The odd story of Middle Eastern sperm

Well, I don't recall reading about this before, but here it is in the New York Times.   While we have all heard of male sperm counts dropping for unclear reasons around the globe, apparently, male infertility has been recognized as a real problem in the Middle East for decades:

Over the past 30 years, my research has focused on male infertility in the Middle East. There, genetic sperm defects — the main cause of male infertility — are particularly common and often run in families. High rates of male smoking, ambient air pollution in the major cities and the stresses of war, too, have taken a costly toll on male reproductive health. Yet the region not only has made tremendous technological advances in combating male infertility but also has undergone a dramatic change in societal attitudes toward the problem.

Back in the 1980s, as a doctoral student, I headed to Egypt to study infertility. Semen analysis had become widely available there by the 1970s, and by the time I arrived, ordinary Egyptians — including many a male cabdriver I spoke with — were aware that men could have “weak” sperm. Scientific advances had made clear that infertility was not just a female burden....

Since those early days, much has changed as a result of several factors. Medical progress, religious permissions and government efforts have combined to make male infertility treatment much more accessible. But men themselves have played a major role in lifting taboos, in ways that are instructive for the West.

The changes began with Islamic clerics, who were among the world’s first religious leaders to approve in vitro fertilization as a solution to marital infertility. A permissive fatwa covering IVF issued in Egypt in 1980 allowed the introduction of high-tech assisted reproduction across the Muslim world. The next decades saw an IVF boom, and today, the Middle East claims one of the strongest IVF sectors in the world.

This emergence of high-tech reproductive medicine took a leap forward in the 1990s, with the introduction of a new and particularly effective form of IVF treatment known as intracytoplasmic sperm injection (ICSI, pronounced “ik-see”), a breakthrough that gives infertile men a real chance to become biological fathers. The coming of ICSI to the Middle East was a technological revolution that in turn led to a social revolution. As more and more infertile men sought the widely advertised “ICSI solution,” male infertility was transformed from a masculinity problem into a medical condition....

As men like Nabil have come to acknowledge their infertility problems and seek treatment, they have helped to lighten the heavy load once carried by their wives: the scrutiny from in-laws, the social ostracism, the threats of divorce or polygynous remarriage. Indeed, the introduction of high-tech male infertility treatment and Middle Eastern men’s eager embrace of this technology have had positive effects on gender relations across the region.

To be sure, there are very real and important differences between the Middle East and the West when it comes to male infertility. In the Middle East, most infertile couples are barred from using donor sperm to conceive, despite the religious permissibility of many other treatments and technologies such as ICSI. In the West, ICSI has long been widely available, but the cost sometimes makes it inaccessible, particularly in the United States. But the primary obstacle has come from men’s own silence on the subject — and here is where the Middle East can serve as an instructive example.