Skip to main content Accessibility help
Hostname: page-component-7d684dbfc8-rcw2t Total loading time: 0 Render date: 2023-10-01T20:25:17.751Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "coreDisableSocialShare": false, "coreDisableEcommerceForArticlePurchase": false, "coreDisableEcommerceForBookPurchase": false, "coreDisableEcommerceForElementPurchase": false, "coreUseNewShare": true, "useRatesEcommerce": true } hasContentIssue false

Chapter 4

Published online by Cambridge University Press:  05 May 2022

R. John Aitken
University of Newcastle, New South Wales
Get access


What is happening to the human male?Something strange is happening to the human male. The incidence of testicular cancer is increasing dramatically in all the advanced economies on Earth, male infertility has reached epidemic proportions, sperm counts are declining at an alarming rate and paternal impacts on offspring health are becoming increasingly apparent. Notably, the incidence of testicular cancer shows a strong correlation with socio-economic development such that, globally, it has become the major cancer afflicting young males. In parallel with the increased incidence of testicular cancer, sperm counts have been falling across the globe. The reason for this decline in semen quality is uncertain at the present time but it may be an indirect reflection of falling testosterone levels, possibly fuelled by oestogenic factors in the environments we inhabit, the food we eat, the water we drink, the drugs we take, the lifestyles we adopt and the metabolic patterns we experience in affluent society. The resultant oestrogenic load may impact male reproductive health at any point in sexual development from fetal life to adulthood. Controlling the exposures responsible for these impacts on male reproduction is essential because, if current trends continue unabated, it will have as major impact on the future of our species.

The Infertility Trap
Why life choices impact your fertility and why we must act now
, pp. 132 - 179
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


4.10 References

Aggerholm, AS, Thulstrup, AM, Toft, G, Ramlau-Hansen, CH, Bonde, JP. Is overweight a risk factor for reduced semen quality and altered serum sex hormone profile? Fertil Steril 2008;90(3):619626.CrossRefGoogle ScholarPubMed
Aitken, RJ. The male is significantly implicated as the cause of unexplained infertility. Semin Reprod Med 2020;38(1):320.Google ScholarPubMed
Aitken, RJ. Antioxidant trials-the need to test for stress. Hum Reprod Open 2021;2021(1):hoab007.CrossRefGoogle ScholarPubMed
Allen, Y, Matthiessen, P, Scott, AP, et al. The extent of oestrogenic contamination in the UK estuarine and marine environments: further surveys of flounder. Sci Total Environ 1999;233(1–3):520.CrossRefGoogle ScholarPubMed
Andrew, MN, O’Connor, WA, Dunstan, RH, Macfarlane, GR. Exposure to 17α-ethynylestradiol causes dose and temporally dependent changes in intersex, females and vitellogenin production in the Sydney rock oyster. Ecotoxicology 2010;19(8):14401451.CrossRefGoogle ScholarPubMed
Auger, J, Kunstmann, JM, Czyglik, F, Jouannet, P. Decline in semen quality among fertile men in Paris during the past 20 years. N Engl J Med 1995;332(5):281285.CrossRefGoogle ScholarPubMed
Axelsson, J, Rylander, L, Rignell-Hydbom, A, Giwercman, A. No secular trend over the last decade in sperm counts among Swedish men from the general population. Hum Reprod 2011;26(5):10121016.CrossRefGoogle ScholarPubMed
