I was holding a plastic testicle when I was told I might be infertile. It was a teaching prop passed around during my consultation at the Royal Marsden in London. The surgeon, a spry Australian with a Crocodile Dundee twang and the bedside manner of a sports physio, was talking me through the pros and cons of a prosthetic ball. I had just been diagnosed with stage 3 testicular cancer and was due for surgery.
“Oh, you’ll need to go to the sperm bank before chemo,” he added. Chemo can render you infertile, usually temporarily, so patients are advised to put some on ice.
No, I hadn’t. And I hadn’t exactly been careful.
He gave a kind of thoughtful grunt. “Well, it’ll be good to have the analysis done. There’s a link between getting testicular cancer and already being infertile.”
• I was fit and healthy. Then I got testicular cancer at 26
And with that, the floor tilted. I was 26. I didn’t want children yet — they were filed under “later”, along with pensions — but I wanted the choice. And now, with one raised eyebrow, he’d suggested that the choice might already be gone.
A week later, I found myself at the andrology clinic — the wank bank — in a windowless room with a tiny plastic pot, a yellow biohazard bin and a clingfilm-wrapped remote control. The intimacy of masturbation was made medically urgent, sterile and surreal.
I did what needed doing, and returned the revoltingly warm pot to the nurse. The results, she told me, would take a week.
So began seven long days during which my brain discovered an entirely new sport: speculative infertility. I imagined a future without children. Wrapped in the prospect of losing a testicle was the idea that it could have been decorative all along.
When the phone finally rang, it was good news. My sperm count was on the low side of normal, but with good motility and morphology. I wasn’t infertile. They could freeze what they had and keep it, he said, sounding rather pleased with his generosity, for ten years.
That should have been the end of it, but the scare has stuck with me ever since, long after I completed the chemotherapy and was declared cancer-free. I had discovered a world where men find out that the assumption of fertility is just that: an assumption.
Male infertility is on the rise. Global sperm counts appear to have halved over the past 50 years, with a particularly sharp decline since 2000. Testicular cancer rates are going up too — by nearly 25 per cent this century in the UK. The two, probably, are linked. Take your pick of toxic 21st-century living: pollutants, obesity, microplastics, food additives, smoking, drinking — even tight underwear. Nothing has been conclusively proven, but it’s probably some combination of all of them.
• ‘Humanity at risk’ as sperm counts plunge
Others are more sceptical. Allan Pacey, professor of andrology at the University of Manchester, points out that much of the data comes from men attending fertility clinics, and that falling sperm counts don’t necessarily equate to falling fertility. He agrees something is going on — but that the doomsday prophecies help no one.
What is irrefutable is the scale of the problem. Around one in seven couples in the UK struggle to conceive, and in up to half of those cases, the man is the problem. Roughly 7 per cent of men are clinically infertile — about the same proportion who have diabetes — but unlike diabetes, it’s barely discussed. Worse, when men are diagnosed, the system rarely investigates why. Instead, they’re sent to IVF clinics where suboptimal sperm can be bypassed in a lab. It’s a medical sleight of hand that leaves the underlying problem undiagnosed and unsolved.
What IVF can’t disguise for ever, though, is the way female biology interacts with male flaws. A younger woman’s eggs can often compensate for defective sperm; by the time both partners are older, those flaws are laid bare. Which suggests that rising infertility rates may have less to do with collapsing sperm counts than with the point in life when we finally need them.
Fertility has traditionally been framed as a women’s issue. But in one noisy corner of the internet, that assumption is being weaponised. The much discussed “manosphere” has become a cocktail of resentment, conspiracy and locker-room biology. Now scores of pro-natalist influencers urge men to procreate as if the fate of civilisation rests entirely on their loins. And in some cases, they mean it literally: Elon Musk, father of at least 11, speaks about overpopulation being a myth and insists on the moral duty to repopulate the earth.
Elon Musk in the Oval Office with son X Æ A-Xii in February
REUTERS
Pronatalism — in favour (pro) of birth (natal) — is a term that has gained traction in recent years, particularly in conservative pockets of America.
