Men, the other side of infertility coin

Child-bearing is the one responsibility bestowed upon women that has gone unchallenged for generations, bringing with it both the joys of motherhood, and agony of untold proportions for women who “fail” to conceive.

Though, often discussed in hushed tones, every so often the atrocities visited upon women who have not had babies are laid bare in the press.

The good thing is that more women have opened up about female infertility and discussions about assisted reproductive technology, and the need for citizens to access these services in the public healthcare system, are taking place.

The other side of the infertility coin – men – remains untouched. A good proportion of men still have their heads deeply buried in the sand about any role they may play in infertility. Yet, statistics remain the same – among couples with difficulties conceiving a third are a result of issues in the female partner, a third from issues in the male partner, and a third from issues in both partners.

Numbers do not lie, but male attitudes towards infertility remain a monolithic iceberg, and nearly every doctor who handles couples with fertility issues has his/her own story to tell.

SHE'S NOT THE PROBLEM

It is not uncommon for a man to drag his wife into a doctor’s office, declaring that she is infertile and never acknowledging that he could be contributing to their lack of children. Worse still is the arrogance of such men, as they stand in the dock accusing their exasperated wives of the “crime” of inability to have children.

I once saw a couple like this. The man adamantly claimed that his wife had failed in the only responsibility allocated to her – that of bearing him children. He was the breadwinner and had provided her with everything, much to the envy of her peers. Yet she had not conceived in three years. When I enquired why he didn’t think he could possibly be contributing to their childless state, he proudly retorted that he had fathered two children in his previous relationships and hence had a proven track record of fertility.

His wife did not resist the suggested investigative tests, but the man would hear none of it, so we struck a deal: If his wife’s tests raised no valid cause for their infertility, we would do a semen analysis. All the tests gave the woman a clean bill of health, so the man had to oblige and take the tests he had vehemently rejected.

Verdict: His semen had no trace of sperm; he was incapable of naturally impregnating his wife. He challenged the results and we were forced to repeat the test in two different labs before he finally conceded. His ego was further crushed when he learnt that the babies he had proudly laid claim to did not belong to him despite years of diligent child support payments. He was a humbled man who was lucky to have a forgiving wife. The couple sought care abroad and were able to conceive and give birth to a healthy set of twins through assisted reproductive technology.

Before then was a couple I met at the ante-natal clinic as a medical student. The woman was expecting a second baby and on this visit, her husband came along. While addressing a different matter in relation to the pregnancy, it came to light that her previous baby could not possibly have been sired by her husband. While he went out to collect her laboratory results, she came clean and said that she had done what was necessary to sustain her marriage.

GET YOUR HEAD OUT OF THE SAND

Her husband had been married three times before and each time, the marriage dissolved because of the women’s inability to conceive. After a year with the fourth wife without conception, the village gossip queens told her about the fate of her predecessors. She opted to take matters into her own hands and find a home-grown solution to the problem.

She teamed up with her mother-in-law, falling back on unspoken traditional practices, to make it happen, and in a few months, was well on the road to motherhood, courtesy of her brother-in-law’s contribution. It had been a blissful four years in that marriage and she had no intention of allowing anyone to rock that boat. In her defence, she had the moral sense to keep it in the family.

Of the routine tests required of a couple while investigating the cause of infertility, men have it easy as they are required to provide a sample of their ejaculate for examination, a simple, non-invasive semen analysis test.

Women, on the other hand, go through a slew of expensive and invasive tests that call for grit and patience. A hysterosalpingogram for instance, requires a radio-opaque dye to be introduced into the woman’s reproductive tract to ascertain the outline of the uterus and the patency of the fallopian tubes. It is invasive and quite uncomfortable for the woman but one that cannot be avoided.

Back to the rule of thirds, society needs to acknowledge the contribution of men to infertility if we are to effectively tackle the problem of involuntary childlessness.

The most important take-home message for all men today would be: virility is not a measure of fertility. The capacity to have an active sexual engagement with outstanding libido does not in any way speak for the ability to contribute to successful conception of a baby.

Pulling out our heads from the sand is no mean feat. It requires a complete societal change in attitudes towards men and their fertility. We must desist from stigmatising men who have fertility challenges, be more sympathetic and accepting to allow them to seek help instead of taking it out on their partners.

Let us sustain positive conversations and demystify these challenges. The war on infertility cannot be won on the female front alone!