Blazer, VS, Iwanowicz, LR, Henderson, H, et al. Reproductive endocrine disruption in smallmouth bass (Micropterus dolomieu) in the Potomac River basin: spatial and temporal comparisons of biological effects. Environ Monit Assess 2012;184(7):43094334.CrossRefGoogle ScholarPubMed
Boeri, L, Capogrosso, P, Ventimiglia, E, et al. Heavy cigarette smoking and alcohol consumption are associated with impaired sperm parameters in primary infertile men. Asian J Androl 2019;21(5):478485.Google ScholarPubMed
Bonhommeau, S, Dubroca, L, Le Pape, O, et al. Eating up the world’s food web and the human trophic level. Proc Natl Acad Sci USA 2013;110(51):2061720620.CrossRefGoogle ScholarPubMed
Botelho, MT, Fuller, N, Vannuci-Silva, M, et al. Unusual male size vs sperm count relationships in a coastal marine amphipod indicate reproductive impairment by unknown toxicants. Aquat Toxicol 2021;233:105793.CrossRefGoogle Scholar
Bray, F, Ferlay, J, Soerjomataram, I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68(6):394424.CrossRefGoogle ScholarPubMed
Brotons, JA, Olea-Serrano, MF, Villalobos, M, Olea, N. Xenoestrogens released from lacquer coating in food cans. Environ Health Perspect 1994;103:608612.CrossRefGoogle Scholar
Brydøy, M, Fosså, SD, Klepp, O, et al. Paternity following treatment for testicular cancer. J Natl Cancer Inst 2005;97(21):15801588.CrossRefGoogle ScholarPubMed
Buvat, J, Ardaens, K, Lemaire, A, et al. Increased sperm count in 25 cases of idiopathic normogonadotropic oligospermia following treatment with tamoxifen. Fertil Steril 1983;39(5):700703.CrossRefGoogle ScholarPubMed
Cariati, F, D’Uonno, N, Borrillo, F, et al. Bisphenol A: an emerging threat to male fertility. Reprod Biol Endocrinol 2019;17(1):6.CrossRefGoogle ScholarPubMed
Carlsen, E, Giwercman, A, Keiding, N, Skakkebaek, NE. Evidence for decreasing quality of semen during past 50 years. BMJ. 1992;305(6854):609613.CrossRefGoogle ScholarPubMed
Carroll, K, Pottinger, AM, Wynter, S, DaCosta, V. Marijuana use and its influence on sperm morphology and motility: identified risk for fertility among Jamaican men. Andrology 2020;8(1):136142.CrossRefGoogle ScholarPubMed
Castellini, C, Totaro, M, Parisi, A, et al. Bisphenol A and male fertility: myths and realities. Front Endocrinol (Lausanne) 2020;11:353.CrossRefGoogle ScholarPubMed
Chang, WH, Li, SS, Wu, MH, Pan, HA, Lee, CC. Phthalates might interfere with testicular function by reducing testosterone and insulin-like factor 3 levels. Hum Reprod 2015;30(11):26582670.CrossRefGoogle ScholarPubMed
Chodick, G, Epstein, S, Shalev, V. Secular trends in testosterone- findings from a large state-mandate care provider. Reprod Biol Endocrinol 2020;18(1):19.CrossRefGoogle ScholarPubMed
Chua, ME, Escusa, KG, Luna, S, et al. Revisiting oestrogen antagonists (clomiphene or tamoxifen) as medical empiric therapy for idiopathic male infertility: a meta-analysis. Andrology 2013;1(5):749757.CrossRefGoogle ScholarPubMed
Cocuzza, M, Esteves, SC. Shedding light on the controversy surrounding the temporal decline in human sperm counts: a systematic review. Sci World J 2014;2014:365691.CrossRefGoogle ScholarPubMed
Dobbs, RW, Malhotra, NR, Greenwald, DT, et al. Estrogens and prostate cancer. Prostate Cancer Prostatic Dis 2019;22:185194.CrossRefGoogle ScholarPubMed
Elenkov, A, Giwercman, A, Zhang, H, Nilsson, PM, Giwercman, YL. Increased risk for prostate cancer related mortality among childless men in a population-based cohort followed for up to 40 years. Scand J Urol 2021;55(2):125128.CrossRefGoogle Scholar
