Men Struggle With Infertility Too — Why Aren't We Talking About It?

Willie F.* grew up thinking he wouldn't be able to father biological children: he has a chromosomal abnormality that causes infertility. Still, when he and his wife were ready to become parents in 2007, he got a semen analysis at a fertility clinic. After several months of hormone therapy failed to restore his sperm production, a reproductive urologist recommended surgical sperm extraction (TESE)⁠, where sperm are removed from the testicles under local anesthesia. "It seems so casual in retrospect, him making conversation and joking even as he chopped me up, fully awake," says Willie, now 48. The procedure resulted in the couple's biological daughter, now 16.

Willie attempted TESE again in 2010, 2012, and 2014 (and a microscopic TESE that same year), without success, and eventually relied on donor sperm to conceive his son, now 9 years old. As he slogged through these procedures, he struggled to find a community that had experienced the same thing — leading him to create r/maleinfertility on Reddit in October 2013. Today, the community Willie moderates has more than 11,000 members and is growing, with screen views increasing 180 percent and engagement 450 percent from year over year, according to a Reddit spokesperson. Willie hopes the community "offers an anonymous platform where men can clumsily express fear, doubt, and hope and find support, guidance, and commiseration."

According to Willie, men most often post their semen analyses — which assess the quantity of sperm, whether they're moving (motility), and their shape (morphology) — to ask for analysis and advice from peers. About 5 percent of the community's posts involve men posting a "totally normal" semen analysis for advice (a group violation), often because men don't know how to compare their results to standard ranges. Willie says that's an indicator that there's little information given to men, in general, about infertility.

Just as Willie discovered via Reddit, he's not alone: men are responsible for roughly half of all infertility cases, which impact about one in seven couples. Many men are surprised to find out they're struggling with fertility in the first place, because there's a common belief that infertility is a women's issue. But that perception is changing. When Democratic vice presidential candidate Tim Walz shared his and his wife Gwen's struggles to conceive and subsequent IUI journey, it garnered attention because it's uncommon for a man to share their role in fertility, particularly on a national stage.

Neel Parekh, MD, is a male infertility and men's health specialist in the department of urology at the Cleveland Clinic Foundation.

Bobby Najari, MD, a professor in the department of urology at NYU Langone Health and associate chief of urology at Tisch Hospital.

Jenna Turocy, MD, an ob-gyn and reproductive endocrinologist and infertility specialist at Columbia University Fertility Center.

"Really, it's both [a men and women's issue]," says Dr. Neel Parekh, a male infertility and men's health specialist. While most issues are manageable and many couples can get pregnant with a doctor's help, misconceptions and shame around male infertility keeps many men from seeking care in the first place.

Male infertility patients are typically in their thirties and have been trying to conceive for at least a year, according to urologists who specialize in male fertility⁠. A comprehensive male workup sometimes gets delayed, perhaps due in part to misperceptions created by biology itself. When it comes to fertility, women really do have a "biological clock" because they're born with all the eggs they'll ever have. That means fertility starts to decline around the age of 35, dropping rapidly after the age of 40. In men, however, most causes for infertility have nothing to do with age. That said, sperm quality does decrease with age, especially in men over 50.

Men also often assume their sperm counts are high if they have a "normal" quantity of ejaculate. But sperm usually make up "about five percent of the overall amount of fluid. The rest is prostate and seminal vesicle fluid," says Dr. Bobby Najari, a professor in urology. That means it's impossible to know the actual amount or quality of sperm in ejaculate — or the sperm's morphology and motility — without a sperm analysis.

Fertility doctors are ob-gyns who are generally trained to treat both women and men. They usually bring up the male part of the equation at the first appointment and can counsel male patients about their test results and treatment options. But "a very low percentage of patients actually get referred" to urologists who specialize in male fertility, Parekh says, possibly in part because many ob-gyns tend to recommend in vitro fertilization (IVF) right off the bat. "You only need one sperm to have a child through IVF," he adds.

Patrick and Faith Rowe started trying to conceive in October 2022. Testing initially suggested Patrick's testosterone levels and sperm volume were normal, but a sperm analysis in August 2023 uncovered abnormal sperm morphology. Doctors provided no cause and "little information on accessible life changes," according to Faith. They instead recommended IVF — a notoriously costly journey. The couple, who are both 30 and live in Davie, FL, even considered traveling to Brazil or Columbia to afford the procedure. "We were devastated and felt we had hit a total roadblock," Faith says. "We were overcome with the feeling of 'why us,' and felt triggered seeing how easy the conception process was for others." The Rowes eventually conceived a few months after Patrick's abnormal sperm analysis, without IVF. Their son is due in December this year.

