It's time for men to start talking about male infertility. I'll go first.
The more I thought about my experience, the more I reflected on how there’s no lexicon to discuss the emotional fallout of male infertility.
What is the point of Ben Ashwell?
This Question follows me around. It’s in line at the grocery store, and in my bedroom at 1 a.m., and 3 a.m., and 5 a.m. The Question looms over me when I’m trying to enjoy my coffee. It’s there when I’m chopping an onion for dinner, and when my wife leaves the house for the long walks she’s started taking.
In the fall, I found out that I can’t have children naturally. My medical history is “entirely unremarkable,” and I’m “well developed, well-nourished, in no apparent distress,” according to the fertility doctor’s notes.
The same is true for Gaby, my wife. I’m negative for 60 medical conditions, including bronchitis, joint stiffness, and excessive bleeding. I’m positive for dizziness when I don’t wear my glasses. We have had zero children, zero abortions, and zero miscarriages. And I have zero sperm.
In medical terms, it’s called azoospermia. It technically means the absence of sperm. According to Johns Hopkins Medicine, it affects 1 percent of all men and 10 percent of men with fertility issues. In a stadium full of 50,000 men, 500 of those men would be azoospermic.
Gaby and I tried for a few months before she ordered the semen testing kit. I was barely aware she was months into a series of experiments on herself – measuring her hormones, temperature, and menstrual cycle. We had sex at certain times of the month and certain hours of the day. Gaby was like a scientist, and I was happy to have plenty of sex.
I thought very little about the semen test itself, apart from the awkwardness of depositing a sample in a pot that was small enough to require dedicated attention. The results were stark. “There were no sperm cells found in your semen,” the report said, in large, bold type at the top of the page. To diagnose azoospermia, doctors recommend analysis of two samples, but we skipped that step and scheduled the first available appointment with a fertility doctor.
In the days after we received the news, we were quiet and caring with one another. We were hurting, but we lacked the vocabulary to communicate that hurt. We’ve been together for ten years, married for seven, and we’d never said the words “azoospermia” or “infertility.” Gaby and I are blessed with a transcendental love — I know I’ve loved her before, somewhere, and I know I’ll love her again, somewhere else. But as we spoke and hugged and expressed our love, an unavoidable distance cracked opened between us.
We had words, but not the right ones. Our hugs were suddenly out of context, like a birthday cake at a funeral.
Gaby buried herself in research, spending hours each night in Reddit groups dedicated to infertility. I fell silent and looked for distractions. I drank too much. I ran until I couldn’t anymore. I read books I’d put off for years. I worked more than I should have. But despite it all, The Question kept showing up: What is the point of Ben Ashwell?
Gaby doesn’t understand The Question. She says it’s the perspective of a fundamentalist Christian. We’re not religious, or even spiritual. We’re not Darwinists. We live in Berkeley with a French Bulldog.
The Question is so simple, so carnal, that it’s hard to ignore.
At the most basic level, I believe the meaning of life is to perpetuate life. It’s a reductive, universal truth; the foundation that the search for meaning is built upon. Studies suggest 9.2 percent of men between the ages of 15 and 44 have problems with fertility. For the men who don’t have to consider their own fertility, I suppose this may be reassuring.
To be a man, so the stereotype goes, is to exist with the quiet confidence that no matter what you do with your life, your legacy is assured by having sex with a woman at the right time of the month. After a night with Captain America, you better believe you’ll be pregnant. If you mess around with Bruce Springsteen, you’ll have a boss baby on the way.
For the first time in my life, I was forced to seriously think about having children. Or, more precisely, not having children. As the reality dawned that this wasn’t just a switch that I could flip, I discovered how much I longed to be a parent and how much I’d taken for granted that I would be one.
I receded into myself. Gaby tried again and again to talk about it, but her love felt like pity. I wanted to be compassionate and acknowledge that this was hard for her too, but I resented how quickly she seemed able to recalibrate her expectations.
I gave Gaby the names of two friends that she could tell, in addition to her mom and our doctor. Beyond these confessions, we were to act as if nothing was wrong. Gaby started going out for long walks alone. Every time the door clicked shut, I assumed what it meant: she’d be telling others about how I couldn’t provide. Sometimes her walks lasted for hours.
A couple of weeks after the first fateful test, wildfires tore up and down the West Coast. We woke up one morning to an angry, blazing red sky. Then pitch darkness at midday and ash falling from the sky like snow.
We cut out of town, renting a house in the clean air of rural east Idaho. Each morning I gazed out of the window in awe at the towering spectacle of the Grand Tetons. The Tetons were formed by two tectonic plates grinding against one another for hundreds of million years. The jagged mountains of the Teton Range seem to rise out of nowhere into sharp granite angles. The range is 40 miles long, and the highest peak, the Grand, is 13,775 feet.
I sipped coffee and traced the range across the sky. Some mornings the peak of the Grand was shrouded in an alpine cloud, but mostly it appeared clear and magnetic. After a couple of days, The Question changed. In the shadow of such a striking mountain, it felt self-indulgent. Now, I asked: What is the point of any of us?
The New Question was reassuring in its nihilism. In the shadow of The Tetons, no one and nothing mattered. And everyone and everything mattered. Then, a call from the doctor came with some new results: my hormones appeared in the normal range. It was a sign that my body might be making sperm.
CBAVD. Maybe some letters you’d read in an eye test, a challenging hand at Scrabble, or the forgettable license plate on your rental car. Inside a urologist’s office, CBAVD stands for congenital bilateral absence of the vas deferens.
