What we miss when we ignore male infertility

What we miss when we ignore –

In the midst of the global pandemic in mid-2020, Luke and his partner made the decision to start a family. For years, he had internalized the common belief that contraception was the key to preventing pregnancy, a message he absorbed during his teenage years. “You’re told not to have sex without a condom, or you might get someone pregnant,” he recalls. “So when you’re older, you assume everything should work smoothly. When it doesn’t, you’re left unsure of what to do or where to turn.” After 18 months of attempts without success, the couple visited their general practitioner, only to be directed toward a series of diagnostic tests for the wife. Over the following year, Luke noticed a pattern: all appointments were booked under his partner’s name, and even when he filled out paperwork, his wife was contacted despite his details being already on file. “The entire system assumes it’s a woman’s issue,” he says. “Men are treated as an afterthought, completely overlooked in the process.” It wasn’t until a failed IVF cycle that Luke was finally informed his sperm might be the root of the problem. “I was like, ‘Now you’re telling me?'” he adds. “There were things on my side that could have been checked earlier, instead of viewing me as just a secondary participant.”

The Gendered Lens of Fertility Care

Infertility impacts approximately one in six couples, with around half of these cases attributed to male factors, either independently or in conjunction with female issues. Yet, even with this statistic, the focus of fertility treatment often remains on the female side. According to the latest National Institute for Health and Care Excellence (NICE) guidelines, couples who have been trying to conceive for 12 months without success should be evaluated as a unit. However, in practice, men are frequently sidelined, with their roles reduced to being a passive element in the diagnostic process.

“There can be genuine exclusion even if it’s unintentional,” says Prof Bola Grace of University College London. “Men tell us it can happen across services—whether it’s how care is delivered, how fertility clinics operate, or even in counselling settings.”

Grace’s 2019 research highlights this issue, revealing that many men desire a more active role in fertility planning but often feel their input is disregarded. This exclusion, she argues, creates a self-perpetuating cycle: when men are not included in the process, they become less engaged, reinforcing the perception that they are not interested in fertility matters. “We’ve created a cycle where men are excluded, but then they’re also blamed for not showing up,” she explains. The consequences extend beyond the individual. Women often end up shouldering the majority of the emotional and logistical burden, from managing the coping strategies to making critical decisions about treatment.

When problems are identified later, the diagnostic process can become more invasive, with treatments that are costly and complex. This delay not only increases the physical and emotional toll on couples but also limits their options. “If we don’t address male infertility early, couples may face a longer, more expensive path through fertility care,” Grace notes. The issue, she emphasizes, is not just about diagnosing men but about integrating their perspectives into the entire journey.

Historical Roots of the Imbalance

Since the birth of the first试管婴儿, Louise Brown, in 1978, fertility treatment has largely been framed around women’s biology. IVF involves stimulating the ovaries, retrieving eggs, and fertilizing them in a lab before implanting the embryo back into the uterus. This process, while groundbreaking, centers on the female reproductive system, leaving men’s contributions to the equation often undervalued. Most men are simply asked to provide a sperm sample, then wait as the science takes over.

Allan Pacey, a professor of andrology at the University of Manchester, points to this historical context as a major factor in the current disparity. “Fertility units and clinics are typically led by gynaecologists, whose training focuses on female reproductive health,” he says. “Male fertility is often treated as a secondary concern, even though it plays a crucial role in the success of conception.” While some gynaecologists may go above and beyond to address male factors, Pacey argues that this approach is inconsistent across the healthcare system. “At the level of the GP or secondary care clinic, men can be an afterthought,” he adds.

Pacey also critiques the policy frameworks that shape fertility care. The Department of Health recently released separate men’s and women’s health strategies, outlining the government’s 10-year vision for healthcare in England. However, fertility is mentioned 20 times in the women’s strategy, with dedicated sections on support and clinical guidance. In contrast, the men’s document references fertility just five times, typically linking it to issues like obesity, alcohol consumption, or other general health topics. “This is a missed opportunity to level the playing field,” Pacey remarks. “Fertility care should be a shared responsibility, but the current approach reinforces the idea that women are the primary focus.”

Breaking the Cycle: A Call for Change

The question remains: how can the system better support men when they are told they may have fertility issues? And what steps can be taken to encourage men to open up about their concerns? Pacey suggests that training healthcare professionals to recognize the importance of male factors is essential. “Gynaecologists are trained to look at female fertility, but they can also be taught to appreciate the male side,” he explains. This includes not only diagnostic checks but also emotional support and education.

Grace emphasizes the need for a cultural shift within fertility services. “If men are not included in conversations from the beginning, they’re less likely to engage,” she says. This lack of involvement can lead to frustration and a sense of helplessness. “Men want to be part of the process, but they’re often treated as a footnote,” she adds. To combat this, she advocates for more inclusive practices, such as ensuring men’s names are on appointment records and involving them in decision-making.

Improving male participation in fertility care could have significant benefits. Earlier diagnosis may reduce the need for invasive procedures, while shared responsibility can ease the burden on women. “When men are involved, the entire process becomes more collaborative,” Grace argues. “It’s not just about treating the problem—it’s about addressing the experience of the couple as a whole.”

Ultimately, the current system’s bias toward female infertility has created a gap in understanding and addressing male issues. By rethinking the way fertility care is structured, both at the clinical and policy levels, healthcare providers can ensure that men are not overlooked. This change would not only improve outcomes for couples but also foster a more equitable approach to reproductive health. “We need to make sure men are seen as equal partners in the journey,” Pacey concludes. “Only then can we truly support everyone involved.”