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---
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Tag: ["🤵🏻", "❤️", "🍆"]
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Date: 2023-07-29
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DocType: "WebClipping"
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Hierarchy:
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TimeStamp: 2023-07-29
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Link: https://nymag.com/intelligencer/article/male-sperm-count-decline-semen-analysis-fertility-business-politics.html
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location:
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CollapseMetaTable: true
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---
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Parent:: [[@News|News]]
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Read:: 🟥
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---
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```button
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name Save
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type command
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action Save current file
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id Save
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```
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^button-TheSpermDeclineHasCreatedBigBusinessNSave
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# The Global Sperm Count Decline Has Created Big Business
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## Sperm Fever
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## The tantalizing business opportunities and disorienting politics of the worldwide decline in man’s most precious bodily fluid.
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By , a features writer at New York covering politics, ideas, business, and culture
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Illustration: Adam Maida
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**Some time after** his father, Abraham, strapped him to an altar and attempted to sacrifice him to God, Isaac suffered another misfortune. He and his wife, Rebekah, struggled to have children. “Isaac intreatied the Lord for his wife, because she was barren,” reads the King James Bible. “And the Lord was intreated of him, and Rebekah his wife conceived.”
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But was she barren? Lately, I’ve been wondering. Rebekah appears to have been significantly younger than Isaac. They didn’t wed until he was 40; their children weren’t born until Isaac was threescore years old. Studies show that advanced paternal age is associated with increased risk of miscarriage and that men contribute to at least a third, and maybe closer to half, of global cases of infertility. Plus stress has been shown to degrade semen quality, and Isaac had had the whole mountaintop brush with filicide. Maybe the Bible is wrong. Maybe the problem was Isaac’s sperm.
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Six thousand years later, a 25-year-old management consultant named Khaled Kteily spills a tray of scalding Starbucks teas on his lap. It’s 2014, and he’s on a work trip in Oklahoma. When he finally gets to a medical clinic, there’s no burn unit. A few months later, now enrolled at Harvard’s Kennedy School of Government, his injuries have healed — superficially, at least. A friend is undergoing chemotherapy and freezes his sperm as a precaution, and it gets Kteily fretting about his own fertility. “Imagine I couldn’t be the husband or father that I want to be,” Kteily says. “Imagine I meet someone and have to be like, ‘By the way, you should know: My balls burned off in a freak tea accident, and I can never give you children.’”
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Kteily makes an appointment to test and freeze his semen at a lab in Cambridge, where the act of watching the clinic’s pornos and depositing his sample feels like a degrading counterpoint to the eventual pursuit of starting a family. “This is one of the most profound things that I’ve ever done,” he says. “But the experience I had was, you know, jerking off in the back of an alleyway. And I became really fixated on just how far apart these two feelings were.”
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This gives him an idea for a start-up. It’s 2017 now, and the men’s-health unicorns Hims and Roman (now Ro) debut, creating a lucrative, direct-to-consumer pipeline for erectile-dysfunction pills. Kteily thinks, *What if men could order a thoughtfully branded sperm-test kit to their home, sparing them the discomfort of interfacing with the medical system?* If the sperm looked bad, he could sell advice and supplements for improving it. If the sperm looked good, he could charge customers to ice a sample in cryostorage. On one level, he would be competing in the embarrassing penis-stuff arena. In a more meaningful sense, he would be educating clueless Isaacs and lifting the burden from blameless Rebekahs.
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“If all it takes is for you to masturbate one time to preserve the ability to have kids, why isn’t everyone doing this?” Kteily recalls thinking. “In the future, everyone will freeze their sperm. It’s going to be a rite of passage.” He calls his new company Legacy. His faith in the concept is unshakable. On Legacy’s website, he promotes fake worldwide offices. “I put Toronto, Singapore, Geneva, London, because I’ve always believed that this is going to be a multibillion-dollar global type of company,” he says. But the success of the company is far from assured. Then, in November of that year, he receives his own kind of divine intervention.
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An academic journal publishes a paper called “Temporal trends in sperm count: a systematic review and meta-regression analysis.” It is written by Hagai Levine of Hebrew University and Shanna Swan of Icahn School of Medicine at Mount Sinai, among other veteran epidemiologists. It is the largest-ever study of [sperm counts](https://www.thecut.com/2018/10/why-is-everybody-freaking-out-about-declining-sperm-counts.html), analyzing 185 previous studies of 42,935 men from 1973 to 2011. They find that overall counts have declined by 59 percent and that average concentration has fallen by half, from around 99 million sperm per milliliter to 47 million. Anything below 15 million is regarded as an impediment to reproduction, to say nothing of zero per milliliter, where the trend line seems to be heading.
