What we miss when we ignore male infertility

What We Miss When We Ignore Male Infertility

What we miss when we ignore -

During the pandemic, as the nation was under lockdown, Luke and his wife resolved to begin their family. "For years, I was taught that unprotected sex could lead to pregnancy," he recalls. "By the time we were adults, we assumed things would naturally fall into place. When they didn’t, we were unsure of the next steps or where to seek help." After 18 months of unsuccessful attempts, the couple consulted their general practitioner and were directed to specialized tests at a fertility clinic. Over the subsequent months, Luke observed that the focus remained solely on his wife. Appointments were listed under her name, and even when he completed paperwork, his wife was contacted despite all his information being available. "The system assumes the issue lies with the woman," he explains. "Men are often treated as secondary figures in the process." It wasn’t until after a failed IVF cycle that Luke was informed his sperm might be the cause. "I was surprised—why wasn’t this checked earlier?" he says. "I felt like I was just along for the ride, not an active participant."

The Silent Struggle

Infertility impacts approximately one in six couples, with roughly half of cases attributed to male factors, either independently or in combination with female issues. According to NICE guidelines, couples facing conception difficulties after 12 months of unprotected intercourse should be evaluated as a unit. However, experts highlight that men are frequently sidelined in diagnosis, treatment, and discussions about fertility. "Men can be unintentionally excluded across different services," says Prof Bola Grace of University College London. "This happens in fertility clinics, counseling sessions, and even in how care is structured." A 2019 study led by Grace revealed that many men desire greater involvement but often feel unheard. This exclusion, she argues, creates a cycle: when men are not included, they become less engaged, reinforcing the belief that they are not invested in the process. "We’ve set up a scenario where men are excluded yet blamed for not participating," she notes. The consequences extend beyond men—women frequently shoulder the burden of planning, worrying, and making decisions. Delays in identifying male infertility can lead to more invasive procedures, higher costs, and a longer journey for couples.

A System Shaped by Women

Since the first IVF birth in 1978, fertility care has been predominantly centered on women, partly due to biological factors. IVF involves ovarian stimulation, egg retrieval, laboratory fertilization, and embryo implantation. Men, by contrast, typically contribute a sperm sample and wait for the process to unfold. This framework has influenced how fertility services evolved, according to Allan Pacey, a professor of andrology at the University of Manchester. He points out that most fertility clinics are led by gynaecologists, whose training emphasizes female reproductive health, while male infertility is often addressed as an afterthought. "Some gynaecologists excel in this area, but at the level of general practice or secondary care, men are frequently overlooked," he says.

At the policy level, similar disparities persist. The Department of Health recently released separate strategies for men’s and women’s health, outlining the government’s 10-year healthcare vision for England. Fertility is mentioned around 20 times in the women’s document, with dedicated sections on support and clinical guidance. In the men’s version, it appears only five times, mostly linked to obesity, alcohol use, or general health. Pacey, who once chaired the British Fertility Society, calls this a "missed opportunity to balance the focus" on male reproductive health. The underrepresentation of men in these strategies underscores a broader trend in how infertility is perceived and addressed.

Breaking the Cycle

How can the system better support men when fertility issues are identified? And what steps can encourage more open dialogue about male infertility? The current structure, which prioritizes women, may perpetuate a cycle of exclusion. By integrating men more actively into the process, healthcare providers could foster shared responsibility and improve outcomes for all couples.