Jared Wright, 36, from New York, vividly recalls the life-changing moment he received his diagnosis. The doctor walked in, took off his hat, and said, “I’m sorry—you’re diagnosed with non-obstructive azoospermia.” Reflecting on that moment, Wright says, “I felt like somebody died.”
Infertility is diagnosed when conception doesn’t occur after a year or more of unprotected sex. Poor sperm quality—such as azoospermia—is often the cause, manifesting as low sperm count, little or no sperm in the ejaculate, or sperm that can’t move effectively to fertilize an egg. Blockages can also hinder sperm delivery. “If you have had a really bad testicular infection, those can scar the tubes that carry the sperm from testicle to the ejaculate,” says Ronald Anglade, M.D., a urologist in Atlanta. Age can also play a significant role.
According to a 2013 report titled “Infertility and Impaired Fecundity in the United States,” about 9 percent of men of reproductive age in the U.S. experience infertility, with one-third of infertile couples facing male-related issues. Black men have the highest infertility rate at 13.2 percent, with Hispanic and Asian men at 12.8 percent, and White men at 11 percent. Only 1 percent of men seeking infertility treatment were Black. Many Black men equate their ability to procreate with their identity. “We live in a society with a very narrow conceptualization of manhood and masculinity,” says Darren D. Moore, Ph.D., L.M.F.T., Clinical Professor & Associate Director of Clinical Training and Supervision for the Marriage and Family Therapy Master’s Degree program at The Family Institute, Northwestern University. “Particularly in the Black community, a man is someone who can produce revenue and children. A man’s ability to produce is associated with his perceived strength. Therefore, if he presents with fertility issues, he is often ridiculed and sometimes has his manhood questioned.”
Confronting the Stigma of Male Infertility
This mindset often leads to partners being automatically blamed when conception issues arise. Brandon Johnson, 43, from Virginia, now a Black infertility therapist, recalls his wife being offered an egg donation due to this assumption. His desire to protect her and remove the stigma of infertility led him to open up about his diagnosis at age 32. “At the time, I thought I was less than a man,” Johnson admits.
For Carl E. Lambert Jr., M.D., a family physician in Chicago, his infertility diagnosis was a “come to Jesus moment.” Lambert, 38, and his wife had been trying to conceive for nearly a year before he agreed to be evaluated. “There was a little bit of denial there,” he says. “And I think for a lot of guys, that might be the first response.” When he finally saw a doctor, he discovered he had a low sperm count.
Receiving an infertility diagnosis brings up intense emotions. “We go through the stages of grief and loss because you are losing a valuable part of you,” Johnson explains. He emphasizes the importance of allowing oneself to go through the stages of anger, depression, bargaining, and acceptance, recognizing that these feelings can fluctuate.
“If you’re having difficulty having a child after trying for a year or two, don’t keep trying for five, six, and seven years without being evaluated,” advises Anglade. Following an initial semen analysis, a urologist can outline available options. If sperm count is low, medications like Clomid and/or HCG may be prescribed to boost testosterone and sperm production. If sperm is present, either in the semen or needing to be extracted from the testes, intrauterine insemination (IUI) might be recommended first, with in vitro fertilization (IVF) as a subsequent option if needed.
Lambert was evaluated a year after he and his wife started trying to conceive. The couple eventually welcomed a child through IVF and later had a second child without assistance. Wright underwent surgery for varicocele—scrotal varicose veins—to address his condition. He has since tried sperm retrieval for IVF, but no transfer has been successful to date. He and his wife plan to continue trying with their remaining healthy embryos. “I had to figure out whether it was more important to have a child that came from my loins or to be a father—and I wanted to be a father more than anything,” Johnson reflects. “So we started looking into different ways to have children.” After numerous unsuccessful IUI attempts, Johnson and his wife adopted a child. Amid trying to realize his parenting dreams, he recommends reconnecting with oneself, including finding a hobby that brings joy or helps release pent-up emotions. “Anger builds tension and that builds up in your body,” he says. “A physical activity will help to release it.”
Anglade emphasizes that consistent movement and a healthy lifestyle, including no drug use, are crucial for men wanting to have children. “You want to stay active; you don’t want to be obese—maintain a good weight,” he says. “Smoking is a big risk factor that causes infertility, so no nicotine or marijuana.”
Most importantly, Moore advocates for men to educate themselves and others. “We need safe spaces to learn about infertility and opportunities to process our personal experiences,” he says. “We also need support as we deconstruct our identities, in an effort to reconstruct them in a way that does not allow fertility status to determine one’s manhood.” Johnson agrees, no longer letting his diagnosis affect his self-perception. “You are, as a person, greater than your infertility,” he asserts. “Your infertility is a part of you, but it doesn’t have to keep you down.”
While assisted reproductive treatments are costly, Wright credits his health insurance plan as a New York State employee for making them affordable. However, he still pays between $200 and $250 per semen analysis. Since May 2023, 21 states have enacted new fertility-insurance coverage laws, and 13 have fertility-preservation laws for medically induced infertility. Resolve, the national fertility association, is a valuable resource for understanding health insurance options and other support services.
(This story is featured in the May/June 2024 issue of ESSENCE).
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