To any man rushing out to buy the new over-the-counter fertility test available from Boots, I say this: enjoy the excitement while it lasts. For you, the chance to find out whether your sperm count is “normal” or “low”’ may feel like one small step for a man.
But women know that when that first packet of SpermCheck Fertility drops into the shopping basket you’ve taken one thumping great leap for mankind – straight into an abyss of anxiety.
Today, that quickie test – taking 10 minutes, available for just £29.99 – may make you feel “in control” of your end of the fertility business, revealing who is hitting the World Health Organisation’s target level of 20 million or more sperm per millilitre.
Tomorrow, you may purchase a second test, or a third, or bulk-buy online “for friends”, because it was “fun” or “fascinating” to do, or you dropped the test in the loo, or the result can’t be right and must be due to yesterday’s bike ride, or those tight trousers, or that hot bath, or actually because the first test was clearly part of the two per cent margin of error quoted by manufacturers.
From now on, you are just one more minnow swimming about in the maelstrom of an infertility business estimated to be worth £3 billion globally and rising, shopping for facts and certainties, when all you can really do is grasp at hopes and dreams.
Welcome, gentlemen, to our world, where women are constantly sold the promise of “control” – over our faces, figures and finances, but especially over our fertility. The world where we’ll happily spend all our disposable income and more on products to assist conception: from expensive herbal supplements to ovulation kits, pregnancy detectors to thermometers. The world where oocytes – egg cells, to the uninitiated – are an obsession, not a high score in Scrabble. For now it’s your turn to enter this emporium of reasons to rejoice, or to despair.
Perhaps you are tempted by some red healing crystals, or Ayurvedic medicine, or even the prospect of “Snowballs” cooling underwear (still in development, and based on the theory that the testes need to be kept cool to produce healthy sperm). Or maybe you just want to stock up on one of the vitamin supplements packed full of amino acids and herbs known to thin the blood, in the hope of improving erectile quality.
Of course, the reality for men – as for women – is far less frivolous than my shopping lists suggest.
Male fertility is in decline, as research published last December showed. Between 1989 and 2005, average sperm counts fell by a third in a study of 26,000 men, increasing their risk of infertility, according to researchers from the Institut de Veille Sanitaire in St Maurice. The quantity of healthy sperm produced was also reduced, by a similar proportion.
The findings, published in the journal Human Reproduction, confirmed findings over the past 20 years that shows sperm counts declining across the world. Many reasons, ranging from tight underwear to toxins in the environment, have been advanced to explain the fall, but no definitive cause has been found. The European Commission has even set up a working group, Reprotrain, to tackle the increasing crisis around “Male Reproductive Biology and Andrology”.
Some men won’t need the new test. They already know, or suspect, they have a problem (it is estimated that problems with sperm account for about a third of known fertility problems) but are probably suffering in silence. Far less attention, after all, is paid to the psychological effect failure to conceive can have on men.
Jo Hemmings, a behavioural psychologist and relationship coach, says: “Perhaps because women are deemed to have a stronger maternal instinct than men’s paternal instinct, and gestate, give birth and breast feed, they have received more attention than men. And so men are often seen as having an almost interdependent role – more of a support role to their partner’s emotions, than a need to express emotions in their own right.”
Men do not have quite the same sort of societal “permission” to express feelings around infertility, she notes. “Yet for many men, there are feelings of inadequacy, low self-esteem, guilt, shame and anger. This can often lead to a withdrawal from communication – and indeed sexual dysfunction – making the problem that much more difficult.” Old stereotypes have not done much to help. Men with fertility problems may find it grimly ironic that, until recently, all males were considered fertile until proven otherwise, even in old age. And there were only two realistic ways of altering that: a vasectomy or condoms.
For, just as attention has focused on women’s experiences of infertility, so has the medical establishment concentrated on women’s control of fertility.
Scientists have been talking about a male contraceptive pill since the early 1980s (with many women sceptical as to whether they would trust a man to take it), but we are still not there.
According to the NHS, research is focusing on combinations of hormones – synthetic testosterone and progestogens – with some in phase III trials, the last stage of clinical trial before a medicine is given a marketing licence. Scientists in Israel are looking into how blood-pressure drugs called calcium channel blockers (such as nifedipine) may alter the metabolism of sperm so that they are not able to fertilise an egg – such a pill could be on offer as early as 2015, researchers suggest. We won’t hold our breath.
In the meantime, rising levels of anxiety seem to be doing a better job on suppressing fertility than hormones. Researchers note that the increase in the number of men diagnosed with infertility seems to correlate with increasing anxiety in general. In July, psychiatrists at the University of Cambridge and the University of Hertfordshire reported that more than 8 million people in Britain suffer from anxiety disorders – up from 2.3 million people in a 2007 study.
Of course, infertility makes people anxious, raising the possibility of a vicious cycle. The impact of male infertility is an area “where the man’s psychological and physiological reactions should be considered far more seriously than current research would suggest”, argues Hemmings.
And yet, silence still surrounds the issue in many quarters. Visitors to the female-dominated Mumsnet website forum discussing conception quickly learn that there is no such thing as TMI (too much information) among women desperately seeking reassurance as they attempt to get a BFP (Big Fat Positive) line on their pregnancy test. But hop over to the Men’s Health site forum on “becoming a dad” and users seem more worried about whether their wives will still be attractive after giving birth.
Look, too, to the Hollywood stars who – refreshingly – are admitting to fertility problems more openly than before; they are overwhelmingly female. You won’t find many men risking their He-Man reputations. A rare exception is Tom Arnold, the hero of True Lies and ex-husband of Roseanne Barr, who said earlier this year: “I have a very low sperm count. I didn’t think fatherhood was in the cards for me, I’ll be honest.”
Given this backdrop, perhaps SpermCheck will help to get men talking about infertility as openly as women do. Certainly, men and women need to accept when there is a legitimate problem – and not be afraid to ask for support. At the time of the contraceptive pill being introduced, Germaine Greer said: “The management of fertility is one of the most important functions of adulthood.”
Fifty years on, how we handle infertility is at least as vital.