After 18 months without success, the couple saw their GP and were referred for further tests in hospital and at a fertility clinic.
Over the next year or so, Luke says the focus was entirely on his wife. Appointments were all in her name. When he had to fill out paperwork, his wife was contacted even though all his details were on file.
“At the heart of it, the whole system is based on the assumption that it’s a woman’s problem,” he says. “The male side gets totally overlooked.”
It took more than a year, and a failed round of IVF, until Luke was told there might be an issue with his sperm. “I was like, ‘Now you’re telling me?'” he says. “There were things on my side that could have been looked into much sooner, rather than treating me as an accessory to the process.”
Infertility affects roughly one in six couples and about half of those cases are linked to male problems, either alone or alongside female causes. Under the latest clinical guidelines from NICE (National Institute for Health and Care Excellence), couples still struggling to conceive after 12 months of unprotected sex should be assessed together as one unit, with men and women offered further checks in parallel. Yet experts say men are often sidelined in diagnosis, treatment and in fertility conversations.
“There can be genuine exclusion even if it’s unintentional,” says Prof Bola Grace from University College London. “Men tell us it can happen across services – in how care is delivered, in fertility clinics and in counselling.”
A study led by Grace in 2019 found many men wanted to be more involved in the fertility process, but often felt their voices were not heard. The result, she argues, is often self‑perpetuating – some fertility services don’t include men, so men engage less, which reinforces the idea they are simply not interested. “We’ve created a cycle where men are excluded, but then they’re also blamed for not showing up,” she says.
This can have real consequences, she adds – not just for men but for women, who often end up having to deal with far more of “the coping, the planning, the worrying, the decision-making”.
It can also mean problems are picked up later, tests and treatment can be more invasive, and couples may face a tougher, more expensive path through fertility care. So how could the system offer more support when a man has been told he may have a problem? And what more could be done to get men to talk more openly about fertility?
Signs of a shift
There are indications that awareness is starting to shift.
New PSHE lesson plans for schools in England, developed by the British Fertility Society and Cardiff University, now give male fertility risks – from poor diet to smoking and steroid use – the same prominence as those faced by women.
And at this year’s giant Fertility Show in London’s Olympia, attended by around 2,000 people over two days, organisers said male infertility would be placed centre stage for the first time. Stalls offering high-tech sperm testing kits sat alongside more established services such as egg freezing and pregnancy supplements, while seminars focused on sperm quality and the latest treatment options for men.
“[It’s] not a token addition. Not a side conversation,” said the show’s content director, Sophie Sulehria. “It’s about recognising that male fertility is not a niche topic. It’s a fundamental part of reproductive health. And it deserves the same visibility, the same investment, and the same compassion.”
Doctors working in the field also say they are seeing a shift and that it matters for reasons beyond having a family. Growing evidence suggests male infertility can be a marker of wider health problems from obesity to smoking or hormonal abnormalities, according to Prof Alnajjar, who also speaks for the British Association of Urological Surgeons.
“Healthier men tend to have better reproductive health, and an abnormal sperm test can sometimes be the first sign that further medical assessment is needed,” he says. “That’s why I believe male infertility should not be viewed solely as a pregnancy issue; it should also be recognised as an important men’s health issue and an opportunity for early intervention.”
For men like James, whose lives have been shaped by infertility, progress like this cannot come soon enough. “We’re not going to change the stigma that still exists by burying our heads in the sand and ignoring it anymore, but by getting it out there,” he says.
“As soon as we’re more open, then fewer people are going to think it’s taboo, or that anyone is any less of a man for actually talking about it.”
‘Ignored by the system’
Since the first IVF birth in 1978, fertility treatment has largely been framed around women, partly for biological reasons. IVF involves stimulating the ovaries to produce eggs, retrieving them, fertilising them in a laboratory and then implanting the resulting embryo back into the womb. By contrast, most men provide a sperm sample and wait for science to do its thing.
That imbalance has shaped how fertility care has developed, argues Allan Pacey, professor of andrology (a medical specialty focused on male reproductive health) at the University of Manchester. He says fertility units and clinics are typically led by gynaecologists, whose training focuses on female reproductive health, while male fertility can often be treated as a secondary concern.
“Now, there are some really good gynaecologists 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.”