Evenson, DP, Djira, G, Kasperson, K, Christianson, J. Relationships between the age of 25,445 men attending infertility clinics and sperm chromatin structure assay (SCSA®) defined sperm DNA and chromatin integrity. Fertil Steril 2020;114(2):311320.CrossRefGoogle ScholarPubMed
Gao, Y, Niu, X, Qin, Y, et al. Unexpected culprit of increased estrogenic effects: oligomers in the photodegradation of preservative ethylparaben in water. Water Res 2020;176:115745.CrossRefGoogle ScholarPubMed
Gardner-Thorpe, D, O’Hagen, C, Young, I, Lewis, SJ. Dietary supplements of soya flour lower serum testosterone concentrations and improve markers of oxidative stress in men. Eur J Clin Nutr 2003;57(1):100106.CrossRefGoogle ScholarPubMed
Ginsburg, J, Okolo, S, Prelevic, G, Hardiman, P. Residence in the London area and sperm density. Lancet 1994;343(8891):230.CrossRefGoogle ScholarPubMed
Gomathi, C, Balasubramanian, K, Bhanu, NV, Srikanth, V, Govindarajulu, P. Effect of chronic alcoholism on semen–studies on lipid profiles. Int J Androl 1993;16(3):175181.CrossRefGoogle ScholarPubMed
Gross-Sorokin, MY, Roast, SD, Brighty, GC. Assessment of feminization of male fish in English rivers by the Environment Agency of England and Wales. Environ Health Perspect 2006;114(Suppl 1):147151.CrossRefGoogle ScholarPubMed
Guo, L, Jing, J, Feng, YM, Yao, B. Tamoxifen is a potent antioxidant modulator for sperm quality in patients with idiopathic oligoasthenospermia. Int Urol Nephrol 2015;47(9):14631469.CrossRefGoogle ScholarPubMed
Hart, RJ. The impact of prenatal exposure to Bisphenol A on male reproductive function. Front Endocrinol (Lausanne) 2020;11:320.CrossRefGoogle ScholarPubMed
Hart, RJ, Doherty, DA, McLachlan, RI, et al. Testicular function in a birth cohort of young men. Hum Reprod 2015;30(12):27132724.Google Scholar
Hashimoto, S, Bessho, H, Hara, A, et al. Elevated serum vitellogenin levels and gonadal abnormalities in wild male flounder (Pleuronectes yokohamae) from Tokyo Bay, Japan. Mar Environ Res 2000;49(1):3753.CrossRefGoogle ScholarPubMed
Hassan, MA, Killick, SR. Effect of male age on fertility: evidence for the decline in male fertility with increasing age. Fertil Steril 2003;79(Suppl 3):15201527.CrossRefGoogle ScholarPubMed
Heer, E, Harper, A, Escandor, N, et al. Global burden and trends in premenopausal and postmenopausal breast cancer: a population-based study. Lancet Glob Health 2020;8(8):e1027e1037.CrossRefGoogle ScholarPubMed
Høyer, S, Riis, AH, Toft, G, et al. Male alcohol consumption and fecundability. Hum Reprod 2020;35(4):816825.CrossRefGoogle ScholarPubMed
Hsing, AW, Tsao, L, Devesa, SS. International trends and patterns of prostate cancer incidence and mortality. Int J Cancer 2000;85(1):6067.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
Huang, B, Wang, B, Ren, D, et al. Occurrence, removal and bioaccumulation of steroid estrogens in Dianchi Lake catchment, China. Environ Int 2013;59:262273.CrossRefGoogle ScholarPubMed
Huang, C, Li, B, Xu, K, et al. Decline in semen quality among 30,636 young Chinese men from 2001 to 2015. Fertil Steril 2017;107(1):83–88.e2.CrossRefGoogle ScholarPubMed
Itoh, N, Kayama, F, Tatsuki, TJ, Tsukamoto, T. Have sperm counts deteriorated over the past 20 years in healthy, young Japanese men? Results from the Sapporo area. J Andro. 2001;22(1):4044.Google ScholarPubMed
