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Infertility is unfortunately very common. A recent study showed that 22% of men and 26% of women in a large cohort had reported that they had been attempting to conceive for 12 months without success (Thea van Roode, 2015). According to the CDC, about 12% of couples will have difficulty getting pregnant or carrying a pregnancy to term (CDC.gov). There are many different ways to create a family and many different family structures. For purposes of this article, we’re talking about males and their female partners.
We have all learned by now that a woman's ability to use her own eggs to conceive is directly correlated to her age. In other words, as a woman ages, her fertility decreases, and she's likely to have more problems getting pregnant (asrm.org). And if we paid attention in biology class, we know that it takes both a healthy egg and a healthy sperm (as well as a few other factors) to make a baby. Yet, we spend a lot of time talking about female infertility and reproductive health and less time talking about male factor infertility, even though when heterosexual couples experience fertility problems, they are caused by a male fertility issue at least a third of the time (CDC.gov).
So, why is the discussion uneven when we know fertility problems can be caused by an individual and sometimes combined factors? And what harm does this lack of discussion and education potentially create? I know from working with women, men, and couples for years both at Progyny and in a clinic setting that knowledge is power and so much of what alleviates the stress around fertility is knowledge about the process. It can be confusing and daunting when you don't know what to expect, and the fertility process is no different. It can be frightening at first. There are a lot of unknowns about what is going to happen, why getting pregnant hasn’t happened yet, and, most importantly, what one can do to be successful. When we don’t talk about the male partner’s role in this and male factor infertility, we’re only addressing half the battle.
Here are some important facts to keep in mind—whether you're trying to understand the role your partner plays in the process, considering a fertility treatment, or simply need more information.
1. Male infertility is common and fairly simple to diagnose. Usually, a reproductive endocrinologist, OBGYN, or primary care physician will order a semen analysis which is a test that analyses a male’s sperm quality. Most sperm banks or fertility clinics will perform the semen analysis, which can identify issues such as sperm count, sperm motility, sperm production, and semen quality, among other problems in fertile or infertile men. Testosterone levels can also play a role.
2. A reproductive endocrinologist is an expert in the diagnosis and treatment of infertility and the specialist with whom most people and couples will start when they are having difficulty conceiving.
3. A male partner who is diagnosed with any type of abnormality may be referred to a urologist for further diagnosis or treatment.
4. Many male factor issues can be overcome by treatments such as intrauterine insemination (IUI) and in vitro fertilization (IVF). In some cases, lifestyle changes can improve sperm count, testosterone levels, and other issues, and a specialist can work with you to identify what kinds of changes can influence fertility.
If family-building is important in your relationship, it makes sense to talk about it with your partner and start exploring your options as soon as you encounter difficulty. Keep in mind that the age of the female partner is important. Infertile couples should talk to their physician about both female and male infertility to ensure you can access the wide range of options for fertility treatment. For many, the first step is to talk to your primary care physician or gynecologist. You can also check your medical benefits and find an in-network reproductive endocrinologist who specializes in infertility.
When you begin to see a fertility doctor, it’s important that you bring your male partner with you as many appointments as he can attend. He should be included in the decision-making in terms of the treatments you choose to undergo. Ask him questions about how he’s feeling about this process. If it is a male factor issue, many men I’ve talked to throughout the years report that they feel guilt and shame—guilt because their female partner must undergo treatment she might not otherwise have had to and shame because it’s their biological imperative to create offspring and it’s not working out how they had hoped. Feelings of inadequacy can have adverse effects on the self-esteem and mental health of infertile men (Domar, 2011).
Men sometimes feel their role is to ‘fix things,’ and infertility is something they cannot fix on their own. Asking for help can be difficult, and the feelings of loss of control can be really confusing and anxiety-provoking. Talk through your feelings with your partner whether the fertility issue is male or female. It’s ok to talk about this with him and assure him that you understand his reproductive health issues aren't his fault. Make sure his opinions are heard and his questions are answered. Be open about your feelings too. If you are feeling frustrated and stressed out, be sure to tell him. Don’t keep your feelings bottled up. Don’t be embarrassed to talk about eggs, sperm quality, and all that goes into baby-making!
If you and your partner are going through infertility you know how disruptive it can be to your life, your relationship, your schedule, and—if you don’t have covered benefits through your employer—your finances. Besides the disruption it can cause in your life, the process can be disappointing (since in vitro fertilization and other treatments sometimes fail), and full of ups and devastating downs. You will both feel less stress if you talk it through and lean on each other through this process. If you need some guidance, explore support groups in your area (RESOLVE is a good place to start). A lot of people say talking it through with others who are going through a similar scenario is very helpful. If you feel more comfortable outside of a group setting, seek out a couple’s counselor who specializes in infertility. You can find a counselor at resolve.org as well as other sites such as Psychology Today.
The bottom line is, if you are on this journey with your partner, remember that you are in this together. Not talking about men's health and fertility, fully understanding your options, and carefully choosing your next steps can mean a delay in treatment, choosing the wrong treatment, or not accessing treatment altogether. Approach your infertility treatment as you would any other challenge you face as a couple. You might find that your communication is improved, that your relationship is made stronger, and that you end up feeling closer to your partner because of your journey together!
 Cumulative incidence of infertility in a New Zealand birth cohort to age 38 by sex and the relationship with family formation van Roode, Thea et al. Fertility and Sterility, Volume 103 , Issue 4 , 1053 - 1058.e2
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