By: Tom Grills, University of Oxford Micro-intern at Jack Fertility
Tom Grills is a Biomedical Sciences student at Keble College, Oxford.
Views expressed are his own.
Our society has made the subject of male fertility and sperm taboo- this is massively detrimental for the young population. As a young student myself, it’s not something I have considered as an issue and definitely not something that I would have conversations about with my friends, despite the fact I ran the Movember campaign for my college last year, which is focused on men’s mental and physical health. Fertility for men, especially in my age group, is something that just isn’t discussed enough.
I will start this article with a question- what percentage of fertility issues involve an element of male infertility? I assumed, wrongly, that this would be a low number. However, I couldn’t have been more wrong. In a study published by Thonneau et al (1991) [1], they found that in over 50% of the cases they studied, there was an element of male infertility. A point to note is that this doesn’t mean 50% of men are infertile - this was the number of male fertility issues in a group of couples who were struggling with infertility. Furthermore, this isn’t to say that male infertility is the only issue, however, the discussions around male fertility don’t appear to nearly match what the statistics require.
In addition to this, male infertility is on the rise. The so called ‘spermageddon’ scenario, although perhaps not sounding overly serious, describes the fall in total sperm count in the past 50 years. It is reported that the total sperm count has decreased by an estimated 62.3% from 1973 to 2018 [2], potentially leaving the average person with sperm reliant on assistive technologies in the future.
How may our traditional image of masculinity be hurting your masculinity?
Why does this nonchalant attitude to male fertility perpetuate in our society? What about the topic of fertility is so scary to men and stops us from talking about it. Maybe it’s the emasculating nature of fertility clinics; potentially it’s the fear that if we can’t provide adequate sperm, we fail as men. It certainly isn’t aided by the lack of infrastructure around male fertility. This speaks to our societies broken idea of masculinity. What makes up the ‘perfect man’- is there even such thing? The most distorted thing about this concept is that some of the activities that are presented as ‘macho’ and ‘manly’ can actually damage people’s ability to produce viable sperm, leading ultimately to an emasculating feeling.
A key example of this can be found in the gym. Before starting this example, I will clarify that going to the gym is in no means a bad thing, or bad for your reproductive health. Many sources, such as HimFertility which is talked more about in the final section, advise exercise as a way to improve your reproductive health. However, there is a subset of gym goers who (illegally) use steroids, to unnaturally enhance their physique. Particularly, this can be seen on social media in the community of fitness influencers. More and more influencers are becoming open about use of anabolic steroids and have started talking on the negative side effects of them, however there is still a large number of ‘fake nattys’ as they are colloquially referred to as, who lie about steroid use. One example of an honest influencer, and someone who I believe is making a real difference, is Noel Deyzel, who has made a few videos talking about his prior use of steroids and the issues this has caused himself, but moreover why the fitness industry has to take care to not glorify the use of steroids to young audiences. These videos particularly hit home as Noel fits the stereotypical masculine look for a bodybuilder on steroids, and yet is talking sensitively about the issues his previously lifestyle choices are currently having on him. This work is great, however not enough is said about the issues that steroid use can cause for future fertility specifically. Whilst Noel hasn't addressed fertility or his own fertility status publicly as far as I am aware, a multitude of studies have looked at the negative effects of steroids on fertility, and when combined with the knowledge of the widespread use of steroids (in a 2016 article by Osta et al [3], they quote the number of anabolic steroid users in the United States as 3 million), the potential significance of this issue starts to come to light...
Image 1. Noel Deyzel, a fitness influencer who is real and open with his use of steroids and how this has effects his health.