James, WH. Secular trend in reported sperm counts. Andrologia 1980;12(4):381388.CrossRefGoogle ScholarPubMed
Jensen, TK, Andersson, AM, Jørgensen, N, et al. Body mass index in relation to semen quality and reproductive hormones among 1,558 Danish men. Fertil Steril 2004;82(4):863870.CrossRefGoogle ScholarPubMed
Jobling, S, Williams, R, Johnson, A, et al. Predicted exposures to steroid estrogens in UK rivers correlate with widespread sexual disruption in wild fish populations. Environ Health Perspect 2006;114 (Suppl 1):3239.CrossRefGoogle ScholarPubMed
Joffe, M. Decreased fertility in Britain compared with Finland. Lancet 1996;347(9014):15191522.CrossRefGoogle ScholarPubMed
Johnson, AC, Dumont, E, Williams, RJ, et al. Do concentrations of ethinylestradiol, estradiol, and diclofenac in European rivers exceed proposed EU environmental quality standards? Environ Sci Technol 2013;47(21):1229712304.CrossRefGoogle ScholarPubMed
Johnson, SL, Dunleavy, J, Gemmell, NJ, Nakagawa, S. Consistent age-dependent declines in human semen quality: a systematic review and meta-analysis. Ageing Res Rev 2015;19:2233.CrossRefGoogle ScholarPubMed
Jones, RC. To store or mature spermatozoa? The primary role of the epididymis. Int J Androl 1999;22(2):5767.CrossRefGoogle ScholarPubMed
Kasman, AM, Thoma, ME, McLain, AC, Eisenberg, ML. Association between use of marijuana and time to pregnancy in men and women: findings from the National Survey of Family Growth. Fertil Steril 2018;109(5):866871.CrossRefGoogle ScholarPubMed
Keihani, S, Craig, JR, Zhang, C, et al. Impacts of abstinence time on semen parameters in a large population-based cohort of subfertile men. Urology 2017;108:9095.CrossRefGoogle Scholar
Kidd, KA, Graves, SD, McKee, GI, Dyszy, K, Podemski, CL. Effects of whole-lake additions of ethynylestradiol on leech populations. Environ Toxicol Chem 2020;39(8):16081619.CrossRefGoogle ScholarPubMed
Kidd, SA, Eskenazi, B, Wyrobek, AJ. Effects of male age on semen quality and fertility: a review of the literature. Fertil Steril 2001;75(2):237248.CrossRefGoogle ScholarPubMed
Kirby, MF, Allen, YT, Dyer, RA, et al. Surveys of plasma vitellogenin and intersex in male flounder (Platichthys flesus) as measures of endocrine disruption by estrogenic contamination in United Kingdom estuaries: temporal trends, 1996 to 2001. Environ Toxicol Chem 2004;23(3):748758.CrossRefGoogle ScholarPubMed
Koh, SA, Sanders, K, Deakin, R, Burton, P. Male age negatively influences clinical pregnancy rate in women younger than 40 years undergoing donor insemination cycles. Reprod Biomed Online 2013;27(2):125130.CrossRefGoogle ScholarPubMed
Koji, T, Shibata, Y. Global changes in epigenomes during mouse spermatogenesis: possible relation to germ cell apoptosis. Histochem Cell Biol 2020;154(2):123134.CrossRefGoogle ScholarPubMed
Lee, MS, Lanes, A, Ginsburg, ES, Fox, JH. Delta-9 THC can be detected and quantified in the semen of men who are chronic users of inhaled cannabis. J Assist Reprod Genet 2020;37(6):14971504.CrossRefGoogle ScholarPubMed
Leusch, FD, Moore, MR, Chapman, HF. Balancing the budget of environmental estrogen exposure: the contribution of recycled water. Water Sci Technol 2009;60(4):10031012.CrossRefGoogle ScholarPubMed
Levine, H, Jørgensen, N, Martino-Andrade, A, et al. Temporal trends in sperm count: a systematic review and meta-regression analysis. Hum Reprod Update 2017;23(6):646659.CrossRefGoogle ScholarPubMed
