What it's like to be a man who can't have kids

Stephen Curtis, 41, always imagined being a father.

“I wanted to have kids, even before I knew how. That was always the plan.”

He and his wife, Stephanie, started trying as soon as they married.

“There are more moving parts in a woman's body and more things that could potentially go wrong, I guess.

“I've never heard about someone who, about a man who, I mean, I know there's shooting blanks. [That] Is what they call it, right?”

There was a battery of tests for his wife and he completed the one test he could do - a sperm sample. A few weeks later, the doctor asked him to repeat the test and did not explain why.

In the world of fertility treatment, requesting a second sperm sample is an indicator that something is likely amiss.

​Male infertility is on the rise globally, with an unexplained decline in sperm quality since at least the 1970s. The male partner is the primary cause of infertility in about a third of cases and is a contributing factor to a third of cases. Yet, when couples are initially faced with infertility, like Curtis, the knee-jerk reaction is that the issue lies with the woman, according to New Zealand fertility specialists.

​Similar to the female response, infertility in men presents a challenge to identity, potentially morphing into depression, anxiety, and low self-esteem. A large majority of men who encounter infertility are unlikely to talk about it.

​Of the men who are presented with fertility issues, “they would put up a facade of being okay and being very business-like about it,” says Dr Amir Zarrabi, a Dunedin-based urologist and male fertility specialist.

​“But we have realised that the emotional toll on men is significant. To tell a guy in his 30s that you are sterile or you are not producing sperm or you have this genetic abnormality is a profound diagnosis to get...”

Curtis’ second sperm sample confirmed the results of the first: his body did not seem to be ejaculating sperm.

“I remember my GP saying to me, ‘I've never ever heard of somebody having zero [sperm count]...

“She is supposed to say something comforting, something like ‘It’s okay. We can treat it. You know, there are ways.’ So that’s when the alarm bells started ringing.”

He went for a biopsy with Auckland clinic Fertility Plus, which they were assigned to attend in order for the treatment to be covered by government funding. The results came in 10 minutes later while Curtis and his wife were still at the clinic. No sperm was present. The medical diagnosis is azoospermia.

“I didn't get it at the time. I didn't. I know that's bad, I guess, but I didn't really understand the weight, the ramifications of what they were saying.”

Azoospermia affects approximately one percent of men. In some cases, it is treatable, according to Dr Devashana Gupta, a fertility specialist and gynaecologist with Repromed, an Auckland-based fertility clinic. Other times, there is no way forward and no explanation.

For men with a low sperm count, lifestyle factors such as obesity, smoking, vaping, and exposure to certain toxins can be a contributing factor.

“Obviously, phone radio frequency and waves as well around the scrotum isn't a good idea,” she added.

Enlarged varicose veins, called a varicocele, on the testicles can result in increased heat. It can have a major impact on testosterone levels and sperm, which thrive at temperatures about two degrees below body temperature, says Zarrabi. That's why the testicles hang outside the body.

“Now, unfortunately, a lot of these varicoceles are undiagnosed,” added Zarrabi, citing a tendency for fertility clinics the world over to specialise in female-focused fertility treatments.

A small surgical procedure can treat a varicocele. About 75 percent of patients will experience significant improvement in their “sperm parameters, to allow them to have natural conception and not go through IVF,” Zarrabi says.

Where there is a low but present sperm count, intrauterine insemination (IUI), where the sperm is inserted into the uterus at the optimal time, can also increase odds of success, says Gupta. IVF is a step further, where an egg that is fertilised in the lab is implanted in the uterus. Even that is successful only 40 percent of the time for couples under 35. That figure decreases as couples age.

Genetic abnormality can be a cause. In some cases, a complicated surgical procedure can be performed with limited success, says Zarrabi.

“...There comes a point where I have to tell the couple, ‘Listen, we have exhausted all the options.

“There is just nothing to be done, and they need to start thinking about adoption or donor sperm, and that's really a tough conversation to have.”

And that’s where Curtis found himself: unexplained male infertility with no further treatment options.

The couple explored adoption, but domestic adoption to non-family members is incredibly rare in New Zealand, with only a dozen or two instances each year. Even if they were successful, Curtis feared he would not connect with the child like he might if it were biologically his. The same went for the sperm donor option.

“What if I don't connect to the child, but if we don't [go for the options] can I live with that? Knowing that I've stood in the way of my wife having something she wants?”

At that point, it was a ‘no’ for Curtis, so the couple put their decision-making on ice. They did submit an application to a sperm donor, surmising that they would make a decision if they were successful, a process that typically takes two years.

It was about this time that Curtis says he would have benefited from the advice of another man who faced infertility. The couple wasn’t exactly private about their journey, but no one in their circle of friends and family could relate.

The fertility clinic connected him with another man who had used a sperm donor for his kids, but a coffee date never eventuated. He didn’t want to speak with a fertility counsellor, which most clinics offer as part of their treatment.

“I wanted to talk to someone who's been through it, who has had assisted reproduction.”

Andy Leggat, the psychology director at Fertility Associates, which has fertility clinics throughout the country, says women far outnumber men in seeking help processing an infertility diagnosis or for support through grueling fertility treatments.

Each patient - female, male, or nonbinary - comes with a unique psychological blueprint and needs when it comes to fertility counselling.

“For men... often there is a huge sense of grief, sometimes shame, sometimes guilt, guilt that my partner and I are now needing to go through fertility treatment and she is going to bear the burden of these incredibly physical treatment protocols as a result of a male factor challenge.”

Curtis’s moment of clarity came when the couple were selected by a sperm donor after only six months of waiting. It felt like fate.

However, even with a sperm donor secured, success was uncertain. The embryo made from the donor sperm and an egg from Curtis’ wife was implanted through IVF. It worked on the second attempt.

Curtis now has two boys aged 18 months and four years. They even look like him.

“I just realised if you adopt a child, you just make the decision one day and you sign a form. This is my child, and it doesn’t matter. The genes aren’t yours, and they’re not even your wife’s, either, if you are adopting.

“But what makes the child yours is the decision you make, so I made that decision.

“These are my kids and that's that.”