Evening Standard - ES Magazine
OUT FOR THE COUNT
It’s not just women who have ticking biological clocks — but men’s fertility still is barely discussed. asks why
Toby Trice, 31, and his partner, Katie Housley, 31, had been trying for a baby for six years before they found out the real reason they’d not been able to get pregnant: Trice’s fertility was the issue, not Housley’s. Even worse: it is a discovery that could have been made years earlier, before the two rounds of IVF and two miscarriages, if he had taken a simple, five-minute, non-invasive test.
Trice, a semi-professional racing driver, was eventually diagnosed with a varicocele problem, which affects 15 to 20 per cent of men. Three months after a straightforward, two-hour operation to remove some swollen veins from his testes, the couple found out Housley was pregnant. They now have a 10-month-old son, Oliver, but that hasn’t rid Trice of the trauma. ‘I still feel incredibly emotional knowing what we went through could have been avoided if I’d got checked earlier,’ he says of their £15,000 IVF journey. ‘I’m frustrated with the system because it could have prevented all that heartache.’
Trice might be among a depressingly small number of men happy to speak about their infertility experience, but his story is more common than you might think. One in seven British couples are believed to experience infertility issues and in 50 per cent of these cases, it’s the man’s fertility that is behind the problem, not the woman’s. Testicle issues and sperm abnormalities are common reasons — and even in the absence of any medical issues, sperm counts in the developed world have reportedly halved over the past 40 years.
It turns out that men have their own ticking fertility clocks to factor in, too. A new study found that the male biological clock impacts fertility more than originally thought, with a ‘significant drop’ occurring in the live birth rate for women between 35 and 40, if the male partner is aged 40 or older — a fact that could be due to declining sperm quality and the DNA damage that happens due to age. Professor Geeta Nargund, coauthor of the study and medical director of Create Fertility, says many couples have no idea but it can take five times as long to conceive when a woman has a male partner over 45, and the risk of miscarriage is twice as high (compared with those with partners under 25). For fathers over 45, there is also a greater risk of mental health disorders including autism and ADHD.
‘[Male fertility] has been a very taboo subject until now,’ says Nargund, explaining that stories about older celebrity fathers such as Rupert Murdoch, Rod Stewart and Mick Jagger, who all had kids in their 60s and 70s, have ‘blinded’ many men to the fact that they have a biological clock. The truth, she says, is that for every Jagger there are men in their 40s or 50s left ‘devastated’ to discover they’re too late for natural conception.
Nargund’s goal is not to scaremonger. There is enough anxiety around fertility already. Rather she wants to raise awareness and reset that balance between the sexes — not just because too much of the fertility burden is on women but because men, too, are being done a disservice. Many are unaware of the true facts around their fertility and a lingering misogyny and embarrassment around the issue means that fewer men are proactively getting themselves checked. This is important given that men have fewer fertility ‘reminders’ such as periods, says Dr Hana Patel, a fertility expert in Dulwich.
When men eventually do find out they might have fertility issues, Nargund says it can be both ‘devastating’ and ‘emasculating’, impacting their work, relationships and mental health. ‘I felt powerless,’ broadcaster Simon Reeve, 50, said of being told he was infertile. ‘It was the hardest thing I’ve ever had to go through,’ agrees construction worker Kevin Button, 37, who says his relationship fell apart after his infertility diagnosis. ‘I was so angry but I felt like I couldn’t tell anyone.’
For others, even the prospect of infertility can be isolating. ‘It’s been quite lonely, my male friends don’t really talk about these things,’ says Max*, 29, a recruiter from Elephant and Castle who is looking into private fertility testing after finding out that a male family member had infertility issues. ‘Being fertile is linked to your masculinity so worrying about my fertility feels like an admission of weakness,’ says Gus*, 30, a videographer from Brixton who recently read up on the male biological clock but says there’s too much male ‘bravado’ to raise his concerns with friends. So why does the fertility burden still generally fall to women? What is stopping men talking about it — and is anything being done to change this?
