Male infertility clinics are filled with fertile men. At least, that’s what they tell themselves.
So found Cambridge University sociologist Liberty Walther Barnes who set out in 2007 to study male infertility. Barnes spent more than 100 hours tracking urologists and infertility experts in five U.S. male fertility clinics, observing daily interactions with patients and interviewing reproductive endocrinologists, embryologists, nurses, genetic counselors, and psychologists. Barnes also followed 24 heterosexual married couples diagnosed with male infertility due to low or zero sperm counts. To her surprise, despite trying to impregnate their wives for more than a year and visiting a male infertility clinic, more than half of the men did not consider themselves infertile.
Where, she wanted to know, are all the infertile men?
And so for the next six years, Barnes tried to unpack the gender assumptions that influence male perceptions about fertility, infertility treatment decision-making, and the medical community’s reaction to infertile men. The result, Conceiving Masculinity: Male Infertility, Medicine, and Identity will be published in May 2014, and reconsiders two major gender myths that Barnes argues pervade the $3 billion dollar fertility industry and ultimately do a disservice to both infertile men and women.
The first stereotype, she says, is that women will do anything to get pregnant. The second is that men will avoid infertility treatment at any cost. Yet Barnes found that when couples were given the choice to pursue a female-focused treatment like in vitro fertilization (IVF), or a male-focused remedy like surgery, they unanimously chose the male course first, even if the man didn’t necessarily consider himself “infertile.”
There was, in fact, a strong sense among both men and women that male-focused solutions were a more “natural” way to get pregnant, explains Barnes, and that physical participation in fertility treatments was a “manly way” for husbands to “protect their wives.” The problem, she says, is that many doctors tiptoe around a man’s fertility issues, and that specialists often push IVF on infertile couples—so that men aren’t really given a choice in the first place.
According to Dr. Marc Goldstein, professor and chief surgeon of male reproductive medicine at NewYork-Presbyterian/Weill Cornell Medical Center, male infertility is as common as female infertility. For one-third of couples the problem is the man’s, another third deal with a female’s issues, and the remaining third struggle with a combination of both. But Goldstein says he regularly sees couples where a woman has already undergone an invasive and expensive fertility procedure like IVF before a simple semen analysis is even done on her partner—and it’s zero.
Doctors are much more comfortable talking about infertility with their female patients, Goldstein says, mostly because of the deep social stigma surrounding male infertility. Men, he explains, tend to falsely associate infertility with impotence and see reproduction challenges as an assault on their masculinity.
“Going back to biblical days, infertility was always blamed on the woman,” Goldstein says. “Only within the past 25 years or so has attention been paid to men.” And when a woman doesn’t conceive, she usually consults her gynecologist, who applies a gynecological knowledge base— female-focused treatments—and often only checks a man’s fertility as a “last resort.”
According to a recent report discussed at a meeting of the International Federation of Fertility Societies and the American Society for Reproductive Medicine, 5 million IVF babies were born in the past three and a half decades—with 2.5 million of them born in just the past six years—evidence of how socially mainstream IVF is now and how far female reproductive technology has come.
But men lag behind. When it comes to male infertility, we’re only now emerging from the dark ages, says Dr. John Jain, a reproductive endocrinologist at Santa Monica Fertility in Los Angeles. For example, scientists are just starting to study how environmental factors may impact the quality of semen. Jain finds that men are reticent to talk about their own fertility and naïve about how common male infertility is. Though, he admits, the most critical fertility factor is undeniably the age of the woman.