The poster couple of the movement are Simone and Malcolm Collins, a weird blend of Silicon Valley technocrats and Mormon homesteaders. They’ve got four children already, with dozens more embryos in cold storage. They run a foundation that claims having children is the only way to stave off civilisation’s collapse.
• Read more expert advice on healthy living, fitness and wellbeing
At its best, pronatalism is a sensible response to falling birth rates in the western world. At its worst, it slides into paranoia about “replacement”, the fear that white western nations are being outbred by the developing world and that we must all jump into bed and fight back.
Into this maelstrom pour the self-styled “alpha” fertility gurus, their Instagram grids alternating between soft-focus family portraits and shirtless videos in cryotherapy chambers, promising to double your sperm count with raw liver, Himalayan salt, red-light testicle tanning, and supplements. It’s the Andrew Tate brigade podcasting and pep-talking about male dominance and reproduction. It’s the wannabe tech bros who, between raising seed funding, are raising actual seed, publicly, performatively, almost competitively.
‘It’s insane. It’s Tripadvisor for sperm’
What unites them all is the framing of reproduction — and by extension, male potency — as not just a personal choice, but a heroic, world-saving duty. It is an oddly intoxicating blend of legacy, ego and marketable masculinity. And the message trickles down, consciously or otherwise, into how ordinary men feel about their own fertility. If these men are ostentatiously parading theirs, what does it mean if yours is in doubt?
The answer, some decide, can be found in online support groups. These range from the well-meaning to the completely unhinged. In closed Facebook and Reddit groups, men upload screenshots of their semen analyses, diagnosing each other and prescribing the next move. “It’s insane,” one man tells me. “It’s Tripadvisor for sperm.”
Members debate the merits of “home insemination kits” with the earnestness of a wine club comparing vintages. The so-called “turkey baster method” has its own cult following.
The fact men are reduced to crowdsourcing medical advice from other men on the internet speaks volumes about the vacuum of care. If the system offered proper support and investigation, they wouldn’t be here at all.
On the fringes hover gurus like Dr Robert Kiltz, a fertility doctor who prescribes the “BEBBIIS diet” (pronounced “babies”) — bacon, eggs, butter, beef, ice cream, intermittent fasting and salt — to combat low libido and low sperm. His success is built on rejecting ultra-processed diets and pushing people back toward natural, animal-based foods. The problem is the packaging: male fertility is sold as something to be cured by his bacon and ice cream gospel.
And then there is NoFap: an abstinence movement that originated as a remedy for porn addiction and which insists men should avoid ejaculation for weeks or months to “reset” their systems and unleash “superpowers” — increased testosterone, better sperm, magnetic sexual energy. Around it swirls an online fertility bazaar: CoQ10 supplements, a legitimate antioxidant sometimes prescribed in clinics, now sell on TikTok Shop.
Influencers recommend dunking your testicles in bowls of ice to “shock” sperm into life, or boosting testosterone by chopping wood, or simply “doing more winning”, says one square-jawed TikTok influencer called Simon. Gym YouTuber Jesse James West filmed a 30-day NoFap challenge claiming his sperm and testosterone were “reset”, while devotees of semen retention insist that by day 12 you’ll have “energy and confidence”, and by day 50 you’ll be “better than 90 per cent of men”. Even Mike Tyson once claimed five years of abstinence made him stronger in the ring — a macho myth now recycled online as if it were sound science.
The gym YouTuber Jesse James West, who filmed a 30-day challenge claiming his sperm and testosterone were “reset”
JESSE JAMES WEST/INSTAGRAM
Medical labs recommend two to three days’ abstention before a sample, warning that anything over ten can harm sperm quality. But, online, pseudoscience drowns out data. It’s seductive, because it offers something the medical system often doesn’t: a sense of agency.
‘The life we’d pictured together suddenly disappeared’
To be told you’re infertile or “subfertile” is to be told you’re somehow less of a man. Fertility has always been bound up with cultural ideas of manhood, power and legacy. And the diagnosis is still soaked in shame.
