As the saying goes, “it takes two to tango” and when conceiving this holds very true. Whilst we all know both a sperm and an egg are needed for fertilization, when it comes to a couple’s infertility, sometimes this basic concept falls by the wayside. As a male infertility specialist, I see many times that when the wife is unable to fall pregnant, she is the one that goes through a barrage of tests first, even sometimes with quite invasive ones, before any doctor considers investigation of the “male side of the equation”.

This is despite the fact that a male factor is either the primary cause or a significant contributor to a couple’s infertility about 50% of the time. It is important to note that infertility guidelines published around the world, from leading organizations, recommend that for an infertile couple with unexplained infertility, both the female and the male should be assessed AT THE SAME TIME. I have lost count of the number of times I have been referred a patient, and the problem was solely with the man, but it has taken many months and sometimes YEARS before a doctor decided to arrange for a male fertility assessment. This despite the wife going through multiple tests and treatments. For some couples “time is of the essence” and this delayed period of actually working out what the problem is, and with whom, is time that can never be recouped.

[e.n. While not sure how much of the blog readership this is the case for, there are many people who don’t check the male side of infertility because they are advised that from a halakhic perspective there is a problem testing a man. This is based on the assumption that the tests will involve masturbation (which is considered שכבת זרע לבטלה) and therefore they will exhaust all options of female infertility before even once testing the male. It is important to note that 1) not all rabbinic authorities would rule that this is שכבת זרע לבטלה since it’s for a clear purpose in moving forward fertility, and therefore check with your halakhic authority and 2) there are some medical alternatives to masturbating for sample collection. Those can be discussed both with your doctor and halakhic advisor.]

Furthermore, sometimes fixing a male cause of infertility can result in a couple avoiding IVF.  Even if a couple is destined for IVF, sometimes treating the male factor can improve the chances of successful IVF.

There are also several potential medical problems that can be associated with male infertility, so making this diagnosis is important to potentially help identify other medical health issues that may need treatment in their own right. Some of this is based on newer and emerging evidence and so it is important that if any tests are abnormal, the husband is assessed by a specialist in male infertility such as a urologist, who can not only treat the male problem but is well trained to assess for these other health issues. Also, some tests need halakhic guidance, so this also needs to be taken into consideration.

So the take-home message from this blog….A male factor is a contributor to infertility in 50% of cases, so don’t delay in getting assessed! If a problem is found, don’t just accept it – see a specialist who has specific sub-specialist training in male fertility.