2.3 Engaging men in fertility discussions

Although the biological contribution of both men and women is necessary, fertility discussions disproportionately focus on women and infertility is often perceived as a female issue. However, research shows that men and women are equally affected by infertility (62, 63). Studies (64–66) have shown that approximately 40–50% of all cases are due to “male factor” infertility. Furthermore, the reproductive impact of paternal ageing, albeit significantly less pronounced than that of female ageing, is at least partly responsible for the link with reduced fertility and the increase in pregnancy-related complications and adverse outcomes for offspring (67–69).

The low involvement of men in fertility discussions impedes the implementation and promotion of effective, male-friendly fertility practices and policies (70). Advanced paternal age plays a significant role on male fertility and on the health of the offspring (13), contributing to reduced fertility of a couple especially when the woman is also of advanced age. Male fertility starts to decline around the age of 45 (26, 71). Advanced paternal age can be associated with decreased serum androgen concentration, diminished sexual activity, changes in testicular morphology and deterioration of semen quality (volume, motility and morphology), reduced DNA integrity of sperm and, possibly, epigenetic effects (68, 72–74). A review of fertility awareness studies showed that men had little knowledge of factors influencing fertility (75).

We advise couples experiencing difficulties conceiving to attend healthcare consultations together as both partners are affected by the decisions and outcomes of the investigation and treatment. We advocate the active participation of men, recognition of their responsibility in the informed decision-making process regarding sexual and reproductive health issues, and the use of male contraceptive methods (76). Policies highlight the importance of fertility awareness and preconception health for all men and women whether or not they choose to have children (77). This is because a component of preconception health focuses on people staying healthy throughout life.

We recommend increasing support for men to engage with fertility awareness, family building, preconception care and reproductive health services. Some of the key issues and improvement opportunities related to increasing fertility awareness for men are highlighted in Figure below.

Figure: Issues and improvement opportunities for improving fertility awareness for men. Grace et al. 2019 (70).

Given the increasing recognition of the importance of paternal influences in child health (78, 79), men should be encouraged to take a more active role and support should be provided for those who may feel sensitive or embarrassed by the topic. Men and women should also be encouraged to take part in discussions and to encourage the involvement of their partners.
Male-friendly websites and mobile applications based on robust scientific evidence are effective resources for fertility clinics to reach out and educate men in this area. Healthcare providers, researchers and educators may well have succumbed to the traditionally held beliefs regarding male involvement and interest in this subject. We recommend that clinics routinely provide men with reproductive health information. However, it is important to note that when encouraging partner involvement, the necessary safeguards should be implemented to prevent discrimination or the marginalisation of women who do not have a male partner or who choose not to involve their male partner in their care.
Healthcare professionals (HCPs) are typically ranked as the most trusted source for providing fertility information (80) – hence their engagement is critical. Studies have shown that educating healthcare providers in fertility awareness can help to improve the quality of information provided (81, 82). Moreover, people who had consulted their healthcare professionals were more knowledgeable about their fertility status (83). However, the quality of advice provided depends on the HCP’s knowledge as well as their attitude towards fertility information and whether they feel it is their duty to provide such information.

Although school education remains a consistent source of information, it does not adequately cover fertility education. Healthcare professionals play a key role in improving fertility awareness and are often cited as the most trusted fertility information source. However, they are not necessarily better informed than the general population. Studies have highlighted gaps in the HCPs’ fertility knowledge. HCP clinical management recommendations regarding infertility also revealed significant shortcomings in their knowledge of related risks, especially in the case of ethnic minorities who are at higher risk. The need to educate both the general public and healthcare professionals is apparent from the lack of knowledge about fertility and preconception. However, it is not uncommon to find that healthcare professionals are unclear of their role in fertility education. Evidence suggests a lack of clarity among healthcare professionals as to whether preconception care and education is their responsibility (84). The lack of established guidelines regarding fertility education is a contributing factor.

Additional HCP training on fertility and reproductive health is required to boost fertility awareness. In terms of wider implications, improvements through a more holistic life-long approach to reproductive health, including family building, should be a key component of public health programmes. This requires collaborative initiatives supported by policy makers, healthcare professionals, educators and other special interest groups in order to help individuals achieve their desired goals in terms of family building.

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