Feet a blur, I pedalled my bike as fast as possible down the canal towpath, pot of semen in my rucksack, desperate to get to the hospital in time to conceive. Of all the bewildering, life-changing, traumatic experiences of the IVF process, this is the one I most remember now, the winter slipstream on my sweaty face, all the dreams of my partner and I contained in a plastic pot nestled next to laptop, book and bike lock.
We had been trying to have a child for a while, timing sex with apps and temperature readings, drinking little, taking supplements, but nothing had worked. The months ticked on. Admitting defeat, we went to the local doctor, who helpfully said that the universe told her we would conceive. Did she say that to everyone? Thankfully, the universe also told her to refer us to our local hospital for initial investigations into our fertility, and potential IVF treatment.
The introductory lecture was packed with couples in their late 20s to early 40s. The atmosphere was one of nervous energy as our collective presence in the room made public an intimate struggle. There was an audible gasp, and pointed glances from women to their male partners, when the doctor told us that male fertility has declined by 50% since the second world war. Most of us clearly had no idea, but there it was, on a graph on the screen. Sperm count, concentration, motility (how well the sperm can “swim”) and morphology (the quality of the sperm) is decreasing, though scientists don’t conclusively know why. Age and lifestyle can be factors, as well as our bodies absorbing the toxic detritus of our polluted environment.
Kevin McEleny, consultant urologist and chair of the British Fertility Society, tells me that male infertility is the sole reason why around a quarter of couples struggle to conceive and is a contributory factor in approximately half of cases, not that you’d know from a culture that blames women for prioritising careers over children. “One of the misconceptions is that men are all fertile and that infertility is the woman’s fault,” McEleny says. “A lot of men don’t realise just how common the sperm quality issue is.” He believes that is in part because the subject is taboo, connected as it is to deep-seated neuroses about who we are: “It’s all quite closely tied up in masculine identity – in which men are supposed to be decisive, strong, potent, fertile. You’ve got expressions like ‘it takes a lot of balls to do this’ and so on.”
I’d probably fallen into these assumptions and thought patterns myself, in denial about my own part in our lack of ability to conceive. It had been regular persuasion from my partner that had got me to the lecture theatre in the first place. I’d certainly not discussed it with anyone. It was hard to know where to turn for information or support. Daniel Burbidge, a psychotherapist and member of the British Infertility Counselling Association (BICA), says: “There is a real challenge getting men through the door” to discuss fertility. Instead, he says, men tend to employ coping or deflection strategies, as he puts it, “keeping the pain that they experience entirely to themselves” in a “secret grieving process”. Men also often feel that they should know the answer and “want to take physical action to try to fix the problem”. That necessary action, though, can be a cause of issues in itself. “There are long-term implications from having to disclose these very intimate details of their private life to strangers, and a lot of men are anxious about even being examined,” says McEleny. Whereas women are often well acquainted with secondary care hospital services, we find intimate physical examination, blood tests and giving a semen sample “quite hard to deal with”.
I can hear tiny violins of faux sympathy given everything that women have to face when it comes to reproductive health, but this was certainly the case for me. Although as an infant I had live-saving treatment from the NHS, IVF was the first time I had to visit a hospital on a regular basis as an adult. Squeamishness around blood tests was nothing compared to the awkwardness of having to “produce a sample”. I was given a little pot and ushered into a grimly nondescript hospital room. I had thought there might be a comfortable couch, perhaps DVDs of erotica to suit all tastes, or at the very least a couple of old-fashioned jazz mags for inspiration but no – just a plastic chair, table and roll of thick tissue. A visit to the erotic memory palace had to suffice. It was tricky to focus with a waiting room full of patients just on the other side of the door but, job done, the pot was placed into a small wooden hatch in the wall. Leaving, I spotted that, according to the logo on the bin, the contract for medical waste removal was run by Bates Office Service Ltd. I had to stifle giggles.
I wasn’t so amused when the results came back. Analysis of my lads, as I had started to refer to them, confirmed that the count, concentration and morphology were poor. I felt almost hurt by the diagnosis, as if the sperm were both part of me and separate, that they had let me down, and I them. Perhaps my mum had been right when, after we got our first microwave in the 1990s, she told me not to stand in front of it in case the radiation made me infertile.
As men, we can be so dissociated with the intimacies of our bodies that we struggle to make a meaningful connection with their functions and punish ourselves for it. I have always been terrible at sport and never felt truly like a man because of it. My sperm, then, were reflecting the body they came from by being similarly pathetic. Burbidge says that this is a common issue. “That discovery can give rise to a feeling that you’re either inadequate or not virile, which are masculine norms that society imposes on men, or at least we feel that we have to live up to.”
My reaction was certainly confused. I would be happy for friends who had conceived, while also bursting into tears of jealous sorrow. Yet there was also a more stereotypical male reaction of wondering if, in terms of career and free time, a childless future might not be so bad. There was no real guidance from the nurses and doctors we were seeing other than “be supportive”. On hospital visits I often felt distant from a process so removed from my own body and control, but which would still change my life, whether it failed or succeeded.