The doctor asked me to drop my pants and I blushingly did. We made possibly the idlest small-talk I’ve ever mustered, while he gently probed. “Do you happen to know how many kidneys you have?” he asked after a minute or so. I told him I was born with one. He let go of my balls immediately. “So I can feel,” he said proudly. Exam over, pants on.
We walked down the corridor to his office, where Gaby was waiting and where we first heard that string of letters. CBAVD is detected in nearly 1 percent of male infertility patients. It’s associated with azoospermia because the condition can prevent sperm from being transported through the vas deferens to become part of semen.
In the simplest terms, the diagnosis means I was born with a vasectomy. The fellas clocked off work early on the day they were supposed to build the tube that takes the sperm from the epididymis to the urethra.
The science, like most things, is complicated. In short, studies suggest an association between a gene for cystic fibrosis, having one kidney, and being without a vas deferens. Unusually, I am not a carrier of the gene but my diagnosis was the same: CBAVD. It became clear that, if I was making sperm, it would need to be surgically removed to get anywhere.
As I lay in a hospital bed before the surgery, I read through the disclaimer I was asked to sign. I was nervous about being under general anesthetic, and even more nervous about what the doctor would find when they cut me open. My eye skimmed the disclaimer and settled on a phrase I’d normally breeze straight past.
“…and, in rare cases, may result in death,” it read.
The Question re-emerged. What is the point of Ben Ashwell? What if this is it? I smiled as I thought about an epitaph on a gravestone:
Loving husband, son, and brother
Died as he lived; with no sperm in his semen
But then what if I died while a doctor pumped vials of sperm out of my body? It would surely be a fitting way to resolve The Question:
Loving husband, son, and brother
Gave his life to perpetuate life
The nurse cleared her throat. I snapped out of the daydream and signed the disclaimer. The doctor — a wonderful, sadistic, alpha male — put me to sleep, then cut open my scrotum and pumped me dry.
More accurately, the surgery involved two different procedures: a microscopic epididymal sperm extraction (MESA) and a micro-testicular sperm extraction (micro-TESE). With the MESA, the doctor used a microscope to search for sperm in the epididymis, a duct that sits awkwardly on top of the testicles like a toupe. The micro-TESE was even more direct, requiring an incision directly into the testicle to search for sperm.
At one point the doctor even had a testicle fully out of my ball sack, he told me later with glee. I didn’t share his passion for detail, but I did share his delight at the result: We’d retrieved more than enough sperm to begin IVF.
As the days passed and the pain subsided, so too did my crises of existence and masculinity. Before, I could barely discuss the matter with Gaby. Now, I wanted to tell the world.
The more I thought about my experience, the more I reflected on how there’s no lexicon to discuss the emotional fallout of male infertility — at least, not one I’ve found. Even in supportive fertility groups on Reddit, discussions of male infertility mostly relate to clinical diagnoses, rather than the emotional collateral. There must be some corner of the cultural stage where that dialogue can occur — where men can discuss their shame and their guilt, their pain, and their doubts.
We can form a whole new language that moves us away from the reductive and sexist tropes tied to infertility, that a woman’s biological clock is the single biggest fertility issue. For one in three heterosexual couples with fertility problems, there are issues with the man and the women, and in a further 8 percent of cases, male fertility issues are the only cause, according to the CDC. It’s high time that men participate in a more progressive discourse about family planning.
A few days after the surgery, our friend Stephen texted to ask if we wanted to go on a hike. Gaby drafted a vague excuse to cover for my inability to walk from one side of the house to the other without a bag of frozen peas between my legs. But I stopped her. Instead, I started typing: “Bit of a life update over here: I had to have surgery yesterday, related to some reproductive issues. I would love to see you, but I’m pretty much bed-bound.”
I took a deep breath and hit send.
One minute later, Stephen replied: “Were you born without a vas deferens?”
Gaby and I stared at our phones in disbelief. Expletives followed. It turns out that Stephen had recently learned all about CBAVD from a friend. This friend – who I’ll call David – had undergone the same procedure last year and has the scars to prove it. This thing that had felt so personal, so private, and so shameful now felt normal and even humdrum. In a stadium of 50,000 men, 500 may have azoospermia.
When I spoke to David a few days later, there was an instant kinship borne out of shared experience. David also endured the crises of meaning and masculinity and felt the same distance grow between him and his wife. He also felt the same resolution and desire to reach out, to educate people. I was breathless and manic on the phone. It felt like something was happening — like we were forming a new language together.
David shared a perspective that helped my ability to process immeasurably. Most men experience no pain in relation to the birth of their children, he said. But not us. While the pain we felt – like several fish hooks pulling each of our testicles in different directions – is not the same pain women bear, it’s still something.
“Pain is growth, and we experienced pain,” David said.
When David wakes up at 1 a.m., and 3 a.m., and 5 a.m., it’s not The Question that keeps him up. It’s his daughter. As he rolls sleepily out of bed, he reminds himself how much he really wanted this life. He hopes it will shape him into a dad who’s loving and attentive and present. A new notion of masculinity appeared in front of me. I hope I will become a dad – through IVF or other means – and I hope that this experience will shape the dad that I become.
These days, Gaby and I spend a lot of time talking about what kind of parents we want to be. She’s going through IVF, which is a whole new minefield, and we talk through the permutations of each step of the way. I join Gaby for her walks now.