Keeley Dennett is a second year Biology student at Lady Margaret Hall, University of Oxford. All views expressed are her own.
The fertility journey of most heterosexual couples is somewhat straight forward- with approximately 85% of couples at reproductive age experiencing success in their endeavours. However, the remaining 15% will still experience difficulty in conceiving even after a year of unprotected sexual intercourse- this also does not account for the difficulties experienced by single people who produce sperm who would like to have children, and non-heterosexual couples. There can be many possible reasons for this difficulty in conceiving, however, one of the most ignored and taboo factors influencing reproductive success is male infertility.
Negative and indifferent attitudes to male infertility over time have resulted in the burden of infertility and fertility testing being placed on individuals with uteruses, however, with the advent of male fertility testing and discussions surrounding infertility becoming more common, it is important for individuals to understand all the options available when beginning their fertility journey.
In this blog, we will discuss attitudes to male fertility testing and explain how technologies will improve conversations around fertility for fathers of the future.
Unsuccessful conception? What next?
In the instance that an individual with a uterus experiences difficulty in becoming pregnant, the next step in the journey is often for the couple to consult a medical practitioner to discuss fertility treatments. There are many reasons why individuals will experience fertility issues, for example: lack of regular ovulation, poor semen quality, or even reproductive health issues such as endometriosis.
Despite the causes of infertility being equally as likely between individuals producing sperm, and individuals with a uterus, the majority of fertility assessments and treatments on offer to those attempting to conceive, e.g. intrauterine insemination, and IVF (in vitro fertilisation), are focused on the individual with a uterus.
This has been standard practice since the 1930s. At this point in time, sperm analysis became common in labs investigating couples with "barren marriages", however the majority of fertility treatments were still conducted on the individual with the uterus.
For a delightful overview of the history of semen analysis, please enjoy this Journal of Reproductive Sciences article here.
There could be many reasons for the gynocentric focus of fertility assessments and treatments, however, the attitudes towards treatments, in particular, can become damaging to both individuals with sperm and those with uteruses, propagating the cycle of being misunderstood, embarrassed, and ashamed.
In a study carried out by De Jonge et al (2022), it was found that out of 1,171 participants, only 18.9% of individuals who identified as male sought help regarding their infertility, compared to 27% of men seeking help because of their partner, and 52% of men seeking help in collaboration with their partner. It was also found that 73% of men were very unlikely to discuss their fertility issues with others, hence contributing to the taboo nature of infertility.
Results and conclusions found from Grace et al (2019) can be used to expand on these findings. This study showed that people who identified as male, and people who identified as female both felt that fertility was a “woman’s issue”, with men reporting that they often feel left out of discussions regarding fertility.
In support of De Jonge et al (2022) suggesting that only 18.9% of people who produce sperm, Grace et al (2019) claimed that males also appear to lack “self-motivation” in finding medical care for their infertility issues. This lack of “self motivation” can become an issue for two reasons:
It portrays the claim that people who produce sperm are not important in their own fertility journey, which in turn…
Places the burden and responsibility of fertility on people with uteruses.
This could be one reason for lack of provision and discussions around male infertility and fertility testing- which needs to change in the immediate future.
So... what’s to come?
In order for people who produce sperm to become more involved and engaged with their fertility journey and future fatherhood, many applications are being produced and distributed to the general public.
The production and distribution of new applications should aim to engage men in discussions around fertility and make it easy and efficient for people who produce sperm to undergo fertility testing.
One of the ways that male fertility diagnosis and treatment could change in the future is through sperm selection by machines and artificial intelligence for intracytoplasmic sperm injections (ICSI). Sperm selection usually involves technicians removing dead sperm cells from a semen sample, and also separating highly motile sperm from less motile sperm, to find a sperm cell most fit for direct injection into an egg cell. However, advancements in scientific machinery could allow sperm selection to occur at a quicker rate and occur more efficiently as the procedure will be conducted by machinery rather than technicians.
The application of this technology would allow people who produce sperm to easily undergo fertility treatment, therefore minimising the burden placed on patients.
In addition, by advertising the ease of sperm selection by machines, individuals who produce sperm will become more informed and more engaged in their fertility journey, consequently changing their attitudes to discussions around fertility.
