Struggles with male infertility and IVF take their toll
This past Father’s Day, June Ramales got up at five, as usual, and went about his morning routine. Then his wife handed him a fortune cookie. Inside it said, “Your future will change.” It wasn’t until he saw the little romper with the words “Daddy’s Strongest Swimmer” printed on it that he understood: she was pregnant. “I stared my eyes out for about 10 minutes,” says Ramales. “I could not believe it.”
That joyful morning came after a series of “emotionally exhausting” father days when Ramales was not yet the father he had always wanted to be. Before he and his wife had their baby boy in February, they had tried intermittently for years.
They had undergone fertility treatment about five years earlier, and when those procedures were unsuccessful, they took a break. “It was just physically draining for my wife, and emotionally for me, because I got to watch her go through the treatments,” says Ramales. “It was tough because I couldn’t do anything.”
They began trying again in December 2021, embarking on a grueling round of IUI (intrauterine insemination), where sperm is placed directly into the uterus at the optimal time to fertilize an egg. The successful procedure – a few days after Mother’s Day – was their last attempt before embarking on the more physically and financially taxing IVF (in vitro fertilization) process. “After trying for so long, we kind of lost hope,” says Ramales. “Last year when we finally got that news, it was like maybe there is a God.”
Yet Ramales has not forgotten how difficult those years of hope and heartbreak were. “I started to feel like it was a curse,” he says.
While he emphasizes the physical endurance his wife undertook and took the brunt of the medical procedures, he did have to make some changes to address the low sperm count that was part of the reason they struggled to conceive. become. “I had to exercise, quit smoking, eat healthier. I couldn’t wear tight boxer shorts.” But he says the emotional burden was the hardest part. He struggled to explain how he felt to his wife, who didn’t fully understand where he was coming from, until she read a book about infertility with a male perspective. The grief was compounded by the fact that part of his desire to be a father was to “be there” for a child in a way his father had not been – his biological father left when he was born; his stepfather repeated the pattern when Ramales was 17.
He did what he could to take care of his mental health: therapy, diaries, joining a Fertility Matters Canada Facebook group. But when he tried to reach out to other men in the group or talk to friends, he noticed people shying away from the conversation. “No one really wants to talk about it,” he says. “Growing up, men are taught not to share their feelings.”
While we as a society have rightly gotten better at talking openly, empathetically, and sensitively about women’s struggles with infertility, the male experience of this deeply personal challenge has not received the same attention.
Neil Hyde knows this all too well. He and his wife, both healthy in their thirties, were stunned when they couldn’t conceive. They struggled with infertility for six years, after which they decided to launch a podcast detailing their journey.
“We wanted to document it, because we found there were no real sources,” says Hyde. “Once we started talking about it, we heard from a lot of people who were also going through it or had been through it.”
The eight-episode podcast called One in six following the statistic that one in six people worldwide is affected by infertility, starting on their sixth round of IUI – the so-called “make or break” round before moving on to more intensive procedures. Then follows the Hydes as they undergo IVF, which in their case involved traveling from Newfoundland to Calgary, as there are no clinics offering this procedure in their home province.
Hyde says he felt like he was “the rock” in the situation, especially during IVF, which involves implanting a fertilized egg in the uterus. “Whatever feelings I had felt a little small in light of what Jen was going through,” he says. “I couldn’t really be too emotional or too devastated because someone in the room had to drive home. You cannot hug yourself and someone else at the same time. I had to be there for her.”
Feeling a sense of powerlessness, he did his best to support his wife by keeping abreast of the things he could handle: appointment times, terminology, giving her hormone injections. “I was lucky that Jen has a needle phobia,” he jokes. “I soon became a nurse, so that was a very small part I could play to help.”
Some of the hardest moments were those that should be festive: holidays; gatherings with friends and their children. “You had to work yourself into who you were going to be now, like the ‘nice uncle,'” says Hyde.
The Hydes intended to release the podcast regardless of the outcome of their fertility journey. Coincidentally, Jen got pregnant through IVF. Shortly after the birth of their first child, they had a spontaneous natural pregnancy and a few weeks ago their second was born.
Hyde is aware that this is not the case for everyone. Much of the feedback on the podcast came from people who had gone through eight or nine rounds of IVF, used donor sperm, tried surrogacy, and still hadn’t had a baby. “We were lucky, but with every blood test I was prepared for the worst,” says Hyde. “It wouldn’t be the end of the world — we’d get another dog, we’d travel more — but it’s not the world we hoped for.”
While men don’t experience nearly the same external “pressure, pressure, pressure” that women experience when it comes to procreation, there is a certain primal urgency. It’s your ticket to immortality. In the most prehistoric way, it’s being the alpha male, having all these kids, spreading your genetic code, all that old stuff,” says Hyde. “It’s about creating life, and no matter how much you try to deny it, it’s there. It defines you, it gives you purpose.”
Dr. Dan Nayot says his male patients often feel an extra layer of guilt while trying to conceive. “They wish they could do it themselves,” says Nayot, a reproductive endocrinologist, infertility specialist, and medical director at The Fertility Partners. “Like, ‘Give me the needles, give me the procedure,’ but biology just doesn’t work that way.”
Nayot points out that male infertility, the semen side of the equation, accounts for about a third to half of cases. “We know that infertility is on the rise,” he says. “There is good evidence that sperm quality has declined over the past decade.” No one is sure why; theories include exposure to pollution or endocrine disruptors.
Nayot says patients are often “shocked” when they walk into a fertility doctor’s office and find out they have a problem with sperm quality. While sexual dysfunction is usually picked up on because if you don’t ejaculate you know you have no chance of getting pregnant through intercourse, “with semen you don’t really know unless you check.” To illustrate this point, someone who has undergone a vasectomy produces sperm, but it does not contain any of those all-important sperm cells, which are only visible at the microscopic level.
While the causes of poor sperm quality aren’t fully understood, Nayot points to factors that can exacerbate it, including age, medical problems such as uncontrolled diabetes, thyroid dysfunction or obesity, medications such as testosterone therapy, and lifestyle factors such as smoking, cannabis use, poor sleep, stress or “anything which warms up the testicles,” like cycling at a pro level.
You can’t change your age or genetics, but you can change your lifestyle. Nayot is chief medical advisor to Bird & Be, a Canadian company that offers fertility support products, including home sperm testing and prenatal supplements for men. “The most important thing is to get screened,” says Nayot. “Then you understand the ‘why’ and optimize what you can.”
Fertility struggles often result in “massive relationship strain” for the couples Nayot sees, and for men, it often manifests from a wounded ego. “Unfortunately, a false correlation between fertility and masculinity still exists,” he says. “It is not associated with your sex drive, anatomy or sexual performance. People can have a high sex drive, no problems in bed and severe male infertility.”
Although the stigma is improving, the sense of isolation is still strong. “Because people don’t talk about it, men think they’re the only ones,” says Nayot. “In reality, it’s very common.”
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