Navigating Male Fertility: A Conversation with David Ireland
Male Fertility · Podcast Recap
Learn More →Navigating Male Fertility: A Conversation with David Ireland
The founder of Fertility for Men on his own eight-year journey, the gaps in care for male partners, and why early testing changes everything.
Key Takeaways
- Male factor is involved in roughly 50% of the estimated 1 in 6 couples globally who struggle to conceive naturally — yet men are frequently left out of fertility appointments and conversations entirely.
- Early semen analysis and a urology referral can meaningfully change a couple’s care trajectory, but testing for men often doesn’t happen until well past the one-year mark, sometimes not at all until years into a couple’s journey.
- David’s own undiagnosed varicocele wasn’t identified until four and a half years into his fertility journey, illustrating how much time can be lost without early male-side testing.
- Emotional support for men going through fertility struggles is a significant, largely unaddressed gap in clinical care — most clinics offer little to no structured support for the male partner specifically.
- Simple, non-medical relationship strategies (like fertility-free date nights, small acts of daily support, and open partner check-ins) were highlighted as genuinely valuable tools for couples navigating this process together.
Fertility conversations are still overwhelmingly centered on women, even though male factor plays a role in about half of all cases of couples struggling to conceive. In a recent episode, host Kelsey sat down with David Ireland, founder of Fertility for Men, to talk about his own eight-year fertility journey with his wife, the significant gaps he experienced in male-focused care, and what he’s since built to help other men navigate this experience with more support than he had.
David’s Story: Eight Years, Multiple Countries, and an Unexplained Diagnosis
David and his wife began trying to conceive while living in Australia, where early testing revealed a low sperm count. After relocating back to the UK, they saw numerous consultants over the following years, often receiving inconsistent or incomplete information. Despite being generally healthy with no smoking, drug use, or obvious risk factors, their case was ultimately classified as unexplained infertility. It wasn’t until four and a half years into their journey that David learned he had a varicocele, a diagnosis that had gone unidentified through years of prior appointments.
The Discrepancy Men Experience in Fertility Care
David was candid about how sidelined he often felt during appointments, describing a dynamic where clinical conversations focused almost entirely on his wife, while his role was reduced to showing up for a sample collection. Despite attending every appointment to support his wife, he described feeling like there was little space made for him as an active participant in the process, a pattern he believes is common for many male partners.
“It felt like: do your job, go away, and that was it. There was nothing really directed for me. It takes two to tango, and I definitely wasn’t part of that whatsoever.”
How Partners Can Support Each Other Through the Process
David offered a few concrete, low-pressure ways men can show up for their partners: small consistent gestures (cooking dinner, offering a foot massage), and deliberately building in time that isn’t focused on fertility at all — like a walk, an outing, or simply spending time together as a couple rather than as “the couple trying to conceive.” Kelsey echoed this, sharing that she often recommends fertility-free date nights to her own clients, specifically revisiting activities a couple enjoyed together before their fertility journey began, as a way to reconnect outside the pressure of the process.
Men’s Mental Health: An Often-Isolated Experience
One of the more striking parts of the conversation centered on how differently men and women tend to process fertility struggles socially. David noted that men are far less likely to talk openly about fertility issues with friends or peers, often due to stigma or simply not having a space to do so, leading many men to feel isolated even when, statistically, they’re far from alone. Kelsey shared a story from her own practice where a male partner going through infertility eventually connected with several other men at his workplace going through similar experiences, once the topic was finally brought into the open, illustrating how much unspoken shared experience often exists beneath the surface.
The Biggest Gaps David Identified in Fertility Care
Reflecting on his own experience, David highlighted several recurring gaps:
- Delayed or absent early testing for men. Semen analysis and urology evaluation are often not prioritized early in a couple’s journey, despite being relatively quick and affordable compared to the cost of proceeding straight to IVF or IUI without that information.
- Minimal emotional support structured specifically for men. Many clinics offer, at most, a single optional counseling session post-treatment, with little to no proactive emotional support built into the process beforehand.
- Underdiscussed lifestyle and environmental factors. Diet, alcohol, smoking, and environmental toxin exposure can meaningfully affect sperm DNA fragmentation and overall sperm health, but these connections are often not clearly communicated to male partners.
David’s Advice: Get Tested Early, and Don’t Suffer in Silence
When asked for one piece of advice to leave listeners with, David’s answer was direct: get tested early, and don’t go through this in isolation. Given how often testing is delayed for male partners, and how isolating this experience can be without support, both points reflect the core gaps he’s built Fertility for Men to help address.
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Get the Sperm Count Blueprint →Sources & Further Reading
- Fertility Confidence Podcast. “Navigating Male Fertility with David Ireland.” Episode transcript.
- David Ireland, Founder, Fertility for Men. Instagram: @fertility4men. Newsletter: “The Male Mail.”
There’s a 50% Chance Male Fertility Is Keeping You From Getting Pregnant
Half of all infertility cases involve a male factor. Yet sperm testing is still the last thing most couples are told to do — and the numbers being called “normal” are far from it.
