Late last year, I went in search of men. I know what you’re thinking: Join the club. But I wasn’t looking for just any men; I was looking for men who count themselves among the growing number of guys struggling with infertility. I began scrolling through online support groups.
But as I swiped through Reddit and Facebook (and ruined my curated Instagram algorithm), I noticed something strange. In all these so-called men’s groups, the members seemed to be overwhelmingly female. With permission, I joined a few and put up posts asking for men to reach out to me. Nearly every time, moments later my DMs filled with some version of: “I know you asked for men, but I’m a woman and I’d be happy to share my partner’s experience.”
I was floored. Where were all the men? And why were women connecting on their behalf?
I first talked to Sarah*. When she and her partner Jack* began trying to have a baby, she, at 37, assumed it might be difficult. After six months of trying, she got tested and discovered she had a lower-than-ideal egg count. It wasn’t too much to worry about, though. Her doctor recommended IVF to speed things along.
Even though Jack was 45, no one had counseled him to get his sperm tested until IVF entered the picture. Neither Sarah or Jack had even considered he might be part of the problem. When the doctor called to say they were unable to find any sperm in Jack’s sample, a condition called azoospermia, the couple was shocked. “We were like, ‘That’s a thing!?’” Sarah says now.
The Infertility Trap
Jack was left reeling from the news, unable to move forward. Feeling her own clock ticking, Sarah took charge. She found doctors who could perform a procedure that attempts to extract sperm from testicular tissue, encouraged Jack to go for it, and even went as far as transporting his next specimen. She hunted for guidance online and when she couldn’t find a suitable group on social media for those dealing with an azoospermia diagnosis, she started her own.
“It was immediately full of women,” she said. “Like, immediately.”
As we sat on a Zoom call together, Sarah read me a rare post from a man: “I’m curious if there are any men in this group…” it began. The poster added that in the nearly two years he’d been in the group—which now has thousands of followers—he’d failed to find another man he could directly share his experiences with.
By then, Sarah wasn’t surprised. It’s something she continues to hear often, in both her azoospermia group and other in-person and online infertility ones she joined herself.
The notion that female partners carry the emotional load in heterosexual partnerships isn’t new. But this divide seems even more extreme when couples are dealing with male infertility. When men do share their experiences in online groups and on Reddit, they rarely discuss their emotions; their focus tends be more on clinical outcomes and less on personal impact.
This tracks with the results of a new Cosmopolitan survey designed to uncover the differences between men’s and women’s attitudes toward infertility. When it comes to people who want kids but don’t yet have them, 50 percent of women say they plan to proactively talk with a doctor about their fertility. For men, that number falls to 18 percent. And though a growing body of research shows that men are equally responsible for infertility, women report feeling much more exhausted by the idea that it’s on them to conceive a child. They also feel significantly more burdened than men by that responsibility.
“Women automatically seek community. We want to talk to people about it,” Sarah says. “When our partners are dealing with male factor infertility, we go find other women whose partners are dealing with it and swap stories and ideas and thoughts, then take those back to our male partners.”
Research shows she’s not wrong. While we’ve all heard of “fight or flight,” more recently, psychologists have begun exploring a behavioral response to stress now labeled “tend and befriend.” The working theory is that certain sex-based hormones may drive these patterns, in which women will seek out community in times of hardship, deriving solace from crowdsourcing knowledge and helping those around them. This may be added to thousands of years of socialization in which women have performed the role of caretaker—but that doesn’t mean the women I spoke to find it any less exhausting.
Elizabeth,* who works remotely in public health in the Pacific Northwest, told me her husband is her “bestie.” They go to music festivals together, have a close circle of friends, and generally have a balanced and supportive relationship. But when it came to navigating infertility, Elizabeth said a lot of the mental and emotional load was on her shoulders.
“He’s a high school teacher, so he doesn’t have a lot of bandwidth for extra stuff,” she said. “He also doesn’t work from home, so I end up making a lot of the appointments just because I have more time.” Her husband underwent a varicocelectomy, a surgical attempt to improve male fertility, and the couple, who were 28 and 30 when they first started trying to conceive, have now spent two years watching friends around them have healthy babies while they are still not parents.
When Elizabeth asks her husband to talk about the emotional or logistical aspect of their journey, he will happily engage with her, but she can tell it’s rarely on his mind. Meanwhile, she’ll have been going over everything on a loop for days.
“I go back and forth about being annoyed by it, because at the end of the day, we are a partnership,” she said. “I want to support him in the ways that make sense for us, and this is a team effort. But it is a lot extra on me.”
Part of that extra load is particularly unavoidable. Elizabeth, and many of the women I spoke to who are trying to conceive, experience grief when their period comes each month. We are the first to know when we are—or are not—pregnant.
