Ruminations

The Conception "Problem" Partner : Fragile Psyches

"We had just gotten married and a thousand things were going through my mind: Will we stay married? Will she leave me? What's going to happen to our relationship?"
"It's hard for a man to express what he's going through and [to] say, 'I'm the problem'."
Bryan Dube, 40

While the average sperm counts have dropped for all men, that is still considered within the normal range needed to conceive. Getty Images

"When I see patients in my office, women often say, 'I hope it's me and not him'. The reality is that it's 50/50."
"More people who come to us have a male factor for infertility than ever before."
Dr. Arthur Leader, OB-GYN, Ottawa

"Something is very wrong with the way we live."
"It's amazing that so many people can't conceive naturally -- it's really something we should pay attention to."
"One possible explanation is that men residing in Western countries over the last decades were exposed to new man-made chemicals during their life course, and there is more and more evidence that these chemicals hurt their reproductive function. We don’t know for sure why this is happening, but our findings should drive massive scientific effort to identify the causes and modes of prevention."
Hagai Levine, epidemiologist, professor, Hadassah University Medical Center, School of Public Health, Jerusalem

"The general consensus is that 'real men' gush sperm."
"Male infertility destabilizes the presumed fundamental basis of masculinity disrupts traditional gender roles and hits personal masculine identities right where it counts."
"These doctors [male infertility specialists] put a lot of effort into making men feel manly in their clinics [avoiding using words such as 'infertile', or 'infertility'."
"Instead, they would say 'Your sperm count is at three million and I was hoping for 15 million'. When a man hears that, they could think that's really good, but in fact it's terrible."

Liberty Barnes, medical sociologist, University of Oregon

"We need to help them [men] too."
"No one talks to young men about the fact that they could be infertile or why they might be infertile."
"These are medical situations that they should be aware of."
Marcia C. Inhorn, medical anthropologist, Yale University

Life begins … but for western couples the process is becoming more and more difficult. Photograph: Mark Evans/Getty Images

Bryan Dube most certainly was not aware of, nor made aware of the fact that there was nothing wrong with his masculinity, and that he is among the modern cohort of young men whose sperm count is low because of circumstances he knows nothing about, but shares with a multitude of others. His lack of knowledge steeped him in doubt about himself, about his value as a man, about his future status as a parent and husband. In short he was puzzled, fearful and short-changed.

He and his wife wanted a family. They soon discovered that would be a costly venture for them, even though in the end they were more fortunate than many who took the same hopeful route to parenthood. A round of in vitro fertilization (IVF) was costly at $10,000; all the more so that it turned out to be unsuccessful. They paid out to freeze more eggs, and a year later tried again and finally 2013 brought them a son.

Presumably, he is now a lot more knowledgeable than he had been as a newly-married in his mid-30s. Very seldom discussed, but a reality, male infertility is rising in the general population. Last year, the results of a meta analysis of studies on the issue saw publication in Human Reproduction Update, concluding on the evidence that sperm counts have fallen and continue to fall in Western countries, representing a conservative 52.4 percent drop from 1973 to 2011.

Dr. Leader co-founded an IVF clinic in Calgary at Foothills Medical Centre and went on to co-found the Ottawa Fertility Centre after a stint as professor of obstetrics, gynecology and medicine at the University of Ottawa. He feels the reasons that can be attributed to this situation of growing male infertility are manifold, beginning with the decision by men to wait longer to have children, when their 'best before' date for sperm fertility is under age 40.

The social myth that men remain virile long, long after women lose their battle with their biological clock around age 35, persists. With aging, sperm quality declines, including the shape and movement of the sperm. Dr. Levine, lead author of the sperm count study, feels environmental factors and lifestyle factors must be included. That means exposure to chemicals such as pesticides, heavy metals and radiation, along with poor diet, inactivity and smoking -- all play a part in male infertility.

The irony is glaring. In just about every and any medical specialty men are studied and research models males as the paradigm of best outcome. Not, however, when it comes to infertility; it is a social shibboleth. Experts point out the prevailing assumption that the main symptom of infertility is impotence, whereas sperm count, shape and movement as well as blockage in places such as the testicles and vas deferens can represent fertility interference, yet not necessarily result in inability to have an erection.

Male infertility does not denote a lack of masculinity. What it represents is a medical condition. And the issue of reproduction health should no longer be confined to educating women about the conditions that interfere with their ability to conceive. There is an obvious and urgent need to extend the conversation about reproduction health to be more inclusive, sweeping men into the issue to advise that infertility affects both genders in ways that are gender-specific.