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Spermpocalypse headlines proliferate. Kteily orients his start-up pitch around the *Children of Men* scenario of mass sterility and a client base that will get only more anxious about safeguarding its semen. Legacy begins to grow. Kteily incubates his company at the Harvard Innovation Lab, accelerates it at Y Combinator, and wins a TechCrunch battle in Berlin. The pandemic, with its stimulus-flush home shoppers and ambient health anxiety, brings Legacy into start-up adolescence. By the end of 2022, the company has landed contracts with major insurers, tens of millions in funding from blue-chip venture-capital firms, and celebrity backing from Justin Bieber, Orlando Bloom, and the Weeknd. FirstMark’s Rick Heitzmann, on the *Forbes* “Midas List” of golden-touch VCs, leads Legacy’s series-A fundraising round. “It feels like all the megatrends are in that space,” Heitzmann says of the male-fertility market. “Whether it’s the megatrend around declining sperm or the megatrend around people waiting longer to have children.”
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Kteily boasts that Legacy is now testing and freezing the most semen in the country. And what used to be a lonely obsession has become normal to talk about in polite company. “The average well-read guy has heard about this,” Kteily says. “Maybe he doesn’t know the exact details. But he knows that something is happening with sperm and it’s bad. That didn’t exist five years ago.”
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Then again, neither did the competition. In the half-decade since the sperm-crisis study was published, a number of *other* at-home sperm-testing kits have hit the market. There is Yo, and Fellow, and Path Fertility. Significantly, there is Dadi — Kteily’s nemesis — which he says once tried to steal Legacy’s name, and which last year was bought by Ro for a reported $100 million. The European kits have also arrived, also with euphemistic names. ExSeed launched in Denmark, Mojo in Britain. Jack Fertility, from the U.K., is set to debut this year. Their founders, too, observed a megatrend and sought to capitalize.
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Kteily has staked his claim to the Zeitgeist, buying the URL spermking.com and redirecting it to his personal LinkedIn page. He thought about sending the traffic to Legacy’s website but decided against it. “I was like, *But no, I am the sperm king.*”
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Khaled Kteily, the founder of sperm-test-kit company Legacy, claims he is testing and freezing the most semen in the country. Photo: Noam Galai/Getty Images for TechCrunch
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**The sperm king** and his rivals are merely the business end of a concern that is working its way through the American psyche with unpredictable results. The interest has been stoked at intervals by Swan, who in 2021 wrote *Count Down,* a book-length expansion on her study. Bearing the arresting subtitle *How Our Modern World Is Threatening Sperm Counts, Altering Male and Female Reproductive Development, and Imperiling the Future of the Human Race,* it attributes the sperm reduction largely to hormone-disrupting pesticides and plastics. In late 2022, she reunited with Levine to publish another, even scarier paper. This one found sperm vanishing not just in Europe and North America but worldwide and at an accelerating rate since 2000.
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Mainstream awareness of the sperm problem has brought backlash. Some of it is the expected scientific quarreling. Various urologists and fertility specialists accuse Levine and Swan of alarmism and clout chasing; others don’t like their methodology. A group of professors from Harvard, MIT, and elsewhere attacked the research from a different angle, arguing in an academic publication and in Slate that it emboldens men’s-rights groups and white nationalists by fomenting fear of population decrease and ethnic replacement. (“They’re social scientists, not scientists,” Swan says in retort. “They may not understand reproductive epidemiology.”) Incongruously, these critics have found common cause with the likes of Steven Milloy, a climate-change denier and tobacco-industry advocate, and the American Chemistry Council, the chemical industry’s formidable lobbying group. The former has said Swan is “on a crusade” to “scare people” and the latter accuses her of stirring up “chemophobia.”