- Male factor is involved in 50–70% of infertility cases — yet sperm testing is still routinely the last step, not the first.
- The WHO’s lower limit for “normal” sperm concentration is 15 million/mL — the 5th percentile. At that level, estimated per-cycle pregnancy odds are around 5%.
- Optimal sperm concentration sits at the 50th percentile of men who successfully conceived: approximately 60–73 million/mL.
- Below 30 million/mL, pregnancy probability drops off sharply. Above 50 million/mL it plateaus near the natural per-cycle ceiling of 20–25%.
- Sperm concentration is not fixed. A targeted, data-driven approach can produce significant improvement — often within 3–6 months.
When a couple struggles to conceive, the instinct — in clinical settings and at home — is to start with her. Her cycle, her hormones, her ovulation. This is understandable. It is also costing couples months, and sometimes years, they do not need to lose.
The data is unambiguous: male factor is involved in somewhere between 50 and 70% of infertility cases. Not as a rare secondary concern — as a primary driver, half the time. Yet semen analysis is still treated as the test you run after everything else has been checked, if it gets run at all.
What the statistics actually show
Infertility is clinically defined as 12 consecutive months of trying to conceive without a pregnancy. When researchers break down the causes, the picture looks like this:
This does not change based on prior pregnancies. Sperm quality and concentration shift over time, affected by age, health, stress, illness, and lifestyle. A previous successful conception — in this relationship or a past one — is not a current result. Testing still matters.
Why “normal” doesn’t mean what it sounds like
The reference range most clinics use comes from WHO guidelines. Under those guidelines, a sperm concentration of 15 million per millilitre is considered normal. A man who hits that number is typically told everything looks fine.
What that framing leaves out: 15 million/mL is the 5th percentile. It was derived from a dataset of men who did achieve pregnancy with their partners within 12 months — but the threshold was drawn at the very bottom of that group. Ninety-five percent of those men had better numbers. The threshold was not placed where success is likely. It was placed at the floor of the range where it has occasionally been shown to work.
At 15 million/mL, the estimated per-cycle probability of conception is approximately 5%. That is the number being rubber-stamped as acceptable in clinical semen analysis reporting.
The 50th percentile of that same dataset — the midpoint of men who successfully conceived — sits around 73 million per millilitre. A practical target for optimisation is above 60 million/mL. That gap, between what clears the bar and what actually reflects fertility potential, is not a minor technical distinction. It is where most couples who are told “nothing is wrong” are quietly losing time.
Where the real drop-off happens
Pregnancy probability by sperm concentration is not a linear curve. The steepest decline happens below 30 million/mL — which is still well above the WHO minimum threshold that triggers no clinical concern.
Above 50 million/mL, per-cycle pregnancy probability plateaus near 20–25% — a ceiling that reflects biological limits, not sperm count. Getting from 60 million to 100 million makes little practical difference. Getting from 15 million to 60 million makes a significant one.
Subfertility vs. infertility — and why the gap matters
One reason male factor gets missed is that clinical concern is triggered by infertility thresholds, not subfertility. If a result clears 15 million/mL, it does not prompt a referral or a follow-up conversation. But a man at 25 million/mL is not in the same position as one at 70 million/mL — and treating those results as equivalent is how couples end up in a prolonged stretch of “keep trying” that didn’t need to last as long as it did.
Subfertility — results that are technically within range but far from optimal — is common and, in many cases, improvable. The research base for male fertility nutrition, lifestyle, and supplementation is more robust than most people realise, partly because sperm concentration is a measurable, repeatable endpoint that is straightforward to study. Randomised controlled trials exist. The evidence base is there. But it cannot be applied well without knowing what the actual numbers are.
Getting tested — and reading the results correctly
A clinical semen analysis — where the sample is produced and analysed on-site at a lab — remains the most reliable method. At-home testing has improved; one option used in fertility-focused clinical programmes is Fellow, which runs morphology and returns actual numerical data rather than a simplified pass/fail result. If at-home results come back low or irregular, confirming with a clinical sample before building any treatment plan is the sensible next step.
When results come back, the question is not just whether concentration clears 15 million/mL. It is where concentration sits relative to the 50th-percentile target. Below 60 million/mL, there is room for improvement. Below 30 million/mL, understanding why — structural, hormonal, or lifestyle-related — should come before any intervention is started.
Testing is the beginning of a plan, not the end of a conversation.
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A focused resource for anyone whose sperm concentration is below optimal — or who doesn’t yet know where it stands. Covers how to interpret your numbers, the most common reasons concentration is low, and how to build a targeted plan based on what the research actually supports.
Get the Blueprint → Includes the Full Male Lab GuideReferences
- World Health Organization. (2021). WHO laboratory manual for the examination and processing of human semen (6th ed.). WHO Press. https://www.who.int/publications/i/item/9789240030787 — Source for sperm concentration reference ranges, including the 5th percentile lower threshold of 15 million/mL used in clinical semen analysis reporting.