“In our culture, reproduction is women’s work. That work includes everything from conception to pregnancy, childbirth to breastfeeding. Infertility support groups, online chat groups, books, websites and blogs are led by women, written by women and geared toward women,” says Liberty Barnes. “Men are missing from our collective imagination and social dialogue when it comes to infertility.”
Barnes should know a thing or two when it comes to attitudes toward male infertility. Currently a research associate in the Department of Psychology at the University of Cambridge in the UK, Barnes has spent the last 7 years investigating the topic by shadowing doctors in fertility clinics and talking to couples with male infertility. All of her research led to the publication of her book Conceiving Masculinity: Male Infertility, Medicine and Identity.
But is what she says regarding society’s attitudes toward male infertility accurate? Is infertility primarily seen as a woman’s issue?
“Unfortunately, the myth that infertility is just a female problem is very prevalent in the US,” says Diana Cummins of Resolve: The National Infertility Association. “Women are the recipients of most of the medical testing and procedures, regardless of the cause of the infertility, so this leads people to believe that the infertility lies solely with the woman.”
“Also,” Cummins adds, “women are more likely to speak about their infertility struggles and seek emotional support, even if the problem lies with their partner. This gives the impression that infertility only affects women.”
According to the American Society of Reproductive Medicine, in 40% of all infertile couples, the male partner is either the main cause or contributing cause of infertility.
Male infertility is mainly caused by sperm abnormalities, such as low sperm production, misshapen or immobile sperm, or blockages that stop sperm delivery.
Such abnormalities can be caused by numerous medical conditions, including ejaculation problems, infection, varicocele (swelling of the veins in the testes), undescended testicles, erection problems and celiac disease.
Environmental factors – such as exposure to industrial chemicals or radiation – can also reduce sperm function and production. Medical News Today recently reported on a study suggesting that chemicals found in toothpaste and sunscreen may interfere with sperm production.
Health and lifestyle factors – including smoking and emotional stress – may also lead to male infertility. A 2013 study published in the British Journal of Sports Medicine associated a sedentary lifestyle with reduced sperm quality, while other research found a high-fat diet may negatively impact quality and concentration of sperm.
Of course, the main sign of male infertility is the inability to conceive a child. But unlike many other health conditions, male infertility often does not have any obvious signs or symptoms.
This means that if a couple is having problems conceiving, both sexes should be evaluated for infertility in order to determine the source of the problem. This begins with talking to a health professional – usually a urologist – who will carry out a basic interview and examination.
For both men and women, the thought of talking to a health professional about fertility is scary. Naturally, there will be feelings of embarrassment, low self-esteem and maybe even a sense of blame. “Men also tend to feel guilty that their wives or partners need to undergo infertility treatment if the cause is their own,” says Corey Whelan, program director at the American Fertility Association.
But it appears men experience an additional worry. Many fertility experts, including Susan Seenan, chief executive of Infertility Network UK, say that a lot of men see infertility as a threat to their masculinity, “and the fact that they can’t ‘fix’ the problem often means they won’t discuss the issue at all,” says Seenan.
However, Barnes says that from her work, she has found that men who are at the receiving end of infertility say they do not feel the condition affects their sense of masculinity but that it is considered emasculating by others.
“While they understood that in the broader culture male infertility is considered unmanly, they carefully thought about their particular diagnosis and were able to make sense of it in terms that preserved their sense of masculinity,” she explains.
She adds that it is other people’s perception of male infertility that makes talking about the condition “taboo.”
“We presume infertile men are suffering deep anguish, but the truth is, male infertility makes everyone feel uncomfortable. Doctors, wives, families, the media, and everyday folk feel compelled to protect men from a crisis of masculinity like male infertility.”
But it is not only a sense of embarrassment or a potential threat to masculinity that can deter men from talking about infertility. Cummins believes that lack of understanding surrounding male infertility makes it harder for men to talk about it openly. She says:
“Male reproductive health in general is so misunderstood, to then talk about and share when there is a problem is very difficult for men to do. This lack of knowledge definitely impacts the male response to an infertility diagnosis.”
“The general public understands that male infertility exists,” adds Barnes. “Yet, few people realize that it is as common as female infertility. Most people know that male infertility can be assessed through a semen analysis. But many people are unaware that there are specialists who focus specifically on male infertility.”
Indeed, there are a series of tests that can detect male infertility. A sperm and semen analysis involves a trained expert assessing a man’s sperm count from a semen sample, as well as the shape (morphology) and movement (motility) of the sperm. If any abnormalities are found, further tests will be required.
Other tests to detect male infertility include hormone evaluation, genetic testing and a physical examination, which can usually pick up varicocele.
Assisted reproductive technology (ART) involves obtaining sperm either through normal ejaculation or surgical extraction. The sperm is then either inserted in the female genital tract, or used for in vitro fertilization (IVF) where it is combined with a partner’s egg inside a laboratory.
In the case of hormonal problems, there are hormone replacement medications available that may reverse infertility, while antibiotics may treat an infection of the reproductive tract.
But of course, as with female infertility, not all treatments work. In the case of female infertility, there has been an array of medical research looking to address such problems.
Last year, Medical News Today reported on a study detailing how a new IVF technique – labeled “endometrial scratching” – may increase pregnancy rates by 20%. Other research, published in the Proceedings of the National Academy of Sciences, reported on a new method to induce egg growth in infertile women.
But has the same amount of effort been put into research for male infertility? Not according to Barnes.
“Amazing research is being done now in the field of male reproductive science,” she says.
“Unfortunately, the historical focus on women’s bodies means that male infertility research has lagged behind. We have inherited a medical system and medical technologies that are primarily focused on women.”
Barnes believes that the medical community needs to embark on some major changes in order to shift more focus on treatment for male infertility. She notes that treatment for female infertility is a “well-defined medical specialty,” but that treatment for male infertility is not as well organized.
“As a result,” she adds, “men do not always know where to find the proper channels for help with their infertility issues. Some men are happy to pursue IVF each time they want a child, but others would very much like to fix their fertility problems so that they can impregnate their partners themselves. These men find the medical system very frustrating and unsympathetic to their needs.”
However, Seenan believes that, so far, there have been major advances in research and treatment for both male and female infertility.
“Where we have to be careful is that this research continues and future generations benefit from further advances, that we try to prevent fertility problems so that fewer people suffer from it in future,” she adds.
But there is one point that all fertility experts are in agreement on: there needs to be more awareness and focus surrounding fertility in general. “Once that happens,” says Cummins, “it will be a natural outgrowth that male infertility is talked about.”
Barnes believes that for infertility to be viewed as a shared issue, society needs to abolish the association between male infertility and masculinity. She believes that those with an influential voice – such as the media, doctors and bloggers – can kickstart the process by talking about male infertility more openly.
Whelan agrees, particularly when it comes to the role the media can play in raising awareness of male infertility. “The press needs to become our allies in this area and focus less on celebrity stories and more on everyday folks,” he says.
But could it be that we are already on our way to increasing focus on male infertility? Is infertility starting to be viewed as an equal issue among couples?
Barnes says that in general, each generation is more open about discussing sex and reproduction. “Also,” she says, “we see more egalitarian approaches to marriage and the division of labor with each generation.”
“Thanks to this kind of social progress, I noticed that younger men find it easier to acknowledge and openly discuss their infertility issues and are striving for a team approach to family building with their partners. I believe we are progressing toward shared reproductive responsibility.”