By Alex Downs
Editor’s Note: For Men’s Health Awareness month, we are delighted to share this synopsis of the study, “The Prevalence of Couple Infertility in the United States from a Male Perspective: Evidence from a Nationally Representative Sample,” by Louis JF et al. Alex Downs wrote this article while enrolled in the FACTS elective during his final year of medical school at Pacific Northwest University of Health Sciences. This synopsis highlights the importance of viewing infertility as a shared reproductive health challenge and emphasizes the valuable role men play in fertility research, counseling, and clinical care.
Want to better understand the science behind fertility awareness and restorative reproductive medicine? The FACTS elective offers medical students and residents a unique opportunity to explore fertility awareness-based methods (FABMs) through evidence-based education, case discussions, and mentorship from clinicians across specialties. Healthcare professionals can also expand their knowledge through FACTS CME courses and the FACTS Certification Program, which are designed to equip clinicians with practical tools for incorporating fertility awareness into patient-centered care.
Introduction
Infertility is defined as the inability to conceive after 12 months of unprotected intercourse. While the definition is straightforward, the way infertility is often studied and discussed places the focus almost entirely on women. As a male medical student hoping for a career in obstetrics and gynecology, I have noticed how this framing can unintentionally put the weight of infertility solely on a woman’s shoulders. Fertility, however, is never an individual issue. It is a shared challenge for a couple, and the health and circumstances of both the male and female partner matter.
“The way infertility is often studied and discussed places the focus almost entirely on women … however, (it) is never an individual issue. It is a shared challenge for a couple.”
Louis and colleagues recognized this imbalance and sought to estimate infertility prevalence based on men’s reports. Using data from the 2002 National Survey of Family Growth (NSFG), they asked whether men could provide reliable information on time to pregnancy and whether those data would align with female-based studies. Their findings suggest that men contribute meaningfully to infertility outcomes and that their voices strengthen our understanding of reproductive health.[1]
Methods
The study included 4,928 male respondents between 15 and 44 years old. Of these, 157 were actively trying to conceive with a female partner and were eligible for analysis. Infertility was defined as taking more than 12 months to achieve pregnancy.
The authors used the current duration approach, which estimates the total time a couple spends trying to conceive based on how long they have already been trying at the time of the survey. This method corrects for the fact that couples with longer attempts are more likely to be captured in cross-sectional studies. Weighted survival models were then used to generate prevalence estimates and identify risk factors.[1]
Results
The prevalence of infertility reported by men was 12% with a 95% confidence interval of 7-23%. This estimate is consistent with female-based studies and prospective cohort data, which supports the reliability of male reporting. The median time to pregnancy was 4.3 months.
Several factors were associated with a longer time to pregnancy. Older men, particularly those between 35 to 45 years old, compared with 17- to 24-year-olds, were linked to more than double the duration. Men without health insurance and those who hadn’t already fathered a biological child were also factors associated with longer times to pregnancy. These associations remained significant even after adjusting for socioeconomic and demographic variables.[1]
“Several factors were associated with a longer time to pregnancy: older male age, particularly those between 35 to 45 years old … men without health insurance and those who hadn’t fathered a biological child.”
Discussion
What stands out most in this study is its reframing of infertility as a couple’s shared challenge rather than just a woman’s problem. In clinical practice, infertility conversations are often directed primarily toward women, which can unintentionally leave male partners on the sidelines. Louis and colleagues show that men can provide valid information that complements female data and gives a fuller picture of couple infertility.[1]
This perspective highlights a common observation during rotations. In fertility-related visits, male partners are often either sitting quietly in the background, excluded from conversations, or absent from the room altogether. The counseling and emotional burden typically fall solely on women. While OB/GYN practices naturally emphasize female health, excluding men risks leaving women to bear the entire responsibility alone. Framing infertility as a shared challenge aims not to minimize women’s unique experiences but to ensure they are not forced to carry the weight alone.
“Framing infertility as a shared challenge aims not to minimize women’s unique experiences but to ensure they are not forced to carry the weight alone.”
The study also highlights factors that warrant more attention. Male age, for example, is rarely centered in fertility discussions, yet this paper provides evidence that it matters. Similarly, the link between health insurance and a longer time to pregnancy shows how access to care influences outcomes. These findings remind me that infertility counseling should never be limited to one partner. Both partners bring risk factors, and both deserve to be involved in the plan of care.
From a research perspective, this study is important because it confirms that about 9-14% of reproductive-aged men in the United States are experiencing couple infertility, a figure consistent with female-based reports. That consistency adds credibility to male reporting and supports the involvement of men in future population-based studies.
Looking ahead, this raises important future directions, including normalizing men’s participation in fertility discussions so women are not left to carry the burden alone and making reproductive health screening and counseling for men a routine practice while also integrating men into fertility awareness and conversations with OB/GYNs to ensure both partners feel equally supported.
“This raises important future directions including normalizing men’s participation in fertility discussions … (and) making reproductive health screening and counseling for men a routine practice.”
In conclusion, Louis and colleagues demonstrate that men can provide reliable data on infertility, and more importantly, that infertility is not one partner’s burden. It is a couple’s shared challenge. This framing is highly relevant when considering a career path in obstetrics and gynecology. Supporting couples through infertility means ensuring that both partners are present; both are heard; and both are engaged in the journey.[1]
References
[1] Louis JF, Thoma ME, Sørensen DN, McLain AC, King RB, Sundaram R, Keiding N, Buck Louis GM. The prevalence of couple infertility in the United States from a male perspective: evidence from a nationally representative sample. Andrology. 2013;1(5):741–748. doi:10.1111/j.2047-2927.2013.00110.x.
ABOUT THE AUTHOR
Alex Downs is a fourth-year medical student at Pacific Northwest University of Health Sciences in Yakima, WA. He completed his undergraduate education at Carroll College in Helena, MT. He plans to pursue a residency in obstetrics and gynecology and has a strong interest in mentoring, patient education, and caring for underserved populations. He enrolled in the FACTS elective to deepen his understanding of fertility awareness-based methods and to learn how to integrate these approaches into patient care in a way that promotes empowerment, trust, and whole-person health.
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