After struggling to get pregnant for two years, Liberty Walther Barnes scheduled an artificial insemination procedure but, the day before the appointment, a bout with the flu had killed all but a handful of her husband’s sperm.
Though doctors convinced them to go ahead -- “conception only requires one sperm” -- Barnes said she blamed herself for her inability to conceive, “as if my egg had willfully refused to be fertilized.”
Barnes, an assistant researcher in the Department of Sociology at the University of Cambridge in the United Kingdom, set out to find out why women carry the burden of men’s infertility and why attitudes of shame and denial prevent men from getting the medical help they need. The result was the new book, "Conceiving Masculinity: Male Infertility, Medicine and Identity."
“My husband was not infertile,” she told ABC News. “But it was probably my first time thinking about male infertility and how come all the pressure was on me? I feel like I have to will my egg to get pregnant and do a lot of work to help my husband feel comfortable and safe.”
Barnes and her husband eventually conceived, despite the initial setback with her husband’s sperm.
“What I was interested in as a sociologist is what social systems are in place to allow men to feel this way,” she said. “The doctors weren’t telling them they were infertile. And it occurred to me these men were not identifying as infertile when I started asking.”
About 30 percent of all infertility is attributed to male factors, according to Resolve: The National Infertility Association. The group says men are not as willing as their female partners to talk about their experience, adding on its website that “perhaps this is because we traditionally think of children as a woman's province, or because over the ages, conception has been thought of as the woman's responsibility.”
An estimated 7.3 million women sought infertility services since the National Center for Health Statistics began tracking in 1955. But only in the 21st century did comparable data become available on men’s fertility, according to Barnes.
Female infertility is a board-certified subspecialty, but male infertility has no equivalent, according to Barnes. Andrology is a subset of urology. Female specialists outnumber males five to one, she said.
Women bear the brunt of male fertility as doctors send couples straight to IVF, rather than exploring options for infertile husbands. Barnes said that men’s medical issues are not adequately addressed because society prizes male fertility and virility. Take, for example, the oft-used expression for an infertile man who “shoots blanks.”
Doctors, too, collude with society to cushion the blow, according to Barnes.
“They measure every step to protect these men’s masculinity,” she said. “They don't want them to be humiliated so they try to make a patient feel better.”
Two thirds of male patients don't know they're sterile because doctors use confusing language when diagnosing infertility rather than giving the facts, said Barnes. They use metaphors like “engines” and “baseball,” she added.
According to Barnes, one doctor talked about “lots of wheels on this machine,” and another referred to the testicles as a “factory” and the vas deferens as a “bridge.”
When Barnes began her research for the book, she joined Resolve and noticed their meetings were attended largely by women and not men. She also went to big conference on infertility at UCLA and “the men attending were claiming they were not infertile” -- even those with a “zero sperm count.”
At first, she had a difficult time finding subjects.
Through specialists, she shadowed 24 men in five clinics throughout the United States, observing their appointments and following up with telephone interviews.
“Men recruited for the study met the clinical definition, but they didn’t understand they were infertile -- even men with zero sperm count,” she said.
New technologies have redefined male infertility. In a procedure developed in the mid-'90s, doctors can extract premature sperm cells from testicles and use them in an IVF procedure with intracytoplasmic sperm injection (ICSI).
Dr. Philip Werthman, a top male fertility surgeon from Los Angeles who was featured as “the sperm doctor” on the reality show, “Chasing Maria Menounos,” disagreed with Barnes that doctors “hide or whitewash” a patient’s infertility issues.
“The metaphors are a method of connecting with patients and a way to educate about anatomy, physiology and pathology in a rapid way that most men can understand and connect with,” he said.
He added that men are “not happy to hear they have issues with fertility.”
“They take it as an affront to their masculinity and virility,” he said. “For some men, it becomes an emotional issue and an ego issue to not be able to fulfill their masculine duty and take care of their wives and provide, in a sense, and can lead to denial.”
Such was the case with Denny Ceizyk, who was told by another doctor that he had an unexplained low sperm count with bad motility.
“I was in absolute denial -- I didn’t want to tell anyone,” said Ceizyk, 47, who is from Tucson, Ariz.
He and his wife, who was diagnosed with endometriosis, had been trying to get pregnant for a year.
“I didn’t want to tell anyone,” he said. “Like most guys, I was skeptical that it was true. I came from a family of three and she of four, so I so no reason why we would a problem conceiving.”
Ceizyk said it was true men “don’t understand their own biology,” and many of the doctors “looked at it like it was a non-issue and something to just overcome.”
“My sperm count was a million -- I thought that was plenty,” he said. “Why did I need a $1,000 process? It was ignorance. Forty million [sperm count] is the bare minimum and I was way under.”
Ceizyk wrote a memoir about the couple’s $70,000 ordeal, "Almost a Father," and writes a blog with the same name.
In six years, they had 11 embryo transfers, five IVFs, six infertility doctors, three miscarriages and two cross-country trips to a specialty hospital in New Jersey. They finally conceived their now-11-year-old daughter in an intracytoplasmic sperm injection procedure, extracting sperm that was injected into one of his wife’s eggs.
Attending support groups early on, there were no other men and “in some cases they weren’t allowed,” he said.
The couple started their own Resolve support group in Tucson.
“It saved me,” he said. “It was normalizing and to have the commonality of experience with other men.
“It ended up being a team effort and, by starting to actually learn the [medical] terminology and participate in conversations, we got much closer," he added. "It ended up being a team effort.
“My wife is my true hero," he said. "She was the one who gave me the courage to evolve into a team player in our parenthood pursuit, and we have run a couples support group helping other couples find a way to develop a new form of intimacy in their baby-making pursuits, even when they include a staff of doctors and medical protocols."