Researcher explores the invisible, ignored epidemic of male infertility

Liberty Walther Barnes

Culturally speaking, infertile men are invisible. That’s the finding of Cambridge University medical sociologist Liberty Walther Barnes, who spent six years tracking patients of five U.S. male fertility clinics and found that more than half of the men she tracked did not consider themselves infertile— despite trying to impregnate their wives for more than a year and having a low or zero sperm count. 

The reason, according to Barnes: Everybody tiptoes around a man’s fertility and specialists often push treatments like in vitro fertilization (IVF) on infertile couples, despite it being a female “solution” to what is equally likely to be male “problem.” Also, men just don’t have any of the social support that infertile women have.

A mother of four kids, Barnes, 38, recently spoke with Today Moms about her new book, “Conceiving Masculinity: Male Infertility, Medicine, and Identity.”  

What sparked the idea for your research?

Barnes: Around twelve years ago, my husband Levi and I started seeing a fertility specialist. I have an irregular menstrual cycle and the first thing the doctor wanted to try was artificial insemination with Levi’s sperm. But the night before we were going in, my husband came down with this awful flu, huddled in a blanket and shivering. Still, we went to the office the next morning, and there was Levi holding this sad little cup and the doctor told us “All of your sperm is dead.”

What struck me was how protective they were of Levi, telling him not to worry, it only takes one sperm. No one actually uttered the word infertile. Meanwhile, I was the one made to feel like my egg had to find this one sperm, that, as the woman, it was all riding on me to make this work.

In her new book, Liberty Walther Barnes writes about the invisibility of male infertility.

By the time I got into the field, I started interviewing men at fertility clinics and quickly discovered, lo and behold, these men do not think they’re infertile — even if they have a zero sperm count.

After a while, I would just ask them up front, do you think you’re infertile? And sometimes, they would talk about how they had this “problem” or “challenge,” but infertility wasn’t the word they used or how they thought to describe themselves.

How can men being treated for infertility not think they’re infertile?

Barnes: It’s really important to understand that these men aren’t simply in some kind of deep-seated denial. This isn’t about an individual guy not understanding his body. Infertile men are part of an entire culture that doesn’t talk about male infertility, and will protect a man’s “manhood” at any cost. I discovered this whole social structure in place — doctors, nurses, the media — making sure, every step of the way, men don’t have to ever admit that they’re infertile. Even wives tread gently regarding their husband’s fertility issues. 

For about a hundred years, we’ve had two basic assumptions that have shaped medical science and reproductive research. The first is that having babies is a woman’s work and the social myth goes, a woman will do anything to get pregnant. At a certain age, women are painted as these people just desperate to have children, who will undergo any kind of fertility treatment necessary.

The second is that a man’s masculinity is tied to his virility. Think about the expressions we use: “That takes balls” or “He’s shooting blanks.”

Why do women bear the brunt of infertility treatments?

Barnes: The same ideas about gender that have guided birth control research — why don’t we have a male pill, for example — shape the way we treat infertility among couples.

Most commonly, we treat women first and there are a lot more options. Take IVF, a frequent treatment for infertile couples. While I don’t object to IVF and it’s provided many miracles for many people, it’s centered on a woman’s body, regardless of a man’s sperm count. IVF doesn’t fix any underlying “disorder.” Instead of figuring out how to raise a man’s sperm count, we often concentrate on getting more eggs out of the woman, or hyper-stimulating ovulation using the popular drug Clomiphene. There just isn’t a clearly medically defined protocol for infertile men as there is for infertile women.

Isn’t that treating a woman for the man’s medical “problem”?

Barnes: Yes, precisely. But it’s crucial to remember that both men and women are being disadvantaged here. Women are getting stuck with the brunt of medical treatments and men are being ignored by the medical system. The whole infertility process reveals that a lot of our ideas about gender do no one any favors.

So what’s the best way to break the cycle and help infertile men?

Barnes: That’s the million-dollar question. How do we break the social taboo? In the short term, we need a clearer path for moving infertile men through the medical system. Doctors, nurses and spouses need to talk more openly about male infertility. And couples need more information about the prevalence of male infertility and all the treatments available.  

Long term, we need more male-centered reproductive research. We can’t change gender norms overnight. But reproduction is a good place to start. Of course, it probably wouldn’t hurt if a Hollywood actor like George Clooney or an athlete like Kobe Bryant ever announced they were suffering from male infertility.

Jacoba Urist is a health and education reporter in NYC. She also writes for The Atlantic. Follow her on Twitter @JacobaUrist.