Breaking the gender bias around infertility in menBreaking the gender bias around infertility in men

Infertility is a complex issue that affects millions of couples worldwide, yet discussions surrounding it often gravitate toward the female experience. However, recent research and medical insights have brought to light the significant role that men play in infertility, challenging the prevailing narrative and highlighting the need for greater attention to male reproductive health. Men contribute to 40 to 50 per cent of all infertility cases, underscoring the importance of considering both partners in the diagnosis and treatment of infertility, rather than exclusively concentrating on women.

Breaking the stigma around male infertility

Despite the prevalence of male infertility, societal taboos and stigma often prevent open discussions about the topic. Professor Richard Lea, Professor of Reproductive Biology and Chair of Society for Reproduction and Fertility (SRF) in the UK notes that male fertility issues are rarely discussed publicly, contributing to a lack of awareness and support for affected individuals. “The topic of male fertility is often viewed as taboo and is not openly discussed. There are concerns that our lifestyle and environment are not doing our fertility any good,” he says. This silence can have detrimental effects on men seeking assistance for fertility concerns, further exacerbating the problem.

Prof. Richard Lea, Professor of Reproductive Biology and Chair of Society for Reproduction and Fertility

Male infertility is rarely discussed in India, says Dr. Suparna Bhattacharya, Fertility Consultant, Nova IVF Fertility Kolkata. “There must be awareness created among the men; that they too may be responsible for the problems caused in conception. It is estimated that at least 50 per cent of the instances of infertility are due to the male factor, if not more,” she adds.

Dr. Bhattacharya identifies various lifestyle factors such as smoking, drinking, and drug abuse as contributors to male infertility. Additionally, exposure to high temperatures, particularly in the workplace, can detrimentally affect sperm count. She categorises the causes of male infertility into three types: pre-testicular, affecting hormonal regulation of the testicle; testicular, impacting normal sperm production due to defects in testes development; and post-testicular, hindering sperm travel despite production, often due to genital tract defects or ejaculation problems.

Once we determine the cause, we can give appropriate treatment to the patient, she says. “Male infertility is a prevalent but curable factor that exists in the current day and age. One should accept and seek medical help rather than shy away from this common matter.”

Dr. Suparna Bhattacharya, Fertility Consultant, Nova IVF Fertility Kolkata

The financial burden

Exacerbating the stigma, financial constraints make the issue harder to address. Costly fertility treatments like invitro fertilisation (IVF) or intracytoplasmic sperm injections (ICSI) are often the only option for couples facing difficulties conceiving. Additionally, infertility is often not recognised as a medical illness and hence tends not to be reimbursed or covered under health insurance in many Asian countries. Payment for infertility treatment is therefore largely out of pocket, and its high cost can be a barrier to access. According to a report by The Economist, Dr. Kamthorn Pruksananonda, Associate Professor, Director of Chula IVF, Department of OB/GYN, Chulalongkorn Hospital, Thailand, notes that patients who seek treatment for gynaecological diseases do not mention their concerns about infertility to physicians because “any mention of infertility in their medical history will be used to reject reimbursement by insurance companies as it is not considered as a disease.”

An international consortium of experts, spearheaded by the University of Melbourne’s Dean of Science, Professor Moira O’Bryan, is urging governments and health systems worldwide to recognise male infertility as a prevalent and serious medical condition to break this financing barrier.

“Unlike many other medical conditions, genetic screening to diagnose male infertility is extremely limited because it is not covered by public health care or insurance, and because research into genetic causes of male infertility has not been funded,” O’Bryan says. “For most infertile men, the cause of their infertility is unknown. When it is known, few targeted treatments exist. Globally, the huge economic and social burdens of male infertility are not well appreciated. The cost of treatments and the impacts of infertility on mental health, relationships, and productivity are enormous.”

Prof. Moira O’Bryan, Dean of Science, University of Melbourne

Currently, the diagnosis of male infertility relies on factors such as family history, physical examinations, hormone profiles, and semen analyses. “Given compelling evidence that male infertility can be a biomarker for other diseases, this seems a missed opportunity to improve men’s health on multiple levels,” O’Bryan says. She emphasises the benefit of establishing a global “biobank” of tissues and clinical data from men and their partners, prioritising genomic sequencing and improved diagnostic tests for men, and conducting rigorous studies on the impacts of endocrine-disrupting chemicals on male reproductive health.

The mental toll

A survey by Fertility Network UK has shown that men diagnosed with infertility feel emasculated and suffer from poor mental health. However, there is little support and treatments are so focused on the partner who will carry the pregnancy, that men and other partners are often left out of the treatment process. “By the time they seek medical advice, men experiencing infertility are often in emotional distress, which is made worse when their doctor can’t determine the cause nor offer any treatment,” O’Bryan adds.

A new study links anxiety and depression to impaired sperm quality, providing valuable insight for fertility clinics and mental health professionals. Anxiety and depression can significantly impact overall well-being, reducing a man’s ability to cope with stress and the demands of infertility treatment. Addressing these mental health issues can help improve quality of life and overall health, which may indirectly contribute to better IVF outcomes.

The mental toll on the female partner can also be disproportionate because of the opaqueness of male fertility. Professor Robert McLachlan, who leads the male reproductive research programme at the Hudson Institute of Medical Research in Australia, says medically assisted reproduction was often the default response to male infertility. “This fails to address the cause and pushes the burdensome and invasive procedures and associated risks onto women,” says McLachlan, who also consults to Monash IVF Group.

“Compared to fertile men, infertile men appear to experience a higher rate of a range of chronic health disorders and even a shortened lifespan,” he says. “We need more research into these issues and whether their offspring may inherit these characteristics.”

Advances in medical technology

According to GlobalData, the assisted reproductive technology (ART) devices market is forecast to grow at a compound annual growth rate (CAGR) of more than four per cent, with the global market value reaching US$282.9 million in 2023. However, advancements in diagnostic solutions have the potential to reduce the need for such interventions, thereby alleviating financial burdens and improving accessibility to care.

Advancements in medical technology have also revolutionised the diagnosis and treatment of male infertility. Sperm diagnostic testing solutions provide clinicians with a non-invasive way to assess sperm quality and quantity, offering a less intimidating path to diagnosis. Similarly, automated devices such as JOMDD's AI-Assisted Automatic Sperm Sorting Device and Memphasys’ Felix offer innovative approaches to male fertility assessment, promising improved outcomes for couples struggling to conceive.