Male infertility & men’s mental health

Problems with how the testicles make sperm are the most common cause. A man may make fewer sperm than usual, or none at all. A complete lack of sperm is found in about 10 to 15 in 100 men with infertility.

A varicocele, an enlarged vein in the scrotum, is found in about 40% of men with fertility problems. It can raise the temperature around the testicle and affect sperm.

Sometimes sperm are made but can’t get out, because of a blockage, a past vasectomy, or tubes that formed differently. This causes about 10 to 20% of male infertility. Problems with erections or ejaculation can also play a part.

Things that can affect sperm include

• Diabetes
• Genetic conditions, such as Klinefelter syndrome
• Hormone imbalances
• Infections, such as mumps, gonorrhea or chlamydia
• Past injury to the testicles
• Thyroid problems
• Undescended testicles in childhood

Cancer treatments can also affect fertility. Freezing sperm before treatment is one way to protect future options.

In about half of male infertility cases, no cause can be found. That can be frustrating. It also means it is very unlikely that anything you did “caused” it.

You are usually asked not to ejaculate for about 2 days, then give a sample by masturbating into a cup. Some clinics offer a special collection condom to use during sex instead. The lab looks at how many sperm there are, their shape and how they move.

Sperm counts naturally vary over time, so you may be asked for more than one sample. A slightly unusual result does not necessarily mean a man is infertile.

A doctor will ask about your health, past injuries, high fevers, childhood illnesses like mumps, and your sex drive. A physical exam can spot things like a varicocele. Blood tests for hormones, genetic tests or other tests may follow.

A urologist, a doctor who specialises in male reproductive health, is often the person to see.

Ideas that help

• Ask if you can give the sample at home and bring it in
• Bring a written list of questions
• Remember the staff do this every day
• Use humour with your partner if it helps you both
• Write down results and words you don’t understand, and ask

Many men feel they have let their partner down. Infertility is a medical condition, not a choice or a failing. A partner usually wants you beside them, not punishing yourself.

You may grieve the idea of a biological child, or of passing something on. This grief is real, even when nobody else can see it. It can come in waves, especially around birthdays, holidays and friends’ baby news.

Research suggests that the longer infertility goes on, the more stress tends to build, and the more sex life can suffer. Getting support early can help stop this from piling up.

Experts call for challenging the idea that masculinity equals fertility. You are still the same person: your values, humour, care and strength haven’t changed.

Questions to ask yourself

• What makes someone a good man, to me?
• What do the people who love me value in me?
• What kind of father, uncle or mentor do I want to be?
• Would I judge a friend in my position the way I judge myself?

In some communities, infertility is wrongly blamed on the woman, or on curses or spiritual causes. These beliefs can stop men from getting tested or treated.

You can honour your faith and culture and still see a doctor. Many faith leaders support people getting medical care.

Many men hide their feelings or avoid talking, which can raise the risk of mental health struggles. Research also links being more open about infertility with better mental health.

Trouble with “scheduled” sex is so common that fertility experts list it as a sign counseling may help. You are not broken if timed sex feels like pressure.

Ways to ease it

• Keep some touch and time together that is not about trying
• Laugh about the awkwardness together
• Talk openly about how the pressure feels
• Tell your clinic if timed sex is causing problems; there may be other options

Experts say sexual problems linked to infertility should be part of your care, not ignored. Tell your doctor what is happening. For treatment options, talk with your clinical provider.

Even with a male cause, much of fertility treatment happens to the female partner’s body. Men often say they feel left out or overlooked, and that most support is aimed at women.

Ways to stay involved

• Ask questions of your own at appointments
• Ask if the clinic counselor can see you too, or both of you together
• Go to as many appointments as you can
• Keep track of dates and paperwork

Seeing a partner go through tests and procedures because of your diagnosis can stir up guilt and helplessness. Saying this out loud, gently, often brings couples closer than hiding it.

Things you might say

• “I hate that you’re going through this because of me.”
• “I’m in this with you, all the way.”
• “How can I make this week easier for you?”

One partner may want to talk and research, while the other needs space or keeps busy. Neither is wrong. Agreeing on a regular check-in time can help you meet in the middle.

Research links lower fertility in men with

• Heavy drinking
• High blood pressure
• Obesity
• Smoking or other tobacco
• Using marijuana or illegal drugs

Some workplace and environmental chemicals may also affect fertility. One myth to drop: the type of underwear a man wears is not related to infertility.

Some research suggests depression is linked with lower semen quality. Looking after your mental health is good for you whatever the cause.

Many men with infertility live healthy lives, and many causes have nothing to do with lifestyle. Changes are about caring for yourself, not proving you “deserve” a baby. For any medical questions, talk with your clinical provider.

Some men feel relief at a way forward. Others grieve the genetic link, or worry they won’t feel like the “real” dad. Many feel all of these at different times.

Counseling can help with questions about family, identity and what to tell a future child.

Some couples choose adoption or fostering. It helps to give yourselves time to grieve before deciding, so the choice feels like a step toward something, not only away from pain.

Some people decide to stop and build a life without children. It can bring grief and relief together. Talking with others who made the same choice can help.

RESOLVE: The National Infertility Association (resolve.org) trains volunteers to run free support groups, in communities and online. Ask whether there are groups for men or for couples.

Ways to start

• “Can I tell you something private? We’re having fertility problems, and it’s on my side.”
• “I don’t need advice. I just need someone to know.”
• “Can we go for a walk? I’ve got a lot on my mind.”

Side-by-side activities, like a walk, a drive or a game, can make talking feel easier.

Helpful

• Ask how he is doing, and really listen
• Check in again later, not just once
• Keep it private unless he says otherwise
• Treat him exactly as you did before

Try not to say

• “Just relax and it’ll happen.”
• “Shooting blanks?” or any joke about it
• “You can always adopt.”