The Secret World of Male Infertility

In our confessional culture there is one thing that is rarely spoken about – male infertility.

Almost 8 million couples in America alone suffer from infertility. In an estimated third of all infertile couples the problem will lie with the man, but if you surf the net and visit forums you’d be forgiven for thinking that infertility was a female only medical condition. Thousands of women are writing about the problems but almost no men. Fertility is so tied up with our ideas of masculinity and virility that most men refuse to talk about infertility for the shame and embarrassment it will engender.

Male infertility is one of the last great taboos. And I can understand why. When my wife and I were struggling to make a baby I also found it hard to vocalize my feelings. My failure at fatherhood ate away at my very being and made me feel less of a man. Friends later told me that my body was physically hunched from the emotional weight of my baby wait. I didn’t want to talk about it to anyone and certainly not mates. I would walk past children playing in the park and I’d feel my heart breaking into tiny pieces. Consumed by Buggaboo envy I’d see couples pushing their baby strollers and want to punch them in the face. I would oscillate wildly between anger and depression. After learning a friend of ours was pregnant I didn’t leave my bedroom for two days.

Last month a close friend of ours announced that they were about to have a baby. Later that night over a few glasses of wine the husband admitted they had gone through IVF 5 times. And furthermore his sperm was at fault. Only now that a baby was on the way did he feel he could open up about their ordeal. During the whole traumatic journey he had spoken to no one. He said he felt too full of shame and guilt.
I know how he felt. I am ashamed to admit that when my wife and I both had our fertility tests I sat in the doctor’s room waiting for the results silently praying that my sperm would not be judged to be ineffective and that instead it would be my wife’s eggs at fault.

I know of another couple where the wife told everyone the problems was with her eggs, when in fact it was her husband’s low sperm count, to shield him from the embarrassment. It’s telling that while female celebrities have spoken openly about their struggles to conceive I can’t think of one male celebrity that has admitted to a low sperm count. Like Chlamydia, men with infertility problems are everywhere. Lost and isolated blokes who would rather chew off their own arms than discuss the number, motility and quality of their sperm.

One of the consequences of this male silence is that, despite men and women being equally responsible, infertility is still seen primarily as a woman’s problem and most of the research and resources is focused on them.

I urge men to speak out and be open about their infertility struggles. I realise now that there is no shame associated with it. Being a father and being man is not defined by the potency of our white stuff.
I hope my novel will give more men the strength to speak out. And also for women going through IVF to realise that despite their partner’s outward appearance of strength and detachment, there is a man next to them who is just as emotionally invested as they are.

What is IUI and how can it help male factor infertility?

What is IUI?

Intrauterine insemination (IUI) is process where sperm are artificially placed in the uterus with the help of a catheter. This procedure helps to ensure that more sperm are available and able to access a woman’s egg, thereby aiding fertilisation and conception. IUI is the updated name for what was once known as artificial insemination.

Who Can Use IUI?

IUI is usually suggested for those couples who have been trying to conceive for a year or more without success and have been found to have infertility issues..In general, artificial insemination is used when:

A woman’s cervical mucus is scant or hostile to sperm. Through IUI, sperm directly reaches the uterus, bypassing the cervix and the cervical mucus.

The man has a low sperm count, though the sperm should be healthy.\r\n\r\nMale infertility due to antibodies in his own sperm. Sperm not damaged by the antibodies will be separated and used in the IUI process.

Ejaculation issues due to vaginal muscle contractions or psychological problems.

Retrogade ejaculation,  a condition where the semen goes back into the bladder rather than being expelled from the body.

Couples who cannot naturally have intercourse due to disability, injury or premature ejaculation.

How does IUI work?

In the process of IUI the fertilisation of the egg and sperm occurs naturally, although the sperm is given a kind of “push” or “helping hand” into the uterus. Intrauterine insemination can be performed with or without the use of fertility drugs. If fertility drugs are used it is called a “stimulated cycle” because the drugs stimulate ovulation. If drugs are not used it is called an “unstimulated cycle” or “natural cycle”.

IUI begins with an ultrasound check-up of the female to determine the size of the follicles that can mature into eggs. She is then given oral fertility drugs, if she has decided to use these, to help stimulate a greater number of egg follicles to mature.
Next, with the help of ultrasound scanning and blood tests to check for estrogen levels (estrogen is the hormone released by the female body to help the growth of the eggs), follicular growth is monitored. In women who have taken fertility medications, this also helps in individualising drug doses, keeping track of potential side effects and reducing the risk of multiple pregnancy.

