Male infertility: silence, shame and why nobody talks about it

“What did they say?” she asks as he gets into the car.

He holds the envelope with the results on his knees and stares straight ahead through the windscreen. “Nothing much. The results are a bit low. We’ll repeat it.” Then he turns on the radio, slightly louder than usual. At home he puts the envelope in the drawer under the television. For the next three weeks he doesn’t say a word about it — not to his partner, not to his brother, not to the friend he plays basketball with every Thursday. When his mother asks over the holidays whether there will be some news soon, he laughs and says they still have time.

This scene is composite, but I have heard almost every piece of it in one version or another. When a couple can’t conceive, the conversation turns almost automatically to the woman’s body: to her cycle, her hormones, her age. In this story the man is often the one waiting in the corridor, driving to appointments and holding her hand. But when it turns out that part of the reason lies with him, something particular happens. Instead of a conversation, there is silence. And with male infertility, silence has its own shape, its own reasons and its own cost.

The half of the story nobody talks about

In 2023 the World Health Organization published an estimate that roughly one in six adults experiences infertility at some point in their life. What is often forgotten is that this is not a “women’s” figure. In a 2015 review of global data, Agarwal and colleagues summarised that a male factor is the sole cause in roughly a fifth to a third of infertile couples, and contributes to about half of all cases.

Half. And yet in waiting rooms, on forums and in conversations between friends you hear far less about it. Women talk about infertility — at least among themselves — more and more often. Men hardly talk about it at all. That doesn’t mean it doesn’t hit them. It means they have no space for it, no words, and often no people they could say those words to.

This post is not about medical causes or about what particular values on a test result mean. Those are questions for a doctor — the gynaecologist overseeing your care, or the specialists at a fertility clinic, who also work with men. I’m interested in something else: what happens inside a man, and inside a couple, when it turns out the “problem” is his too.

Why it cuts so deep

In many cultures, ours included, fertility and masculinity are tightly intertwined. Everyday language gives it away: jokes about “weak swimmers”, hints about who is a “real man”, questions an uncle asks after his third glass. In these sentences fertility gets confused with sexual potency, even though they are two completely different things. A man with infertility can have an entirely ordinary sex life. But in his head the line easily blurs.

In 2015 the researchers Esmée Hanna and Brendan Gough reviewed qualitative studies on how men experience infertility. The same thread ran through many of the accounts: the diagnosis was experienced not only as medical news, but as a blow to who they were as men. Some described feeling “less”, feeling that they had deprived their partner of something she was owed, or that they had broken a chain stretching back through generations of their family.

That last thought matters a great deal in relational family therapy, the approach I am training in. A child is not only the wish of two people. A child is also the continuation of a story — of a surname, a farm, a father’s trade, a grandfather’s name. A man who grew up feeling that his task was to “carry the family on” can experience infertility as an unmet obligation to people who may no longer even be alive. Often he can’t put these expectations into words until someone asks.

How distress shows when it doesn’t show

In 2012 Karin Hammarberg and Jane Fisher reviewed research on the psychological and social aspects of infertility in men. One of their findings seems to me the most important: on standard questionnaires men report less distress than women, which is why it was long assumed that infertility affects them less. But when researchers actually talk to men, a more complicated picture emerges. The distress is there; it is simply expressed differently, and men often don’t recognise it as distress.

What can it look like?

• Retreating into work. Longer hours, a new project, overtime that wasn’t there before. Work is an area where you can still succeed.
• Irritability. Anger over small things, a short fuse with colleagues, arguments about matters with no obvious link to infertility.
• Taking over the logistics. He books appointments, reads up on procedures, keeps the spreadsheet. On the surface he’s very involved, while emotionally he may be keeping a safe distance.
• Physical signs. Poorer sleep, more alcohol, more hours in front of a screen, less exercise.
• Silence about himself. He talks about “our” problem, but not about how it is for him.

If this list sounds familiar beyond infertility, that’s no coincidence. I described a similar picture in Depression in men: anger, withdrawal and silence instead of tears. I’m not saying every man with infertility is depressed. I’m saying that men’s distress often hides behind behaviour that others read as “he’s holding up well”.

The supporter with no support

When a couple goes through fertility treatment, most of the procedures, examinations and medication happen to the woman’s body — even when the cause lies with the man. So the man finds himself in an odd role. He is part of the diagnosis, but not part of what is happening. He often sits to one side while the staff discuss with his partner what comes next.

Tobias Wischmann and Petra Thorn summarised in 2013 that men in this role often see themselves primarily as support for their partner. That is good and important. But it has a side effect: if my job is to be strong for her, then I have no right to be weak myself. Men who think like this don’t show their sadness, so as not to “add to her burden”. Their partner, meanwhile, may read their calm as indifference.

As early as 2004, in interviews with men who had been through assisted reproduction, Karen Throsby and Rosalind Gill noticed how often the men described themselves as being “outside” what was happening. Some experienced this as relief, others as invisibility. Almost all of them, though, had little space in which they could talk about it.

What happens in the couple

Infertility tests every relationship; I wrote about this in more detail in Infertility as a test for a couple: what happens to the relationship. When the cause lies with the man, though, a particular pattern often appears in the couple, and it is worth naming.

He stays silent because he is ashamed. She stays silent because she wants to protect him. And so something surprising happens on the outside: when relatives and friends ask what is going on, she is the one who answers — often in a way that leaves the burden with her. “We’re still waiting for results.” “They found something with me.” Not because she wants to, but because it’s easier than giving away his secret. A quiet alliance forms, in which she carries someone else’s burden and he carries the feeling that she lied because of him.