Most crucially, male factor infertility—especially in severe cases—will require women to undergo a kaleidoscope of medical interventions including IVF regardless of their reproductive viability. The physical impacts can be extreme, and for Martha Jackson, who lives with her husband, Adam, in the Cayman Islands, the process was almost fatal when she had a major blood clot in reaction to a treatment preparing for IVF.
“I would never blame Adam,” Martha said. “But at the same time, if he didn’t have male factor infertility and I didn’t have to have a hysteroscopy to remove a fibroid because we needed IVF, I wouldn’t have ended up with the blood clot.”
Sitting beside Martha on our call, Adam agreed. He was diagnosed with azoospermia, which affects around 1 percent of men. After many grueling tests and procedures, it was deemed impossible for him to produce sperm. If the couple wanted to conceive a child, they’d have to use donor sperm.
The effect on couples receiving this diagnosis is swift and devastating. Martha said she immediately went into research mode.
“I was so obsessed with getting as much information as I could, I couldn’t even focus at work,” Martha said. She joined online support groups, listened to podcasts on infertility and donor conception, and researched the best doctors—no matter that seeing them put the couple into debt. Then she would share what she learned with Adam, as the two of them tried to grapple with how male infertility would shape their future as a family.
Adam took a different approach. Joining a support group didn’t feel particularly effective. Neither did seeing a therapist. Instead, he focused on work, on building their house, and occasionally talked with a close friend or family member. “I would dip in from time to time to check with Martha on the progress of where we were at with seeing the doctors,” Adam said. “But when I saw the timeline was super far away, I stopped concentrating on it and stopped thinking about it.”
Nevertheless, the fallout of the diagnosis has had an undeniable and lasting effect. He describes his emotions like lava bubbling under rock, ready to burst through at the slightest trigger. He left the church he had grown up attending. He felt like the pastors’ promises of prayer-based good outcomes lacked authenticity. Infertility had forever altered his relationship with his faith.
The women I spoke to relayed the myriad ways that infertility had been difficult for their partners. The respect and love for these men was evident. But they also seemed tired. And no one was thrilled with the uneven distribution of work.
After Sarah started the online support group for men with azoospermia, she found Jack a therapist, guided him to groups for dads of donor-conceived children, and cared for his mental well-being until he got to a place where accepting donor sperm felt good.
“I mean, if you look at it one way, I was just doing it all selfishly to get the outcome I wanted,” Sarah said. “But on the other hand, he would have totally spiraled without the support he had, and a lot of that funneled through me.”
According to Cosmopolitan’s survey, men without kids are less likely to worry that age will be a factor in their fertility, less likely to have seen a doctor about fertility, less likely to think about their fertility, and less likely to feel burdened by the responsibility of conceiving a child. While we hear about the female biological clocks all day long, stories of historical monarchs with multi-decade age gaps producing heirs and octogenarian movie stars like Al Pacino fathering babies on their second or third shot at family life have seeped into our collective consciousness.
So when that paradigm shifts, as it did for Jack when he found out he likely had never been able to produce sperm, it is, to quote Sarah, “a mindfuck.”
And perhaps the bodily functions of it all makes the topic extra uncomfortable to share with friends or family who could potentially be a support system. We may all be adults, but for most people, especially men, using the words “testicles” and “sperm” while at a dinner party or in a local bar is probably not going to feel like casual or comfortable conversation.
So what is the cost—for women, men, and couples—of this unequal emotional labor? When women have to shepherd their male partners through infertility struggles, the isolation within a partnership becomes all the greater. Resentment and stress can lead to poorer health outcomes. Several women I spoke to said that the interpersonal ruptures had been so severe that they either separated from the partners they’d had fertility issues with or nearly had.
This imbalance could also have wider-reaching effects on policy. In South Carolina, an extreme proposed abortion ban could prohibit fertility treatments like embryo freezing. If men aren’t engaged in the process of addressing infertility, they are less likely to understand the implications of laws like this and could be less likely to oppose them. “Men need to be part of this conversation, because these policies, while wrapped in ‘reproductive health’ affect them, too,” said Danielle Melfi, CEO of RESOLVE: The National Infertility and Family Building Association.
Those who chose the path of using donor sperm said the years spent struggling have since faded. Thinking back to that time, they have it compartmentalized: a trauma tucked away in the back of their psyche as their once seemingly disengaged partners have turned into present and happy fathers. “Telling the story now, it almost feels like that was a different time, a different place, different people,” Sarah said. But for those who now have children—as for those who don’t—the sense that the burden could have been shared more equally remains.
No one thinks men and women must deal with the stress and grief of male infertility in the same way. But until men become more comfortable taking responsibility for their own care, the choice for many women seems to come down to carrying that extra weight—or going it alone.
*Name has been changed.
