What we miss when we ignore male infertility

What we miss when we ignore male infertility ByJim ReedHealth reporter In mid-2020, while Covid lockdowns gripped the country, Luke and his wife decided to start a family. "All through my teens the message was clear: don't have sex without a condom or you might get someone pregnant," he says. "So, when you're older, you expect everything to just happen normally. When it doesn't, you don't know what to do or where to go." After 18 months without success, the couple saw their GP and were referred for further tests in hospital and at a fertility clinic. Over the next year or so, Luke says the focus was entirely on his wife. Appointments were all in her name. When he had to fill out paperwork, his wife was contacted even though all his details were on file. "At the heart of it, the whole system is based on the assumption that it's a woman's problem," he says. "The male side gets totally overlooked." It took more than a year, and a failed round of IVF, until Luke was told there might be an issue with his sperm. "I was like, 'Now you're telling me?'" he says. "There were things on my side that could have been looked into much sooner, rather than treating me as an accessory to the process." Infertility affects roughly one in six couples and about half of those cases are linked to male problems, either alone or alongside female causes. Under the latest clinical guidelines from NICE (National Institute for Health and Care Excellence), couples still struggling to conceive after 12 months of unprotected sex should be assessed together as one unit, with men and women offered further checks in parallel. Yet experts say men are often sidelined in diagnosis, treatment and in fertility conversations. "There can be genuine exclusion even if it's unintentional," says Prof Bola Grace from University College London. "Men tell us it can happen across services - in how care is delivered, in fertility clinics and in counselling." A study led by Grace in 2019, external found many men wanted to be more involved in the fertility process, but often felt their voices were not heard. The result, she argues, is often self‑perpetuating - some fertility services don't include men, so men engage less, which reinforces the idea they are simply not interested. "We've created a cycle where men are excluded, but then they're also blamed for not showing up," she says. This can have real consequences, she adds - not just for men but for women, who often end up having to deal with far more of "the coping, the planning, the worrying, the decision-making". It can also mean problems are picked up later, tests and treatment can be more invasive, and couples may face a tougher, more expensive path through fertility care. So how could the system offer more support when a man has been told he may have a problem? And what more could be done to get men to more talk openly about fertility? Since the first IVF birth in 1978, fertility treatment has largely been framed around women, partly for biological reasons. IVF involves stimulating the ovaries to produce eggs, retrieving them, fertilising them in a laboratory and then implanting the resulting embryo back into the womb. By contrast, most men provide a sperm sample and wait for science to do its thing. Image source, AFP via Getty ImagesImage caption, In 1978 Louise Brown was the world's first baby to be born following successful IVF That imbalance has shaped how fertility care has developed, argues Allan Pacey, professor of andrology (a medical specialty focused on male reproductive health) at the University of Manchester. He says fertility units and clinics are typically led by gynaecologists, whose training focuses on female reproductive health, while male fertility can often be treated as a secondary concern. "Now, there are some really good gynaecologists that do it well, because they're interested in this, but at the level of the GP or the secondary care clinic or the tertiary care clinic, men can be an afterthought." At a policy level, there are similar imbalances, he says. The Department of Health has recently published separate men's and women's health strategies, setting out the government's 10-year vision for healthcare in England. Fertility features around 20 times in the women's version, with a page devoted to support and clinical guidance. In the men's document it is mentioned just five times, and mostly in relation to obesity, alcohol or other health issues. Pacey, also a former chair of the British Fertility Society, calls this a "missed opportunity to level the playing field". "This is absolutely not saying that we should do less for women, we should probably do more for women as well," he says. "But by giving men a proper role, we can fundamentally change what happens in the future, both in terms of their experiences, but also in the terms of what we can do research-wise or treatment-wise." A Department of Health and Social Care spokesperson said: "It is right that me

What we miss when we ignore male infertility

Key takeaways

More in top