Medical Examiner

It’s Nobody’s Fault

Vengefully gleeful stories about male infertility distract from the real problem.

It’s not her, it’s you. Possibly.

Photo by Image Point Fr/Shutterstock

Male fertility is a new epidemic, at least if you’ve seen the news coverage. This burgeoning crisis seems to be related to the effects of age, inspiring headlines such as: “Men Also Suffer Age-Related Infertility,” “Too Old to Be a Dad,” “High Manxiety: Thirtysomething Men Are the New Neurotic Singles,” and my favorite, “The Male Biological Clock—It’s Tick-Tick-Ticking Too.”

Is it true? Do men have biological clocks like women? Is male infertility an epidemic? And why does everyone seem so excited by this? “On playgrounds across the country, it’s getting tougher to tell who’s watching the kids—dad or granddad,” begins a WebMD feature. “We know that once women reach their mid-30s, their risk of having a child with a genetic abnormalities increases sharply. Now we know that the age of fathers can also contribute to that risk.” 

There’s a smidgen of Schadenfreude in these mostly female-penned articles, a smug unspoken undertone: That’s right, men. Aging women are not the only ones with fertility problems … you guys have it, too.

I get it. I really do. My husband and I have hit many of what he likes to call “speed bumps” (which I’m more likely to call “catastrophes”) in the fertility process. Whether it’s IVF eggs failing to fertilize, embryos failing to develop, or a pregnancy miscarrying, I go to the doctor for more tests. Every time, I’m not-so-secretly hoping they’ll find that there’s something wrong with him. But when the doctors say it’s likely not him, not his late-40-something-year-old sperm, and it’s probably either my early-40-year-old eggs or, when we have perfect embryos, my body or immunology or something that they just can’t seem to figure out, I deflate in disappointment.

“Why would you want it to be me?” my husband asks. “Either way we’d have a problem.”

He’s right. Failing to have a baby is no fun, not when you’ve been at it since the beginning of your marriage. So what does it matter whose fault it is?  

I can’t tell him that just for once I would like to stop feeling like our lack of children is all my fault. That just for once it would be nice to hear that there’s something wrong with my husband. That his sperm is fragmenting, that he’s too old, too selfish, too focused on his career, on finding the right time. The same Greek chorus of blame that haunts me.

I’m sure many women today feel this way, too. They’re sick of hearing about how they need to go husband-hunting in college, à la the “Princeton Mom,” and they’re “calling BS on biological clock extremists.”

Studies do show that it takes longer for older men to conceive. For men older than 45, there was a fivefold increase in the time to pregnancy relative to men younger than 25, according to a 2003 study in Fertility and Sterility.

“In the past we thought men’s fertility was not affected by age,” says Natan Bar-Chama, director of male reproductive medicine and surgery at Mount Sinai Medical Center. “Now we’ve learned there is a component to paternal age to try to conceive, and certain conditions, such as schizophrenia and Down syndrome, could have increased risk as men get older.”

A number of recent studies link older fathers to increases in the risk of autism and schizophrenia, inspiring headlines such as NBC’s “Older Dads at Risk for Passing Along Mental Disorders.”

“But when you look at the numbers, you have to separate what the absolute risk and the increased risk is,” Bar-Chama notes. “The absolute risk is still really very small.”

Overall, the whole “men have a biological clocks which tick inexorably and then at a certain point it’s all over” is a “media thing,” says Marc Goldstein, surgeon-in-chief of male reproductive medicine and surgery at the Cornell Institute for Reproductive Medicine and New York–Presbyterian Hospital/Weill Cornell Medical Center. “There’s a slow, gradual decline in testicular function in men—but it’s not dramatic.” He adds, “There is no sudden drop. If a man is otherwise healthy—no diabetes, heart disease, is not obese—those men can maintain reasonable fertility in old age.”

Goldstein wants there to be increased awareness about male infertility, which accounts for problems in about one-third of couples having trouble conceiving, although others put it at 15 to 20 percent.

But the default expectation when a couple has trouble conceiving is still to assume it’s the woman’s problem. “What do they do?” asks Goldstein. “They go to the wife’s doctor.” Male fertility specialists have seen women undergo major testing before the man’s sperm was even sent out for analysis.

And that’s become an institutionalized problem. As sociologist Liberty Walther Barnes writes in her new book, Conceiving Masculinity: Male Infertility, Medicine and Identity, “When a heterosexual couple cannot achieve pregnancy, the problem is assumed to be her. This widespread assumption has resulted in a general lack of public awareness on the prevalence of male infertility. It has also challenged the direction of reproductive science and shaped the practice of infertility medicine.”

There are many reasons to start by focusing on male fertility problems. Male fertility problems are generally easier to treat. And if male problems were treated, there would be no need for intrauterine insemination or in vitro fertilization, which bypass male infertility problems such as low sperm motility or quantity.     

Expect to hear more about male infertility. The market is expected to grow to $301.5 million by 2020, according to an Allied Market Research report in April: “The major factors driving the male infertility market are the change in lifestyle, increasing age, environmental effects, etc., and these factors are majorly contributing to the rise in male infertility levels.” One of the major limitations to the male infertility market is the social taboo. “Out of 32-40 percent infertile men, only 15 percent of the men opt for the treatment for infertility due to the embarrassment, guilt, etc.,” according to the Allied report.

So it looks like the question isn’t whether we should focus on male infertility but how? Certainly not with a vengeful glee that men can suffer the way we women have.

Masculinity can be fragile. And it takes a real beating when trying to have a baby—whether it’s the perfunctorily timed sex, dealing with the hormonal swings of a woman on IVF medication, or suffering through the sometimes sexless months of IVF—and that’s when male factor infertility is not even diagnosed.

In my peregrinations to various IVF clinics around the world, I’ve met many women dealing with male-factor infertility. At first, I’m envious of them; I know the likelihood of their getting pregnant is probably higher than mine, because if male-factor has been diagnosed—and finding that “if” usually takes a long time—it’s often less complex to treat. But then I see their faces fall and hear their stories of dejected, angry husbands, and I realize their marriages have suffered so much.

It’s not easy to live with any infertility, not for women, not for men. Women have borne enough responsibility for fertility in the past, and shame for infertility too. Let’s not share the blame—and shame—with men, but think of infertility as the medical condition it is, and welcome any science that aims to treat it.