Clinicians say the picture is beginning to shift, but only gradually. “Things are moving in the right direction, but we are still well behind,” says Prof Hussain Alnajjar, a consultant urological surgeon at University College London Hospitals and the Cleveland Clinic London.
For example, it is starting to become more common for a man to see a specialist before his female partner – if an initial semen analysis suggests a potential problem. “That’s what I mean by things are changing but it’s happening slowly,” he adds. “Overall, women are still far more likely to be assessed first when it comes to infertility.”
For men like James, 34, from North Yorkshire, that slow pace of change has shaped their experience.
After James and his wife had difficulty conceiving, he had what he describes as an “ostrich moment”; months of burying his head in the sand while his partner went through all the checks and tests. “Every day, I think about that moment and the time wasted,” he says.
James was away for work on a construction site when the results of his semen analysis eventually came through. He was told his sperm were “weak, slow and malformed” and later found out he would struggle to conceive naturally. The near three-hour drive home that day was “like a blur, very painful”.
There were delays with his diagnosis. It took another two years – and a private consultation with a urologist – before he was given a full physical examination and more advanced hormonal tests. After years of trying, and multiple rounds of IVF, the couple’s fertility treatment was ultimately unsuccessful.
“You’re the partner of someone who you love unconditionally, but you view yourself as the cause of their pain,” he says. “You feel you’re the reason they can’t have a child.”
Male infertility can often be mixed up with ideas of virility and masculinity, making it more difficult for some men to acknowledge or discuss the problem. Prof Pacey recalls hearing about a barbecue where “all the women were at one end talking about IVF, and all the men at the other talking about football”.
James did not see his fertility problems as a challenge to his masculinity, but the stigma surrounding the issue meant he struggled to find support during that time. “It’s just you and your partner dealing with this, so it feels like you’re an island and there’s no-one else out there like you,” he says. “You don’t know where to go, who to turn to, or what to say.”
Under UK law, fertility clinics must offer counselling before treatment, but it need not be free or ongoing. The fertility regulator, the HFEA, says that there are far fewer support groups – either online or in the real world – for men than for women. But there are some signs that may be starting to change.
Shaun Greenaway, 43, was diagnosed in 2018 with azoospermia – a condition in which no sperm are present in the semen. The cause is unclear, although he had severe mumps as a teenager – a virus known to be linked to male infertility.