Eavesdrop in any secret Facebook group or support group meeting, and there’s a common refrain: In the infertility experience, women typically get the raw end of the deal. Much like pregnancy and childbirth, women endure most of the physical wear-and-tear throughout fertility treatment — from injecting their bodies with hormones to undergoing invasive surgery to enduring a bevy of diagnostic tests. The man’s job? To ejaculate into a cup.
Of course, that’s not a totally fair generalization. Recent research shows that male factor infertility accounts for up to 30 percent of infertility issues, and some men have to undergo uncomfortable procedures like TESE extractions (surgical sperm removal) and varicocele repair (which corrects tangled blood vessels in the scrotum). But for the majority of couples in which the woman struggles with infertility, the male partner usually has it pretty darn easy. (Physically, anyway. The emotional toll can be a whole other story.)
So what happens when men refuse to do their part, even if it’s seemingly simple? My friend found out the hard way when her husband flat-out refused to get a semen analysis even though they’d already been trying for a few years and no health concerns were detected on her end. Their efforts came to a screeching halt — largely because he decided he’d rather give up on having a baby than take that necessary step forward in diagnosis.
Such an extreme stance is hard to fathom, but it’s more common than one might expect. “I’ve seen a lot of cases where couples are not on the same page about how they want to move forward,” says Dr. Joshua Hurwitz, a fertility doctor at Reproductive Medicine Associates of Connecticut. “Men are much more reluctant to look into [the issue] than women, and there is a hardcore group of men who just do not want to be part of the process.”
Thirty-three-year-old Sasha* can relate. Since she and her husband Sam* first met in high school, they’ve been through a lot. Not only have they spent almost a decade trying to conceive, but Sam was diagnosed with lymphoma at age 28. Though he’s now 33 and cancer-free, their quest for a baby continues. The couple has done several rounds of IVF using sperm that Sam froze before undergoing chemotherapy, but all have been unsuccessful so far. According to Sasha, it’s been “suggested over time that Sam could still produce [healthy] sperm,” but he’s not interested in finding out whether that’s the case.
“He has always found an excuse not to get tested and would change the subject,” shares Sasha. “While it hasn’t caused problems between us, I do feel as if he is disconnected from this process. A small gesture like getting tested [would] show he cares and is committed to this as much as I am. Maybe it’s a pride or male ego thing, but I think that’s just one small price to pay for all that I’m putting my body through.”
For those in similar situations, all hope doesn’t have to be lost. Hurwitz recommends taking things incrementally — starting with a joint consultation rather than jumping straight to a semen analysis, which can be daunting for men. “A lot of men feel weird when they walk in, but by the end of an hourlong consultation, guys are usually on the same page about moving forward,” says Hurwitz. “A little bit of counseling goes a long way.”
Hurwitz has two major points he hits when dealing with men. The first is how common male factor infertility actually is; in fact, Hurwitz estimates the number at close to 40 percent of infertility cases (rather than 30 percent). “I want them to know they’re not alone,” says Hurwitz. “I also point out that no one is insulting their masculinity — this is purely medical, and we’re just trying to go through algorithms and strategies to find out what’s holding you up as a couple.”
He also employs sports analogies to get men more invested. “I always tell men that this is a team sport — they can’t do it without their partners and their partners can’t do it without them,” he says. “We’re working together to achieve the common goal of building a family, so they need to get off the sidelines and get in the game.”
For men who simply refuse to even set foot in a fertility doctor’s office, options do exist for at-home testing. Case in point: Trak Male Fertility Testing System, an FDA-cleared device which measures a man’s sperm count as “low,” “moderate,” or “optimal” based on World Health Organization guidelines. However, sperm count isn’t the only deciding factor for male fertility, and since at-home tests don’t evaluate motility (shape) or morphology (movement), it’s best to visit a specialist for a complete picture.
According to Hurwitz, males should work on setting aside their ego and doing just that. “For a guy, the workup for semen analysis is pretty basic, while the female side is extremely invasive,” says Hurwitz. “If a female partner is going to go through all of that work, the man should step up. I feel strongly about that.”
*Names have been changed.