treated me as an accessory to the process
For decades, the architecture of fertility care has been built around a single assumption — that infertility is a woman's burden to carry. Yet roughly half of all cases involve male factors, and men across the UK find themselves treated as bystanders in a process that concerns them equally. The human cost of this structural blind spot is measured not only in delayed diagnoses and failed treatment cycles, but in the quiet suffering of men who have no language, no community, and no clinical pathway to call their own. Slowly, the conversation is beginning to turn.
- Men are waiting more than a year — sometimes through failed IVF cycles — before anyone investigates whether the fertility problem originates with them.
- NHS services are structurally oriented around female reproductive health, with gynaecologists leading clinics and male patients routinely receiving appointments booked in their wives' names.
- The exclusion creates a self-reinforcing cycle: men are sidelined by the system, disengage as a result, and are then blamed for not showing up.
- The psychological toll is severe — men describe feeling like the cause of their partner's pain, navigating grief and stigma in near-total isolation, with no support groups or clinical counselling designed for them.
- Gradual shifts are emerging through new school curricula, a growing male fertility podcast community, and the first Fertility Show to place male reproductive health at its centre.
Luke grew up absorbing a single message about fertility: don't get someone pregnant. So when he and his wife tried to start a family in 2020 and nothing happened, he had no framework for what came next. After eighteen months, they entered the NHS fertility system — and for the year that followed, nearly every appointment was booked in his wife's name. It took a failed round of IVF before anyone suggested his sperm might be the issue. "There were things on my side that could have been looked into much sooner," he says, "rather than treating me as an accessory to the process."
Luke's experience reflects a systemic pattern. Infertility affects roughly one in six couples, and male factors account for about half of all cases — yet NHS services have evolved around female reproductive health, with gynaecologists leading most clinics and male fertility treated as secondary. NICE guidelines call for men and women to be assessed in parallel after twelve months of trying; in practice, this rarely happens. Professor Bola Grace of University College London describes the result as a self-reinforcing cycle: men are excluded from care, disengage, and are then blamed for their absence. Meanwhile, women absorb the emotional and logistical weight, problems go undetected longer, and couples face a more expensive, more invasive path through treatment.
The policy imbalance is stark. The Department of Health's recent men's health strategy mentions fertility five times — mostly in relation to obesity or alcohol. The women's version references it roughly twenty times, with dedicated clinical guidance. Professor Allan Pacey of the University of Manchester calls this a missed opportunity. For men like James, thirty-four, from North Yorkshire, the consequences were years of watching his wife undergo every test while he waited. When his semen analysis finally returned — showing weak, slow, and malformed sperm — it took another two years and a private consultation before he received a full physical examination. Multiple IVF cycles ultimately failed. "You view yourself as the cause of their pain," he says. "You feel you're the reason they can't have a child."
Male infertility collides directly with ideas of masculinity and virility, making it harder to acknowledge and nearly impossible to discuss. Shaun Greenaway, diagnosed with azoospermia after severe mumps as a teenager, found no support and no community when he needed it most. He and a friend co-founded the Male Fertility Podcast, comparing the current conversation to where mental health was a decade ago — still taboo, but beginning to open. His co-founder Ciaran spent two years before taking control of his health; after seven IVF rounds and two miscarriages, his wife gave birth to twins.
There are signs of change. New school lesson plans in England now give male fertility risks equal prominence alongside female ones. This year's Fertility Show in London placed male reproductive health at its centre for the first time. Doctors are also noting that an abnormal sperm test can be an early signal of broader health problems — a reason, they argue, for earlier and more systematic male assessment. For those whose lives have already been shaped by the gap in care, the shift cannot come soon enough.
Luke was told not to worry about pregnancy until he was older. "All through my teens the message was clear: don't have sex without a condom or you might get someone pregnant," he recalls. "So when you're older, you expect everything to just happen normally. When it doesn't, you don't know what to do or where to go." In mid-2020, as lockdowns settled across the country, he and his wife decided to try for a family. After eighteen months of nothing, they saw their GP and were referred to hospital tests and a fertility clinic. What followed was a year of appointments, nearly all scheduled in his wife's name. When paperwork arrived with his details already on file, the clinic contacted her anyway. The entire machinery of diagnosis seemed built on a single assumption: that infertility was her problem to solve.
It took more than a year, and a failed round of IVF, before anyone told Luke his sperm might be the issue. "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." Luke's experience is not unusual. Infertility affects roughly one in six couples, and about half of those cases involve male factors—either alone or combined with female causes. Yet across the NHS, men are routinely sidelined in diagnosis, treatment, and even basic fertility conversations. The clinical guidelines from NICE state that couples struggling to conceive after twelve months should be assessed together, with men and women offered parallel checks. In practice, this rarely happens.
Professor Bola Grace from University College London has studied how fertility services treat men. "There can be genuine exclusion even if it's unintentional," she says. "Men tell us it can happen across services—in how care is delivered, in fertility clinics and in counselling." Her 2019 research found that many men wanted deeper involvement in the fertility process but felt their voices were ignored. The result is a self-reinforcing cycle: fertility services don't include men, so men engage less, which reinforces the perception that they simply don't care. "We've created a cycle where men are excluded, but then they're also blamed for not showing up," Grace observes. The consequences ripple outward. Women end up bearing the emotional and logistical weight—the coping, the planning, the worrying, the decision-making. Problems are detected later. Tests become more invasive. Couples face a longer, more expensive path through fertility care.
