The conversation on fertility—whether you’re thinking about kids in the near future or not—is still plagued by anxiety-inducing messages that keep women up at night picturing a ticking biological clock. Women deserve better—no fear mongering, just facts. So Glamour took the pulse of what women do and don’t know about their reproductive health to bring you the Modern State of Fertility.
The fertility conversation feels distinctly female. Case in point: Women are now being invited to egg-freezing parties—social events built entirely around talking about female fertility—to learn how to preserve, and pay for, their fertility future. Try to picture that same scene among men: A group of dudes gathered together over beers in earnest conversation asking, Have you thought about freezing your sperm, bro?
Men are literally half of what it takes to have a baby. A third of all cases of infertility in hetero couples is attributed to male issues, the exact same number of cases attributed to female factor causes (the rest are either a combination of male and female factors or considered indeterminable). Fertility is a team sport, in other words, but the burden of learning about fertility, planning to have a baby (or not have a baby), and dealing with the emotional challenges of infertility often falls disproportionately on women. “One in 10 men in America are infertile,” says Tom Smith, CEO and founder of Dadi, a male-fertility start-up that analyzes and freezes sperm. “Yet all the onus and pressure is placed on the woman.”
It’s the kind of B.S. double standard that reeks of the same sexism behind the lack of male birth control—it also doesn’t jibe with medical standards. “Anytime you evaluate only one member of a couple, you only get half the story,” says Michael Eisenberg, M.D., associate professor of urology at the Stanford University Medical Center and medical director at Dadi. It’s becoming increasingly critical that we don’t overlook men: A 2017 study found that sperm concentration in men in Europe, North America, and Australia has dropped by more than 50 percent in the last 40 years—a decline that shows no signs of leveling off—sparking headlines questioning a “reproductive apocalypse” for men.
So why aren’t more men talking about fertility?
“Men don't think about it, because our entire lives we've been told that men can fertilize an egg well into their nineties,” says Smith. Technically, this is true—the oldest man believed to have fathered a child was 96—but it’s the exception, not the rule.
“I think it's easy to see how the conversation and the ‘blame,’ should we say, has been placed on women," says Nataki Douglas, M.D., director of translational research for the department of obstetrics, gynecology, and women’s health at Rutgers University and chair of the medical advisory board at women’s fertility start-up Modern Fertility (Glamour’s partner in a survey of just how much women know about their fertility). "We do have a finite number of eggs. We lose them as we age, and we don't make new ones.” Men, however, don’t deal with the same biological clock; they continue to make new sperm well into adulthood, though the quality steadily declines, increasing the risk for genetic mutations, preterm births, and more complicated pregnancies. In other words, “the sperm of a 90-year-old is going to be different than the sperm of a 30-year-old,” says Dr. Eisenberg.
When Smith turned 30, he went to the doctor to see what he could be doing proactively to preserve his health. “I asked for every single test under the sun to be done, but the thing that was never broached at all was the topic of fertility,” he says. Given his interest in the topic, he brought it up. “The reaction was that it's not something that's typically done,” he says. “It’s not that there isn't a need—it's just not typically done.”
Male infertility simply doesn’t seem as visible as female infertility, experts say. A pregnancy very clearly telegraphs a woman’s ability to have a baby, but so, roughly, does menstruation. “One of the key differences between men and women is women have a monthly feedback cycle,” says Smith. “Men have no such cycle and only find out if they have an issue when they can’t conceive.”
Historically, women were almost always assigned the blame if a couple didn’t conceive—women were labeled as barren and in many cultures could be cast off if they couldn’t deliver an heir. Those stereotypes still linger. In the Glamour x Modern Fertility survey, more than 40 percent of women said people think less of women who deal with fertility challenges; just half of that felt the same social tax applies to men. The double standard affects medical care too. “Until pretty recently there were not many specialists in male reproduction,” Dr. Eisenberg says. “Without experts in the field, a lot of times male evaluations just weren’t done.”
Women are left to pick up the slack. “I think a lot of times, the wives or partners are the gatekeepers,” bringing their male partner to the fertility specialist or urging him to get tested, Dr. Eisenberg says.
“Culturally I think it can be harder for men to talk about having trouble conceiving—it can be interpreted as a challenge to masculinity,” says Paula Brady, M.D., assistant professor of obstetrics and gynecology at the Columbia University Irving Medical Center, and reproductive endocrinologist at the Columbia University Fertility Center. It’s a medical issue just like any other, even though it’s not often seen that way, she says. “It's just such a significant, emotional, culturally loaded area about which open dialogue has not been encouraged—even less so in men than in women,” she says. “I think that's a lot of the struggle.
What is it going to take, then, for a group of guys to start talking about their future fertility? About whether they should get tested? Freeze their sperm? “That's the billion-dollar question,” says Dr. Eisenberg. “I advocate that men check their semen quality annually to see if there is any decline. And if there is a decline, then we can think about ways that we can try to mitigate that,” by boosting overall health measures like weight and activity levels.
Normalizing the conversation around reproductive health—for both women and men—is a start. Dr. Eisenberg sees that conversation evolving already. “More men will ask me tough questions in a serious way, even in a group setting like a dinner party, rather than in a joking manner, the way they used to,” he says.
It’s a move that’s long overdue. “Everybody knows somebody who's experienced these issues,” Smith says. “If men are more active in that conversation, it also helps take the onus and stigma off women.” In other words, it could be 50-50.
Macaela MacKenzie is the senior health editor at Glamour. Follow her on Twitter @MacaelaMack and Instagram @macaelamac.
