by Marinos Alexandrou the co-founding Director of International Andrology https://london-andrology.co.uk/  - the first international healthcare company specialising in men’s intimate healthcare. Marinos is also the co-founder and director of Adam Health https://talktoadam.com which covers sexual health, male fertility, testicular and prostate health, hormonal issues and a range of other issues. He and his team of doctors came up with this article about the most common fertility problems that men experience. Adam Health offers health assessments, appointment booking, home test kits as well as an online men's health pharmacy.

There are many different causes of male infertility, but we mostly come across poor semen quality. There are many reasons as to why men are infertile, however approximately 25% of male infertility cases are unexplained in the UK.

How common are these problems? Are they becoming more common?

Infertility is a widespread issue. In about 50% of couples with infertility problems, male infertility may be a contributing factor. About one in 20 men have low numbers of sperm and approximately one in 100 men have no sperm at all in their ejaculate. Studies have shown that male infertility is becoming more common and sperm counts have declined by over 50% in western countries in the last 40 years. There are a number of different reasons including environmental and lifestyle factors for this rise.

What treatments are available for these problems?

A semen analysis or sperm test will help to identify the cause of infertility. Many men that seek help from our specialists may have poor sperm quality but this does not necessarily indicate that they are infertile. They may be diagnosed with an underlying health issue affecting sperm quality or quantity in the semen that needs to be investigated further and where possible, treated. There are several ways to address male infertility issues such as medical and surgical treatments. Medical treatments tend to address lifestyle, hormonal unbalances, erectile and ejaculatory problems and urogenital infections.  Surgical interventions include correction of anatomical anomalies such as varicocele or obstruction of the sperm ducts, and sperm retrieval as part of assisted reproductive technology (ART). Lifestyle changes can be as simple as dietary changes, regular exercise or food supplements. It is vital to consult a specialist to guide you through the most effective treatment that will address the possible underlying issues.  

How do these problems affect men emotionally? Do many find it a struggle?

The stigma associated with infertility is a very real problem for men and many struggle to come to terms with their condition so it is paramount that male infertility is acknowledged and men feel able and safe to express their feelings about the issues surrounding their infertility. Men closely identify sexual prowess with reproduction and adverse feelings about masculinity are common in infertile men. This can lead to poor mental well-being, self-esteem issues and feeling marginalised.

Why do you think many men struggle to talk about these problems, or find it difficult to deal with? Do many suffer in silence?

Despite the fact that more information is available, many men struggle to come to terms with infertility problems, many do not receive or seek support. There are several reasons as to why men suffer in silence. Some have been mentioned above. There are still huge misconceptions within society that infertility is predominantly a female issue when this is clearly not the case. This excludes many men from infertility conversations and accounts for the relative lack of care and services for men with fertility problems. Men often feel as if they are wasting time and resources. Men can feel excluded as their needs are often ignored, which is why spaces for sharing experiences are so important.

A better understanding of men’s reproductive health is needed, and more open conversations must be had, including increased attention in the media. In addition, there is still an expectation that men are able to deal with issues of infertility and get on with their lives. This is both unrealistic and outdated. Men are half of the fertility equation and should be treated as such.

Can you give some advice on how men can help when the fertility problem is their partner's problem? What should they do, and what should they not do? 

It is essential that the channels of communication are kept open. Ask how you can support her. Try to get involved in the process, talk to her about the treatment and how it is making her feel. Don’t suppress your emotions about what you as a couple are going through.

Why is it that currently women are subject to such rigorous testing, whereas for men it's usually just checking their sperm count?

There are a number of reasons as to why the evaluation and diagnosis of men can often be neglected when compared to the tests that women receive.

Certainly the misconception that infertility is primarily a female issue plays a part, but it is also a well established fact that men on average tend to have less contact with doctors than women. 

In society, women will have contact with doctors from the point of menstruation, through to pregnancy, they undergo a strict cervical cancer screening process and of course consult their doctors during menopause. For men, there is no structured screening to identify sexual and reproductive health issues.