Liu, J, Dai, Y, Li, Y, et al. A longitudinal study of semen quality among Chinese sperm donor candidates during the past 11 years. Sci Rep 2020;10(1):10771.CrossRefGoogle ScholarPubMed
Lübbert, H, Leo-Rossberg, I, Hammerstein, J. Effects of ethinyl estradiol on semen quality and various hormonal parameters in a eugonadal male. Fertil Steril 1992;58(3):603608.CrossRefGoogle Scholar
MacDonald, AA, Herbison, GP, Showell, M, Farquhar, CM. The impact of body mass index on semen parameters and reproductive hormones in human males: a systematic review with meta-analysis. Hum Reprod Update 2010;16(3):293311.CrossRefGoogle ScholarPubMed
Macdonald, AA, Stewart, AW, Farquhar, CM. Body mass index in relation to semen quality and reproductive hormones in New Zealand men: a cross-sectional study in fertility clinics. Hum Reprod 2013;28(12):31783187.CrossRefGoogle ScholarPubMed
Mallozzi, M, Leone, C, Manurita, F, Bellati, F, Caserta, D. Endocrine disrupting chemicals and endometrial cancer: an overview of recent laboratory evidence and epidemiological studies. Int J Environ Res Public Health 2017;14(3):334.CrossRefGoogle ScholarPubMed
Mazur, A, Westerman, R, Mueller, U. Is rising obesity causing a secular (age-independent) decline in testosterone among American men? PLoS One 2013;8(10):e76178.CrossRefGoogle ScholarPubMed
McPherson, NO, Tremellen, K. Increased BMI ‘alone’ does not negatively influence sperm function – a retrospective analysis of men attending fertility treatment with corresponding liver function results. Obes Res Clin Pract 2020;14(2):164167.CrossRefGoogle Scholar
Meeker, JD, Ehrlich, S, Toth, TL, et al. Semen quality and sperm DNA damage in relation to urinary Bisphenol A among men from an infertility clinic. Reprod Toxicol 2010;30(4):532539.CrossRefGoogle ScholarPubMed
Mínguez-Alarcón, L, Williams, PL, Chiu, YH, et al. Secular trends in semen parameters among men attending a fertility center between 2000 and 2017: identifying potential predictors. Environ Int 2018;121(2):12971303.CrossRefGoogle ScholarPubMed
Moreau, J, Gatimel, N, Parinaud, J, Leandri, R. Results of intrauterine inseminations with two pooled sequential ejaculates in cases of oligozoospermia. Asian J Androl 2018;20(5):523524.Google ScholarPubMed
Mukherjee, A, Koli, S, Reddy, KV. Regulatory non-coding transcripts in spermatogenesis: shedding light on ‘dark matter’. Andrology 2014;2(3):360369.CrossRefGoogle ScholarPubMed
Nassan, FL, Arvizu, M, Mínguez-Alarcón, L, et al. Marijuana smoking and outcomes of infertility treatment with assisted reproductive technologies. Hum Reprod 2019;34(9):18181829.CrossRefGoogle ScholarPubMed
Ognjenovic, M, Ambrosini, GL, Malacova, E, et al. Associations between major dietary patterns and testicular function in a population-based cohort of young men: results from the Western Australian Pregnancy Cohort (Raine) Study. Andrology 2019;7(3):273280.CrossRefGoogle Scholar
Payne, KS, Mazur, DJ, Hotaling, JM, Pastuszak, AW. Cannabis and male fertility: a systematic review. J Urol 2019;202(4):674681.CrossRefGoogle ScholarPubMed
Perheentupa, A, Mäkinen, J, Laatikainen, T, et al. A cohort effect on serum testosterone levels in Finnish men. Eur J Endocrinol 2013;168(2):227233.CrossRefGoogle ScholarPubMed
Ribeiro, C, Tiritan, ME, Rocha, E, Rocha, MJ. Seasonal and spatial distribution of several endocrine-disrupting compounds in the Douro River Estuary, Portugal. Arch Environ Contam Toxicol 2009;56(1):111.CrossRefGoogle Scholar
