Despite their prevalence among those who are trying to conceive, fertility challenges remain a taboo and highly stigmatized topic of conversation in the United States and around the world. Maybe that's because of the heartbreak often involved in the process of trying to have children, or maybe it's because we Americans tend to get squeamish about sex. Either way, we are doing hundreds of thousands of people a disservice by shying away from this crucial conversation.
According to the CDC, 81,478 infants were born as a result of ART (Assisted Reproductive Technology) of one sort or another in 2018, and this number continues to rise. In fact, you probably know someone who has had a fertility challenge—trouble conceiving, a miscarriage, or myriad other possible issues. These challenges may be caused by a genetic predisposition, or they may be a result of environmental or lifestyle-related factors. Smoking or excessive drinking, for example, are lifestyle factors known to impact fertility, according to the National Institutes of Health. The NIH also states that exposure to certain pesticides may also be linked to infertility, although studies are still ongoing.
If we as a society don't like talking about infertility, we like talking about assigned-male infertility even less. Infertility treatment is often talked about in terms of the treatment an assigned-female person needs to undergo, as though it doesn't take both egg and sperm to make an embryo. This is true despite a steady decline in sperm production and motility over the last few decades. A study published by Dr. Hagai Levine et al. in a 2017 issue of Human Reproduction Update showed that sperm concentration in Western countries dropped 52.4% between 1973 and 2011. Total sperm count among the same males plummeted 59.3% during the same time period.
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If we, as a society, don’t like talking about infertility, we like talking about assigned-male infertility even less.
These numbers are troubling, and they should be—especially when it's so hard for males to get access to information about fertility treatments. Inaccessible treatment for sperm-producers means hardship for the whole family unit—whatever it may look like. A family unit may include a same-sex couple trying to source all the materials for conception, a transgender woman who wants to freeze her sperm before undergoing HRT (hormone replacement therapy), or a heterosexual couple who have been trying to conceive to no avail. Whatever the case, everyone who wants to have a baby should have all the options (including the less expensive ones) at their fingertips.
This depends a lot on the specific situation at hand. According to John Orris, MD, of the Pennsylvania-based clinic Main Line Fertility, each prospective parent (or parents) will come into the clinic with a unique set of needs. Assigned-female people may have problems with uterine tissue, such as fibroids, or diminished ovarian reserve (not enough eggs), or scarring caused by endometriosis. Assigned-male patients may be suffering from teratospermia (sperm with form defects), azoospermia (lack of sufficiently motile sperm), or varicocele (enlarged veins in the scrotum). Any combination of these will result in a different treatment plan that will have a different price tag.
Plus, of course, the makeup of the family unit is a factor in the necessary treatment. For two men trying to have a baby, Dr. Orris tells Health that the first step is to "secure a good fertility center, one that will facilitate finding a GC (gestational carrier)," along with a reproductive physical that would include a sperm count.
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"The main question," says Dr. Orris, "is how many kids do you want and how old are you? If you're 38 and you want four kids, we don't have as much time as we would if you were 24." This will determine whether a couple can opt for IUI (intrauterine insemination) or ICI (intracervical insemination), both of which are far less expensive than IVF (in vitro fertilization) or other, more costly, treatments.
That being said, there are some concrete numbers out there. Here are a few, to give you an idea of the potential cost.
Whether these costs are or are not covered by insurance depends on what kind of insurance you have and whether you live in a mandated state—one that has designated infertility as a condition that must be covered by health insurance companies. There are currently 17 states that require health insurers to either cover or offer partial coverage of infertility treatment. Coverage, of course, varies and depends on the specific insurers. If you reside in the other 13 states, you may receive little to no coverage at all.
There are, of course, the regular routes to save on medical infertility treatments—comparing costs of different providers or getting some tests done at free or low-cost clinics. An additional avenue that too few consider, though, is the one that has to do with assigned-male infertility. We tend to overlook (or even avoid) this piece of the puzzle, despite the fact that sperm-related issues cause infertility challenges between 20-30% of the time, according to the NIH. Because costs for treatments—even surgeries—that affect assigned-male infertility are significantly lower (and the treatments themselves are less time-intensive), ignoring this side of things is a wasted opportunity.
Costs for treatments—even surgeries—that treat assigned-male infertility are significantly lower than those for assigned-female infertility.
Organizations, such as Legacy or Sppare.me, are actively working to reduce both the cost and the stigma around assigned-male infertility. Khaled Kteily, CEO of Legacy, tells Health that he set out to create "a product that's affordable, accessible, [and] convenient." Kteily made it clear that this was something that our society needs. "Why would this not be a no-brainer?" asks Kteily. "Masturbate at home one time, pay $200, and you can have a family for the rest of your life. When you put it in those terms it kind of sounds absurd [not to consider], especially when you compare it to something like egg freezing, which is expensive, invasive, [entails] weeks or hormone injections [and] surgical extraction under anesthesia."
According to Kteily, freezing sperm with Legacy starts at $40 a year, and maintaining accessible pricing is a key part of the business model. By avoiding a brick-and-mortar location, the company is able to both provide a nationwide service at a low cost.
These types of options aren't well-known enough, but they may provide a major cost reduction for families with fertility challenges, hetero or otherwise. For example, two women in New York trying to conceive with a known donor in California wouldn't need to fly back and forth or pay costly clinic fees. Instead, the donor would have a full analysis done at Legacy's lab in San Antonio, and the sperm would be shipped in vials to the women's doorstep.
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Before any of these services can be useful in lowering overall fertility costs, though, the conversation around male fertility has to change. "For a lot of men, virility is equal to masculinity," explains Kteily. Equating these two leaves very little room for conversation about treatment for potential challenges.
That being said, the overall perception of freezing sperm and infertility treatment in general seems to be shifting, at least a little. Dr. Orris shares that, although many men do feel iffy about the initial semen analysis, the couples he works with are both committed to the process.
"[They're] working together to get this done, [and] the spouse wants some skin in the game, too," says Dr. Orris. Meanwhile, Legacy has begun working with the Navy SEALs (the "manliest men you can think of," jokes Kteily) as the sole company to freeze soldiers' sperm before deployment.
"[That] makes a ton of sense," says Kteily, "if you're at risk of being wounded in action or killed in action, […] you want to freeze your sperm." In addition, the company is working on legislative advocacy by furthering and supporting bills that would make access to fertility treatment less expensive and more accessible.
Making a family takes many different forms and can be a long, arduous journey for many. Still, there are ways we can make it easier on ourselves; getting the help we need is a good first step. This means vulnerability, and it means retooling the way we perceive conception.