The roots of this imbalance run deep. Since the first IVF birth in 1978, fertility treatment has been framed around women, partly for biological reasons. IVF requires stimulating ovaries, retrieving eggs, fertilizing them in a lab, and implanting an embryo. Men, by contrast, provide a sample and wait. That fundamental asymmetry has shaped how fertility services evolved. Most clinics and units are led by gynaecologists, whose training focuses on female reproductive health. Male fertility becomes a secondary concern. "At the level of the GP or the secondary care clinic or the tertiary care clinic, men can be an afterthought," says Allan Pacey, professor of andrology at the University of Manchester. At a policy level, the imbalance is stark. The Department of Health recently published separate men's and women's health strategies. Fertility appears roughly twenty times in the women's version, with a dedicated page of support and clinical guidance. In the men's document, it is mentioned five times, mostly in relation to obesity, alcohol, or other health issues. Pacey calls this a "missed opportunity to level the playing field."
James, thirty-four, from North Yorkshire, describes his own experience as an "ostrich moment"—months of burying his head while his wife underwent every test and check. When his semen analysis finally came back, he was told his sperm were weak, slow, and malformed. He learned he would struggle to conceive naturally. The near three-hour drive home that day was "like a blur, very painful." It took another two years and a private consultation with a urologist before he received a full physical examination and advanced hormonal tests. After years of trying and multiple IVF cycles, the couple's treatment ultimately failed. "You're the partner of someone who you love unconditionally, but you view yourself as the cause of their pain," James says. "You feel you're the reason they can't have a child." Male infertility collides with ideas of virility and masculinity, making it harder for men to acknowledge or discuss. The stigma means many men navigate the experience alone, without support groups or counselling. "It's just you and your partner dealing with this, so it feels like you're an island and there's no-one else out there like you," James says.
Shaun Greenaway was diagnosed in 2018 with azoospermia—a condition in which no sperm are present in semen. He had severe mumps as a teenager, a virus linked to male infertility. He and his wife eventually had children through sperm donation, but Shaun navigated much of that journey alone. "There was absolutely no support, and no-one was talking about it from a personal perspective, so I decided I was going to share my story," he says. With his friend Ciaran Hannington, who was also told he had fertility problems in 2012, Shaun co-founded the Male Fertility Podcast and a support network for men. They compare the conversation around male infertility today to where mental health was a decade ago—still taboo but slowly becoming more open. Ciaran took two years before he "started to take control" of his situation, improving his diet, cutting alcohol, and adjusting his exercise. After seven rounds of IVF and two miscarriages, his wife finally gave birth to a boy and a girl.
There are signs the system is beginning to shift, though slowly. New PSHE lesson plans for schools in England now give male fertility risks—poor diet, smoking, steroid use—the same prominence as those faced by women. At this year's Fertility Show in London, attended by around two thousand people over two days, male infertility was placed centre stage for the first time. High-tech sperm testing kits sat alongside egg freezing and pregnancy supplements. Seminars focused on sperm quality and treatment options for men. "It's not a token addition," 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." Doctors also note that male infertility can signal broader health problems—obesity, smoking, hormonal abnormalities. "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," says Professor Hussain Alnajjar, a consultant urological surgeon. For men whose lives have been shaped by infertility, this recognition 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," James 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."
Notable Quotes
At the heart of it, the whole system is based on the assumption that it's a woman's problem. The male side gets totally overlooked.— Luke
We've created a cycle where men are excluded, but then they're also blamed for not showing up.— Professor Bola Grace, University College London
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.— Professor Hussain Alnajjar, consultant urological surgeon
The Hearth Conversation Another angle on the story
Why do you think fertility services developed this way—with women at the centre and men treated as almost incidental?
It's partly biological. IVF is invasive for women—hormones, egg retrieval, implantation. Men provide a sample and that's it. But that asymmetry became structural. Clinics are run by gynaecologists trained in female reproductive health. Male fertility expertise never developed the same way.
But the guidelines say couples should be assessed together. Why doesn't that happen?
Guidelines and reality are different things. A woman books an appointment, she's the patient, her name is on the file. When the man needs to be involved, the system has to actively change course. Most of the time it doesn't bother.
What's the actual cost to men of being sidelined like this?
Delayed diagnosis is one thing—Luke waited over a year before anyone looked at his sperm. But there's also the psychological weight. You're told your whole life that infertility is a woman's issue. Then you find out you're the problem. And you're dealing with it alone, because there's no support, no language for it, no one talking about it.
Is it just about healthcare design, or is there something deeper about how men relate to fertility?
Both. The system fails men, but men also struggle to engage. Some won't even take a sperm test. Some won't change their diet or stop smoking even when told it could help. There's shame mixed in with the stigma. It feels like a challenge to your masculinity.
So what would actually change things?
Visibility. When male fertility is talked about openly—in schools, at fertility shows, in support groups—it stops being taboo. When doctors recognize that a bad sperm test might signal other health problems, they start treating it seriously. When men see other men talking about it, they feel less alone.
Do you think that's starting to happen?
Slowly. Very slowly. But yes. The Fertility Show putting male infertility centre stage for the first time—that matters. New school curricula giving it equal weight. Men starting support groups. It's not fast enough for people like James or Luke, but the direction is shifting.