Willie F. * grew up thinking he would never be able to father a biological child because he has a chromosomal abnormality that causes infertility. Still, when he and his wife were ready to become parents in 2007, he underwent a semen analysis at a fertility clinic. After months of hormone therapy did not restore sperm production, the reproductive urologist recommended surgical sperm extraction (TESE), which removes sperm from the testicles under local anesthesia. Willie, now 48, said: “In hindsight, it seems like a very casual incident. He was still talking and joking with me while I was wide awake, cutting me to pieces.” speak As a result of this surgery, the couple’s biological daughter, now 16 years old, was born.
Willie tried TESE again in 2010, 2012 and 2014 (as well as a microscopic TESE the same year) without success, and ultimately relied on donor sperm to conceive her son, now 9 years old. . As he worked through these procedures, he struggled to find a community of people going through the same thing, leading him to create r/male infertility on Reddit in October 2013. Today, the Willie-managed community has over 11,000 members and is growing with screens. According to a Reddit spokesperson, views are up 180% and engagement is up 450% from last year. Willie hopes the community will “provide an anonymous platform where men can awkwardly express their fears, doubts and hopes, and receive support, guidance and sympathy.”
Willey said men most often submit their semen analysis, which assesses sperm quantity, whether it’s moving (motility), and shape (morphology), and ask colleagues for analysis and advice. Approximately 5 percent of the community’s posts include men posting “totally normal” semen tests seeking advice (a mass violation), but many involve men comparing their results to the standard range. It’s because you don’t know how. Willie says this is a sign that men in general are given little information about infertility.
As Willie discovered on Reddit, he’s not alone. Approximately half of all infertility cases are caused by men, affecting approximately 1 in 7 couples. Many men are surprised to learn that they are struggling with infertility in the first place, as it is commonly believed that infertility is a women’s problem. However, that perception is changing. As Democratic vice presidential candidate Tim Walz talks about his and his wife Gwen’s struggle to conceive and subsequent IVF journey, it’s rare for men to share their role in fertility, especially on a national stage. Therefore, it attracted attention.
Experts featured in this article:
Dr. Neil Parekh is a male infertility and men’s health expert at Cleveland Clinic Foundation Urology.
Dr. Bobby Nadjari is a professor of urology at New York University Langone Health and associate director of urology at Tisch Hospital.
Dr. Jenna Tulosi is an obstetrician-gynecologist, reproductive endocrinologist, and infertility specialist at Columbia University Fertility Center.
“This is actually a problem for both men and women,” says Dr. Neil Parekh, a male infertility and men’s health expert. Although most problems are manageable and many couples can conceive with the help of a doctor, misconceptions and shame surrounding male infertility prevent many men from seeking treatment in the first place.
According to urologists who specialize in male infertility, male infertility patients are typically in their 30s and have been trying to conceive for at least a year. Comprehensive testing for men is sometimes delayed, perhaps due in part to misconceptions created by biology itself. When it comes to fertility, women actually have an “internal clock.” This is because a woman is born with all the eggs she will ever have. This means that fertility begins to decline around age 35 and declines rapidly after age 40. However, for men, most causes of infertility are not related to age. However, sperm quality declines with age, especially in men over 50.
Men also often think that their sperm count is high if their ejaculate volume is “normal.” But normally, sperm “makes up about 5 percent of all body fluids. The rest is prostate and seminal vesicle fluid,” says Dr. Bobby Nadjari, a professor of urology. This means that without analyzing the sperm, it is impossible to know the actual quantity and quality of sperm in the ejaculate, or the morphology and motility of the sperm.
The pressure to be fertile and get pregnant “naturally” is BS — here’s why
IVF as a solution?
Fertility doctors are generally obstetricians and gynecologists trained to treat both women and men. They usually bring up the male part during the initial consultation and can advise male patients about test results and treatment options. But “the percentage of patients who are actually referred to a urologist who specializes in male fertility is very low,” Parekh said. Perhaps part of the reason is that many obstetricians and gynecologists tend to immediately recommend in vitro fertilization (IVF). “Only one sperm is needed to produce a child with IVF,” he added.
We were overwhelmed with the feeling of “why us” and felt inspired to see how easy the pregnancy process was for others.
