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Where is Fertility in Men’s Health? The Silent Struggle

By Isabelle Kearns, a Crankstart Scholar and undergraduate candidate reading History at Jesus College, University of Oxford. All opinions are her own.


Despite male fertility issues being well-documented as an increasingly significant global health phenomenon, discussions about male fertility remain absent from conversations about men’s health. Jack Fertility’s core mission is to address and challenge this gendered take on health and combat the implications for men and women: reducing the fertility burden borne by women and integrating men into conversations about their health. We fiercely believe that people with sperm deserve access to their sperm health data, and should be able to monitor and optimise their reproductive health regardless of their fertility goals.


As it stands: male fertility


8-12% of couples worldwide are affected by infertility, making it a global health issue. Despite the worrying identification of a long-term decline in sperm quality, which has seen worldwide sperm counts halved in the last 40 years, infertility continues to be couched as a woman’s issue. Even when male fertility is engaged with, it is frequently in relation to other health issues. This ignores the diverse causes behind male fertility problems and sustains our cultural disengagement with male infertility as an issue in and of itself. 



Figure 1: Infertility is caused by about one third female factors, one third male factors, and 40% unexplained or mixed factors. (FNUK/NHS/NIH)  


A failure to engage?


Despite the significant psychological and medical implications of male infertility, there has been little popular, and limited medical, engagement with infertility as a men’s health issue. Although half of infertility cases involve male factors, men have been neglected in research, diagnosis, and treatment. The ingrained cultural view of infertility as a woman’s issue, which also frames male infertility as emasculating, has made ‘infertile men invisible’ and maintained asymmetrical medical standards between men and women. 


This is situated within the wider context of systematically poor health outcomes for men. Men’s health is characterised by shorter lifespans and higher rates of chronic disease, revealing that the failures in addressing male fertility issues are none too surprising. Fertility diagnosis and treatment is systematically geared to women, who are almost always tested prior to male partners, often very invasively. Currently, the National Institute for Health and Care Excellence guidelines give GPs no option but to refer men with fertility problems to IVF clinics. Ultrasounds, which can determine the presence of varicocele (a clump of varicose veins in the testes), which causes 40% of male infertility cases, are hardly offered. In our current system, men are an afterthought. 


The problematic way that we look at male infertility is compounded by the inaccessibility of medical treatment. Research by Fertility Network UK shows that 63% of patients have had to pay for their own medical treatment, at an average cost of £13,750. This financial barrier is a significant obstacle, particularly when coupled with the social taboo of, specifically male, infertility. These problems are intensified by unequal access to healthcare, where locational discrepancies in fertility care across the UK have created a postcode lottery. Indeed, while the National Institute for Health and Clinical Excellence states that the NHS should offer women under 40 three full cycles of IVF, only 12% of Clinical Commissioning Groups do so. Unfortunately, access to fertility treatment continues to be delayed, expensive, and unequal. 


The positioning of infertility as a woman’s issue has not only impacted engagement with men’s physical health, but also their mental health. While the emotional burden of infertility is shared by both partners when trying to conceive, it is particularly heavy for the partner experiencing the fertility issue. As men grapple with the health implications of infertility, they are silenced by the cultural taboo around complaining about health problems. During his journey to conceive, Gareth Down, the founder of The Fertility Podcast, felt that he ‘didn’t have a right to talk or complain’ about the taboo subject, feeling that this unfairly diverted focus from his wife. Research by Fertility Network UK has highlighted the extent of male marginalisation, with many respondents discussing how their entire fertility journey was geared to their partners, relegating them to secondary partners, even in official medical communications. 90% of respondents revealed that they felt depressed during the process, and 43% felt suicidal. The consignment of men to the periphery in conversations about fertility is outdated and isolating: something must change. 


Hope for the future 


Clearly, integrating male fertility issues into the wider framework of men’s health is necessary. A core aspect of this transition is the early testing of sperm quality, which informs men about their fertility potential at an early age – empowering them to pragmatically plan for the future and take control over their health – while simultaneously reducing the fertility burden on women. 


Going forward, equal emphasis must be put on both male and female reproductive health through the purposeful inclusion of men in conversations, research, and treatment. Already, social taboos have begun to lessen as individuals speak about their fertility journeys, reassuring other men that they are not alone. With the rise of celebrities like Rhod Gilbert raising awareness with his Stand Up to Infertility and Celebrity Save our Sperm on Channel 4, the topic has entered the mainstream.


This means that, despite enduring systematic barriers, the future promises progress


References 

  1. Kleeman, J., (2017) ‘‘It tears every part of your life away’: the truth about male infertility’, The Guardian, 18 November 

  2. Kumar, N., Singh, A. K., (2015) ‘Trends of male factor infertility, an important cause of infertility: A review of literature’, Journal of Human Reproductive Sciences, vol. 8.4, pp. 191-96

  3. Ravitsky, V., Kimmins, S., (2019) ‘The forgotten men: rising rates of male infertility urgently require new approaches for its prevention, diagnosis and treatment’, Biology of Reproduction, vol. 101.5, pp. 872–74

  4. Schrock, L., (2022) ‘We need to break the taboo around male fertility’, The Economist, 16 August

  5. Urist, J., (2014) ‘Researcher explores the invisible, ignored epidemic of male infertility’, Today, 5 May 

  6. The far-reaching trauma of infertility: Fertility Network UK survey (2022)

  7. The IVF postcode lottery: What you need to know, TFP Fertility UK (2020)

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