Half of infertility cases involve a male factor. That's not a new number and it's not a hidden one, however it's certainly less talked about.

Most couples who walk into a fertility clinic still walk in because she made the appointment.

I've been thinking about why. I had a conversation with Dr. Kolettis for the Our TIES podcast that gave me the clearest answer I've heard. Dr. Kolettis is a urologist who did his fellowship in male fertility at the Cleveland Clinic, has served on the American Urological Association's Male Infertility Best Practice Policy Update Panel, and is a past president of the Society for the Study of Male Reproduction. He's been doing this since the 1990s. He has seen a lot of men come through his office, usually after a lot of other appointments.

When I asked him why male factor gets overlooked, he named three things.

The misconception

"There's a misconception that infertility is a, quote, female problem," he told us. He thinks it's improved, however, he also thinks it's still there. That single belief, carried quietly in the back of a couple's mind, shapes every conversation they don't have. It shapes whose body gets tested first. It shapes whose appointment gets scheduled first. It shapes who feels responsible when something isn't working.

Half of the time, it's wrong.

An unfamiliar system

The second thing Dr. Kolettis pointed to is structural. Women have a gynecologist. Men of reproductive age, for the most part, don't have an equivalent.

"A man's partner has gynecologists usually as her doctor," he said. "But men don't have a doctor like that really. I think that having a gynecologist could make it easier to kind of transition to having fertility evaluation for a woman, where I think for a man it would involve just kind of seeking that out more on his own, which is probably more difficult to do."

That last part is the quiet one. For a woman, a fertility check-in can happen inside a relationship with a doctor she already trusts. For a man, it means picking up a phone, explaining a situation to a stranger, and asking for something he may never have asked anyone for before.

It's not a small ask.

The feeling

The third thing Dr. Kolettis said is the one I keep coming back to.

He described what he sees in his office when a man does finally come in. Men are reluctant, he said. It can feel awkward, embarrassing. The partner is often the driver. Then he named something most men won't say out loud.

"If a man has a low sperm count, he might feel... like it's his fault, or might feel guilty, somehow less of a man," Dr. Kolettis said. "You can pick up on those kinds of feelings that he may have. Might not explicitly say it, but you can tell that sometimes men feel that way."

A urologist who's been doing this since the 90s, telling us what he's watched men carry into the room without saying.

That's the part of this conversation that isn't about statistics.

What Dr. Kolettis pushed back on

He didn't leave that observation sitting on the table. He corrected it.

"That's not the way we should be thinking about things, like whose fault is it?" he said. "There are male factors and female factors. So it's not. We separate the couple kind of artificially. Male evaluation, female evaluation. But really, it's the combination of the two that's important."

Fertility is a couple's situation. The clinic runs the tests one person at a time because that's how the science works. The story isn't one person's story, though. It never was.

The takeaway

Half of the fertility story is a man's. The reason that half often goes untested isn't about capability or willingness. It's about a misconception, an unfamiliar system, and a feeling most men don't talk about. All three can be changed. The first step is treating a fertility check-in as information, not a verdict.

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*This post reflects conversations from the Our TIES podcast and is intended for general informational purposes only. It is not medical advice, a diagnosis, or a treatment recommendation, and it should not be used as a substitute for professional medical guidance. Always consult a qualified healthcare provider about any health condition, including questions related to fertility. Quotes from Dr. Peter Kolettis have been lightly edited for readability. The meaning remains the same. 

Community notes

• Male factor refers to a cause of infertility originating in the male partner, as opposed to female factor or a combined cause.

• The "half of infertility cases involve a male factor" figure comes from decades of clinical and epidemiological research on heterosexual couples presenting with infertility. The typical breakdown is roughly one-third female factor, one-third male factor, and one-third combined or unexplained, which is where "about half involve a male factor" comes from. Sources include the American Society for Reproductive Medicine and the American Urological Association.

• Dr. Kolettis's observations about men feeling "at fault" or "less of a man" are his clinical observations from decades of practice. They are consistent with broader qualitative research on men and fertility, but they are observations, not a formal study.

• Cultural attitudes about men seeking medical care appear to be shifting across generations, with some research suggesting younger men are somewhat more willing to seek preventive care. How much this is changing the dynamic Dr. Kolettis describes is an open question.

• Same-sex male couples, trans men, and men who have driven their own fertility evaluation exist and don't fit the pattern Dr. Kolettis described. This post focuses on the most common clinical dynamic he sees.