If an abnormal but addressable semen analysis is uncovered later in the process, "that's frustrating," Najari says. For example, Parekh recently counseled a couple who had been through two failed rounds of IVF before getting referred to a male fertility specialist. An exam of the male partner uncovered a varicocele — the most common cause for male infertility. A varicocele is a varicose (abnormally dilated⁠) vein in the testicle. It can block blood flow and negatively impacts sperm production, decreasing sperm quantity and quality⁠. About 15 percent of all men have a varicocele, but the condition affects 40 percent of men with infertility, according to Najari.⁠ While varicoceles usually don't cause fertility issues, "if you're having fertility issues or pain, then there may be a reason to fix it," Parekh says. He performed a routine surgery to fix his patient's varicocele, and the couple recently told him they got pregnant naturally.

"There's perhaps an over-reliance on in vitro fertilization to address a situation that could be improved if the male was evaluated by a specialist earlier in the process," says Najari. He adds that he works alongside ob-gyns at his clinic who are quick to refer patients to him if there's any question about male infertility; the patients who are referred late are usually coming for a second opinion. "I do think we do a thorough evaluation of both," says Dr. Jenna Turocy, an ob-gyn and infertility specialist, adding that urologists may be "seeing the worst-case referrals."

Men's involvement in the infertility discussion, of course, varies a lot. Some men recognize that a semen analysis "a little bit easier" than a full female fertility workup, says Najari, and initiate appointments at an infertility clinic — although "that's probably not the majority," according to Turocy. More often, men seek help when their female partner visits an ob-gyn at a fertility clinic. They may arrive with an at-home sperm analysis from Amazon or Walgreens in hand, which only assess sperm counts (not motility and morphology) — and, as Willie has witnessed on Reddit, results can be hard to interpret without the help of a doctor. But they "can be the initial check," Turocy says.

Just as frequently, men delay infertility care because they — and even their doctors — still think of infertility as a women-only issue. This can lead to shame and embarrassment, a sense that infertility suggests they're not a "man." Faith says Dave "was hard on himself and felt an immense loss of masculinity knowing that he was failing to help build our family." When couples come in together, Parekh says the woman often does the talking for both. "Society places heavy emphasis on masculinity and guys being able to have kids," he says. "One of the things we need to work on is having men be more open about fertility issues."

These misperceptions are particularly unfortunate because doctors can diagnose and treat most cases of male infertility. Addressing lifestyle factors like smoking and diet can not only improve fertility but reduce the risk of other health problems down the line.

Even a super-clean lifestyle, however, doesn't guarantee that sperm will be normal – which can come as a shock to men. "They feel like, I haven't done anything wrong. Why is this aspect of my health not optimal?" Najari says. For many, surgery can fix blockages, and medications can address hormonal imbalances.

Over the past five years, urologists are also seeing more male infertility due to testosterone replacement therapy (TRT), sold via online clinics promising to boost energy and fitness levels and fight aging⁠. Men may not bring up past TRT use because they're embarrassed and because "there is this misconception that it increases their sperm, where actually it's doing the opposite," says Turocy. Understanding that TRT is the root cause of infertility may prevent couples from going through unnecessary and costly rounds of IVF. Ultimately, Turocy says that 90 percent of all cases of male infertility "does have great treatment options."

Some men tell Najari they feel that they're letting their partner down. But male infertility is not a question of manhood; it's a medical issue, often with a solution. As Turocy puts it, "I am always reassuring patients that fertility is a disease. It can affect females and it can affect males." Given more knowledge and the right support, Willie hopes that men "with less-than-ideal results discover that a semen analysis result is a snapshot in time and might improve, and that those without sperm find kinship and perhaps an alternate path toward fatherhood if they so desire."

*Name has been shortened for privacy.

Colleen de Bellefonds is a Paris-based journalist with two kids and a serious baguette habit. She covers science, health, parenting and French culture for US News & World Report, Well+Good, Women's Health, Self, Healthline, and more.