The surgery waiting room, full of couples clutching yellow files of their case notes, always had an intense atmosphere. I have never known a physical space in which hope was such a tangible emotion. During the period of treatment, we took my nephews and nieces to a toy shop, in the window of which was a little soft toy of Mr Mole from Wind In The Willows. I wonder if this sounds strange or twee, but we nearly cried in front of everyone as we bought it as a symbol of the depth, and frequently pain, of our yearning. Moley sat on the shelf by the telly, as if peering out at us while we conducted IVF’s daily rituals of medicalised intimacy.
When a courier arrived with a gigantic box of drugs, needles and a bright yellow sharps bin with a biohazard label on the side, I freaked out. It all felt so brutally artificial, sci-fi almost. My partner took short shrift with this nonsense, adding that as she couldn’t face injecting herself, I was going to have to do it. Despite a lifelong terror of needles, I shut up sharpish. Dr Luke, as we jokingly referred to me, became adept at finding a place to, gently as possible, inject my partner with Fyremadel and Meriofert, these clear liquids that promised so much. The satisfaction of curing a phobia I thought was indelible was dwarfed by what this little procedure really meant – for the first time, I felt fully involved.
Seeing your partner endure this agonising process of multiple daily injections and invasive medical procedures (the removal of eggs and the insertion of embryos), while all that is really asked of you is to have a blood test and crack one off into a plastic pot, makes you only too aware of a cruel gender imbalance. I found that the only answer was to put as much thought and care into my responsibilities as possible, to try to silence the male ego, the need to take control, the defiant anger I, and many men, sink into when faced with feelings of inadequacy. Helping with the injections was a way of channelling this unruly energy in a positive direction. It meant that when I had to not just “provide a sample”, but ejaculate into a pot to pedal to the hospital to fertilise my partner’s eggs, it was an oddly beautiful moment. What was lacking in intimacy between the sheets in this conception was made up for in collaboration, tenderness and support.
The good news came that we had two viable embryos. One was carefully placed into the womb after three days, while the other was left for five days to mature before being frozen. Battling together in hope and against anxiety, we took the pregnancy test from the cupboard where it had sat for so long. A few more seconds passed… and then we hugged and cried as two lines appeared like tracks to a new future – with three of us.
Christmas came and went. And then, on a walk one cold January afternoon, it became terrifyingly clear something was very wrong. My partner collapsed in pain, barely able to move. We drove home, called 111, and were told to go to A&E. Due to Covid restrictions, I wasn’t allowed to go in, but had to sit outside through the small hours of a winter’s night. I’d found IVF to be an intensely lonely process and now, sitting in a cold car parked next to icy tanks of oxygen that hissed ominously as they kept Covid patients alive, this became even more acute.
The one bit of good advice we’d been given by friends was to hope for the best and prepare for the worst, and that’s what we did for days of tests until we were given the horrible news that the pregnancy was ectopic. Devastated, I struggled to get my head around what had happened, and where we were now. Could I grieve for a pregnancy that had been just a few weeks old? Could we go through it again? McEleny says that these situations can be hard for men to process. “Men and women tend to see problem solving slightly differently,” he says. “Men want the decision to be made, so they can move on to the next step, whereas women really want to reflect on where they are and where they’re feeling at the moment.”
It was hard putting ourselves back into another cycle of hope and fear with the insertion of our only remaining embryo. I tried to visualise it nestling safely in the womb, endlessly dividing, becoming a person. This time, the pregnancy held. We had the joy of hearing the ultrasound techno of a beating heart, seeing scans of legs, arms, a huge head, like my own when I was born. Yet IVF is such a fraught process that we never felt we could be entirely confident. The most recent figures from the Human Fertilisation and Embryology Authority reveal that 27% of transferred frozen embryos result in a live birth. We endured worrying dashes to the hospital when we thought we couldn’t feel foetal movement, spending long nights of sleeplessness with every permutation of what could go wrong playing through my mind, just as it had for months.
With a declining birthrate and Britain’s notoriously poor childcare provision forcing many to delay having children, embarking on this long, lonely and stressful IVF journey is going to become more common. Everyone I spoke to for this article hoped that there would be better funding, both for treatment (we were lucky to have a local authority that funded three rounds) and counselling. McEleny believes that just as conception via donated sperm and Viagra for erectile dysfunction were once taboo, we will soon have a better conversation among men around IVF. “Having a child using fertility treatment isn’t strange,” he says, “it’s just something people have to have, and society should be a little bit kinder about it.” As with so many aspects of contemporary masculinity, perhaps men need to be kinder to themselves, too.
I took a photograph of the moment our boy was born by caesarean section, being lifted up and out with arms outstretched, screaming for life as what had at times felt like science fiction became a beautiful fact. Every night in his cot he cuddles that soft Mr Mole we bought as a symbol of hope, and snores his quiet snores.
Luke Turner’s Men At War: Loving, Lusting, Fighting, Remembering 1939-1945 is published by W&N at £10.99. Buy it for £9.61 at guardianbookshop.com
