In 2018, Kent resident Toby Trice took up go-kart racing in an effort to distract himself from recent bad news. The 31-year-old and his partner had experienced a second unsuccessful in vitro fertilisation (IVF) in their years-long attempt to start a family. The procedure was necessary due to his own infertility.
“I fell into a huge depression because I thought I was alone. I didn’t have anyone around to seek support through,” says Trice. “I was ashamed of the fact that I wasn’t able to have a child. Once a month go-karting at a local track was my escape from dealing with fertility.”
Trice, now a professional racing driver, was diagnosed with swollen veins in his testes that were inhibiting his sperm production, a condition known as a varicocele, one of the most common causes of infertility among cisgender men.
When people think of infertility, the common conception is that it is an issue affecting cis women. However, there has been a 50 percent decline in sperm production over the past 40 years, according to a 2017 study from the European Society of Human Reproduction and Embryology (ESHRE). Half of infertility cases include some form of male factor. In the UK, one in seven couples currently struggle to start a family.
“I spent 27 years in charge of a facility that did male fertility diagnoses. Over that time, every man that came through the door thought he was the first one,” says Allan Pacey, professor of andrology at the University of Sheffield. “There's a low level of education.”
While resources are readily available to cis women experiencing trouble conceiving children, a dearth of information available to their male counterparts contributes to stigma around infertility and a hesitancy to be vocal about the issue. This lack of conversation is detrimental to research that can improve or develop aid for patients.
“Male fertility is at the bottom of the heap for being funded, it's not seen as an important healthcare condition because nobody dies of male infertility,” Pacey says. “I am a dying breed of academics looking at male fertility – there's no one in my institution that's going to follow behind me, it's not seen as an attractive career path.”
The lack of interest in this research results in a scarcity of information on how infertility affects cis men of different ethnicities and sexual orientations. Trans men trying to conceive, as documented by VICE writer Freddy McConnell in his column Dad Bod, face a whole raft of challenges, too.
The only sizeable data around infertility comes from IVF patients – who are largely cis women – and as such, there is no real breakdown of demographics for cis men. According to Pacey, this lack of interest in male fertility among new medical professionals, who would rather focus on life-threatening conditions, will likely thin the ranks of specialists (urologists or andrologists) in the field. This leaves gynaecologists as the primary option available to most men looking to confirm or treat male fertility issues.
Trice, who initially discussed his semen analysis with a gynaecologist, believed that this was the only course of action at the time.
“In hindsight, I look back and think, ‘What a load of madness!’ Why [was] I not seeing someone that specialises in male fertility?” says Trice. “All the way through, even to the point where we went to an IVF round, it was all specialists [in female fertility]. It wasn't until I went to a private doctor that I then saw someone that was specifically trained in male fertility.”
According to Sheryl Homa, scientific director of Andrology Solutions in London, the NHS does not automatically offer tests for male fertility beyond semen analysis, while women might be offered blood tests for hormonal imbalance, for instance. This means men typically have to specifically request further tests from their GPs. Newer tests, like sperm DNA fragmentation or oxidative stress measurements (which test sperm quality), are only performed in private practice, requiring patients to pursue procedures that can result in financial burden.
Many men affected by infertility also suffer mental health side-effects.
“It was a tough pill to take,” says Kevin Button, a South Wales resident diagnosed with Sertoli cell-only syndrome, which results in no sperm being produced in the testicles, eight years ago.
The impact of Button’s diagnosis was compounded by his inability to find others going through similar circumstances. To compensate, the 36-year-old sought refuge in substance abuse.
“I was drinking heavily and ashamed to say, I was taking drugs at the time. I lost my relationship and moved back in with my father,” he says. “There were mixed emotions and I wasn’t in the right mindset, just because of the lack of support.”
Button is now with a new partner with whom he is trying to have a child. However, he still felt there was such a lack of support around male infertility in the UK that in 2020 he entered a competition run by California IVF offering a free round of IVF treatment to the winner. Though Button won the contest, COVID-19 travel restrictions cancelled his planned trip, but he doesn’t regret entering.
“You’ve got nothing to lose,” says Button. “If you want a baby you're willing to do anything, to be honest.”
Gwenda Burns, chief executive of Fertility Network UK, believes education about fertility should begin in schools. “There are so many different areas [affecting] male infertility,” says Burns, “I think starting education younger and making it more the norm to be able to talk about [is key] – there are so many lifestyle factors that can have an impact,” she says.
To this end, Fertility Network UK developed a YouTube series called Your Future Fertility, geared toward students and informing them about things that can impact fertility from a young age including smoking and binge drinking.
Increased media representation can also help those dealing with infertility open up about the issues. TV shows like Friends, and documentaries like The Easy Bit, Channel 4’s Geordie Hospital, and comedian Rhod Gilbert’s Stand Up to Infertility help bring the conversation to the public, but experts say this doesn’t happen often enough to have a lasting impact.
Both Trice and Button are trying to fill the education gap.
After parlaying his go-karting hobby into a successful racing career, Trice uses his platform to bring awareness to male infertility. He is an ambassador for Fertility Network UK, his racing car sports the charity’s logo and he is also involved with Rhod Gilbert’s group HIMfertility.
In 2019 Button founded The Man Cave, an Instagram account and website acting as a support group and resource hub for men dealing with infertility.
“The weight off my shoulders was unbelievable,” Button says of launching the site. “People privately messaged me letting me know that everything is going to be okay, and [that they] were going through the same situation.”
Such support groups can create safe spaces for both men and women to discuss the issues around infertility. For Button, this means organising group walks where attendees can discuss their feelings and find community. Trice leverages digital tools to serve HIMfertility’s international membership.
“We basically allow guys to come on just a Zoom chat. We just kind of wing it, we all jump on together and start talking,” Trice says. “Often they've gone away with more education on male fertility… it just helps them be more direct about what path they're on.”