In some cases, women undergoing IUI may receive an injection of human chorionic gonadotropin (hCG) hormone to stimulate egg growth and cause ovulation. Administering this hormone causes eggs to be released within 30 to 40 hours and provides a better assurance of an egg being present in the ovary when IUI takes place.

Timing is crucial when dealing with IUI, as sperm has to be injected at the precise time when ovulation has occurred or is about to occur.

Around the time of expected ovulation, a sample of fresh semen is collected from the male partner and processed in the lab by washing in a culture medium or using a density gradient column. This is done to obtain good quality sperm while minimizing the number of unhealthy, poor quality sperm. A prompt insemination after the processing is important to increase the success rate.

Sometimes a sperm sample taken at an earlier date may also be frozen and later used for IUI. Sperm is then inserted into the cervix and placed high inside the uterus by using a catheter. It is a painless procedure and does not take more than 20 to 30 minutes. Once insemination is done, regular ultrasound monitoring and pregnancy tests are performed to find out whether the process was successful.

Risk Factors of IUI

While IUI is a relatively straight forward process, like all medical procedures there are risks involved. Risks include infection, brief cramping of uterus or transmission of venereal disease from donor sperms. However, the strict quarantine applied nowadays by sperm banks has decreased the risk of viral transmissions dramatically.

The use of fertility drugs brings with it the risk of a multiple pregnancy. In order to reduce this risk, your doctor may stop your cycle midway. The chance of a miscarriage occurring and having a low birth weight baby is high in the case of multiple pregnancies.

Fertility medications may also cause a rare condition called ovarian hyperstimulation syndrome. Women affected by this will experience an enlarging of their ovaries and a collection of fluid in the abdomen. If this occurs, the IUI process may be stopped before insemination.

Success Rate of IUI

In a given cycle, the possibility of conception is 10% to 20% provided the sperm count is good and the female has a healthy fallopian tube. The woman’s age is also a deciding factor on the success rate, since advanced maternal age results in fewer follicles maturing into eggs.

Doctors usually recommend trying two to three IUI cycles before opting for another fertility treatment, such as IVF.

Cost of treatment: Compared to other fertility treatments, IUI is a lot less expensive.



I am at work, when suddenly I come over all strange. I feel dizzy. The room starts to spin. My guts ache and I have to grip the desk to compose myself. Sadness has run headfirst into my stomach. It isn’t the depth of the story I am editing, about a little girl who loses her pet frog, that brings tears to my eyes, it’s the thoughts that rush up from my subconscious. Will I ever watch this show with a child of my own? Will I ever actually be a dad?

I rush to the Gents, sit on the pan and let the tears come.

Great big watery tears. Buckets of them.

I never cry. I can’t even remember the last time I cried.

I cry for me. I cry for Nyla. I cry for us. I cry for my useless sperm. And then I start crying because I am crying. I am a man with dodgy sperm and I cry.

What kind of man am I? I bet my dad wouldn’t cry. I am not a man at all.

Once I start I can’t stop.  At first I try to hold it in. But I think its best to just let it all flow. Holding it in will only make it worse, like diarrhea, it’s best to just let it all come out. And anyway no one can see me.

I don’t just cry tears, I physically sob. It is embarrassing. I hope to God no one can hear me.

Then after what must have been a good ten minutes, it stops. I wipe away my tears. I feel drained. But in a strange way I feel good. Cleansed.

For a long time I just I sit pondering my existence. If you can’t father a baby what is life for?

It’s a big question and not best suited for a men’s toilet cubicle on the third floor of a seventies office block in West London. So I look around me and wonder instead what compels men to draw knobs on lavatory walls.

Male Infertility Blues

I am not a man like other men. I am infertile.  All I can think about is my semen lost at sea.

I don’t want to go to work. I don’t know if I have the strength to battle the commute. I don’t have a cold but I feel worse than if I had the worst possible man flu. I have “not-fertile enough-to-be-a-man” flu. I wish I could phone work and announce that I had picked up a bad dose of infertility and that there was no way I would be able to do my job today. But I look fine. There are no immediate clues to infertility. From the outside, you can’t see the damage within. Like the banks in the financial meltdown, you have no idea how badly things aren’t working the way they are meant to.

