Legacy Goes to SXSW to Talk About Sperm…

Khaled Kteily
7 min readMar 30, 2022
The Legacy team at SXSW, pictured in front of our sperm ‘infinity mirror’

If you came by SXSW in Austin this year, you may have seen a team of 10 folks talking about sperm in front of a sperm ‘infinity mirror’ or helping run the ‘amazing sperm race’.

Beyond wanting to meet thousands of attendees at SXSW this year, this is part of our broader goal of normalizing conversation around male fertility. Reactions range from bemused to curious to fascinated, and included single men who aren’t thinking about having kids anytime soon as well as couples who are trying to conceive right now.

Now, we know that sperm testing and its subsequent fertility markers will unlock new and novel methods for assessing and delivering long-term healthcare, but why do we care so much about fertility?

As a fundamental part of the human journey, fertility questions are something we don’t always talk about or even think about, but we should. And part of our SXSW trip was presenting to an audience at a session titled “Male Fertility: the Hidden Sperm Crisis”. And here’s what I told our SXSW audience about why.

Fertility rates are dropping, but it’s a nuanced conversation

Overpopulation is nuanced. The kneejerk positive reaction to a reduction in population numbers isn’t going to cut it in serious conversation. All over the world, birth rates are falling, with greater numbers in more developed nations, and we have to consider these events from multiple angles.

We need 2.1 babies per woman or person carrying to term to maintain the current population numbers — this is known as the replacement rate. The USA now averages 1.7. Germany averages 1.5. Japan and Singapore average 1.33 and 1.3, respectively. Many countries expect their population to drop dramatically in the next 80 years — 23 countries, in particular, will see populations drop by half. At current population growth rates, Nigeria will outnumber China by the end of the century!

It’s a complex conversation managing both the effects of human populations on the earth’s resources while also understanding that human communities must continue to thrive for all of us to live well. When the majority of the population is older, it can strain healthcare resources and social security systems. We’re seeing this in Japan already — this is known as an inverted age structure, and it means we might not be able to take care of our elders. And when we are elders, our grandchildren will not be able to take care of us!

Part of what’s causing the decline in global birth rates are good things — like increased access to contraception or greater access for women to education or healthcare. But there are other factors at play, too. Because demographics matter, too.

And the reality is:

  • People are older.
  • They’re meeting later.
  • They’re getting married later.
  • They’re giving birth later.

These shifts create major change in how we approach planning for families and our future.

The science around fertility can help us plan the lives we want

Norms around family building are changing as well. Because people are waiting later to have children, we have to consider the age of both the mother and the father. Notice I included fathers in that statement.

Women have heard practically from birth that their biological clock has a limit. They’ve fielded constant questions about it from others — When will you settle down? When will you start a family? How many kids do you want? Don’t you think you’re waiting a little late?

But men also have a limit on their clock. Just because they can produce sperm well into their geriatric years doesn’t mean that sperm is quality. Older men can experience more instances of infertility than younger men, which makes the fertility question something for everyone.

The rule of thumb with infertility is that one-third is a female factor, one-third is a male factor, and the final third is a joint or unexplained factor. Meaning science tells us this isn’t “just a woman’s issue”.

This particularly matters when we live in a post-nuclear family world, where you’re no longer expected to have a man, a woman, 2.5 children, and a white picket fence. It’s increasingly common to see single parents choosing to have a child. It’s increasingly common for a transgender woman to want to freeze her sperm before beginning to transition. It’s increasingly common to hear about babies born through surrogacy or Assisted Reproduction Techniques like IVF. If you believe you’re going to have a more complex fertility journey, you need to be thinking about your fertility from an earlier stage of life.

Legacy CEO Khaled Kteily and Legacy COO Sarina Richard presenting at SXSW 2022 at a presentation titled, “Male Fertility: the Hidden Sperm Crisis”

Legacy wants more people paying attention to sperm

Male fertility has decreased by about 50% over the last 40 years. Men on average are now half as fertile as their fathers or grandfathers were at the same age. In addition, male fertility declines with each year you get older, and especially in your 30s and 40s. Meaning that despite the attention paid to a woman’s biological clock, there are significant risks for men trying for children later in life as well.

Age is a factor in male fertility

Poor sperm quality can make it more difficult to conceive, increases the likelihood of a miscarriage, and increases the likelihood of having a child born with a congenital condition like Autism. A study of over 130,000 men found that fathers over 40 were 6x as likely to have children born with Autism Spectrum Disorder (ASD).

Another study of 40M births found that older dads are more likely to have children with low birth weight and a higher likelihood of mortality. These babies are also more likely to be born prematurely, struggle with seizures, and are even more likely to cause the mother to develop gestational diabetes.

Women are born with all the eggs they’ll ever have, but men make new sperm continuously. This leaves room for genetic changes and makes sperm a true biomarker of overall health because of fundamental DNA changes present in each sperm. Why aren’t we talking about this?

New chemicals in the environment are also a factor

So what’s causing this? It’s plastics production. It’s the fertilizers and pesticides in our foods. It’s the hormone disruptors and endocrine disruptors. These include phthalates and BPA, chemicals that you find in plastics.

Since the Second World war, hundreds of new chemicals came onto the market within a very short time frame. These chemicals were entering our bloodstream for the first time with almost no federal oversight and with virtually no forethought or planning.

And the problem is that you find these chemicals everywhere. BPA is in our water bottles and our food containers. Phthalates are even worse — they’re in gels and pills and lubricants and sex toys. They’re in the tubing that processes foods, so they’re in milk and yogurts and soups. The CDC has determined that every single person in the United States has a measurable level of phthalates in their body.

Notably, a study of canine sperm found that even dogs living in human households faced a similar drop in sperm quality. Dogs that live in the wild did not. Think of the puppies…

Exposure to these endocrine disruptors — known as forever chemicals — reduces testosterone production, reduces sperm product, and can literally lead to outcomes like smaller penises and smaller testes. There are also risks that they can be passed on to future generations — a phenomenon known as epigenetic inheritance. Your father can literally pass along his low sperm count to you.

What should we do about it?

A study that tracked 40,000 men over 40 years — found that the worse your sperm, the higher your mortality rates. In fact, the worse your sperm is, the higher your likelihood of having cancer, diabetes, or cardiovascular disease. Your sperm quality is a predictor of how long you will live — so pay attention.

If you produce sperm, you should be testing it to understand how healthy it is. If you’re thinking about having kids in the future, you should consider freezing your sperm while your sperm is younger and healthier.

Going one step further: Male fertility is easier to diagnose, easier to treat, cheaper to treat. It’s most commonly caused by what’s called a varicocele, which is easy to treat with a minor surgical intervention or even just with lifestyle changes.

The US is the only country in the world that doesn’t start by testing the male partner, and that is ridiculous. Female fertility testing or egg freezing is expensive, invasive, and painful. Male fertility testing or sperm freezing is easy, cheap, and enjoyable. In fact, I think that a real feminist — one who cares about rebalancing burdens, workload, stress, mental pressure, etc. around fertility and family planning — should be freezing their sperm. It’s no longer women’s responsibility but a shared responsibility.

My vision with Legacy is to change the norms around fertility conversations and sperm. Legacy handles more sperm than anyone in the country, and we’re poised to unlock valuable health messages housed within sperm and semen. We’re making the conversation normal, erasing stigmas around male infertility, and revolutionizing what it means to think about family planning. If you’re thinking about your legacy, it’s time to start now.

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Khaled Kteily

Khaled is the Founder & CEO of Legacy. Prev. at Harvard, the World Economic Forum, and UN Women.