Which is why I wanted to speak to Shaun Greenaway, a 42-year-old man from Devon. His own diagnosis of infertility came at the age of 34.
Like most newlyweds, Shaun and his wife assumed it would just happen. He wanted five children; she was more realistic. They even bought a bigger house in preparation.
The months went by. Friends started asking questions. And still nothing happened. Eventually, they went to their GP. Shaun’s sperm analysis came back: he had azoospermia, no sperm at all. “It was like a trapdoor opening,” he tells me. “The life we had pictured together suddenly disappeared.”
Shaun thought back to a bout of mumps in 2005, when he was 22. The swelling had gone south, leading to something called mumps orchitis, ballooning up his testicles to comical proportions. No one had told him back then that this was a leading cause of infertility.
He tried everything: varicocele surgery, lifestyle changes, even surgical sperm retrieval. Eventually, after much soul-searching, they turned to donor sperm. Their twins were born in 2021.
• Why are so many young men freezing their sperm?
Shaun never saw a therapist. He didn’t want to. He went looking for others, but found nothing. The only support website looked like it had been made on Windows 95.
He decided to build the community that he had needed. A month before his twins were born, he uploaded a video sharing his story. It was raw, uncertain and honest. “It took me eight months to press send,” he says. “I was terrified of being trolled.” The response was immediate and overwhelming. Not just from those around him, but from men going through the same thing.
“I know what I need to do,” he told his wife.
He arranged a meet-up. An unsolicited bat signal uploaded for his newly gained followers: I’ll be at this spot in Hyde Park tomorrow, wearing this sweatshirt, carrying a bag of tinnies. Twelve other strangers showed up.
A WhatsApp group followed. It grew to hundreds of members, a space where men can say what they can’t in clinics or bedrooms. Where they could swap names of specialists, share their stories, ask questions. It became a network of self-advocacy, underscored by a kind of male tenderness that rarely makes it into public view.
He then started The Male Fertility Podcast with Ciaran, a fellow sufferer, where they interview specialists and patients alike, and set up NeXYs, a platform for men going through fertility struggles. “I didn’t want some Corbyn lookalike giving me his best empathy nod. I wanted to ask another man if the steroids made him cry in the middle of the night too.”
Peer-to-peer support, says Allan Pacey, might be the single most effective tool we have. There are only two male fertility counsellors listed in the UK’s national directory — a statistic that reflects both a lack of supply and a lack of demand. Because this isn’t just about medicine. It’s about masculinity.
I want to have children
I was lucky. My sperm count recovered post-chemo, and a follow-up test a few years later showed it was actually higher than before. A weird thing to brag about in a national newspaper, granted, but relevant because it is quite common in testicular cancer patients. Either because the remaining testicle upped its game, or the excised cancerous one had been quietly dragging down the average.
Still, I never allow myself to feel too complacent. Sperm counts fluctuate daily. The cancer could come back. And conception is a symphony of timing, health, luck and sometimes sheer stubbornness.
Meanwhile, my frozen samples are halfway through their hotel stay in Hammersmith. I’ve asked many specialists whether it’s better to use them, the pre-chemo sperm of my younger, cancer-ridden self, or the post-chemo sperm of whatever age I eventually decide to have a child.
The answers come back unanimously ambiguous. No one knows. There have been no long-term studies. Most agree that the chemo poses no danger to the child’s development after two or three years, a milestone I’ve happily passed. As to whether a younger frozen version of me would theoretically be any better? Probably not.
The most important thing is that any pregnancy using frozen sperm would be medicalised. And IVF is no guarantee of success. I can’t, as I joked to their stony faces, walk into the hospital with a cool box, a pipette and my Reddit log-in. (Legally — and perhaps sensibly — I can’t do whatever I want with it.)
I want to have children, and I’m lucky that I should be able to. I’m luckier still to have a back-up plan. But most of all, I am lucky to have had the opportunity to consider a question most men never have to.
We need to talk about male fertility. We need to strip it of its shame, fold it into our ideas of health, and give men the tools and knowledge to protect it. Because if you wait until you’re holding a plastic testicle in a backless hospital gown, it might already be too late.