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The frothy reception to the sperm research makes sense when you place it in the polarized context of the birth-rate debate. Kteily, whose grandparents are Palestinian, likes to point out that the sperm conversation is inherently political. “The most Orthodox Jews, who live in Jerusalem in particular, literally view it as a moral obligation to have more kids, and part of the reason they do this is to counter-balance Palestinians,” he says. “And what that’s done is take Israel very right wing.” If ultra-Orthodox Israelis maintain their current birth rate of 6.7 children per woman, they will account for a quarter of the country’s population in 2050, roughly doubling their voting power today.
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Across much of the developed world, birth rates have fallen below the replacement level of 2.1 children per woman. Kteily has memorized the stats: Germany, 1.6; South Korea, 0.8; America, 1.7. “People don’t understand what that means,” he says, “which is that in 50 years, South Korea is barely going to exist.” (Estimates give South Korea more like 700 years to go.) Or maybe people do understand what it means. A half-century ago, biologist Paul Ehrlich’s infamous depopulation treatise, *The Population Bomb,* earned him a reputation as a crank and a “doomster.” Now, in the late fossil-fuel era, Malthusian climate pessimism is fairly mainstream; in liberal circles, it is unremarkable to voice environmentalist ambivalence about having children.
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The promotion of childbearing, meanwhile, has largely become the province of the right, whose biggest recent success in the natalist realm has been the Supreme Court’s decision striking down *Roe* v. *Wade.* In May, students at Cambridge University protested the screening of *Birthgap,* a film about declining birth rates, on feminist grounds. The director found a more appreciative audience on Jordan Peterson’s podcast, where the discussion was titled “The Epidemic That Dare Not Speak Its Name.” The conservative prime minister of Italy, Giorgia Meloni, recently called discussion of natality a “revolutionary act.” Elon Musk, who has nine known children, voices regular concern over the matter.
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The charged politics of whether the human species should continue to exist is naturally intertwined with the subject of sperm degradation. A progressive who sympathizes with a couple struggling to conceive may shrug her shoulders at talk of a global fertility slump, especially among men. The former sounds heart-wrenching, the latter almost indulgent: *more male status anxiety.* Yet the contours of the sperm-count debate are also unpredictable because the prevailing theory that the crisis was wrought by chemical pollutants makes it harder to write off as a purely right-wing panic. As such, it’s not always obvious who is going to be a sperm hawk and why. The neoagrarian right-wing bodybuilders are tweeting about microplastics; the liberal stalwart Nicholas Kristof warns in the New York *Times* that “something alarming is happening between our legs.”
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There is an all-American quality to this brand of body paranoia. During the pandemic, Nicki Minaj warned that COVID vaccines were rendering men sterile: “My cousin in Trinidad won’t get the vaccine cuz his friend got it & became impotent. His testicles became swollen. His friend was weeks away from getting married, now the girl called off the wedding.” To my ears, it sounded like a lockdown-era update on General Jack D. Ripper’s *Dr. Strangelove* monologue about the plot to “sap and impurify all of our precious bodily fluids” with fluoridated water. Ripper’s lines were a send-up of the John Birch Society’s fixation on fluoridation, which had previously been opposed by Christian Scientists, before the cause was much later taken up on the left by Ralph Nader.
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The more one delves into the sperm discourse, the more it seems like a kind of skeleton key to the reordered politics of the moment. The topic tends to attract not typical partisans but dwellers in a murkier, more alienated zone, where suspicion of corporate America meets hyper-masculinity and ecological concerns collide with fad-diet, clean-living orthorexia. If that sounds like the middle of a lunatic Venn diagram that nobody occupies, consider that it’s essentially the niche of Joe Rogan, the world’s most popular podcaster, who naturally did an interview with Swan about plummeting sperm in which they bemoaned the phthalates in our spaghetti sauce and BPF in our water bottles.
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**Khaled Kteily** grew up in Beirut, attending an English-language prep school before heading to McGill University in Montreal. He’s now 34 and unmarried. He has no children, but he does have 100 vials of his own frozen semen. “I recently decided 2023 is the year I’ve got to take it more seriously,” he says of finding a spouse, as we chat in a café in Williamsburg this spring. “I think I’m actually having a bit of an age crisis. Literally, I’m like, my sperm is declining.” The 100, he admits, is overkill. But he likes to test his own product, compulsively ordering and shipping back kits. (Legacy, now at 40 employees, went remote during the pandemic, and Kteily relocated from Boston to New York.) He is a walking argument for his company: an aspiring but procrastinating father. He’s giving himself until 36 to have kids with live sperm, he says, then will turn to the cryostash.
