When men can't have children, they suffer in silence

A macho culture and lack of awareness around male infertility in Australia is causing men with reproductive hurdles to question their masculinity.

Last month it was revealed sperm concentrations in Western men have declined by more than 50 per cent over the past 40 years — with diet and environmental influences possibly to blame.

And despite an estimated one in 20 Australian men experiencing some kind of reproductive problem, men often suffer in silence when struggling to become dads.

A 2003 study published in the International Journal of Men's Health — Gender, masculinity and reproduction: anthropological perspectives — found infertility is potentially "humiliating and emasculating to men, has a profound adverse impact on masculinity and is more stigmatising for men than it is for women".

Sydney-based subspecialist in reproductive medicine David Greening, who discovered frequent ejaculation dramatically improved sperm quality, said a man's masculinity was strongly connected to his ability to conceive.

"The definition of a male in terms of real masculinity is that he can father a kid," Dr Greening said.

"You might be the toughest, muscliest footballer in the club, but if you can't get your wife pregnant, your sense of self as a real man is terribly impacted.

"Men really feel that, they just don't talk about it."

Data collected in 2006 and published in the Medical Journal of Australia estimated 40 per cent of all infertility among Australian couples could be attributed to male reproductive function.

Andrology Australia reports about one in 20 Australian men have some kind of fertility problem.

Infertility expert Karin Hammarberg undertook research in 2009 with the University of Melbourne which showed men experience grief when the desire to become a father is unrealised, which can become "an enduring sadness" if treatment is unsuccessful.

"Men might be more able to compartmentalise their emotions and to continue to participate in their professional lives without being preoccupied or disabled by anxiety," the study's authors wrote.

"However, it is inaccurate to interpret this action as an indication that men do not experience distress and that empathy and encouragement are not wanted."

'You're shooting blanks'

Dr Hammarberg, now with Monash University, told the ABC it was an "urban myth" men craved fatherhood less than women desired motherhood.

"It's a goal for them as much as it is for women, but the whole childbearing process is focused on women," she said.

"Men often feel guilt when they are going through IVF with their partner ... they might be the problem but she has to do the work."

She said men would often set aside their own feelings to support their partner through fertility treatment.

In terms of infertility's connection to masculinity, Dr Hammarberg said it was mainly men who hadn't had the experience of realising they were infertile who would be making "blokey" comments like "you're shooting blanks".

"When you look at men who had experienced fertility issues, there wasn't such a clear cut connection to masculinity," she said.

"If you have lived through something and had the right help you might be less likely to feel [emasculated].

"This is why the care of men who experienced infertility is important — to talk to them about the fact there is no relationship between masculinity and sperm count."

However, Dr Hammarberg did concede there needed to be more focus on men in regards to reproductive issues to properly support them.

Dr Campbell said women driving the discussion around infertility was likely the reason the impact for men was under-reported and under-researched, agreeing education was key to helping men cope.

"Men talking about an issue without fixing it doesn't help them. A little bit of education about the things they can do would be number one — such as lifestyle changes.

"Nothing like a few facts to help understand a problem."