Kate Brian, operations manager at the charity Fertility Network UK, says the problem is down to public messaging. While men’s partners and female friends might be talking about fertility from their 20s, men tend not to. ‘The general feeling is that [fertility] is not something that impacts men,’ says Simon*, 30, a trader from Vauxhall. ‘It’s hard to know whether it’s down to disinterest on [our] part or a lack of education,’ says Duncan Wilson, 29, an accountant from Greenwich. The only time fertility comes up among his friends is in a ‘jokey’ way when talking about cycling or putting a laptop on their lap, two of the more spoken-about lifestyle choices that can reportedly reduce sperm count.
Several men in the public eye have attempted to close this education gap by sharing their own stories. Reeve has spoken about how ‘unequipped’ he was upon finding out he was infertile (he has since had a son, naturally, thanks to a lifestyle ‘overhaul’ that boosted his sperm). Hollyoaks star Adam Rickitt, 44, has talked of the ‘nerve-wracking’ moment he had to tell his wife he was infertile. And comedian Rhod Gilbert, 53, launched a documentary last year as part of his HimFertility campaign, encouraging men to talk more openly.
Gilbert’s BBC show was well-received, but his, Reeve’s and Rickitt’s brief media appearances pale in comparison to the onslaught of messages the public is fed about female celebrities going through fertility ‘battles’ and male celebrities ‘still [having] it’ when they become older fathers.
Dr Laura Dodge, who led the world’s first study into the male biological clock, says that fertility is ‘the one area in health where men have been neglected’. Research into paternal age is only relatively recent and healthcare is still playing catch-up. While women are widely encouraged to check their breasts and have cervical smear tests, there is less focus on men’s reproductive health despite male fertility testing being cheaper and less invasive (private tests cost £500 for women and only £150 for men). Patel says she feels sad for men in this regard. ‘When men do come to see me, they say: “I didn’t know [things like cycling could affect my sperm count] or how to check my testicles”. I feel like men get a raw deal because they don’t get the same sort of help.’
It’s not just in medicine where men are getting a raw deal. There’s a cultural gap, too — only last year, Cambridge University came under fire for introducing fertility seminars for female, and not male, students. As well as unfairly placing the fertility burden on women, this can leave men in shock when starting a family doesn’t go to plan. ‘Sometimes men feel they need to be the strong one and support their partner, but infertility can be just as painful for them,’ says Brian.
The good news, says Patel, is that there are simple things men can do to boost their fertility, such as wearing loose boxers and boosting their fitness. Another positive is that we’re talking about male fertility more than we were 20 years ago. Fertility Network UK now holds government-funded freshers’ week fertility sessions at universities in Scotland and Wales. It also runs fertility support groups for men nationwide.
Others are — slowly — joining the crusade, like Button, who set up mental health support group The Man Cave in the wake of his diagnosis, and Trice, who is using the traditionally ‘macho’ realm of motorsport to campaign for better conversations around male fertility. His Instagram account @tobytriceracing is plastered with messages for men to get tested and has more than 2,000, mostly male, followers.
But Trice says there is still a long way to go. He is campaigning for men to get their fertility tested before women and for varicocele surgery like his to be available on the NHS. Nargund, meanwhile, is focusing on education. She is pushing for fertility classes to be rolled out on to the national curriculum, not because we should be pressuring young people to start families, but because we should be reducing stigma and ‘empowering [boys and young men] to make decisions about their future’. At the moment, ‘you’re pretty much taught that having sex will get somebody pregnant,’ says Natalie Silverman, host of The Fertility Podcast, whose partner has suffered with infertility.
Brian says she would like to see government-funded fertility sessions introduced at English universities, and Nargund is calling for greater support in the workplace and beyond. Where are the posters urging men to check their fertility? Where is the Movember-scale male fertility campaign?
‘Fertility feels like the last male taboo,’ says Trice. ‘We need to change that.’ The clock is ticking.
“Being fertile is linked to your masculinity, so worrying about my fertility feels like an admission of weakness”