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Kteily himself can feel like an unfrozen sample — a charismatic, troublemaking founder from Silicon Valley’s prelapsarian age, before the falls of Holmes, Kalanick, and Neumann. On his iPhone, every single app’s icon has been replaced with Legacy’s little medallion insignia; he’s just memorized which corresponds to what. On courting investment from Orlando Bloom, Kteily says, “I’ve never been less impressed with anyone. It was the shittiest conversation.” Bloom seemed not to care about the larger mission of helping men procreate. “It was like, ‘How much money am I getting?’ ‘You’ll make lots of money.’ He’s like, ‘All right.’”
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Initially, Legacy’s sperm kit came in a royal-blue box emblazoned with a prep-schoolish coat of arms inspired by Viking mythology and some marketing language about being a “Swiss bank” for your most precious asset. Kteily eventually pivoted to a more discreet, forest-green concept: less *family jewels,* more *family planning.* Legacy now breaks its suite of products into tiers. “For Today” buys you a kit with one at-home sperm test for $375. “For Tomorrow” includes two semen analyses, one STI test, and eight vials with up to five years of cryostorage for $1,195. “Forever” expands the package indefinitely: 12 vials, lifetime cryo, for $5,995. (Cigna, Aetna, and a handful of other insurers will cover a “For Today,” plus at least a year’s worth of storage, depending on the plan.)
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Legacy shipped a kit to my home. Matryoshka style, the elegant green cube opens onto a cylindrical white foam container, under which is a gel pad, which in turn keeps the “transport media” cool, which is contained in another cylinder, under which is the sample cup and a brochure explaining how to deposit your sample and mail it back to a Legacy lab and storage facility. At that point, the company will tell you if your sperm is problematic, as measured by low marks in volume, concentration, count, motility (movement), or morphology (shape). There is debate about whether motility or morphology is a better predictor of fecundity; some swear by DNA fragmentation analysis, which Legacy offers for an added fee of $195.
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If Kteily’s early struggle was to convince investors there was a market for his product, now he has to convince consumers that Legacy is the best kit on the market. The company’s rivals are each a little different: Some freeze, some don’t; some are lab-based, some analyze a video you take on your cell phone. But mostly they are competing for the same customer: someone who’d rather not deposit a sample at a clinic. I can relate. I once had my semen tested at the Columbia University Fertility Center in midtown Manhattan. I was prompted with porn on a Windows desktop computer, categorized by genre and housed in the classic little pixelated manila folders. Upon finishing, I passed my cup through a slat in the wall, which carried some peep-show/glory-hole connotations. Unpleasant — but also, at about $200, not as expensive as Kteily would have you believe.
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As the market has become saturated, the price of Legacy’s test has risen, suggesting a more premium experience. An entry-level test kit used to cost $195, nearly the same price offered by the lower-profile start-up Fellow, which has found a niche partnering with clinics. Legacy recognizes the threat. Once, I Googled Fellow and was presented with a result for Legacy, which billed itself as “A Better Choice Than Fellow.” When I Zoomed with Fellow’s founder and CEO, Will Matthews, who formerly spearheaded *Playboy*’s transition out of nude content, he shared his computer screen with me to show me one of Kteily’s recent LinkedIn posts. In it, Kteily promoted a study showing that at-home kits had been proved as effective as in-person analyses conducted at a clinic. Matthews popped into the comments to tut-tut Kteily: That study was about Fellow’s test, not Legacy’s.\*
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In his professional life, Kteily happily leans into his sperm-king persona, especially on his “fire” LinkedIn page. But in his personal life, he sometimes keeps his job vague. “You say you run a sperm company, and it’s like the music stops,” he says. “Every guy, almost without fail, needs to make one joke. And the first joke is almost inevitably, like, ‘Oh, so can you guys help me with a sample?’” he says. Given the fertility implications for couples, for the world, this grates on him. “Sperm is funny — until it’s not.”
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This is true both for men with actual issues procreating and a growing army of culture warriors who view waning counts as part of a full-blown crisis in masculinity. Last year, near the height of his influence at Fox News, Tucker Carlson released a trailer for a 34-minute documentary called *The End of Men.* The aesthetic of the clip was fascist-camp, with footage of muscular guys bathing, chopping lumber, and confidently tanning their genitals. These were, Carlson seemed to be saying, the kind of men men ought to be. Yet when I watched the full film, which was released in October on a Fox streaming service, it was not the polemic against shifting gender norms that I expected. Instead, Carlson meant something more literal by “the end of men.”
