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During the Covid lockdowns of mid-2020, Luke and his wife made the decision to begin trying for a child. Reflecting on his past, Luke recalls, “All through my teens the message was clear: don’t have sex without a condom or you might get someone pregnant.” Expecting that conception would proceed naturally once they were ready, he was unprepared for the challenges that followed. After trying for 18 months without success, the couple consulted their GP and received referrals for further examinations both at a hospital and a fertility clinic.
Over the following year, Luke noticed that medical attention was almost exclusively focused on his wife. All appointments were booked under her name, and although Luke completed paperwork himself, the clinic consistently contacted his wife rather than him. “At the heart of it, the whole system is based on the assumption that it’s a woman’s problem,” he observes. “The male side gets totally overlooked.” It was only after more than a year and an unsuccessful IVF attempt that Luke was informed there might be an issue with his sperm. Surprised by this late revelation, he reflects, “I was like, ‘Now you’re telling me?’ There were things on my side that could have been looked into much sooner, rather than treating me as an accessory to the process.”
Statistics suggest that infertility affects around one in six couples, with roughly half of all cases involving male factors, either by themselves or combined with female issues. Despite updated guidelines from the National Institute for Health and Care Excellence (NICE), which recommend that couples experiencing difficulty conceiving after 12 months of unprotected intercourse should be assessed jointly and receive simultaneous testing, many experts report that men are frequently marginalized when it comes to diagnosis, treatment, and discussions around fertility. Professor Bola Grace from University College London remarks, “There can be genuine exclusion even if it’s unintentional. Men tell us it can happen across services – in how care is delivered, in fertility clinics and in counselling.”
This pattern of exclusion causes significant repercussions, not only for men but also for women, who often bear the greater burden of “coping, the planning, the worrying, the decision-making,” Professor Grace explains. Delayed identification of male fertility issues can result in more invasive procedures and a more complicated, costly journey through fertility treatment. Moreover, she points out a cyclical problem in which men’s voices are not included, leading them to engage less and reinforcing stereotypes that men are uninterested, when in fact they are often sidelined from the start.
The way fertility care has evolved seems to reflect a bias toward female reproductive health. Allan Pacey, professor of andrology at the University of Manchester, highlights that many fertility centers are run by gynecologists focused on women’s health, leaving male fertility as a secondary concern. “Now, there are some really good gynecologists that do it well, because they’re interested in this, but at the level of the GP or the secondary care clinic or the tertiary care clinic, men can be an afterthought,” he says. This disparity is visible at the policy level too; the Department of Health’s recent health strategies for men and women allocate significantly more attention to fertility in the women’s document than in the men’s. Pacey describes this as a “missed opportunity to level the playing field,” advocating for greater inclusion of men to improve experiences and advance research and treatment options. A Department of Health and Social Care spokesperson affirmed the need for men to receive equal support and stated ongoing efforts to ensure men’s fertility is adequately represented in service planning and delivery.
While progress is occurring, it remains slow. Consultant urological surgeon Professor Hussain Alnajjar notes, “Things are moving in the right direction, but we are still well behind.” Increasingly, men may see specialists before their female partners if initial semen analysis indicates a concern, but women still tend to be assessed first overall. Personal experiences illustrate the impact of these delays and the emotional toll they take. James, 34, from North Yorkshire, describes how avoidance and stigma affected his journey. He recalls an “ostrich moment” when he avoided confronting the issue while his wife underwent multiple evaluations. After receiving a diagnosis of weak sperm, he struggled with feelings of guilt, saying, “You’re the partner of someone who you love unconditionally, but you view yourself as the cause of their pain. You feel you’re the reason they can’t have a child.” The slow pace of diagnostics, long travel, and lack of immediate support left him feeling isolated, a situation compounded by societal stigma linking male infertility to masculinity. James explains, “You don’t know where to go, who to turn to, or what to say.”
Support for men remains limited. Although UK fertility clinics are required by law to offer counselling prior to treatment, this is not always free or ongoing, and fewer male-specific support groups exist compared with those for women, according to the fertility regulator, the HFEA. However, initiatives led by individuals such as Shaun Greenaway, diagnosed with azoospermia in 2018, are creating new spaces for men. Shaun, who became a father via sperm donation, felt compelled to share his experiences due to the absence of personal support. Together with Ciaran Hannington, diagnosed with fertility issues in 2012, he co-founded the Male Fertility Podcast and a support network offering online and face-to-face connections. Comparing male infertility awareness today to mental health discussions a decade ago, Ciaran remarks, “There’s such a deep-rooted stigma but, sadly, it’s one of those topics that you don’t really take any notice of until you have to.” After years of treatment including seven rounds of IVF and two miscarriages, Ciaran’s wife eventually gave birth to twins, highlighting both the challenges and hope present on this difficult path
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