Because I was infertile, I felt like I was failing as a man

“It was a shock to find that the issue was with me,” says Matt O’Malley, 39, who discovered he was infertile when he and his wife, Laura, went for tests after trying for a year to get pregnant. “As a male you assume you can have children – it is supposed to be a given. But in this case it just wasn’t.”

Infertility affects around one in six couples and, according to Fertility Network UK, men account for half of all infertility issues. Generally, 30 per cent of fertility problems are due to the man, 30 per cent due to the woman and 30-40 per cent due to both or unknown causes. In men, low sperm count is the most prominent culprit, but it is not the only factor. Earlier this month, UK-based Newfoundland Diagnostics launched a male fertility testing kit that gives results in five minutes and boasts 98.2 per cent accuracy. A downside of the kit, which costs £12.49, is that it only measures sperm count. 

Matt, a business consultant from Chelmsford, had a high sperm count; the issue for him was motility, which refers to the movement of the sperm, and morphology, which is the shape. 

Poor motility means that sperm struggle to move through the reproductive tract to reach and fertilise the egg. Morphology affects fertility because sperm need to be a certain shape to be able to penetrate the outer layers of the egg. “While there was a slim possibility due to the count,” Matt says, “it was unlikely we would get pregnant, due to the shape and movement, so we were referred for fertility treatment.”

Matt and Laura lived in Hertfordshire at the time and began NHS-funded treatment at Bourn Hall Clinic, which was the first IVF centre in the world. IVF involves stimulating the woman’s ovaries with medication so that they produce many mature eggs simultaneously. The eggs are then collected and mixed with the partner’s sperm. If there are only a few high-quality sperm, then intracytoplasmic sperm injection (ICSI), which involves a single sperm being injected directly into the egg, is usually recommended. 

The process is rigorous, and Matt remembers feeling guilty that Laura was bearing the brunt of the treatment. “The person I loved was being put through something horrific because of my deficiency. The daily injections that left bruises on her stomach, the constant tenderness. It shouldn’t have been happening to her, because it was my issue. It played on my mind a lot.”

A taboo still surrounds male infertility. A study by fertility benefits provider Apryl released this month showed that almost a fifth of men believe that women are most likely to experience fertility issues. “Society still has a stigma when it comes to talking about male fertility,” says Dr Mark Surrey, the co-founder and medical director of Southern California Reproductive Centre. “Many men still feel a stigma in addressing it in their own lives.” 

The Apryl study, which was conducted by Censuswide and surveyed 2,000 UK adults, also found that men are less likely to seek professional help for fertility difficulties compared with women. Some 32 per cent of women said that they would be likely to turn to a fertility or family planning clinic in the UK as a first step. By comparison, only 19 per cent of men said that they would. 

“It makes you think you have failed,” says Matt. “At a basic level, we are here to reproduce. As a male, you should be able to reproduce, and you can’t. The one thing you are meant to do – have a family – you can’t do.” 

Psychotherapist and relationship counsellor Mark Fielding says men with fertility issues can feel emasculated. “Men often grow up with outdated ideas around what it is to be a man. There is the symbolism of male virility and men are given the message that as a man their libido should be high, they should always be available for sex, and they should have no problem fathering children. If any of these are not true, it can create a feeling of excessive shame.”

Male infertility is on the rise. Average sperm count has more than halved among Western men in the past 50 years, according to a study of global trends in sperm count from the University of Jerusalem. There has also been an increase in testicular cancer, and there is evidence that industrialisation may be responsible for both. Studies on male animals found that the development of the testicles was disrupted when their pregnant mothers had been exposed to certain pollutants, and this resulted in lower fertility and higher rates of testicular cancer. 

“There are many potential causes of poor sperm health,” says Surrey. “These include congenital developmental issues, certain medications, diseases, obstructions in the reproductive system, possible environmental toxins, and excessive levels of alcohol consumption or smoking.” 

Matt doesn’t know what caused his low sperm motility. He used to be a smoker, but had given up years before. He drank, but not heavily. There was no history of infertility in his family, and he had never sustained an injury that might have had an impact. Fertility patients are often recommended to make lifestyle modifications and Matt and Laura were determined to give themselves the best chance. 

“We had a drastic lifestyle change,” says Matt, who gave up alcohol in an attempt to boost his fertility. Together, they were exercising four times a week, being strict about their diet, getting early nights and trying to limit work stress. “It sounds dramatic, but you are looking down the barrel of a gun over whether you can have a family or not. We were doing everything to get ourselves into the best position.” 

The couple were in Prague when they discovered that their first round of treatment had worked. “When we did the first pregnancy test and it came up positive, we told ourselves we had to take deep breaths. You don’t want to get carried away, but you do anyway. We were very happy.” 

They continued to get positive pregnancy tests until a viability scan at eight weeks revealed that there was no heartbeat. “That was probably my lowest point,” says Matt. “You’ve gone through the process, you start something, you get the right results. It was horrible. A really tough couple of months. My nature isn’t to worry about what people think, but I just couldn’t bring myself to open up about it with anyone.” 

Laura encouraged Matt to see a counsellor, but it didn’t work out. Friends and family knew what they were going through, but Matt found it difficult to talk openly. According to Fielding, this is common. “Men believe they should be fertile, and this means they feel they can’t open up in a testosterone-fuelled environment like a gym, or a pub, or five-a-side football. So they don’t get peer support in the way women do. When a woman talks about her fertility, other people will be having the same experiences and it gets normalised. But men tend to keep it inside and then they feel there is something wrong with them.” 

Not wanting to lose momentum, they prepared for a second round a couple of months after Laura’s miscarriage. This time, the eggs were of a lower quality, so they agreed with the clinic that two embryos would be implanted. However, after an initial positive pregnancy test, Laura went on to have a second miscarriage. “We weren’t as devastated as we were with the first [miscarriage]. We were hardened by the first experience, and it was so raw still.” 

Matt and Laura had one NHS-funded round of IVF left. “We agreed to give ourselves a year to relax. We went on holiday, had a great Christmas. But it was an emotional rollercoaster and both of us were up and down. With IVF, it is always there. You can never let go. Your life is always waiting on something else.”

In 2018, they tried IVF again and it was successful. The pregnancy was straightforward, but Matt and Laura couldn’t fully enjoy it. “There was a blend of emotions and 20 per cent of that was waiting for something to go wrong.” Despite their fears, their daughter, Elle, was born in April 2019. “It was breathtaking,” says Matt. “There is nothing in this world that can equate to seeing her for the first time. It was perfect, and I had an immense sense of relief that she was here.” 

Three years later, the couple did another round of IVF, using a frozen embryo. Their son, Louis, was born in November 2022. “It didn’t make everything we had gone through insignificant, but it definitely took the edge off. When you are in the trenches, it is the worst place in the world. But obviously if you get that happy ending, you can look back and say it was worth every injection, every appointment.”

Matt believes we need to break the silence around male infertility. “It took me a while not to be ashamed about it, but now I am very open that the problem was mine. It needs to be spoken about, because when you are on your own it can be a very dark place. Sometimes all you need is to know that someone else is going through something similar and it makes that dark place a little bit lighter.”