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A still from Tucker Carlson’s documentary *The End of Men*, which features shirtless bodybuilders and guys exposing their testicles to LED lights. Photo: Fox Nation
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The program opens with black-and-white footage of President John F. Kennedy lamenting the physical fitness of the nation’s youth. “There is nothing I think more unfortunate than to have soft, chubby, fat-looking children,” he says, advocating for young people to “participate fully in a vigorous and adventurous life.” The film cuts to a present-day interview with his nephew [Robert F. Kennedy Jr.](https://nymag.com/intelligencer/article/robert-f-kennedy-jr-2024-presidential-campaign-democratic-primary.html), who is currently running for president as a Democrat, discussing the drop in testosterone and sperm counts. *The End of Men* turns out to be about physical health more than ideology. It attributes America’s steady demasculinization not just to the modern sedentary lifestyle but to literal environmental estrogens — endocrine-disrupting chemicals affecting male hormonal composition. “Our children are swimming in a toxic soup, and no one seems to care,” Carlson narrates. The program includes sad images of factory-farmed calves; one speaker praises regenerative agriculture. If you ignore the shirtless musclemen drinking tall glasses of raw eggs and pining for a return to a “natural order,” much of what’s in here wouldn’t be out of place in a documentary about Monsanto.
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One of the program’s recurring characters is a U.K.-based man who goes by the pseudonym Raw Egg Nationalist. He’s a very online member of several overlapping cohorts, including the meat-eating reactionaries known as the Right-Wing Bodybuilders and the so-called bro scientists, who can be found tweeting journal abstracts. Last year, Raw Egg published a manifesto-cookbook called *The Eggs Benedict Option,* its title a play on Rod Dreher’s localist-spiritual tract, *The Benedict Option.* (He is indebted, in style and substance, to Bronze Age Pervert, the alpha poster in this space.) Raw Egg’s outlook, which marries antipathy to Big Ag and Big Pharma with a yearning for bygone virility, is that modern life has become anti-biological. He regularly derides “soy globalism” — an update on the older “soy boy” insult, whereby the real target isn’t so much the vegan weakling but a synthetic, corporatized culture in general. (Anti-vaccine sentiment can be easily shoehorned into this paradigm.)
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In any case, contemporary sperm politics is such that Raw Egg’s synopsis of Swan’s *Count Down,* published in a Claremont Institute publication called the American Mind, sounds virtually indistinguishable from the version Erin Brockovich wrote for *The Guardian.* “Plastics, electronic equipment, packaging, pesticides, cosmetics, and personal hygiene products all contain chemicals that are known to interfere with the body’s hormonal balance,” Raw Egg wrote. “These chemicals are causing all manner of reproductive defects, ranging from malformed genitals to sperm that can’t swim properly.”
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*The End of Men* captures an anti-modern strain coursing through what some are calling the new right. Last month, in the *New Statesman,* the right-populist intellectual Sohrab Ahmari dubbed Raw Egg and his ilk the “Unabomber right” for what he sees as their misguided response to valid concerns over the dehumanizing effects of industrialization. (Theodore Kaczynski, who had no children, wrote in his manifesto, “Revolutionaries should have as many children as they can.”) “But where the Unabomber resorted to terrorism to disrupt what he called the ‘power process,’” Ahmari wrote, “today’s rightists mostly dabble in edgy memes and lifestyle escapism: the dream that weightlifting, ‘clean eating’ and the like are how you resist Davos Man.” Somewhat more sympathetically, in *Vanity Fair,* James Pogue described *The End of Men* and its protagonists as reacting against forces that had severed “our connection to our corporeality.”
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As if by algorithmic decree, the hosts of the *Red Scare* podcast have also weighed in on sperm decline and its Cassandras. As one of them summed up the Carlson program, “All this stuff used to be associated with leftist hippies and is now associated with right-wing nationalists.”
