The half of the story we forget to investigate

A man sat down in my office last month with his arms folded before I had finished saying hello. His partner had been through the full run of tests over the past year, bloods, scans, all of it, and he had finally come in for a semen analysis he had been putting off since Christmas. When the result showed a low count, he said the thing I hear from men more than any other: ‘So it’s me. I’m the problem.’

I want to take that sentence apart, because almost nothing about it is right.

Fertility is not a woman’s department with a man attached to it. Male factor contributes to around half of the difficulty couples have conceiving. Half. And yet in the room, the worry, the testing and the sense of responsibility still land mostly on women, while the man’s side of the picture goes unopened for months. If we investigate only one partner, we are working with half the story.

So let me tell you the other half.

What a semen analysis actually looks at

The first and most useful test for a man is a semen analysis. It is simple, it is quick, and it tells us three main things: how many sperm there are (concentration), how well they move (motility) and how they look (morphology). One sample, and the plan often changes.

Here is the part men are not told. A semen analysis is not a mark out of ten. The World Health Organization reference range that a lab compares your result against are not a pass line between ‘fertile’ and ‘infertile’.

They are drawn from the lowest few per cent of men who had recently fathered a child, which means a result below the reference range is a reason to look closer, not a verdict that you cannot have children. Men conceive from below those numbers all the time whilst men with reassuring numbers sometimes need help. One sample on one day is a snapshot, not a sentence, which is why we usually repeat it before we conclude anything.

The part that should give you hope

This is where male fertility differs from female fertility in a way that works in your favour, and I wish more men knew it.

A woman is born with every egg she will ever have, and that pool only shrinks. Sperm is different. Your body makes new sperm continuously, on a cycle of roughly three months. That single fact changes what we can do. It means the sample you give me today reflects, in large part, how the last few months have gone, and it means the changes you make now can show up in a fresh analysis about three months later.

So when the cause is something in daily life, and often it is, there is real room to move. Smoking, heavy drinking, carrying extra weight, heat, broken sleep and some medications all affect sperm quality, and correcting them can genuinely shift the numbers. I am not promising a miracle, and I will not pretend lifestyle fixes everything. But telling a man his fertility is fixed and final, when his own biology renews itself every season, does him a disservice.

Causes we can often do something about

Beyond lifestyle, a good number of male factor cases have a specific, treatable cause sitting underneath them. A varicocele, which is a cluster of enlarged veins in the scrotum, is common and, in the right circumstances, correctable. Hormonal problems can sometimes be treated. Blockages in the tubes that carry sperm can occasionally be addressed. And where sperm production is very low or absent, there are still real options, including ways of retrieving sperm surgically and using it in IVF.

The point is that none of this can be sorted out if no one looks. A man who never has a semen analysis is not protecting himself from bad news. He is leaving a treatable problem in the dark and letting his partner carry the whole load of investigation on her own.

Both of you, from the start

This is why, when a couple comes to see me, I want to investigate both partners together from the beginning. It is not a formality. Looking at the man and the woman at the same time is now ordinary good practice among fertility specialists, not a step you reach only after the woman’s tests come back clear. A semen analysis on day one can spare a couple months of testing the wrong half of the equation.

If you are the man reading this, I would gently say this. Your part is not to stand back and hope. Your part is to get looked at, early, so that whatever we find, we find it while there is the most we can do about it.

Whatever your result turns out to be, you are far better off knowing it than avoiding it. A number on a page is not a statement about the kind of man you are, or the kind of father you would be. It is information, and information is the thing that lets us act. If you and your partner have been trying for a while and only one of you has been tested, come in together. We can look at the whole picture, and work out what is actually true for the two of you.