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Reproduction is generally associated with women and consequently men’s reproductive is often neglected. One clear example of this is the discrepancy in female and male contraceptives. Women have over a dozen types of contraceptives, including hormonal, nonhormonal, barrier, and long-acting reversible contraceptives. In contrast, men have only 2 options: vasectomy and condoms. Men do not have hormonal methods, nor do they have long-acting reversible contraceptives, both of which tend to be the most effective and often the easiest to use (e.g. methods like the IUD you can “set and forget” for years). This discrepancy in options means that most heterosexual couples rely on female methods, an arrangement not only burdens women, but it also reduces men’s reproductive autonomy. I have argued that we need more and better male contraceptives as a matter of “contraceptive justice.”

Unfortunately, in the field of reproductive medicine, this discrepancy in options between women and men is not limited to contraception. There is also a similar injustice at play with infertility treatment. There are various options for women with female factor infertility, including medications to stimulate ovulation, intrauterine insemination (IUI), and IVF. All these treatments target women’s bodies: causing ovulation, facilitating meeting of an egg and sperm, and increasing the probability of implantation. For IUI and IVF, men need to contribute sperm and therefore are also affected bodily for these interventions. However, the vast majority of men provide sperm via masturbation, which is typically not understood as a medical procedure. (For men who cannot produce sperm via masturbation, medical intervention may be necessary such as electroejaculation.) While it may be awkward for men to masturbate in a medical office in order to produce semen, it does not carry the same degree of physical harm as the procedures required for women (though there can be psychological harms for both). For instance, there are a variety of unpleasant side effects, such as bloating and nausea, that are common with hyperstimulation drugs and there can be more serious and even deadly side effects, though they are rare.

Currently, the only type of infertility treatment that directly addresses male factor infertility is intracytoplasmic sperm injection (ICSI) in which a sperm is directly inserted into an egg. In order to perform ICSI, a woman must first undergo hyperstimulation followed by egg retrieval. As previously mentioned, these medical treatments are invasive, often have negative side effects, and target women’s bodies. There are no medical treatments for male factor infertility that directly targets men’s bodies. The fact that women need to undergo medically invasive and unpleasant procedures to treat male factor infertility raises justice concerns. Some may object and claim that of course women must undergo treatments since (cis)women are the ones who experience pregnancy. However, we can imagine medications and treatments that directly target men’s bodies to address male factor infertility. While women have hyperstimulation medications available to them if they are “sporadic” ovulators, there is no equivalent medication for men who is not producing adequate sperm or have problems with sperm motility.

Part of the reason we do not have infertility treatments that target men’s bodies is the same reason we do not have male contraception – reproduction and women are generally conflated, and men’s reproduction is frequently overlooked. Elsewhere I have discussed the various gender norms at play in why we do not yet have hormonal or long-acting reversible male contraceptives. I believe some of the same reasons are at play here. For instance, the field of andrology did not emerge until the late 1960s and scientists did not start investigating male hormonal contraceptives until the 1970s, about 50 years after they began researching female hormones contraceptives. Without a strong foundation in men’s reproductive biology, and without money invested in this research, it is difficult for scientists to discover infertility treatments at target men’s bodies. Also, there was a historical belief that if men were virile (i.e. they could maintain an erection and ejaculate), then they were fertile. Women were assumed to be the cause of infertility and we can see this reflected in our language. We see references to a “barren womb,” but I’ve never encountered an equivalent for men, such as a “barren scrotum.” The idea of barrenness is closely associated with women because reproduction is considered a “women’s issue.” And this explains and perpetuates the lack of attention paid to men’s reproduction.

Until we can explicitly recognize that men also experience infertility – and at similar rates of women – and that this is a topic worthy of research, we will continue to not have options for men with male factor infertility. As with contraception, without infertility treatments that target men’s bodies, women will continue to bare the various, particularly the physical, burdens of infertility treatment and men’s reproductive autonomy will be diminished.

Can algorithms show racial bias?   That is the conclusion of a recent article published in Science by Obermeyer, et al., entitled, “Dissecting racial bias in an algorithm used to manage the health of populations.”   According to Science, the algorithm’s goal is “to predict complex health needs for the purpose of targeting an intervention that manages those …

Continue reading "Racial Bias in Algorithms?"

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