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Arguably, it’s more mixed up than that. In December, shortly after the most recent spermpocalypse study was published, Carlson invited Kteily to appear on his Fox News show. Kteily hemmed and hawed. On one hand, here was a massive platform hosted by someone worried about sperm. On the other hand, the nature of that platform would make it challenging to talk about his product in a way that wouldn’t alienate potential customers. The transgender market, it turns out, is a critical segment of Legacy’s clientele. As the number of male-to-female gender transitions increases, so does the demand for sperm freezing, as clients want to preserve their chance at conception after a medical procedure. He played out the worst-case scenario. “I say ‘people with sperm,’ and he’d be like, ‘Oh, you mean *men*?’ And then that’d put me in a situation where I bring up trans people and then he goes to town on me and I probably fumble.” Kteily turned down the invitation.
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Simone and Malcolm Collins, a natalist power couple, at home with their three children. They hope to expand their brood to a total of 13. Photo: Winnie Au
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**Global semen quality is not** exclusively the concern of opportunistic start-ups and the underground right. [Malcolm and Simone Collins](https://www.telegraph.co.uk/family/life/pronatalists-save-mankind-by-having-babies-silicon-valley/) are perhaps best described as the tech world’s preeminent pronatalist power couple. Malcolm used to work as a venture capitalist in South Korea; Simone was the managing director of Dialog, a social club co-founded by [Peter Thiel](https://nymag.com/intelligencer/article/peter-thiel-silicon-valley-contrarian-max-chafkin.html). They have three kids, are aiming for seven to 13, and lead numerous initiatives aimed at reversing birth-rate decline.
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We met in Manhattan for drinks recently, and Malcolm ordered a light beer. Simone, feeding a bottle to their infant daughter, Titan, explained that he was trying to limit alcohol intake on the grounds that too much might impair sperm health. She mentioned a Swan study that found that phthalates in the urine of women in the early stages of pregnancy correlated with reduced “anogenital distance” — the area between the scrotum and anus — in boys they gave birth to. (AGD has been linked to low sperm counts. The *Financial Times,* in a June profile of the octogenarian Swan, primly noted her use of the terms *ass-ball connector, taint, gooch,* and *grundle.*) “The same people who encourage us to fundraise for pro-natalism,” Simone said, “are also encouraging us to fundraise for active research in endocrine disruptors and declining fertility.”
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Both the Collinses and Raw Egg Nationalist are scheduled to appear at Natal, a pro-procreation conference taking place in Austin this December. But they don’t quite share the politics of *The End of Men* crowd. They consider themselves more socially tolerant, and their preferred solutions are not macho lifestyle hacks but tech-accelerationist moonshots: artificial wombs and in vitro gametogenesis, the turning of various human cells into sperm or eggs. (One notable IVG start-up is Conception, backed by OpenAI co-founder Sam Altman.) Last year, an Insider reporter asked the Collinses what distinguished their objective from that of Gilead, the breeder dystopia of Margaret Atwood’s *The Handmaid’s Tale.* They insist that Gilead is the danger, not the goal; in the novel, mass infertility is wrought partly by pollutants.
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Pro-growth centrists such as Tyler Cowen and Matt Yglesias — author of the more-people-is-good book *One Billion Americans* — worry about the effect of fertility decline on economic stagnation. Skittish East Asian governments are spending heavily on programs to incentivize childbearing. Yet to many on the left, there remains something discomfiting about the subject. The Collinses have been called “hipster eugenicists,” partly because they did genetic testing on their embryos before conceiving and partly because of the “Great Replacement” connotations. (For what it’s worth, the Collinses are not hipsters but fairly conspicuous exurban squares.) Malcolm argues his liberal critics have it backward. Politically, he says, the left needs to start reproducing more or else *they* will be replaced. “Their fertility rate is so low,” Malcolm says. “This urban monoculture that dominates our political and economic life today is temporary. We believe in cultural pluralism, so we’re out here recruiting.”
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When I started looking into the start-ups endeavoring to address sperm health, I often heard them described in progressive terms. In the spring, I met a Brooklyn health-tech investor named Leslie Schrock. (She has a stake in Legacy.) Schrock, who has two boys, and who has had three miscarriages, makes a point of focusing on sperm in her latest book, *Fertility Rules.* Far from a manosphere preoccupation, she sees sperm as something we don’t talk about enough, a word that elicits squirms or puerile jokes in a way that talk of ovaries does not. (This taboo may explain why TikTok keeps blocking Legacy from advertising sperm-freezing on its platform, offering shifting explanations for why.) “Nothing’s going to change in women’s health until men take fertility more seriously,” she says, as we chat on the Brooklyn Heights Promenade. In other words, men roam the earth assuming their sperm is healthy, while their female partners are downing prenatal vitamins, cutting out booze, freezing their eggs, and generally trying to optimize their ability to bear children. “Women are acting as treatment surrogates for men in assisted reproduction. They’re getting unnecessary IVF treatments for sure.”
