Let’s talk about male fertility
Fertility and infertility from my experience still generally fall under the woman when general discussions are being had. Women’s biology and physiology is more complex and they have to carry a child as a result of trying to conceive. I think this coupled with the societal perspective on fertility means that we aren’t talking about male fertility enough. If you’d prefer to hear my general musings, then grab a cuppa and join me for the short video below.
Why do we need to open the discussion about male infertility?
The statistics show that the causes of infertility are evenly split down gender. This means that in any couple with infertility 30% will be female, 30% will be male, 25% will be unexplained and 15% will be both.
Couples in the western world are now waiting longer and longer to have children with many people starting trying to conceive in their early to mid-30’s much like Rachel and I did. This means that people are waiting till later in life to try to conceive which consequently makes any fertility treatment they may need as a result of their infertility more complex because of more advanced age.
While many of the infertility issue experienced by women are invisible there are many which can be hinted out through thorough tracking and monitoring of their cycles, which can often lead women to seek support and testing earlier than suggested.
However, with men, unless you produce no semen at all male fertility issues are virtually undetectable through looking at your semen. This means men often don’t find out or even discuss their fertility until they are encouraged or sometimes even forced into getting a full semen analysis as part of fertility testing.
This delay in checking often leads couples to try and conceive for longer than is necessary before seeking support, leading to more assisted reproductive treatments occurring later in life. Which ultimately reduces that couples’ chance of getting pregnant.
Let’s be honest about the ‘maternal’ clock for men
The conversation about the desire to have children again is very female centric. From the many discussions and hours of research I have done what is clear is that many men have a ‘paternal’ clock.
Let’s think about the reasons for this, we are at the end of the day mammals. Our bodies have evolved to sexually reproduce to carry on our gene line. Whilst our intellect and reasoning has evolved substantially over the last 10,000 years that biological desire to pass on your genetics is still there.
I personally have known deep down that I wanted a family from my very early 20’s. But life got in the way, I was focused on education, a career and I never met the right person until I was 30.
When I did, it was wonderful we were both in the same place and wanting children. But Rachel was on injection contraception, which she had to wait to leave her system, then we moved, then I was made redundant.
All of these ‘normal’ life events meant the time wasn’t perfect and so we put off starting to try to conceive properly. Don’t get me wrong, we weren’t actively avoiding trying but we weren’t vigorously pursuing it.
Then when we did start officially trying my desire to have children that paternal clock if you will had been ticking for over 10 years.
What can you do as a man to bring male fertility to the couple’s fertility journey?
Well firstly let’s describe a ‘typical’ infertility journey.
Step 1 – You have a conversation and start trying
Step 2 – A time period passes with no success, usually around 6 months, and the women engages in a conversation and a decision is made to track her cycle and test for ovulation and the man agrees. There is almost always no discussion of male fertility at this point. There may be a discussion about cleaning up your lifestyle, diet and habits.
Step 3 – Another 6-12 months pass and still nothing has happened. The stress has been rising, your sex life has changed because you are now trying to achieve something and often the woman may say I think we should go and get our fertility checked out.
Step 4 – You go and have a discussion with your GP, and they refer you onto a fertility clinic if you’re lucky for testing – As a man I procrastinated this bit for reasons we’ll explore below
Step 5 – You’ll have your fertility testing and get a diagnosis of infertility.
Step 6 – Start whatever assisted reproduction treatments are right for your case. In the case of IVF this must be after a minimum of 2 years actively trying to conceive.
As a man, I thought about my own fertility from step 1 in the process but didn’t hugely engage in the conversation until step 5. For me after about 9 months, I began to feel guilty, inadequate and as though I wasn’t manly enough to conceive. These were quite powerful emotions that I didn’t really know how to deal with.
I procrastinated for a few weeks about going to get checked at the GP for that initial appointment and blamed work. I could have got there earlier but I was trying to work through the what if it’s me thoughts that were swimming around my head.