However I don’t think the total significance of this issue is made clear by the example of the gym. I don’t think that the root of the issue is necessarily one practice, or one habit. The issue is men have a tendency to adopt an invincible mindset. So many men are prone to thinking they won’t be the outlier, they won’t be that rare case. The thought process goes something like “Sure, some cases of hypertension and arrhythmia have been reported from anabolic steroid use, but I’m in good health, so I won’t be one of the rare cases”. This is seen hugely in gym goers who ‘dabble’ in steroid use, believing that one cycle may be so insignificant that they can’t possibly see any health side effects. Sadly, this invincibility attitude extends into fertility. We just assume that we are fertile unless proven otherwise, and then just react to the consequences if they happen to us, which most assume that it won’t happen to them. To make matters worse, this is an issue that’s not defined by rare cases, with 1 in 6 couples experiencing issues with fertility today- this is a very real issue, and this is an issue that can affect you.
What knock-on effects do our traditional views of masculinity have?
The impacts of the stigma around male infertility span a lot further than just failing to have a child. A report from one of the UKs leading fertility charities Fertility Network UK, in combination with researchers from Leeds Beckett University, used a qualitative survey of men who had been struggling to conceive a child- this survey included 41 participants, and was designed to allow men to open up and share what impacts infertility has had on their life. The report publishes some snippets of the story’s men shared, some of the which identified issues that had previously never occurred to me. For instance, one of the issues mentioned was financial debt from failed fertility treatment, as these costs can get very high very quickly. Furthermore, a lack of support and employer help was reported- one particular quote said “I had a good career, good money and I went from this to losing my job due to all the stress... I did not discuss this with my employer as I felt too ashamed”. I feel this distils the essence of the issues facing infertile men. This highlights the shame and taboo that the subject of male fertility holds and illustrates how this can affect careers that had otherwise been successful. Despite being an extreme example, general decreases in mental health in men who struggle with fertility are not- 93% of the men in the study described detrimental effects to their mental health. This can include stress, anxiety and depression. It spans wider than just feeling emasculated- the pressure to provide a family can lead to some men questioning their relationship, feeling they are letting partners down, and increasing pressure in their personal lives because of this when it need not be the case.
Hope is not lost...
There is some support in place for these men, and it is growing, but despite this upward trend, there is a still work to be done. One amazing campaign that is currently running is the HimFertility campaign, originally fronted by the comedian Rhod Gilbert. Gilbert speaks candidly of his own struggles with fertility and HimFertility has set up an excellent website that hints at far more of the issues that can affect fertility than the small number I have spoken on here. This campaign may be quite accessible to older men; however this may miss the mark with the younger generation in my opinion. I feel that some large traction could definitely be made in the student population. Despite the fact that in freshers week, students are bombarded with leaflets and advice, only once have I seen anything related to fertility, and this was still mostly focused on STIs. One way to create more open conversations is to start younger- creating a sex-education system that highlights the issues with fertility that come with certain life choices. This could create a population of men that are more familiar with the effects of what the life choices they make have on their fertility. Backing this up could be campaigns providing warnings on products such as alcohol and tobacco, both known to reduce fertility.
Creating open conversations is key to tackling this issue. We are moving into a time where men can do something about their fertility, proactively. A lot of the damage we may cause ourselves can be reversible and can be helped by small lifestyle changes. And this is where Jack Fertility is leading the charge. Mail in sperm test kits allow for men to move past the embarrassment they may feel at a fertility clinic and allow them to proactively take steps to take control of their fertility.
References:
1. Thonneau, P., Marchand, S., Tallec, A., Ferial, M. L., Ducot, B., Lansac, J., Lopes, P., Tabaste, J. M., & Spira, A. (1991). Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988-1989). Human reproduction (Oxford, England), 6(6), 811–816. https://doi.org/10.1093/oxfordjournals.humrep.a137433
2. Hagai Levine and others, Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries, Human Reproduction Update, Volume 29, Issue 2, March-April 2023, Pages 157–176, https://doi.org/10.1093/humupd/dmac035
3. El Osta, R., Almont, T., Diligent, C., Hubert, N., Eschwège, P., & Hubert, J. (2016). Anabolic steroids abuse and male infertility. Basic and clinical andrology, 26, 2. https://doi.org/10.1186/s12610-016-0029-4