“The focus on women and infertility is warranted,” Jain explains, “especially in an industrialized population like the United States where women are increasingly delaying childbirth for longer and longer to pursue their education and careers.”
Convincing men that they, too, have a biological clock would be a key step in changing social attitudes about male infertility. A man’s fertility does decline with age, just like a woman’s does, as does the genetic quality of his sperm, explains Dr. Harry Fisch, professor of urology and reproductive medicine at NewYork-Presbyterian/Weill Cornell Medical Center and author of The Male Biological Clock: The Startling News About Aging, Sexuality and Fertility in Men.
Unfortunately, when men see actors in their 60’s and 70’s fathering children, they make incorrect assumptions about a man’s biological capabilities, according to Fisch. The truth is, a 70-year old father may be using someone else’s sperm. Schools, he says, should be teaching kids about their biological clocks in sex education— so infertility isn’t a social taboo from the start. Physicians too, he believes, should remove the stigma around infertility and talk to men in their 20’s about how obesity can impact sperm quality, and the kinds of fertility treatments available to them, from improving blockages to treating infection.
“My daughter is in college, and I would tell her to have a baby before she’s 30,” Fisch says. “Nobody talks about it really, but I would tell a son in college the same thing. Have a baby early.” We’ve been told that 35 is a pivotal number in female fertility. Men 35 or older, he warns, have half the chance of fathering a child within a year, compared to someone younger than 30.
But the medical community doesn’t spend much time or energy training doctors to talk about or treat male infertility. It’s just like contraception, says Dr. Florence Comite, a reproductive endocrinologist, who spent 25 years as a professor at Yale School of Medicine, and is the author of Keep It Up, a book for men about andropause, or what’s known as male menopause. There are a lot of options for women, but male fertility treatments are much more limited.
No surprise, she says, given the historical context of medical education, which has always focused on the reproductive system for female health. Training for male health, on the other hand, has always focused on well-known things like heart disease and prostate cancer. As Comite points out, most medical schools don’t have a department of andrology, while they often have departments of endocrinology.
To remove the secrecy and stigma, male infertility may need a high profile advocate and a public health campaign, Barnes says. After all, erectile dysfunction had Bob Dole. Testicular cancer had Lance Armstrong. But male fertility lacks a celebrity to raise awareness that infertility is a “normal” medical condition that “manly men” deal with too.