When you think of infertility, does a man or a woman come to mind first?

Despite the fact that male and female factors play a statistically equal role in infertility cases, female infertility receives more emphasis culturally.

But men experience the stress of infertility too, and have been left out of the conversation for too long.

Dr. Kevin Doody, co-founder of CARE Fertility, shares his insights about male infertility, including how perceptions of it have evolved, and what men who may have a fertility problem need to know and do today.

First, Dr. Kevin explains, it helps to understand the reasons why male infertility seems so overlooked.

Infertility treatment often focuses on the female, even if a sperm problem is to blame.

“We know that a male factor plays a role in about half of all couples in which an infertility factor can be identified,” says Dr. Kevin. “Other factors can be contributing to a difficulty getting pregnant, but sperm problems are quite common.”

“The big difference, however, is that even with a sperm problem, most of male factor infertility is still treated through the female.

“Sperm production issues can sometimes be corrected through hormonal treatments or medication, but that’s less common than other sperm problems, which often can’t be fixed with that kind of treatment.

“Therefore, a lot of the time patients with male factor infertility will still wind up doing in vitro fertilization, or intrauterine insemination — treatments using assisted reproductive technologies that center on the female. That’s just how the problem is most often solved.”

As a result, emphasis is placed on the woman, both at the individual couple level and in the broader conversation around infertility. But infertility can be very stressful on both partners, and everybody takes it differently.

Men still face greater cultural stigmas around infertility, but the conversation is changing.

“As a medical issue, infertility is quite common, but there have always been stigmas in our culture around it,” says Dr. Kevin. “In the 30+ years I’ve been practicing, this stigma has come a long way, but more so for women than for men. Women are more open to talking about it.”

“Culturally, however, we still often associate a man’s fertility with his virility. So it may be less appealing for men to reveal something that could cause others to question their manliness.

“This stereotype actually has no basis in reality, though. A guy can outwardly look very virile, healthy and energetic, and have full erectile function, but still have issues with sperm. Nonetheless, that’s often the perception.

“One thing that’s helped guys not be so embarrassed about it is all the marketing recently for treatments for erectile dysfunction and low testosterone. It’s become more acceptable to say, ‘Hey, not every person has everything working totally functionally.’”

Erectile dysfunction and low T are not necessarily directly related to male infertility, and in fact getting treated for low T can actually contribute to fertility issues.

Nonetheless, low testosterone and erectile dysfunction being more out in the open have helped the infertility conversation become less stigmatized, too.

And if you do have decreased libido or energy and suspect it may be a low testosterone issue, we recommend seeing a fertility specialist — a reproductive endocrinologist — if you’re still building your family.

“We’ve seen men who go to a “Low T” clinic or their regular physician and get put on testosterone thinking that it will help their sperm, but it actually does the opposite. Testosterone shots actually convert to estrogen, and that estrogen in the pituitary gland signals the testicles to stop producing sperm.

“Low testosterone is something you do want to eventually treat, as it can lead to other health problems down the line — just like women with low estrogen are at higher risk of cardiovascular disease and other problems. You just want to wait until you’ve had your children first.”

The first step to identifying the cause is to get a semen analysis.

Fortunately, getting a semen analysis is much less awkward than many guys assume, because now you can collect the semen sample at home.

“CARE Fertility will provide the semen collection kit, and then you just need to abstain for two to three days before collecting it and bringing it back to our office. Our Andrologists can have results back in about one hour. And then you’ll have the answers you need to move forward and treat it.”

But paying attention only to the medical cause and treatment of infertility is not the best way to solve the problem.

“You can’t separate the medical aspects of infertility from the emotional — they’re intertwined,” says Dr. Kevin.

So keep the lines of communication open with your partner, and don’t be afraid to reach out for emotional support.

“This is going to sound like a stereotype, but men and women tend to have different communication styles. Men tend to focus on “report” communication, getting or sharing information with a few words, and women focus more on “rapport” communication. Their problem-solving styles tend to be aimed at building relationships, and that can involve talking more about emotions.

“So, it may not feel as natural to men to express their feelings in general. Instead, they may prefer to keep it inside, or focus more on researching the problem and fixing it. Again, this is a stereotype, and there are always exceptions, but this is what’s common to many men.

Infertility can create stress for the relationship, too, which can also impact sexual function. So, it’s important to keep some spontaneity in your sex life.

“If sex has become something that’s very regimented, and focused entirely on the goal of having a child, then you lose a lot of the other aspects of sex that relate to communication with your partner and intimacy.

“Just be aware that it's not a bad thing to reach out for some emotional support. Talk to your partner about how you’re feeling, and ask for what you need. And it's definitely a good idea to support your partner emotionally through this process, because this can be a stressful journey for you both.

Staying in communication with your partner and being there for each other emotionally are not just ways to make the journey less stressful, or to keep your relationship healthy — they can actually play a role in the success of your treatment.

Male infertility: How men can deal with the stress and stigma