Ricci, E, Noli, S, Ferrari, S, et al. Alcohol intake and semen variables: cross-sectional analysis of a prospective cohort study of men referring to an Italian Fertility Clinic. Andrology 2018;6(5):690696.CrossRefGoogle Scholar
Rodriguez, AC, Blanchard, Z, Maurer, KA, Gertz, J. Estrogen signaling in endometrial cancer: a key oncogenic pathway with several open questions. Horm Cancer 2019;10(2–3):5163.CrossRefGoogle ScholarPubMed
Rohayem, J, Sinthofen, N, Nieschlag, E, Kliesch, S, Zitzmann, M. Causes of hypogonadotropic hypogonadism predict response to gonadotropin substitution in adults. Andrology 2016;4(1):8794.CrossRefGoogle ScholarPubMed
Salas-Huetos, A, Bulló, M, Salas-Salvadó, J. Dietary patterns, foods and nutrients in male fertility parameters and fecundability: a systematic review of observational studies. Hum Reprod Update 2017;23(4):371389.CrossRefGoogle ScholarPubMed
Samarasinghe, SVAC, Krishnan, K, Naidu, R, et al. Parabens generate reactive oxygen species in human spermatozoa. Andrology 2018;6(4):532541.CrossRefGoogle ScholarPubMed
Schramm, P. Alkohol und Fertilität--aus andrologischer Sicht [Alcohol and fertility--from the andrological point of view]. Z Hautkr. 1985;60(13):1026, 1031–1032, 1037–1039.Google Scholar
Shi, X, Chan, CPS, Waters, T, et al. Lifestyle and demographic factors associated with human semen quality and sperm function. Syst Biol Reprod Med. 2018;64(5):358367.CrossRefGoogle ScholarPubMed
Shrestha, SL, Casey, FX, Hakk, H, Smith, DJ, Padmanabhan, G. Fate and transformation of an estrogen conjugate and its metabolites in agricultural soils. Environ Sci Technol 2012;46(20):1104711053.CrossRefGoogle ScholarPubMed
Siegel, RL, Torre, LA, Soerjomataram, I, et al. Global patterns and trends in colorectal cancer incidence in young adults. Gut 2019;68(12):21792185.CrossRefGoogle ScholarPubMed
Skakkebaek, NE, Rajpert-De Meyts, E, Buck Louis, GM, et al. Male reproductive disorders and fertility trends: influences of environment and genetic susceptibility. Physiol Rev 2016;96(1):5597.CrossRefGoogle ScholarPubMed
Stárka, L, Hill, M, Pospíšilová, H, Dušková, M. Estradiol, obesity and hypogonadism. Physiol Res 2020;69(Suppl 2):S273S278.CrossRefGoogle ScholarPubMed
Sumpter, JP. Feminized responses in fish to environmental estrogens. Toxicol Lett 1995;82–83:737742.CrossRefGoogle Scholar
Sung, H, Ferlay, J, Siegel, RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71(3):209249.CrossRefGoogle Scholar
Swan, SH. Semen quality in fertile US men in relation to geographical area and pesticide exposure. Int J Androl 2006;29(1):6268.CrossRefGoogle ScholarPubMed
Swan, SH, Colino, S. Count Down: How our Modern World is Threatening Sperm Counts, Altering Male and Female Reproductive Development, and Imperiling the Future of the Human Race. New York, Scribner, 2021.Google Scholar
Swan, SH, Elkin, EP, Fenster, L. Have sperm densities declined? A reanalysis of global trend data. Environ Health Perspect 1997;105(11):12281232.CrossRefGoogle ScholarPubMed
Swan, SH, Elkin, EP, Fenster, L. The question of declining sperm density revisited: an analysis of 101 studies published 1934–1996. Environ Health Perspect 2000;108(10):961966.CrossRefGoogle ScholarPubMed
Tan, BL, Hawker, DW, Müller, JF, et al. Comprehensive study of endocrine disrupting compounds using grab and passive sampling at selected wastewater treatment plants in South East Queensland, Australia. Environ Int 2007;33(5):654669.CrossRefGoogle ScholarPubMed