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Gender parity aside, there is the *Silent Spring* of it all. Recently, the New York *Times* published an op-ed about the unreal proliferation of microplastics — in our clothes, in the Mariana Trench, in our bowel movements, atop Mount Everest. The author argued that the issue had something for everyone: birth-rate concerns for conservatives, ecological ones for liberals. The journalist Anna Sussman, in her review of Swan’s *Count Down* in the *New York Review of Books,* argued such a distinction was false — that the standard right-left labels simply don’t apply to a problem this big. “Women in coastal Bangladesh are reporting higher rates of miscarriage, which has been linked to the increased salinity of their drinking water caused by sea-level rise; children of pesticide applicators are born with higher rates of birth defects,” she wrote. “In such conditions, the prospect of reproductive ‘choice’ becomes moot. Unlike the middle-class American activists choosing childlessness,” in these vulnerable populations “childlessness is choosing them.”
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**All this agita** presupposes that Spermageddon is actually happening. As long as there has been sperm-decline research, there have been sperm-decline skeptics. Harry Fisch, a urologist and former longtime male-fertility expert at Columbia University, has been railing against suspected Chicken Littles since the 1990s, when an earlier scary-sperm-crisis paper dropped. When we spoke, Fisch volunteered a rather creative rebuttal to the latest research. Perhaps because Swan and Levine studied subjects who were unaware of their fertility status — a supposed strength of the study — oblivious college-aged men were overrepresented. Fisch thought of his sons. What do college-age men do? They drink and smoke weed and do other potentially sperm-degrading activities.
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Paul Turek, a renowned Beverly Hills urologist (and an adviser to Legacy), says he hasn’t noticed any systemic decline in his practice. But if it is real, it makes evolutionary sense. “If you look at monkeys and chimps who are polyamorous, they have big testicles, bigger than humans, with sperm counts in the one billion sperm per ejaculate” because there’s a war among males for females. In contrast, orangutans and gorillas occupy harems in which one male dominates, and their counts are closer to 20 million per ejaculate. In other words, Turek seems to be saying, sperm is trending downward because men aren’t in fierce competition to spread their seed widely.
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Turek hypothesizes that there is a divide between clinicians like him and “Ph.D.’s who run statistics” from above. “I think those of us on the ground don’t see it,” he says. “I’m a surgeon. I don’t get alarmed.” When he sees sperm problems, he attributes it to behavioral factors. “Sometimes it’s a hot tub, or obesity, or tobacco,” he says. “Sometimes it’s hormonal; sometimes it’s a flu, fever, COVID. But I would say 90 percent of the time I can figure it out.”
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In February, the blog Astral Codex Ten, written by the pseudonymous rationalist blogger Scott Alexander, published an exhaustive review of the academic literature around sperm counts. Applying cold, left-brained analysis to the subject matter, he laid out the implications: If the decrease is real, “people will point to the hundreds of studies demonstrating it and prestigious scientists pushing it. Doubters will be compared to global-warming denialists, ignoring science in order to continue their fantasy of consequence-free pollution.” If it isn’t real, it will seem like a “classic panic of fragile masculinity.” He concluded that in retrospect “it will feel obvious that one side was right all along.” At the end of several thousand words, Alexander couldn’t make up his mind which side was right.
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Perhaps the strongest argument against the doom and gloom is that sperm counts alone are not a good predictor of fertility potential, at least until one gets below a very low threshold. Kteily, who has a vested interest in exactly the opposite narrative, will concede the point. “I don’t think you can confidently say low sperm counts are leading to the birth-rate decline,” he says, ticking off a number of contributing factors. “We’re choosing to lead more individualistic lives; chemicals are affecting our ability to reproduce; it’s more expensive than ever to have children.”