Alongside ventures such as sperm selection by machines, companies, such as Jack Fertility, are repurposing well-known male fertility testing techniques to fit a modern audience.
With the rise of “to-your-door” services, e.g. food deliveries, clothing deliveries, and even at home medical screens, Jack Fertility makes it easy for individuals to conduct at-home sperm testing to determine their sperm count. In the future, there may also be a possibility of using sperm as a “biomarker” as an indicator of their overall health, e.g. detection of cancers, chronic illnesses, and mortality.
Studies (e.g. De Jonge et al (2022)) showed that over 50% of men in Northern Europe associate their infertility with negative emotions, e.g. embarrassment and shame, which in turn causes reluctance in being part of discussions surrounding fertility. However, with the ability of sperm tests to be delivered to the homes of clients, people who produce sperm can avoid the “shame” associated with the need for taking a fertility test, and instead can be empowered by the decision to take their health into their own hands, thus changing the narrative and stereotypes around fertility testing, and improving discussions around fertility for everyone.
This post was reviewed by Maryam Rahbar, MSc, DPhil (pending), Jack Fertility CSO.
Male infertility → the inability for a couple to conceive after a year of unprotected sexual intercourse, caused by issues experienced by the individual producing sperm.
Intrauterine insemination → artificial insertion of sperm into the uterus.
In vitro fertilisation (IVF) → the removal of eggs from the ovaries, and subsequent fertilisation by sperm outside of the body. Fertilised eggs are then placed back into the uterus to promote pregnancy.
Biomarker → Biological indicators that can be used to determine medical conditions from outside of the body.
Intracytoplasmic sperm injection (ICSI) → Direct injection of a single sperm into an egg cell, usually occurs during IVF.
De Jonge, C. J. et al (2022). ‘Male attitudes towards infertility: results from a global questionnaire.’ The World Journal of Men’s Health. Viewed 5 December 2022. Available at: <https://wjmh.org/DOIx.php?id=10.5534/wjmh.220099>
Leslie, S. W., Siref, L. E., Soon-Sutton, T. L. & Khan, M. AB. (2022). Male Infertility. StatPearls [Online]. StatPearls Publishing, Treasure Island. Viewed 6 December 2022. Available at: <https://www.ncbi.nlm.nih.gov/books/NBK562258/>
NHS (2020). Infertility. Viewed 6 December 2022. Available at: <https://www.nhs.uk/conditions/infertility/>
Grace, B., Shawe, J., Johnson, S, & Stephenson, J. (2019). ‘You did not turn up… I did not realise I was invited…: understanding male attitudes towards engagement in fertility and reproductive health discussions’. Volume 3. Viewed 6 December 2022. Available at: <https://pubmed.ncbi.nlm.nih.gov/31218265/>
Bem You, J., et al (2021). ‘Machine learning for sperm selection’. Nature Reviews Urology. Volume 18, pp. 387-403. Viewed 6 December 2022. Available at: <https://www.nature.com/articles/s41585-021-00465-1>
NHS (2020). Intrauterine insemination (IUI). Viewed 7 December 2022. Available at: <https://www.nhs.uk/conditions/artificial-insemination/>
NHS (2021). Overview: IVF. Viewed 7 December 2022. Available at: <https://www.nhs.uk/conditions/ivf/>
Jack Fertility (2022). The Future. Viewed 5-7 December 2022. Available at: <https://www.jackfertility.co.uk>
Strimbu, K. & Tavel, J. A (2011). ‘What are Biomarkers?’ Curr Opin HIV AIDS. Volume 5 (6), pp. 463-466. Viewed 7 December 2022. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3078627/>
Human Fertilisation & Embryology Authority (2020). Intracytoplasmic sperm injection (ICSI). Viewed 7 December 2022. Available at: <https://www.hfea.gov.uk/treatments/explore-all-treatments/intracytoplasmic-sperm-injection-icsi/>
Andrade-Rocha (2017). 'On the origins of the semen analysis: a close relationship with the history of the reproductive medicine". Volume 10 (4), pp. 242-255. Viewed 9 December 2022. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5799927/>