Teitelbaum, DT. The toxicology of 1,2-dibromo-3-chloropropane (DBCP): a brief review. Int J Occup Environ Health 1999;5(2):122126.CrossRefGoogle ScholarPubMed
Toppari, J, Virtanen, HE, Main, KM, Skakkebaek, NE. Cryptorchidism and hypospadias as a sign of testicular dysgenesis syndrome (TDS): environmental connection. Birth Defects Res A Clin Mol Teratol 2010;88(10):910919.CrossRefGoogle ScholarPubMed
Travis, RC, Key, TJ. Oestrogen exposure and breast cancer risk. Breast Cancer Res 2003;5(5):239247.CrossRefGoogle ScholarPubMed
Travison, TG, Araujo, AB, O’Donnell, AB, Kupelian, V, McKinlay, JB. A population-level decline in serum testosterone levels in American men. J Clin Endocrinol Metab. 2007;92(1):196202.CrossRefGoogle ScholarPubMed
Uraipong, C, Allan, RD, Li, C, et al. 17β-Estradiol residues and estrogenic activities in the Hawkesbury River, Australia. Ecotoxicol Environ Saf 2018;164:363369.CrossRefGoogle ScholarPubMed
Virtanen, HE, Jørgensen, N, Toppari, J. Semen quality in the 21st century. Nat Rev Urol 2017;14(2):120130.CrossRefGoogle ScholarPubMed
Wallace, EM, Aitken, RJ, Wu, FC. Residual sperm function in oligozoospermia induced by testosterone enanthate administered as a potential steroid male contraceptive. Int J Androl 1992;15(5):416424.CrossRefGoogle ScholarPubMed
Wang, L, Zhang, L, Song, XH, et al. Decline of semen quality among Chinese sperm bank donors within 7 years (2008–2014). Asian J Androl 2017;19(5):521525.Google Scholar
Wise, LA, Wesselink, AK, Hatch, EE et al. Marijuana use and fecundability in a North American preconception cohort study. J Epidemiol Community Health 2018;72(3):208215.CrossRefGoogle Scholar
Xavier, MJ, Mitchell, LA, McEwan, KE, Scott, RJ, Aitken, RJ. Genomic integrity in the male germ line: evidence in support of the disposable soma hypothesis. Reproduction 2018;156(3):269282.CrossRefGoogle ScholarPubMed
Yu, X, Nassar, N, Mastroiacovo, P, et al. Hypospadias prevalence and trends in international birth defect surveillance systems, 1980–2010. Eur Urol 2019;76(4):482490.CrossRefGoogle ScholarPubMed
Yuan, HF, Shangguan, HF, Zheng, Y, et al. Decline in semen concentration of healthy Chinese adults: evidence from 9357 participants from 2010 to 2015. Asian J Androl 2018;20(4):379384.Google ScholarPubMed
Zattoni, F, Gül, M, Soligo, M, et al. The impact of COVID-19 pandemic on pornography habits: a global analysis of Google trends. Int J Impot Res 2020:18. doi: 10.1038/s41443-020-00380-w. Epub ahead of print.CrossRefGoogle Scholar
Zhang, SC, Wang, HY, Wang, JD. Analysis of change in sperm quality of Chinese fertile men during 1981–1996. Reprod Contracept 1999;10(1):3339.Google ScholarPubMed
Zuo, Y, Zhang, K, Deng, Y. Occurrence and photochemical degradation of 17 alpha-ethinylestradiol in Acushnet River Estuary. Chemosphere 2006;63(9):15831590.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Chapter 4
  • R. John Aitken, University of Newcastle, New South Wales
  • Book: The Infertility Trap
  • Online publication: 05 May 2022
  • Chapter DOI:
Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Chapter 4
  • R. John Aitken, University of Newcastle, New South Wales
  • Book: The Infertility Trap
  • Online publication: 05 May 2022
  • Chapter DOI:
Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Chapter 4
  • R. John Aitken, University of Newcastle, New South Wales
  • Book: The Infertility Trap
  • Online publication: 05 May 2022
  • Chapter DOI:
Available formats