A great deal can build up in an alliance like that. She may be angry but unable to show it, because it would hurt him. He may feel guilt and turn it into withdrawal. It helps to distinguish guilt from shame: guilt says “I did something wrong”, shame says “I am wrong”. With infertility a man often doesn’t blame himself for an action, since he didn’t “do” anything — and yet he is ashamed of what he is. I describe the difference in more detail in Guilt and shame are not the same — and the difference matters, and you’ll find a short explanation in the knowledge base under shame.

In 2005 Lone Schmidt and colleagues followed several hundred men and women who had not had a child after a year of treatment. Among the factors linked to greater fertility-related stress was difficulty communicating with one’s partner. It wasn’t about how hard the diagnosis was, but about whether the two of them could share it.

A conversation that can happen

What does it look like when the silence opens, even a little? Here is a short example (composite, not a real person):

“You know I always tell your mum we’re still having tests on my side?”
“I know. Thank you.”
“I’m not saying it so you’ll thank me. I’m tired of it.”
“…I thought I was protecting you by not talking about it. Really I was protecting myself.”
“I just want us to be in this together. Even when it’s ugly.”

Nothing was resolved in this conversation. His mother still doesn’t know, the results are the same. But something shifted: both of them said what the silence was costing them. That is often the first step — not deciding whom to tell, but admitting that the secret is being carried by two people.

Whom to tell and whom not to

There is no rule that fits everyone. Some couples tell everybody and find it easier. Others tell only two or three people. Others still tell no one, and that can be fine too, as long as it is a decision you both made and not a burden carried by one.

What I notice is this: men who tell no one about infertility often don’t even know whom they could talk to. It isn’t only shame; it’s also that their friendships are often built on shared activities rather than on talking about how they are. Sometimes one person is enough — a brother, a friend, a colleague he has already once talked to about something personal.

Three questions can help you decide:

• Is this a decision we made together, or is one of us staying silent on behalf of the other?
• Whom would we tell if the cause lay with the other one of us? If the answer is different, why?
• What would hurt us more — the questions people ask because they don’t know, or the responses that would come if they did?

If you decide to tell people, it helps to know that others often don’t know what to say — and sometimes say something clumsy. Which sentences help and which hurt is the subject of What to say to someone who can’t get pregnant (and what not to).

Exercise: one sentence a week

This exercise is for men who stay silent about infertility, and for their partners. It doesn’t need to be big. In fact, it’s better if it’s small.

1. Choose one moment in the week when you are both at least a little rested — not in the evening after an argument, not in the car after an appointment. Perhaps a walk, perhaps coffee on a Saturday morning.
2. Each of you says one sentence that begins “This week, about all this, I felt …” and ends with a feeling: “… angry”, “… ashamed”, “… scared”, “… surprised that I didn’t care”. One sentence, not an explanation.
3. The other simply repeats what they heard, in their own words. No “but”, no advice, no correcting.
4. Ask: “Is there anything else?” and wait. If there isn’t, that’s fine.
5. Finish with something that isn’t about infertility. Where you’re going next weekend, what you’ll cook. Infertility is part of your life, not the whole of it.

As the exercise is repeated, men often notice that one sentence a week is easier than one big conversation a year that ends in tears and promises. And that this small amount is sometimes all that was needed.

Where this description doesn’t apply

I want to be careful not to create a new image that men then have to squeeze themselves into.

Not every man is broken by infertility. Some accept the diagnosis as a medical fact, talk about it openly and aren’t eaten up by shame. That isn’t denial, it’s a different way of coping. If his partner expects more sadness from him than he feels, that can become a new kind of pressure.

Silence isn’t always shame. Some men simply don’t talk much about things that hurt — not about infertility, not about their father’s death, not about losing a job. If a man like that sleeps well, works, laughs and stays close to his partner, there is no need to “open him up” by force.

The psychological side doesn’t replace the medical one. Talking about feelings is not instead of an examination, a second opinion or the questions a couple has for their doctor. When medical questions remain open, they are worth asking — of the gynaecologist overseeing your care, or at a fertility clinic.

When it’s time for more help. If a man has barely slept for weeks, is drinking more than before, is losing interest in everything that used to bring him joy, or has thoughts that it would be better if he weren’t here, this is no longer just “a hard time”. Then it is right to see a GP or a psychiatrist. If you are having suicidal thoughts and are in Slovenia, call the crisis line Klic v duševni stiski on 01 520 99 00 (every day from 7 pm to 7 am) or the Samaritans helpline in Slovenia on 116 123 (24 hours a day); in an emergency, call 112.

What therapy can offer

Men tend to seek therapy later than women — I described the reasons in Men and therapy: why they come later and what stops them. With infertility this shows twice over: because they don’t admit their distress, and because they feel therapy is “for her”.

Couples therapy can give both partners a space where the man doesn’t speak only as the supporter, but as someone who has lost something himself. In relational family therapy we are also interested in what he learned at home about masculinity, fatherhood and “carrying the family on”. Sometimes it turns out that the shame isn’t his alone — that he carries it across generations, from a father’s or grandfather’s story that nobody ever told to the end. A longer session with a genogram, A Look into the Past, is designed for exactly this kind of exploration. I also work with English-speaking clients.

Therapy can’t change a test result. But it can help make sure the result doesn’t become a secret that drives the two of you apart. If you’d like to read something more general about infertility and the distress it brings, take a look at the short explanation in the knowledge base under infertility and distress.

What to remember

• A male factor contributes to about half of infertile couples — male infertility isn’t rare, it’s just rarely spoken about.
• A diagnosis often hits not only health, but also a man’s sense of masculinity and the expectations he brought from his family.
• Men’s distress often hides in work, irritability, logistics and silence — which is why others, and partners, miss it.
• A couple can form a quiet alliance in which she carries his secret. It is worth naming.
• Less helps than you think: one sentence a week, one person who knows, and a space where he is more than just the support.