“Less of a man”: banishing the stigma surrounding male infertility

When Toby Trice found out about the extent of his fertility problems, he was devastated. A test had shown that Toby had a high level of DNA fragmentation affecting his sperm cells’ integrity. He and his partner, Katie, had been trying for a baby for around six years and after two unsuccessful rounds of IVF, the couple was starting to lose all hope. “At one point, I had a breakdown. I had spent all the years protecting my partner but in doing so, pushed aside my own emotions,” says Toby.

After hitting rock bottom, Toby invested all his energy into becoming a racing driver, harnessing the negative energy and turning it into something positive. By using motorsport as a form of escapism, Toby found a renewed sense of purpose. His goal now is to “disrupt” the stigma around male infertility. He has become an ambassador for Fertility Network (FNUK), co-hosts a men-only online support group and has a documentary about infertility in the pipeline.

In a similar vein, the Welsh comic Rhod Gilbert’s recent thought-provoking documentary (Rhod Gilbert: Stand Up to Infertility) touched on his own experience with infertility, using his Carmarthen wit to do so. Gilbert is frank, honest, and at times hilarious – referring to himself as “Inspector Bonk Juice who is going to take a deep dive into male infertility” and his sperm as “senile swimmers in need of Zimmers.” Jokes aside, the documentary has opened up a new dimension to the conversation about reproduction; that men’s reproductive health seems to be both medically side-lined and socially stigmatised.

Toby and Rhod are not alone in experiencing problems with fertility. Sperm counts have been plummeting throughout the Western world for decades. A 2017 study found that sperm concentration – the number of sperm per millimetre of semen – had declined each year over the previous 40 years, amounting to a 52.4 per cent fall in men from North America, Europe, Australia and New Zealand. Scientists believe the reason is likely to do with the modern environment and lifestyle choices; exposure to cigarette smoke, alcohol and chemicals, stress, obesity and age.

It is estimated that infertility affects 8 to 12 per cent of couples globally, with men being the primary or contributing cause approximately half the time. Despite this statistic, discussions surrounding infertility have tended to prioritise women and ignored men, in terms of both treatments and in the overall process.

With IVF, for example, treatment for women usually involves injecting synthetic hormones, blood tests and ultrasounds. For men? A “simple” sperm sample should do the trick. Yet if a man’s fertility is judged by his semen sample alone, there is no way of detecting “silent infections” like chlamydia. Furthermore, one of the most common causes of male infertility is varicocele (a clump of varicose veins in the testes). Varicocele can be fixed with surgery. But as all women get ultrasounds and men tend not to, many cases like Toby’s go undiagnosed.

“I had a procedure done back in November for varicocele, and I am waiting to find out whether it’s a success as we now have a chance at conceiving”, says Toby. “But, if I had an ultrasound and saw an andrologist back when my partner saw a gynaecologist, my varicocele could have been operated on under the NHS, and we could be sat here with a toddler – it’s incredibly frustrating.”

It’s not just the treatments that have a female-focus, but the overall medical process can leave men such as Toby feeling as if they have been left on the substitute bench: “You feel like a donor. When my results came back, I remember they talked to my wife as if I wasn’t there. I was like ‘Hello? I’m sat right here.’”

Andy Harrod, a psychotherapist and PhD researcher, is part of The Clan of Brother’, a “childless not by choice” male group. Andy spent most of his thirties trying for children with his wife, but after two unsuccessful rounds of IVF and many early miscarriages, they eventually stopped trying. “Towards the end, it was more about grieving for our lost children and finding meaning without them,” says Andy. “After the second IVF, we began the painful process of healing and accepting we wouldn’t have children – a process that doesn’t end.”

Like Toby, the IVF process left Andy feeling discarded: “As a man, I felt like a spare part a lot of the time at the hospital,” he says. “The referral was only addressed to my wife, though they changed it after I asked them too – perhaps a small thing, but it felt important that both of us were recognised. After the miscarriage and the first IVF, all the attention was on my wife. I understand the reasons as to why they wanted to make sure she was physically fine, but only ever asked if she was OK, not me. It felt isolating.”

Dr Robin Hadley, an independent researcher specialising in male childlessness and ageing, added credence to both Toby and Andy’s stories. “The fertility experience focuses on the women’s body and in doing so, isolates men in the process,” he says. Dr Hadley is in his 60s and is childless by choice, but as with Andy, coming to terms with that decision is an ongoing process: “I can rationalise it, but there’s a gap. Being a childless man is disenfranchised grief. It’s like when AIDS/HIV wasn’t recognised in culture but dismissed and hidden away. With childlessness, the same principle applies; there is no narrative to occupy.”

FNUK’s 2020 survey found that 42 per cent of respondents who had undergone fertility treatment did not feel fully involved alongside their partner with 78 per cent saying fertility challenges impacted their mental health. The results show that infertility can have a profound emotional and psychological impact on men as well as women, and support the idea that the female-focus of medical treatment is in need of an overhaul. Tackling social and medical stigma surrounding male infertility is crucial; but where does the stigma come from, and can it be easily combatted?

Many scholars and academics believe it originates in the idea that infertility is an “alternative form” of masculinity, deviating from traditional norms of hypermasculinity and heteronormativity. Or in Rhod Gilbert’s phraseology: “How much of a man [I am] is directly proportionate to how much spunk I have and how lively it is.” Thus, if you are infertile or have fertility problems, you are seen as a threat to what is deemed the norm – the beau idéal of how a man should be: physically strong, dominant and virile. Take conditions like Klinefelter Syndrome (KS), for example. The primary features of the syndrome are infertility, low sperm count, decreased testosterone, and a smaller penis. As a result, KS sufferers are often seen through the lens of this societal norm as being “less of a man.”

“Whilst virility inside of a woman’s body is celebrated, virility outside of a man’s body is celebrated”, explains Dr Hadley. “Men are socialised from an early age to act outside of their bodies, to be a protector whilst women are defined by what’s within; they are protected. That is why it’s rare to see men expressing pain and vulnerability.”

“Culturally, from a young age to your adult life, you’re told to ‘man up’ and not show emotions,” says Toby. “I think that’s ingrained within all of us. Pub banter often involves conversations like ‘I got my wife pregnant again‘ or ‘Having trouble? I’ll get her pregnant for you.’ When you’re desperate to be a dad, hearing those things are hurtful, but you don’t speak up about it as you feel you’re the reason that it makes you feel like less of a man.”

There is a culture of suffering in silence for men – one need look no further than the tragic statistics that suicide remains the single biggest killer of men under 45. There is a cost to this silence, but opening up about an issue that men regard as emasculating will take a lot more than a tea and coffee morning. So what is the best advice for those who are struggling with male infertility?

“My advice is that if you are struggling, join our FNUK’s support group, which is held online,” says Toby. “It can help so much because you know someone else is going through it. Or if you’d rather not, reach out to family and friends because the moment you talk about it and are honest – it’s liberating.”

As sperm counts across the West continue to fall, there is a clear need for a deeper understanding of men’s infertility experiences. To get to a point where men’s reproductive health is accounted for, change has to happen on a medical level (by increasing the amount of information about the prevalence of male infertility and availability of treatments) and on a social level (by tackling societal expectations of “manliness”).

In his documentary sign off, Rhod Gilbert said he hopes that “maybe next year, every pub in the country and every sporting changing room will be full of men chatting openly and confidently and their sperm counts and fertility journeys – without the taboo, the embarrassment and the stigma that currently exists.” Gilbert’s documentary and the willingness of men to tell their infertility stories should encourage us all to give the topic the airtime it so clearly needs. After all, it takes two to tango.