Through our infertility journey we have met many couples and discussed fertility with men and women and some couples have a proactive way of dealing with things which is partly what inspired me to start this website.
Let’s think about a healthy way of approaching fertility when trying to conceive where both the men and women are engaged in their own fertility and your joint fertility.
A more equal infertility journey.
Step 1 – You discuss trying to conceive before you try. This includes:
- Exploring and understanding how your sex life will change and what you will do together to keep that romance and intimacy alive
- You will discuss your lifestyle, how’s your diet, are you exercising, smoking, drinking all the area’s that can help improve fertility.
- Do some baseline tests. Men get a home-based sperm testing kit, these can check the concentration and motility (movement) of sperm and if you have any really problematic results you can immediately go to your doctor to get a full semen analysis done (this step could save you 2 years if male factor, non-treatable infertility is present). Women should track their cycle, understand their regularity, and the structure of their menstrual cycle.
- Agree to how you are going to approach trying and what changes need to be made (men if you do a home sperm test and you agree to make lifestyle changes then you can use a home semen test kit to monitor how those changes are impacting your count and motility)
- Step two – Try to conceive but keep the conversation and the testing going for 6 months, agree at this point if you are over 35 to go the GP now and that if you are over 30 you will go at 12 months. Keep engaged in the conversation, test your sperm again to see the positive impact on your sperm from the lifestyle changes you have made.
- Step 3 – When you reach those agreed milestones, you can now approach the doctor as a couple and not independently in the knowledge, that you are fully informed, you have tested, you have cleaned up your lifestyle and you have both considered male and female infertility. You will feel more empowered and those feelings of guilt and inadequacy won’t be as powerful as they can be if you have never engaged in the conversation. You’ll be so engaged in the process that you’ll be able to advocate for each other’s best interests and ensure it’s taken seriously.
- Step 4 – You will attend all fertility clinic appointments together as it’s your joint journey. The diagnosis will be the diagnosis that you have as a couple, it’s also less likely to be a shock as you have done everything to improve your chances of natural conception.
- Step 5 – Like all other steps in your fertility journey whatever assisted reproductive treatments which may be required. Whether it’s IUI, IVI, IVF or ICSI you will feel comfortable that as a couple you did everything you could and that it wasn’t a one-sided discussion.
Why is the conversation so one-sided in terms of fertility?
We briefly touched on the biological and complexity sides of the argument in the first section. But one area we haven’t looked at is society. Overall societies are becoming more and more openminded, racial and sexual equality are clearly defined and actively pursued. Religious and sexuality choices are respected and understood more with each passing day.
I’m not saying that any of these are perfect – far from it – but the discussions are being had. However, infertility and IVF are not part of the mainstream conversation yet and as such people don’t have experience opening up about it until they find themselves needing to.
This is a personal opinion and not meant to cause offence to either side. Although we have gone a long way to ensure that gender roles are being blurred and quite rightly. There is still a large discrepancy in terms of male rights when it comes to maternity, childcare.
Don’t get me wrong there are a huge number of area’s where women’s rights are hugely impinged , but the reason I mention this is because I think it has an impact on how people have been brought up and what society and nature has taught us in terms of children.
For example, we have been on antenatal classes and had a health visitor round recently and obviously the pregnancy, labour and breast feeding must be aimed at the woman. We have found that people automatically assume that women will be providing the childcare and are shocked and backtrack when we say that after 9 months I will be taking over as I work from home, so it makes sense.
My brother-in-law took a year off after my Sister had her years maternity to care for their children. Some of the comments that he told me he had from work colleagues, other mums and dads and people in general made him feel like there is something wrong with him for doing it, that he should be providing so to speak.
Now I know this has move tangentially off topic, however I am of the opinion that this is partially responsible for why we as a society still view fertility as a female problem, when it is clear from the statistics it is everyone’s problem and there needs to be a societal shift in thinking for men to engage in the fertility conversation as a matter of course.