When a couple spends more than a year trying to conceive without success, they can be diagnosed as infertile. Women over 35 can be diagnosed after six months, because fertility declines with age generally, and women at that age may not have the luxury of a year to try. However, only in about two-thirds of infertile couples does the problem lie with the woman, and only half of those is it with the woman exclusively. This is at odds with the common perception of infertility, which typically lays the issue at the feet of the female half of the couple. In spite of the vulnerability of sperm and sperm production to a host of medical issues and environmental factors—including celiac disease, diabetes, and even chemicals in some types of toothpaste—the clear and direct involvement of women in the reproductive process leads people to think of reproduction generally and problems interfering with it, primarily in terms of the role women play and the effects on women.
Unfortunately, this puts a great deal of stress on women, which can itself make conception more difficult. In a study, women who had increased levels of stress hormones had a harder time conceiving. Even subjects with no previous fertility problems were 29 percent less likely to be pregnant if they were found to have high levels of stress hormone levels rather than low levels. High-stress women were twice as likely to go a year without conceiving, the study found.
The focus on women means less attention paid to male infertility, which could harm the men suffering the problem and delay treatment of the underlying issue. Male infertility is linked to higher mortality, but it is also often responsive to relatively simple fixes that aren’t available to women. Research has found that men with two or more abnormalities in semen—including deficits in motility, odd shape, low semen volume, or low sperm count—have double the risk of death in the eight years following the initial evaluation for fertility issues. That suggests that men who aren’t being evaluated, who assume it is their female partners who have the problem, are unprepared for this higher risk. Moreover, they are unable to get treatment, which could be as simple as a synthetic version of the protein in sperm that primes the ovum for fertilization. This synthetic protein has not been used clinically but shows promise in research settings to help increase male fertility.