What we miss when we ignore male infertility
In mid-2020, during the Covid lockdowns, Luke and his wife decided to start a family.
"All through my teens the message was clear: don't have sex without a condom or you might get someone pregnant," he says. "So, when you're older, you expect everything to just happen normally. When it doesn't, you don't know what to do or where to go."
After 18 months without success, the couple consulted their GP and were referred for further tests at a hospital and fertility clinic.
Over the following year, Luke says the focus was entirely on his wife. Appointments were all in her name. When he had to complete paperwork, his wife was contacted despite his details being on file.
"At the heart of it, the whole system is based on the assumption that it's a woman's problem," he says. "The male side gets totally overlooked."
It took over a year and a failed IVF cycle before Luke was informed there might be an issue with his sperm.
"I was like, 'Now you're telling me?'" he says. "There were things on my side that could have been looked into much sooner, rather than treating me as an accessory to the process."
Infertility affects approximately one in six couples, with about half of these cases linked to male factors, either alone or combined with female causes. According to the latest NICE (National Institute for Health and Care Excellence) guidelines, couples who have tried to conceive for 12 months without success should be assessed together, with men and women offered parallel evaluations. However, experts report that men are frequently sidelined in diagnosis, treatment, and fertility discussions.
"There can be genuine exclusion even if it's unintentional," says Prof Bola Grace from University College London. "Men tell us it can happen across services - in how care is delivered, in fertility clinics and in counselling."
A 2019 study led by Prof Grace found many men wished to be more involved in the fertility process but often felt unheard. She argues this creates a self-perpetuating cycle: some fertility services exclude men, leading men to engage less, reinforcing the perception they are uninterested.
"We've created a cycle where men are excluded, but then they're also blamed for not showing up," she says.
This exclusion has tangible consequences, not only for men but also for women, who frequently bear more of the emotional burden, planning, and decision-making.
It can also delay problem detection, result in more invasive tests and treatments, and make the fertility journey more difficult and costly. This raises questions about how the healthcare system can better support men diagnosed with fertility issues and encourage more open conversations about male fertility.
'Ignored by the system'
Since the first IVF birth in 1978, fertility treatment has predominantly focused on women, partly due to biological factors. IVF involves stimulating the ovaries to produce eggs, retrieving them, fertilising them in a laboratory, and implanting the embryo back into the womb. In contrast, men typically provide a sperm sample and await results.
That imbalance has influenced the development of fertility care, according to Allan Pacey, professor of andrology at the University of Manchester. He explains that fertility clinics are usually led by gynaecologists, whose training centers on female reproductive health, causing male fertility to be treated as secondary.
"Now, there are some really good gynaecologists that do it well, because they're interested in this, but at the level of the GP or the secondary care clinic or the tertiary care clinic, men can be an afterthought."
Similar disparities exist at the policy level. The Department of Health recently published separate men's and women's health strategies outlining the government's 10-year healthcare vision for England. Fertility is mentioned about 20 times in the women's strategy, including a dedicated page on support and clinical guidance. In the men's strategy, fertility appears only five times, mostly in relation to obesity, alcohol, or other health concerns.
"This is absolutely not saying that we should do less for women, we should probably do more for women as well," says Pacey. "But by giving men a proper role, we can fundamentally change what happens in the future, both in terms of their experiences, but also in the terms of what we can do research-wise or treatment-wise."
A Department of Health and Social Care spokesperson stated: "It is right that men receive the same level of support, information and care as women when navigating fertility problems." The department said it will continue collaborating with NHS England to ensure men's fertility is "properly reflected in how services are designed and delivered."
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At one point, Luke underwent an ultrasound scan of his testicles but did not receive feedback for over a year until he followed up with the clinic. The review identified a varicocele, a swelling of veins in the scrotum that can impair sperm quality. He was treated, but the couple's fertility issues continued.
It took an additional nine months and a private consultation with an andrologist before Luke received detailed one-on-one advice on lifestyle and diet.
"It's been a pretty tough, lonely place," Luke says. "There's the blow of finding out there's a male factor involved - which goes against all sorts of stereotypes about masculinity. But then there's a second level: feeling completely left out and ignored by the system."
The couple is currently undergoing another IVF cycle using ICSI, a technique where a single sperm is injected directly into an egg with an ultra-fine needle, rather than fertilisation occurring by exposing the egg to thousands of sperm in a dish.
An ostrich moment
Clinicians acknowledge that progress is occurring but remains slow. Prof Hussain Alnajjar, a consultant urological surgeon at University College London Hospitals and the Cleveland Clinic London, says:
"Things are moving in the right direction, but we are still well behind."