Patrick and Faith Lowe began trying to conceive in October 2022. Tests initially suggested Patrick’s testosterone levels and sperm volume were normal, but a sperm analysis in August 2023 revealed abnormal sperm morphology. Doctors gave no indication of the cause and provided “little information about changes in immediate life,” Faith said. They recommended IVF (a notoriously expensive journey) instead. The 30-year-old couple, who live in Davie, Florida, said they considered traveling to Brazil or Colombia to help pay for the surgery. “We were devastated and felt completely stuck,” Faith said. “We were overcome with a ‘why us’ feeling and felt inspired to see how easy the process of pregnancy was for others.”The Lowes said Patrick’s abnormal sperm A few months after the analysis, we finally got pregnant without IVF. Their son will be born in December of this year.
“It’s frustrating” when a semen test later reveals an abnormal but manageable semen test, Nadjari said. For example, Parekh recently counseled a couple who had gone through two failed IVF attempts before being referred to a male infertility specialist. Examination of the male partner revealed varicocele, the most common cause of male infertility. Varicoceles are varicose veins (abnormally dilated veins) in the testicles. It can block blood flow and negatively affect sperm production, reducing sperm quantity and quality. According to Nadjari, about 15 percent of all men have varicocele, but the condition affects 40 percent of infertile men. Varicoceles don’t usually cause fertility problems, but “if you have fertility problems or pain, you might have fertility problems. That’s a reason to get it fixed.” says Parekh. He performed a routine surgery to correct a patient’s varicocele, and the couple recently told him they had conceived naturally.
“Perhaps there is an over-reliance on IVF to deal with this situation, which could be remedied if the man had a professional evaluation early in the process,” Nadjari says. he says. He added that he works with an obstetrician-gynecologist at his clinic and is quick to refer patients if they have questions about male infertility. Patients who are referred late usually come in for a second opinion. “I think we thoroughly evaluate both,” said Dr. Jenna Tulosi, an obstetrics and gynecology and infertility specialist, adding that urologists are “considering worst-case referrals.” He added that there is a possibility that
Changing the narrative around male infertility
Society values masculinity and men being able to bear children. One of the things we need to work on is getting men to be more open about their infertility issues.
Men’s involvement in the infertility debate varies, of course. Nadjari said some men realize that a semen test is “a little easier” than a complete test of a woman’s fertility and start booking appointments at fertility clinics, but “probably not the majority.” Tulosi says. More often, men seek help when their female partner visits an obstetrician-gynecologist in a fertility clinic. They may arrive armed with an Amazon or Walgreens home sperm analysis tool, which only assesses sperm count (not motility or morphology). And, as Willie witnessed on Reddit, results can be difficult to interpret without a doctor’s help. . But they “could be a good first check,” Tulosi said.
Similarly, men, and even their doctors, often delay infertility treatment because they still think of infertility as a women’s-only problem. This can lead to shame and embarrassment, where infertility suggests that they are not “men.” Faith said Dave was “hard on himself and felt a huge loss of masculinity, knowing he wasn’t helping to build a family.” When couples come together, Parekh said the woman often tells both stories. “Society values masculinity and men being able to have children,” he says. “One of the things we need to work on is getting men to be more open about infertility issues.”
These misconceptions are especially unfortunate because doctors can diagnose and treat most cases of male infertility. Addressing lifestyle factors such as smoking and diet can not only improve your fertility, but also reduce your risk of developing other health problems in the future.
But even a super clean lifestyle doesn’t guarantee that your sperm is normal, and this can come as a shock to men. “They feel like I haven’t done anything wrong so why isn’t my health optimal?” Nadjari says. Surgery can often repair the blockage, and medications can address hormonal imbalances.
Over the past five years, urologists have also noticed an increase in male infertility due to Testosterone Replacement Therapy (TRT), which is sold through online clinics that promise to improve energy and fitness levels and fight aging. I’m checking. Men don’t talk about their past use of TRT because they’re embarrassed, Tulosi says, adding: “There’s a misconception that TRT increases sperm production, but it actually has the opposite effect.” Understanding that TRT is the root cause of infertility may help couples avoid unnecessary and costly IVF. Ultimately, for 90 percent of all cases of male infertility, “there are good treatment options,” Tulosi said.
Some men feel like Nadjari is letting their partners down. However, male infertility is not a problem of masculinity. It is a medical problem, and there is often a solution. As Tulosi says, “I always reassure my patients that infertility is a disease. Infertility can affect both women and men.” With more knowledge and the right support, “men with less-than-ideal results can discover that semen test results are a snapshot in time and can be improved. “We hope that men who don’t have sperm can find blood relatives and perhaps find another path to fatherhood.” That’s what they want. ”
*Names have been abbreviated to protect privacy.
Colleen de Bellefonds is a Paris-based journalist with two children and a serious baguette habit. Covering science, health, parenting, and French culture in US News & World Report, Well+Good, Women’s Health, Self, Healthline, and more.
