Why is nobody talking about the Male Fertility Crisis – A Future Doctor’s Perspective

By Ellis Hall, an undergraduate candidate reading Medicine at the University of Oxford. All opinions are his own.

Why is it that it takes a sperm and an egg to conceive, yet all fertility issues seem to befall women? Overmedicalisation and blame are the symptoms of a frank misogyny in societal treatment within fertility medicine.

Now, more than ever, it is crucial to open the wound and tear into discussion of extreme male fertility decline before it is too late. The potential ramifications for public health and economic growth, not to mention personal wellbeing, are staggering.

Stigmatised, ostensibly emasculating connotations of such conversations are prohibiting progress, simultaneously rendering irreparable harm to future generations; the male fertility crisis needs to be addressed. 

How the Medical System Contributes to the Silence

Fertility challenges are women’s challenges – a misguided assumption that permeates throughout fertility care. Not only is this scientifically inaccurate, but it places an undue burden of blame and stress on women.

With 1 in 6 couples facing infertility, challenges arise leading to influxes of primary care service enquiries, creating a demand which services are ill-equipped for.

The charity Fertility Action reported from survey results that 80% of GPs self admittedly have no formal training in male subfertility, reinforcing a culture of inaccessibility and neglect - the antithesis of our mission at Jack.

Knowing that male fertility has declined 50% in across the past 50 years should be a wakeup call for healthcare providers, policymakers, and men everywhere to know they are not alone. 

Policy Failure and Economic Consequences

A major roadblock in tackling the male fertility crisis is a lack of political motivation. As it stands, NICE recommendations for three cycles of IVF are not adhered to for most of the NHS Integrated Care Boards, due to lack of incentive, or consequence. As a result, creating a fractured country with a fertility ‘postcode lottery’, exacerbating regional health inequities– so much for ‘levelling-up’. 

One of the damaging assumptions is that fertility is not a necessity. This is wholly illogical, given the potential economic upside.

Evidence from the American Journal of Managed Care concluded that children born through IVF represent a net positive return to the government in every respect (i.e., future earnings, healthcare consumption, life expectancy), representing a 700% net return relative to the child’s initial IVF investment. With the total budget for Health and Social Care in 2023/24 being £188.5 billion, around 0.04% (£68 million) of that, is spent on NHS run fertility services. This is a record decline in proportional investment from 40% in 2012 to 27% in 2022.

With ever-widening market of couples facing fertility challenges clearly, Chancellor of the Exchequer Rachel Reeves is missing a trick when it comes to long-term investments in human potential for stimulation of growth and long-term government tax revenue. 

Similarly, the proposed “first men’s health strategy” by Wes Streeting is a poor attempt at performative PR. As it stands, the so-called ‘strategy’ is weak and unfocused, addressing broad strokes of frontline issues such as ‘mental health’ without addressing the fundamental problems of access to services, or educational safety netting in schools. It is becoming increasingly apparent that the NHS’s fundamental mission of ‘free at the point of care’ is not working towards keeping illness at bay, instead treading water in a tsunami of strategic blunders, exacerbated by suffocating bureaucracy and political disincentive. 

Our country is in dire need for sensible, well-informed leadership, focused on empowering access to services. Alignment of a preventative health strategy and scientific evidence such as the Barker hypothesis of the developmental origins of disease, explicitly demonstrating that adaptations to stress and hostility are encoded genetically in-utero. We need to break the cycle. We need a mission of health prosperity underpinned by long-term investment into mental health safety netting, lifestyle medicine, and health education from conception to grave. 

A Call to Action: Time for Systemic Change

Fertility issues are inextricably linked with mental health. A survey of individuals who engaged with fertility services in the UK found that 40% reported experiencing suicidal feelings, a shocking statistic. It is hardly surprising that one Danish study found that couples who experience fertility failure are three times more likely to divorce – this is destroying livelihoods by breaking up families, their hopes, and their hearts. 

The solution: a multi-faceted approach of ensuring equitable access to fertility services across the UK, eradicating the ‘postcode lottery’, improved front line training and awareness of the incline in male infertility in primary care, and a strong lobbying effort including all stakeholders, patients, providers, and policymakers to recognise fertility decline. These are the first deliverable steps towards a better, and more fertile future focused on long-term prevention putting people first. 

The male fertility crisis is real—it’s time we start talking about it, stop wasting precious time and take meaningful action.