For example, it is becoming more common for men to see a specialist before their female partners if an initial semen analysis indicates 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."
James, 34, from North Yorkshire, experienced this slow change firsthand.
After struggling to conceive, James describes having an "ostrich moment"—ignoring the issue while his partner underwent all the tests.
"Every day, I think about that moment and the time wasted," he says.
James was away on a construction site when his semen analysis results arrived, revealing his sperm were "weak, slow and malformed." He later learned natural conception would be difficult. The nearly three-hour drive home was "like a blur, very painful."
His diagnosis was delayed. It took two years and a private urologist consultation before he received a full physical exam and advanced hormonal testing. Despite multiple IVF rounds, the couple's treatment was 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 is often conflated with notions of virility and masculinity, complicating acknowledgment and discussion. 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 issues as a challenge to his masculinity, but stigma made finding support difficult.
"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."
UK law requires fertility clinics to offer counselling before treatment, though it need not be free or ongoing. The fertility regulator, the HFEA, notes far fewer support groups exist for men compared to women, both online and offline. However, signs of change are emerging.
Shaun Greenaway, 43, was diagnosed in 2018 with azoospermia, a condition where no sperm are present in semen. The cause is unclear, though he had severe mumps as a teenager, a virus linked to male infertility.
He and his wife had children through sperm donation, but Shaun navigated much of the experience alone.
"There was absolutely no support, and no-one was talking about it from a personal perspective, so I decided I was going to share my story," he says.
Along with friend Ciaran Hannington, 40, he co-founded the Male Fertility Podcast and a support network for men facing fertility problems, including WhatsApp groups and in-person meetups. They compare today's conversation around male infertility to mental health a decade ago—still taboo but gradually becoming more open.
"There's such a deep-rooted stigma but, sadly, it's one of those topics that you don't really take any notice of until you have to," says Ciaran, diagnosed with fertility problems in 2012. He took two years to "start to take control" by making lifestyle changes—improving diet, reducing alcohol, and adjusting exercise.
After seven IVF rounds and two miscarriages, his wife Jennifer gave birth to twins.
Studies indicate stress, poor sleep, smoking, alcohol, and diet can impair sperm quality. However, short-term lifestyle changes are unlikely to yield significant improvements.
"Any lifestyle change needs to be sustained," says Prof Pacey. "It takes three months to produce sperm from start to finish, so if you stop drinking on a Friday night then don't expect an improvement by Monday morning."
Not all men follow this advice.
Shaun says he's spoken to some women—"never blokes, by the way"—who report their partners refuse to quit smoking, alcohol, and drugs despite knowing the impact on fertility.
"We know the healthcare system needs to catch-up but ultimately it's a two-way street," he says. "And some guys – and some women – need to catch up as well."
A 2022 University of Dundee study found about one in six European fertility specialists regularly struggle to persuade men to provide sperm samples.
Globally, some men feel uncomfortable providing samples, while others assume fertility is not an issue because they are sexually active or have fathered children previously.
Signs of a shift
Awareness appears to be increasing.
New PSHE lesson plans for schools in England, developed by the British Fertility Society and Cardiff University, now highlight male fertility risks—such as poor diet, smoking, and steroid use—equally alongside female risks.
At this year's Fertility Show in London's Olympia, attended by approximately 2,000 people over two days, male infertility was given central focus for the first time. Exhibitors offered advanced sperm testing kits alongside established services like egg freezing and pregnancy supplements. Seminars addressed sperm quality and the latest male treatment options.
"[It's] not a token addition. Not a side conversation," said content director Sophie Sulehria. "It's about recognising that male fertility is not a niche topic. It's a fundamental part of reproductive health. And it deserves the same visibility, the same investment, and the same compassion."
Medical professionals also observe this shift, emphasizing that male infertility relates to broader health issues including obesity, smoking, and hormonal imbalances.
"Healthier men tend to have better reproductive health, and an abnormal sperm test can sometimes be the first sign that further medical assessment is needed," says Prof Alnajjar, who represents the British Association of Urological Surgeons. "That's why I believe male infertility should not be viewed solely as a pregnancy issue; it should also be recognised as an important men's health issue and an opportunity for early intervention."
For men like James, whose lives have been profoundly affected by infertility, such progress is urgently needed.
"We're not going to change the stigma that still exists by burying our heads in the sand and ignoring it anymore, but by getting it out there," he says.
"As soon as we're more open, then fewer people are going to think it's taboo, or that anyone is any less of a man for actually talking about it."
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