEMAND... AS RICHARD SAID, THEY HAVE TO DEMAND THE GOVERNMENT TO PUT UP THE DOLLARS TO ADDRESS THIS PROBLEM BEFORE IT'S TOO LATE.

The caption changes to "Producer: Eric Bombicino, @ebombicino."

Steve says WELL, LINDA, APROPOS OF THE NAME OF THE MOVIE THAT YOU STARTED OFF OUR CONVERSATION WITH ABOUT HALF AN HOUR AGO, I'VE SEEN THAT MOVIE AND IT'S HORRIFYING. LET'S HOPE WE GET A HANDLE ON THIS BEFORE THAT BECOMES REALITY. WHAT'S THE NAME AGAIN IN CASE ANYBODY WANTS TO WATCH IT?

Linda says "CHILDREN OF MEN."

Steve says RICHARD SHARPE, LINDA BIRNBAUM, SHANNA SWAN, GREAT OF ALL OF YOU TO JOIN US ON TVO TONIGHT FOR THIS MOST INTERESTING CONVERSATION. APPRECIATE IT VERY MUCH.

Watch: The Male Fertility Crisis