Among heterosexual couples facing fertility issues, the male partner is a contributing factor about 50 percent of the time. Still, whether it’s contraceptive choices, cryopreservation options, infertility conversations, or prenatal habits, people with uteruses shoulder the bulk of reproductive responsibilities. In short: We’re overdue for a more inclusive fertility conversation, and in 2022, people with sperm will get more attention.
“Studies do suggest a decline in sperm counts and concentrations over time, and that is being attributed to a possible effect of chemicals, pollutants, and toxins in the environment,” Zev Williams, MD, a fertility specialist at Columbia University Fertility Center, says. “While I think more data is necessary to confirm this finding and, if true, determine the cause, I do think the increased focus on sperm health reflects a growing awareness and appreciation for the role of male factor in infertility.”
This growing awareness is helping empower people with sperm to overcome resistance and stigma involved in facing fertility concerns. “How do you reshape that stigma? How do you destigmatize the topic? A big part of that is, well, normalize it,” says Khaled Kteily, founder and chief executive officer of Legacy, a mail-in sperm testing and storage startup founded in 2018 that just completed a celebrity funding round that included investments from DJ Khaled, The Weeknd, Justin Bieber, Orlando Bloom, and Hannah Bronfman. “Next year is really going to be the first year that we are going to see male fertility as something that men, public figures, openly talk about,” he says.
“How do you reshape that stigma? How do you destigmatize the topic? A big part of that is, well, normalize it.” Khaled Kteily, founder and CEO of Legacy
Rising COVID-19 cases and stay-at-home orders meant medical providers needed to rethink fertility procedures that once only happened in-office. As a result, the medical community more readily embraced at-home fertility sample collection technologies that once seemed fringe. “Sometimes it takes a crisis...to prompt these kinds of new developments,” Dr. Williams says.
In-clinic sperm collection is often an uncomfortable experience for patients. There's also an understanding that sperm is damaged as it leaves the body and that, potentially, the problem could be exacerbated by being collected in that traditional specimen cup, says Diana Peninger, CEO of Reproductive Solutions, the company that created ProteX, a specimen cup that allows for at-home sperm collection. At-home testing cups, including ProteX, feature a thermal barrier that protects the sample from temperature fluctuations; they also feature a mechanism that helps the sample remain concentrated, says Peninger, adding that the ProteX cup includes nutrients to keep from compromising the sperm pH level, which makes it easier to assess viability (healthy sperm pH should be between 7.2 to 8.0 according to the World Health Organization). “Now, it is not just, ‘Hey, you can go home and be comfortable,’” Peninger says. “It's, ‘You can be comfortable, you have plenty of time to get it back to the lab [to be] processed, and it's a much higher quality than [you get with] actually collecting in the specimen cup.’”
While ProteX is a medical device that your clinic or provider must request for you, Legacy is a direct-to-consumer at-home testing kit. It costs about $199 for sperm testing that analyzes factors like concentration, motility, volume, and motility count. Legacy also provides storage at $149 per year, which is much less expensive than traditional sperm banks. However, in November, Columbia University Fertility Center launched a styrofoam at-home sperm testing kit that’s only $2 to produce, and Dr. Williams says the facility plans to make it available to everyone in the future. “The goal is certainly to benefit our patients, [and] to benefit all patients,” he says. Developments like these will only become more necessary as the pandemic lingers and will help make sperm-related fertility less stigmatized and more affordable.
Increased affordability means more people—in many different circumstances and stages of life—will be able to partake in these services. According to forecasting by Grand View Research, the global male infertility market was valued at $3.5 billion in 2019 and is projected to reach $5.03 billion by 2027. In April 2021, Legacy announced that it raised $10M in Series A fundraising with the aim of making male fertility accessible for all, including couples trying to conceive, people with sperm going through chemotherapy and testosterone replacement therapy, transgender people looking to preserve sperm, and military families who want to preserve their fertility before deployment.
Other players in the increasingly crowded sperm testing and storage startup space also gained traction among consumers and investors in 2021, setting them up for further growth in the coming year. Earlier this year, Sapyen, an Australian fertility testing company focused on sperm health, launched a beta fertility testing kit for Australians and has sold over 3,500 kits. Roman, a telehealth company that diagnoses and prescribes medications, is in late-stage talks to acquire Dadi, a sperm testing and storage startup launched in 2019, for an estimated $100 million. And in early 2021, Fellow, a sperm testing and storage startup founded in 2020, completed a clinical trial in partnership with the University of California San Francisco and found that its mail-in testing kit was as accurate as semen samples analyzed within one hour of the collection—making it the only at-home sperm testing kit to have clinical validation, according to the company’s press release.
These recent advancements indicate that it’s never been easier to quietly overcome stigma and explore fertility options outside clinical settings.
Beyond sperm analysis and storage, the supplement market is also thinking more broadly about fertility. Companies that address fertility and prenatal health through vitamins like Bird&Be, Perelel, and Natalist have launched vitamins for people with sperm in the last two years. It’s worth noting that more robust clinical trials are needed to confirm the efficacy of prenatal supplements for people with sperm. However, brands’ willingness to create inclusive product lines indicates that people with sperm are becoming more active participants in the reproductive process. “We launched our male prenatal supplement in December 2020 and have seen consistent growth in product sales since,” says Jenifer Dasho, CMO of Everly Health, a telehealth and at-home lab testing company, and general manager of Natalist. “This growth is presumably due in part to more people talking about reproductive health in general, and specifically, the role men play in conception.”
“If you walk down a CVS aisle and you go to the pregnancy test boxes…or to women's prenatal supplements, you'll see a picture of a woman with a baby. And for some people, that is just not their reality." Samantha Diamond, founder of Bird&Be
However, it’s not just cis men that need more inclusion in fertility conversations. “If you walk down a CVS aisle and you go to the pregnancy test boxes…or to women's prenatal supplements, you'll see a picture of a woman with a baby. And for some people, that is just not their reality,” says Samantha Diamond, founder of Bird&Be. By excluding gender identifiers like “for men” and “for women” from the brand’s products, Diamond says birthing people and their partners can find the appropriate nutritional supplements they need.
In 2022, Diamond says Bird&Be will launch an at-home sperm-testing kit and an ovulation screening kit for people with eggs that can serve as something patients can bring to their providers. Dasho also hints that Natalist has fertility developments in the works for 2022, and “inclusivity is always top of mind,” she says.
Ultimately, new testing and storage products, plus destigmatized conversations make for a more accessible world where all people can explore their fertility options without stigma or shame. “I really see fertility on the same trajectory as mental health,” Diamond says. “Ten years ago, mental health was closeted. And now it has literally evolved culturally to the point where people are referencing their therapists at dinner, and people are advocating for therapy left, right, and center. It is so wonderful to see how we've evolved in that conversation, and I think fertility is on that same trajectory.”
Photo Credit: Courtesy of Legacy