Why Has Male Fertility Been Ignored for Over 2,000 Years?
I study sperm for a living, so I am used to the giggles and raised eyebrows. But here is the fact that surprises almost everyone: we understood the female reproductive system in reasonable scientific detail well before we understood the male one — and in some ways, we are still catching up.
This is not an abstract interest for me. As a young and inquisitive scientist, I quickly realised how little knowledge existed around male reproductive health, which pushed me to pursue a PhD in sperm biology and genomics. After years in research, I moved on to fertility diagnostics, with the aim of translating science into real‑world innovations that can move male reproductive health forward.
In the past few years, fertility has finally become a mainstream topic, with greater public awareness and less stigma surrounding fertility challenges. This progress is wonderful, yet male infertility has historically been overlooked, and remains so to-date.
Understanding how our knowledge of fertility has developed throughout history is important to explain how this legacy of neglect still shapes the science, awareness, and stigma around male fertility today.
Seeds, Soil and Vapours
For most of human history, reproduction was guesswork dressed up as theory.
In Ancient Greece, Hippocrates proposed that men supplied the “seed” and women simply provided the soil it grew in. Aristotle went further, arguing that semen carried a mystical heat that shaped the child: hot enough, and you got a boy; too weak, and you got a girl. Neither man had any concept of an egg.
Ironically, this male-centred theory did nothing to advance the actual science of male reproductive health. Men were treated as the whole story, as if male fertility was fixed, uncomplicated, and basically immune to problems, so physicians assumed there was nothing worth investigating. This mindset also held back our understanding of female fertility, because women were simply seen as a passive vessel with no biological contribution of their own. In the end, these assumptions stalled progress on both sides of human reproduction.
Animalcules and Tiny People
The real turning point came in 1677, when Antonie van Leeuwenhoek, a Dutch draper with no scientific training, ground his own lenses and looked at semen specimens – among others - under a microscope for the first time.
What he saw, he wrote, were “animalcules” (Latin for “little animals”), tiny moving forms with tails, “swimming like eels in water.” He reported the discovery to the Royal Society in a letter that is now considered the birth of sperm science.
It was a genuine breakthrough, but it produced a new wrong idea that each animalcule contained a fully formed miniature human, and that the womb was merely an oven for it to grow in. Women, once again, were reduced to incubators.
Image: Illustration by Nicolaas Hartsoeker (1694) on Wikipedia Commons
A Problem Without a Name
By the late 1700s, male infertility was not so much studied, but it started to be engineered around.
Around 1790, the Scottish surgeon John Hunter was approached by a man with hypospadias, a condition where the opening of the urethra is on the underside of the penis rather than at the tip, which in some cases can prevent sperm from reaching the egg during intercourse. Hunter had the idea to collect the husband's semen and inject it into the wife using a warmed syringe. The procedure worked, and the case is widely credited as the first recorded instance of artificial insemination.
This is a remarkable story, which paved the way for modern reproductive science, yet it was still a long way from recognising male infertility as an issue in its own right. The problem was treated as a mechanical obstacle to be solved with a workaround, rather than as a problem with the man’s fertility itself.
IVF's Blind Spot
About 200 years after Hunter’s successful attempt at artificial insemination: in 1978, Louise Brown - the first baby conceived through in vitro fertilisation (IVF) – was born. The technique allowed conception in women with blocked fallopian tubes by fertilising the egg outside the body and then transferring the resulting embryo into the womb. It was a landmark for reproductive medicine, but it did little to help with male infertility: if the sperm could not fertilise an egg on its own, IVF simply did not help.
That gap was not closed until 1992, when intracytoplasmic sperm injection (ICSI), an advanced IVF technique that injects a single sperm directly into an egg, was pioneered in Belgium. For men with very low sperm counts or poor motility, it was transformative. Yet, it is worth sitting with the timeline: fourteen years passed between the first IVF baby and the first real answer for male infertility.
Catching Up, Finally
We now know infertility is roughly a 50/50 split between male and female factors, yet research funding, media coverage and public conversation all took far longer to catch up with the biology.
One of the main reasons male fertility has been neglected is visibility, not in the sense of what could be seen but what could be measured. While female fertility has always produced noticeable signs, such as a missed period or a pregnancy, male fertility didn’t. Even after van Leeuwenhoek saw sperm swimming under his lens in 1677, that observation sat idle for nearly three centuries before it became clinically useful. In fact, semen analysis was not standardised until the mid-1900s, and the World Health Organisation did not publish reference values for a normal sample until 1980. Medicine cannot investigate what it cannot measure, and for most of history nobody had agreed on what a healthy sperm sample even looked like.
Cultural factors have further perpetuated this invisibility. Historically, male fertility has been seen as a sign of virility and masculinity, creating a taboo that not only stalled scientific investigation and clinical attention, but also discouraged men from seeking help.
The encouraging part is that this is finally shifting. Clinicians, researchers, and the media industry are treating men's reproductive health as a subject worth investigating in its own right.
The Future of Male Fertility
The next chapter looks nothing like the past two thousand years, because men increasingly want to be in charge of their own health, rather than finding out about a problem only once they are already trying - and failing - to conceive.
Early screening and diagnostics are becoming available much earlier and much more easily. That matters because sperm production takes around three months from start to finish, so the earlier a man understands his fertility, the more time he has to act on it.
There is also a growing recognition that sperm quality is not just about conception, it is a barometer of a man's overall health. A study following 78,284 men for up to 50 years found that men with the lowest sperm counts had a significantly higher risk of mortality as well as heart disease, diabetes and metabolic disorders. A fertility test, in other words, can double as an early warning system for health span.
Men are also waking up to the fact that their choices do not start at conception. Growing evidence on preconception health shows that a father's lifestyle factors such as diet, weight, smoking status and toxin exposure, in the months before conception can shape a child's development through changes to sperm itself, with effects ranging from birth outcomes to long-term disease risk. Fatherhood, it turns out, starts earlier than a positive pregnancy test.
None of these closes two thousand years of neglect overnight. Yet, for the first time, male fertility is being investigated because men are asking the questions themselves, not because someone built a workaround for them. That is what will finally change the story.
