Hannah Kelly is a third year medical student at St Hilda’s College, University of Oxford, and is the secretary of the Oxford Medical Students' Society. All views expressed are her own.
How can we normalise conversations around male fertility?
It starts with doctors.
Walking into the first of an optional lecture series on early development focussing on male fertility, I was shocked to see there were fewer than 10 of us in the room. Most of us were women. The lecture itself was great, the lecturer was engaging and clearly very passionate about the subject. The issue was there was no one there to hear it.
It is very clear that medicine considers fertility a predominantly women’s issue. In one study it was found that female medical students had higher awareness of fertility than their male colleagues despite having the same curriculum, and women in general have a higher awareness of fertility than men despite the fact that male factors contribute to 50% of fertility issues in couples trying to conceive (1).
Indeed this attitude that fertility is a women’s issue continues long past medical school. In the UK there are around 2,300 Urologists compared to 6,450 Obstetrics and Gynaecologists (2). When considering that urology is a very broad specialty, the number of doctors specialising in male fertility is much lower than those specialising in female fertility. For example, University College London Hospitals Trust employs 32 urology consultants, with only 6 of these consultants specialising in andrology and male fertility(3).
However, this outdated view isn’t confined to medical doctors. A quick search on PubMed, an online database for medical research papers, showed 90,103 results for female fertility (4) compared to 57,428 results for male fertility (5). Research into male fertility issues is lagging behind and is affecting our understanding of infertility.
How can we expect the general public to openly talk about male fertility when the medical profession still considers fertility a women’s issue and research into male fertility issues is sorely lacking?
In my opinion male fertility needs to be taught in more detail, earlier on in medical school, and should be considered at the same time as discussions on female fertility rather than as a standalone topic. Male and female fertility are linked and should be treated as such. Couples trying to conceive should be able to see a gynaecologist and an andrologist in the same appointment as issues with conceiving can often be due to both male and female factors, which need to be considered when treating a couple struggling to conceive.
It is interesting that women are encouraged to visit a gynaecologist before even considering trying to conceive whereas men’s reproductive health is largely ignored until there are issues with fertility.
There are very limited opportunities for men to seek help regarding fertility issues and finding these resources can often be difficult. Given the opportunity to access fertility testing and advice about improving fertility, many men would be able to make lifestyle changes to improve their fertility and conceive naturally rather than resorting to other methods such as IVF.
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References
1. Fertility awareness among medical and non-medical students: a case-control study (Nouri et al 2014)