Global fertility experts are calling for coordinated international action, warning that the non-selective use of ICSI – a technique in which a single sperm is injected directly into an egg – may have slowed progress in understanding the causes of male infertility.
The International Federation of Fertility (FFS) says that while ICSI has transformed male infertility treatment, its non-selective use may have reduced focus on investigating the causes of declining male reproductive function, a concern echoed globally.
IFFS president, Dr Marcos Horton, says declining sperm quality may signal wider health risks, including metabolic, hormonal and cardiovascular conditions, making the lack of scientific progress a broader public-health issue.
“ICSI has been extraordinary for patients, especially where a severe abnormality is present, but it may also mean we are overlooking the underlying biological and environmental factors driving poor sperm quality,” said Dr Horton.
“The Federation is uniquely positioned to unite these voices, and we are now preparing a coordinated global effort to address the decline in male reproductive health.”
The IFFS is coordinating a global response, working jointly with the International Society of Andrology, about a joint international statement and an online summit to set shared research priorities.
Professor Bart Fauser, former co-editor-in-chief of the IFFS journal Global Reproductive Health and leading reproductive-medicine specialist, said the clinical success of ICSI has unintentionally slowed scientific progress.
“ICSI has been a remarkable breakthrough, but it has also diverted attention away from the fundamental question of why male fertility is declining,” said Prof Fauser.
“We have treated the symptoms brilliantly, but we have not addressed the underlying causes – and that must now change.”
The IFFS is calling for:
- Integrated care pathways – coordinated referral routes between fertility clinics, urology, endocrinology and primary care
- Better long-term medical follow-up of men with poor sperm parameters
- Greater research investment into the biological and environmental drivers of declining semen parameters
- Joint international leadership – strengthened collaboration between IFFS and ISA to align global research and policy
IFFS initiatives reflecting this commitment include the IFFS and ISA Male Infertility webinar series, a free educational activity and organising a Pre-Congress Course at the IFFS World Congress in Brisbane in 2027.
Plans for an international online summit are now being explored to set global priorities for research, prevention and clinical care.
Added Professor Fauser: “Male fertility should be recognised as part of overall health across the life course. It is not simply a measure of reproductive capability at a single moment in time.”
Research shows sperm concentration in Western countries has fallen by more than 50% since the 1970s. ICSI was developed in the early 1990s at Vrije Universiteit Brussel by Dr Gianpiero Palermo’s team, with the first successful birth in 1992.
The IFFS represents more than 50 national fertility societies worldwide.
With pix: IFFS president, Dr Marcos Horton; Professor Bart Fauser, leading reproductive–medicine specialist