Male infertility is common, but remains a taboo issue

• Author Amy Klein had four miscarriages and saw 10 specialists before giving birth to her daughter.
• Klein wrote about her experience with infertility in her first book, "The Trying Game: Get Through Fertility Treatment and Get Pregnant Without Losing Your Mind."
• She shared an excerpt from her book about male infertility, which can cause 20% to 30% of infertility cases.

Many people think of infertility as a women's issue, when in fact, 20-30% of infertility can be due to male-factor, in other words, the man. On Mother's Day, many people take time out to acknowledge how hard the holiday can be for women facing infertility. But Father's Day can be painful for infertile men, too, reminding them of their condition, and of the child or children they don't have yet.

When Men Are Infertile

Am I a terrible person? When our first IVF doc came back with the results of our diagnostic tests and didn't find anything wrong with my husband Solomon, I was disappointed. A tiny part of me (or bigger) wanted the problem to be with my husband. The doctor didn't know exactly why I couldn't carry a pregnancy.

They didn't know, but all I could hear was YOU, YOU, YOU, with an Uncle Sam finger pointing hostilely at . . . well, me. Me, me, me.

I was too old.

I was too broken.

I was not able to carry a pregnancy to term. So yes, of course, despite Solomon's speedy and voluminous sperm, I had been hoping, Maybe it could be him.

I thought it would be easier to have someone else to pin it on. Little did I know that male factor infertility is no picnic, either….

An infertility diagnosis is never easy. But I was a fool to wish it on my husband, because well, human decency, but also, according to a study in the Journal of Sexual Medicine, couples struggling with male factor infertility "have a lower sexual and personal quality of life" than couples for whom infertility is unexplained or is due to the woman's biology.

No matter the circumstances, women often blame themselves when struggling to conceive

And, unsurprisingly, "women feel it's their fault no matter what," says Dr. Marie Davidson, a psychologist at the Fertility Centers of Illinois. Even if they don't feel like it's their fault, "they want to protect their husband's feelings," she says.

"I felt responsible for our inability to conceive, as if my egg had willingly refused to be fertilized," medical sociologist Liberty Walther Barnes writes in her book, Conceiving Masculinity: Male Infertility, Medicine, and Identity.

Dr. Davidson says male factor infertility can cause conflict within couples due to coping styles. Men might not want to worry or pursue treatment until after a few months of Trying, but women dealing with infertility might want to seek out treatment ASAP because they're worried their egg quality might be deteriorating the longer they wait.

"There's a lot of pressure on the male partner, because the woman is saying, 'We can't wait, my eggs are going to expire!'" Dr. Davidson says.

A male infertility diagnosis is "hitting way below the belt," punned Dr. Paul Turek, a urologist specializing in male factor infertility and sexual health. "They don't know how to handle it." He finds that men tend to blame themselves, wondering if it was something that happened in childhood, like getting hit with a soccer ball, or some college indiscretion that caused the problem. Because male infertility is much less discussed in the media than female infertility, it could come as a surprise to a man when diagnosed. "It's a biological identity crisis," he says. "Men just aren't prepared for that in life:"

Adam certainly wasn't. The thirty-year-old was shocked when he found out he had very little sperm. "I thought my body would work and follow the plan I had for myself and my family," he says. He felt like the initial diagnosis was a "mistake"; he felt debilitated, then incredibly sad. "It feels like I've let everyone down and I feel like an outsider from the rest of the world." The general expectation on men in society, he says, is that sperm are readily available and a man should just be able to produce them whenever. "I know now this isn't always the case, but that didn't help me feel any better. My self-worth has been damaged: I honestly have a general sense of inferiority knowing this," he says.

Medical sociologist Barnes, whose husband had "dead sperm," wonders about the social framing of male infertility: "How do ideas about gender, including women's reproductive responsibility and the fragility of masculinity, become enmeshed in medical knowledge and practice?" she writes.

In our society, being a fertile male is associated with strength and manliness

In a chapter in Conceiving Masculinity called "Masculinity and Virility in the Social Milieu," she writes about idioms like "shooting blanks." "Compare the idea of 'shooting blanks' to other colloquial jargon such as 'grow a pair' and 'that takes balls.' These fragments of language illustrate the prevailing cultural belief that healthy testicles producing potent sperm are a symbol of strength, courage, power, manliness and masculinity," she writes.

Adam spent many hours online reading every study. He also underwent three biopsies to extract sperm for IVF with ICSI (recommended for male factor infertility). "The worst part is that everything always looked great—so there was always a reason to try again," he says. "What if is a seriously powerful drug."

The sperm extraction surgeries were "scary AF, but much easier to recover from than imagined," he says. "That being said, having been through three biopsies, I hate what it's done to me physically. Now I have the scars as reminders of what will never be."

Adam's sperm failed to fertilize his wife Zoe's sixty (!) eggs, retrieved over numerous IVF cycles. That's when they decided to use a sperm donor—but not just any donor: his brother.

"It's amazing what things you're willing to do and accept being in a situation like this," he says, noting that because he and his brother share genetics, it made using a donor an easier pill to swallow—especially when his wife got pregnant. "I envy those that can live their lives without ever having to consider some of the choices we've been forced to consider."

Amen.

There's an aphorism that when a woman trips on the sidewalk, she gets upset at herself, but when a man trips on the sidewalk, he looks at the sidewalk as if it's the sidewalk's fault. Women have a tendency to blame themselves when things go wrong more than men do. Maybe, then, we women can learn something from men when it comes to infertility. According to Barnes, many men saw their infertility as "just a medical condition" as opposed to a moral failing. Several men told her that infertility "has no more bearing on what masculinity means than any other disorder, injury, or illness." Perhaps if we all, men and women both, were to realize that it doesn't matter which partner is the "cause" of the infertility, we'd be able to move on more easily to the most important part: how to solve it.

From the book THE TRYING GAME: Get Through Fertility Treatment and Get Pregnant Without Losing Your Mind by Amy Klein. Copyright © 2020 by Amy Klein. Publishing by Ballantine Books, an imprint of Random House, a division of Penguin Random House LLC. All rights reserved.

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