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Posted on December 16, 2019 at 2:27 PM

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.

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