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Radio Review: One to One: Benjamin Zephaniah Meets Richard and Terri Clothier (BBC Radio 4 available on iPlayer)

4 November 2019
Appeared in BioNews 1022

The psychological aspects of infertility are generally well-documented. Those who have experience of this will be all too familiar with the devastation, guilt, shame and anger that accompany the diagnosis. That it often comes after several years of visits to the GP, endless tests, interventions and dashed hopes can seem like a crowning insult to exhausted couples struggling with the loss of hope of the imagined child, sometimes against a background of dwindling time and finances.

In three short interviews with husband and wife Richard and Terri Clothier, and Kevin McElery, a consultant neurologist at Newcastle Centre for Life, the presenter and poet Benjamin Zephaniah looks at the less-documented issue of male infertility. This is close to his heart, as Zephaniah is himself infertile, observing wryly that while his younger self was happy to avoid accidentally fathering babies, the eventual diagnosis hit him very hard and was sharply at odds with his public image of 'radical rasta poet man'.

As a result of this, perhaps, his interview has a light touch and has an easy empathy towards his interviewees that helps to establish the tone whilst enabling Richard and Terri's story to be told in a natural, conversational style that never becomes too probing.

After many tests that have focused primarily on his wife Terri, Richard is eventually told by an over-optimistic GP, on the basis of contrary evidence, that his sperm are 'a little lazy, but keep going and your wife will be pregnant by Christmas'. His and Terri's reaction to this misplaced attempt to reassure them is to wait some more – finally receiving a definite answer from another GP who confirms what they know in their heart – that Richard is completely infertile and that assisted conception is now their only option.

Richard's reaction is to cope outwardly, but, as anyone with infertility problems will testify, it is a condition that can alienate us from friends (busy getting pregnant, sometimes even by accident, too busy with children) and family (the weight of expectations, the disappointment of the unwelcome news and the difficulty in receiving the support needed).

The couple experience these things together, yet mostly apart, and Richard struggles to find the support he needs. He describes a trip to a fertility clinic open day, where he hopes he might meet and talk to other couples and find out he is not alone in feeling as he does. Unfortunately, no-one will make eye-contact with him and no-one wants to talk – leaving him evermore isolated and despondent in his predicament. It is a particularly sad vignette, not the least because it represents a wasted opportunity for infertile couples to receive invaluable informal support at their lowest ebb, and is also a reminder of the way infertility affects an individual's confidence and sense of self.

When the couple's treatment is eventually successful resulting in the birth of their son James, Terri is honest about the toll that years of childlessness, pregnancy and a traumatic labour have taken on them both. Yes, they are elated, but both experience a delayed reaction; Terri suffers post-natal depression and Richard struggles to adjust to his new identity as a father.

Those who have been through assisted conception will be familiar with this: the hyper-vigilance through an IVF pregnancy, sensitive to every sign and twinge, and the vague impostor syndrome that can haunt the new parents even at a time on intense joy.

In the third interview of the series, the consultant neurologist McElery discusses the medical issues that cause male infertility. Against a background of general decline in the quality of sperm in studies conducted in Northern Europe, known factors such as obesity, smoking and steroid use, only around 15 percent of infertile men have an identifiable genetic condition. This is problematic as a precise reason for infertility can help towards a sense of closure.

Men's reactions range from severe distress to anger to lack of acceptance; it is relatively common for men to demand further opinions and to express surprise that the infertility is on the man's side. The diagnosis threatens traditionally perceived masculine identities, and even in more progressive communities it is less likely that men will disclose their infertility, inevitably leading to the partner shouldering the responsibility for emotional support.
Interestingly, Zephaniah took a long time to disclose his infertility and describes how he had 'come out as infertile' – a telling choice of words which reflects the difficulty of admitting his involuntary childlessness.

McElery observes that men are more likely to seek support online through peer-to-peer networks, rather than seek to reflect on feelings. Men are driven to find information (as indeed are women!) and approach the issue in a linear fashion, being less likely to strike up a conversation with a stranger and more driven to protect their privacy.

He also asserts that the commercially-driven providers of infertility treatment and assisted conception (by which we can assume pharmaceutical companies and clinics) have a responsibility to counter the dearth of opportunities for couples to meet and talk peer-to-peer. Richard's earlier description of the silences and averted gazes he encountered at a fertility clinic open day confirm that there is a need to include both partners in the conversation about infertility in order to destigmatise male infertility and help unburden couples through a physically and emotionally challenging time.

These three broadcasts, with articulate and engaging guests and a personable, skilled interviewer, help to highlight the main issues in male infertility whilst providing an accessible starting point for further exploration.

20 July 2020 - by Dr Maria Botcharova 
Scientists have made progress towards a reliable technique for treating male infertility...
30 September 2019 - by Dr Jennifer Frosch 
Men who have had fertility treatment to assist conception in the past have a higher risk of developing prostate cancer, a Swedish cohort study has reported...
26 June 2019 - by Shaoni Bhattacharya 
The chance of success with fertility treatment using IVF or ICSI decreases if a man is over 51, according to a new study...
11 March 2019 - by Jakki Magowan 
Chemicals in household carpets and flooring, clothing and upholstery, are damaging sperm quality in men and domestic dogs...
8 October 2018 - by Professor Sheena Lewis 
There has been much media interest in male infertility care this year, but two major issues have stood out. The first is the inadequacy of care for the man, from incomplete diagnosis to non-information about his treatment choices. The second is the use of a vulnerable woman to undergo invasive fertility treatment in order to treat a third party – her male partner. This is unparalleled in other branches of medicine...
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