Let us shine a compassionate light on men’s often-overlooked challenges regarding male infertility.
Through meticulous research and heartfelt narratives, let’s explore the emotional, physical and psychological turmoil experienced by men suffering from fertility issues. By shedding light on this silent struggle, let us seek to foster understanding, empathy and open dialogue surrounding male fertility, ultimately paving the way for greater support and awareness for those on this arduous journey [1].
June’s narrative
Last Father’s Day, June Ramales got up at five, like he always does, and went about his morning routine. Then his wife handed him a fortune cookie. Inside, it read: “Your future will change.”
It wasn’t until he saw the tiny onesie with the words “Daddy’s strongest swimmer” printed on it that it made sense: his wife was pregnant. “I absolutely bawled my eyes out for 10 minutes or so,” says Ramales. “I couldn’t believe it.”
It was the first Father’s Day Ramales could enjoy as a dad after a string of emotional ones. Before he and his wife had their baby boy in February, they had been trying, on and off, for years.
They’d had some fertility treatment about five years before, and when those procedures were unsuccessful, took a break. “It was just physically draining on my wife, and on me emotionally, because I could see her going through the treatments,” says Ramales. “It was tough, because there was nothing I could do.”
In December 2021, they initiated another attempt. They embarked on a grueling round of IUI (intrauterine insemination), wherein they placed sperm directly into the uterus at the optimal time for fertilizing an egg.
The successful procedure – a few days after Mother’s Day, was their last attempt before embarking on the more physically and financially taxing IVF (in vitro fertilization) process. “After trying for so long, we kind of lost hope,” Ramales says.
“Last year, when we finally got that news, it was like, maybe there is a God out there.” Still, Ramales has not forgotten how difficult those years of hope and heartbreak were. “I began to feel like it was a curse,” he says.
In addition to pointing out the physical endurance his wife went through, he also had to make some changes to address the low sperm count that was part of the problem.
“I had to work out, quit smoking, eat healthier. I couldn’t wear tight boxers.” But Ramales says the emotional burden was the toughest part.
He struggled to explain how he felt to his wife. She didn’t quite understand where he came from until she read a book about infertility that included a male perspective.
Compounding the grief was that part of his desire to be a dad was to “be there” for a child in a way that his father figures had not been – both his biological father and stepfather abandoned him at a young age.
He did what he could to care for his mental health: therapy, journaling and joining a Fertility Matters Canada Facebook group. When he tried to reach out to other men in the group or talk with friends, he found that people shied away from the conversation.
“Nobody really wants to talk about it,” he says. “Growing up, men are taught not to share their feelings.”
While we as a society have rightfully improved our ability to openly, empathetically and sensitively discuss women’s struggles with infertility, we do not show the same consideration for the male experience of this profoundly personal challenge.
Neil’s story
This is something with which Neil Hyde is all too familiar. Both he and his wife were healthy thirtysomethings who were baffled by their infertility.
They struggled with infertility for six years, so they decided to launch a podcast detailing their journey.
“We wanted to document it, because we found there were no real resources out there,” says Hyde. “Once we started talking about it, we heard from a lot of people who were also going through it, or had been through it.”
The eight-episode podcast, One In Six, after the statistic that one in six people globally is affected by infertility, begins during their sixth round of IUI – the so-called “make or break” round before you move on to more intensive procedures [2].
It then follows the Hydes as they undertake IVF, which entailed travelling from Newfoundland to Calgary because no clinics offer this procedure in their home province.
Hyde says he felt like he to be “the rock” in the situation, especially during IVF, where a fertilized egg is implanted in the womb. “Whatever feelings I might have had felt kind of minor in view of what Jen was going through,” he says.
“I couldn’t really be too emotional or too destroyed about it, because somebody in the room had to drive home. You can’t hug yourself and someone else at the same time. I had to be there for her.”
He felt a sense of powerlessness, and he did his best to support his wife by staying on top of what he could tackle: Appointment times, terminology and administering her hormone injections.
“I was lucky that Jen has a needle phobia,” he jokes. “I quickly became a nurse, so that was a really small part that I could play to help.”
Holidays and gatherings with friends and their children were some of the most challenging moments. “You had to work yourself into who you were going to be now, like the ‘fun uncle,’” Hyde says.
They intended to release the podcast regardless of the outcome of their fertility journey. Fortunately, Jen was able to conceive through IVF. Several weeks after the birth of their first child, they had a spontaneous, natural pregnancy which resulted in the birth of their second child.
Hyde is conscious that this isn’t the case for everyone. A lot of the feedback on the podcast was from people who had been through eight or nine rounds of IVF, used donor sperm, tried surrogacy and still didn’t have a baby.
“We were lucky, but with every blood test, I was prepared for the worst,” says Hyde. “It wouldn’t be the end of the world – we’d get another dog, we’d travel more – but it’s not the world that we were hoping for.”
While men don’t experience nearly the same external “pressure, pressure, pressure” women do when it comes to reproduction, there is a certain primal urge.
“It’s your ticket to immortality. In the most prehistoric way, it’s being the Alpha Male, having all these children, spreading your genetic code, all that old stuff,” Hyde says. “It’s about creating life, and as much as you try to deny it, it’s there. It defines you, it gives you purpose.”
Dr Dan’s patients
Dr Dan Nayot says his male patients often feel extra guilt while trying to conceive. “They wish they could take it on themselves,” says Nayot, a reproductive endocrinologist, infertility specialist and medical director at The Fertility Partners.
“Like, ‘Give me the needles, give me the procedure,’ but that’s just not how the biology works.”
Nayot points out that male-factor infertility, the sperm side of the equation, accounts for about a third to half of the cases. “We know infertility is on the rise,” he says. “There’s good evidence that decade over decade, general sperm quality has gone down.” No one’s sure why; theories include exposure to pollution or endocrine disrupters.
Nayot says patients are often “shocked” when they end up in a fertility doctor’s office and find out they have an issue with sperm quality. While sexual dysfunction is usually picked up, since if you don’t ejaculate, you know you don’t have a chance of conceiving through intercourse, “with sperm, you don’t really know unless you check.”
To illustrate this point, someone who has had a vasectomy produces semen, but it’s void of those all-important sperm, which are only visible on a microscopic level.
While the causes of poor sperm quality aren’t fully understood, Nayot points to factors that can exacerbate it including age, medical issues like uncontrolled diabetes, thyroid dysfunction or obesity, medications such as testosterone therapy, and lifestyle factors like smoking, cannabis use, poor sleep, stress or “anything that heats up the testicles” such as professional-level cycling.
You can’t change your age or genetics, but you can change your lifestyle. Nayot is the chief medical advisor for Bird & Be, a Canadian company that offers fertility-supporting products including at-home sperm tests and pre-natal supplements for men. “The key part is to get screened,” says Nayot. “Then you can understand the ‘why’ and optimize what you can.”
Fertility struggles often result in a “massive relationship strain” for the couples Nayot sees. For men, it often manifests from a wounded ego. “Unfortunately, there’s still this fake correlation between fertility and masculinity,” he says.
“It’s not associated with your sex drive, anatomy or sexual performance. People can have a high sex drive, no issues in bed and severe male-factor infertility.”
While the stigma is improving, the sense of isolation is still strong. “Because people don’t talk about it, men think they’re the only ones,” Nayot says. “In reality, it’s extremely common.”
[1] https://www.thestar.com/life/2023/06/15/fertility-struggles-take-their-toll-for-men-too.html
[2] https://www.cbc.ca/listen/cbc-podcasts/1338-one-in-six