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Kteily thinks the trend lines are worrisome enough to justify buying a backup plan. Besides, maybe Legacy can one day transcend its current offerings. Sperm is understood as a biomarker for overall health, and the semen in cryostorage might contain valuable data. “Imagine we could tell you, ‘Hey, you smoke. You stop smoking, your sperm motility is going to go up by 10 percent. And we know this because we have 100 people like you,’” Kteily figures. Still, he anticipates the criticism. “Look, the worst angle you can take on us is, like, we’re a for-profit company trying to make science sound worse than it is in order to make money.”
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Like the other kits, Legacy has created a convenient diagnostic — an entry point into conception. But should that diagnostic lead one to pursue a form of assisted reproduction, such as intrauterine insemination (placing healthy, “washed” sperm in the uterus around the time of ovulation) or intracytoplasmic sperm injection (a form of in-vitro fertilization in which a single spermatozoon is implanted into an egg), one would likely have to test all over again at a clinic. If the situation is not so dire, improvements in diet or lifestyle may do the trick. Legacy offers supplements, but even Kteily calls them “the least exciting thing we do.”
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If existential sperm deterioration is uncertain, but a testing kit can’t really help you if it is real, where does that leave Legacy? At first, the leader of the sperm-kit pack, with its earlier and more impressive rounds of fundraising, was arguably Dadi — not Legacy. When Ro, the telehealth giant, bought Dadi last May, it seemed like bad news for Kteily. But when I visited Ro’s website this spring, there were no sperm kits to be found and the equivalent of an UNDER CONSTRUCTION, PARDON OUR DUST sign under the male-fertility tab. By the summer, I learned, it had shelved the product. A Ro spokesperson told me the company had “paused the relaunch” of its male-fertility offerings and was devoting more of its attention to weight-loss drugs. Was this a Ro problem? Or did it spell trouble for the industry?
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Recently, Kteily and I met at a natural-wine bar near his West Village apartment. He is all but singing, “Ding-dong! The witch is dead!” “They shut it down,” he says, convinced of his rival’s collapse. “They shut it down.” He didn’t seem too worried about a sperm-kit-pocalypse. Not only could Legacy now consolidate control over the market, but Dadi’s disappearance may just mean he figured something out that Dadi hadn’t.
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The core of Legacy’s business, the profit-driver, isn’t supplements, and it isn’t testing. It’s freezing. Initially, the company had trained its marketing on fertility-curious single men, before shifting its emphasis to couples. The advantage of the pivot, Kteily found, was that they were freezing at a higher rate. The disadvantage: Couples trying to conceive were, well, trying to conceive. They tended to ask Legacy to *unfreeze* the samples and prepare them for use, which cost more time and money than he had hoped. “So now you have, like, flurries of emails back and forth to clinics across the country,” Kteily says. He faced a paradox: The more frequently customers used the service, the less money the company made. More useful to him were customers who weren’t necessarily conceiving and instead using Legacy as a kind of insurance policy.
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Couples still use the product plenty, but a more unusual coalition generates the meaningful cash. In addition to transgender customers, who bring in about a fifth of the company’s revenue, another 20 percent comes from people with medical conditions or who work “dangerous jobs” — including servicemembers — who freeze sperm as a genetic safety net. Another fifth of the pie comes from vasectomy patients who are preserving semen in case they change their minds, and a reversal fails. (Kteily says this clientele has shot up in the aftermath of *Roe*’s demise, as more men are using vasectomies as birth control.) For all its outward emphasis on sperm calamity, in other words, the company has found itself capitalizing on entirely unrelated aspects of modern life. Despite the egg-drinkers and natalists poring over *Count Down,* Kteily is following the money toward different sperm-anxious constituencies altogether.
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Still, it can’t hurt the bottom line when the headlines move men to contemplate their fertility. In February, a team of Harvard-affiliated researchers published a paper, promoted in a news release with the *Onion*\-esque summary: “Study Shows Higher Sperm Counts in Men Who Lift Heavy Objects.” Accompanying the release was a photo of a man in a flannel shirt, holding a yellow hard hat, standing in front of excavators. Studying 377 men who sought fertility treatment at a Boston facility between 2005 and 2019, the team found that the typical office worker had about half the sperm of a guy performing rigorous labor on the job. The study was made possible by funding from the National Institutes of Health, the National Institute of Environmental Health Sciences — and Legacy.
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\**This story has been corrected to reflect that Kteily shared a study promoting the efficacy of an at-home sperm test, but that he did not claim this study was based on Legacy’s test.*
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The Global Sperm Count Decline Has Created Big Business
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