1. Professor Chris Barratt, who is head of the reproductive medicine group at the University of Dundee and one of the world’s foremost experts on male infertility estimates that infertility affects one in seven couples, and in around 50 per cent of those cases the problem lies with the male.
2. Despite the fact that infertility affects men and women in equal numbers, Dr Liberty Barnes, research associate in the Department of Sociology at the University of Cambridge and author of ‘Conceiving Masculinity: Male Infertility, Medicine, and Identity’, believes that male infertility remains invisible in our society.
3. As part of her research, Dr Barnes spent over 100 hours shadowing doctors and interviewing patients in five infertility clinics. She found a culture designed to enforce gender stereotypes and bolster masculinity and concluded that there is a culturally sanctioned suppression of dialogue around male infertility, to the extent that many infertile men receiving treatment still don’t actually consider themselves infertile.
4. In 2014, Dr Xiao-Ping Zhai, launched ‘Make Fertility Conceivable’, a national campaign to end the stigma attached to male infertility. She argues that for men in the UK, treatment options remain poor and many men do not feel able to discuss their infertility because the subject is still so taboo.
5. As well as greater openness, Dr Xiao-Ping Zhai also wants doctors to stop recommending Intra-Cytoplasmic Sperm Injection (ICSI) as soon as they identify a problem with a man’s sperm count. ICSI is an invasive procedure that injects a single sperm directly into an egg to fertilise it. Unlike normal IVF, ICSI fertilisation takes place inside, rather than outside, the woman’s body. This means that the woman has to endure a harsh drug regime to ready her system for the operation.
6. Dr Xiao-Ping Zhai thinks this is unfair and Dr Barnes agrees. She argues that most cases of male infertility are referred straight to IVF clinics where women bear the brunt of all problems with conception. She says “For many, male infertility is repaired in female bodies.”
7. Despite the fact that it increases the possibility of inherited genetic and chromosomal abnormalities, including cystic fibrosis gene mutations, sex chromosome defects and heritable sub-fertility, the use of ICSI is increasing. Research carried out by the European Society for Human Reproduction and Embryology found that in 1997, ICSI made up only 43% of IVF cycles. By 2002, it accounted for 52% of cycles.
8. Dr Xiao-Ping Zhai argues that ICSI is the wrong approach for most men because only about 10% of cases of male infertility cases are caused by genetic problems or mechanical blockages. The rest are functional issues such as a malfunctioning sperm reproduction system which can be treated by addressing lifestyle issues such as smoking and drinking.
9. Male obesity also affects fertility. It has been associated with lower sperm concentration, motile sperm count, sperm morphology and increased DNA fragmentation. And as global obesity increases, so do rates of male infertility. A recent cross-sectional study of men from the general Danish population found that only 23% of participants had optimal sperm concentration and sperm morphology. The rest either had lower than average sperm counts or were likely to need fertility treatment in the future if they wanted to father a child (Jørgensen et al., 2012).
10. There is some good news. Research led by Dr Jean-Patrice Baillargeon at the University of Sherbrooke in Canada has shown that men who lose weight and adopt healthier lifestyles can improve their chance of conception (Baillargeon, 2015).