Should a Doctor be doing that?


The doctor shoves what looks like a rather large vibrator up a place where no man except her boyfriend should be allowed to go. Fuckin’ hell. I have to admit I wasn’t really expecting that.

My first reaction is to turn away and study the certificates on the wall.

‘Darling what are you doing?’ asks Nyla.

‘I just want to check that this man has the qualifications to do that to you’ I say.

He then moves the instrument around inside here while looking at her ovaries on a black and white TV screen. You know the NHS is in trouble when they can’t even fork out for a colour TV.

I Want To Be A Dad

Maybe it has always been there. Lurking in the back of my mind. Maybe they are thoughts I have carried around since childhood. Maybe it’s the result of genetic imprinting. I don’t know. What I do know is that more and more it’s all I think about. It has became an obsession. I’ve tried to push it the back of my mind. Tried telling myself men shouldn’t think like this, but then I see kids playing in a park or walk past a school and my urges come to the forefront. Its instinctual, a deep down primal urge.

There’s a hole in my life – I’ve tried filling it with sex and drugs and electronic dance music. With TV and movies and football and beer. But that hole is the size of a small child.

I want to be called a daddy. I want to have a purpose. I want to give life meaning.

Lazy Sperm

poor sperm count

For years, my sperm were not put to work. They spent their days slobbing on a couch, reading the papers, watching the footie, drinking beer, and playing computer games. Only getting excited with one night stands who insisted on catching them in rubber. My sperm were not gainfully employed. They were sperm on benefits. Now, when they do finally have a job, they seem reluctant to take the opportunity gifted to them.

Power Point Sex

Nyla is now doing daily temperature readings. She is employing all her power point skills to plot graphs and pie charts. Last week, after dinner, she did a 10 minute fertility presentation using her charts to project our chances of success. She told me about her “fertile window”. She told me that within the average menstrual cycle there are six days when a woman can fall pregnant. Five days before ovulation and the day of ovulation itself.  She told me that by taking her basal temperature readings and regularly checking her cervical mucus she could tell when this is.

‘So,’ she concluded ‘when my mucus is creamy and slightly stretchy we have to fuck. And when it is the consistency of egg white we need to fuck like crazy.’

Egg whites made me think of meringues. 

We have a definite target. And there is an action plan. Devised by Nyla, it consists of ‘lets have sex when I tell you to.’ Today is one of those meringue days.

It should be erotic but somehow it isn’t. I’m starting to feel like a performing monkey.

Fear of Sex

It’s sex night. I’m going to get some hot action. It’s sex night and my woman is at home ready and waiting. It’s sex night and I’m not looking forward to it one little bit. 

I am dreading it. I’ve got a horrible tense knot in my stomach. I know what I’ve got to do and I am worried. The pressure to perform is immense. 

Sex is not fun anymore. It’s serious. 

I’ve always defined my masculinity in terms of sex. 

Always needed it. 

Sometimes got it. 

Always enjoyed it. 

Until now. Not now that we are trying to make a baby. Not now that I am trying to become a dad.


General Facts about Infertility


Infertility refers to the biological inability of a person to contribute to conception.

Both women and men can be infertile.
Doctors specializing in infertility, consider a couple to be infertile if they experience any of the below:
1. the couple has not conceived after 12 months of contraceptive-free intercourse if the female is under the age of 34
2. the couple has not conceived after 6 months of contraceptive-free intercourse if the female is over the age of 35 (declining egg quality of females over the age of 35 account for this age-based discrepancy)
3. the female is incapable of carrying a pregnancy to term.


Worldwide, it is estimated that one in seven couples (approximately 14%) have problems conceiving.


This statistic is broadly the same for every country and seems to have no relevance to a country’s status.
84% of couples who have regular sexual intercourse (that is, every 2 to 3 days) and who do not use contraception will get pregnant within a year.
92% of couples who are trying to get pregnant do so within 2 years.
Infertility is fairly evenly spread across the sexes.
For instance, in the UK, in people going forward for IVF, roughly half of fertility problems with a diagnosed cause are due to problems with the man, and about half due to problems with the woman. However, about one in five cases (20%) the infertility has no clear diagnosed cause.