Paul Rodriguez had been with his wife for 13 years before he ever felt his marriage was seriously in danger. After a few months of trying to conceive unsuccessfully, a sperm analysis in January 2016 revealed a possible reason: Rodriguez had a low sperm count. All of a sudden, new fears about the strength of their relationship began to settle into his mind. 

“What if I can’t have kids? What if I can’t provide my wife with a child? Would this actually cause our relationship to end?” said Rodriguez, a 31-year-old resident of Los Angeles, California. “It was the first time I felt there was a threat to our relationship.”

Rodriguez did what most men are advised by their doctors to do after a low sperm count diagnosis: he started taking vitamins and exercising to see if he could increase his numbers on his own. But by April it was clear that they needed more aggressive treatment. 

In the meantime, he reached out to family and friends about his medical diagnosis in an effort to soothe his fears. His family offered their support but also didn’t know how to react to the news. The male friends he spoke to offered quick condolences but tried to change the subject.

“It’s so rare that it can ever be a conversation; It’s more like, you just vent for a little while, and then they’re like, ‘There, there.’” he said. “And then they want to get out of that conversation as quickly as possible.”

Rodriguez’s situation — and the lack of emotional support he encountered ― is very common for men diagnosed with infertility, explained Susan Klock, a psychologist at the Northwestern Fertility and Reproductive Medicine Practice. 

“People don’t talk about male infertility as much because of its association with male sexuality, male virility [and] being a real man,” she said, “The other part of it is that men in general tend to not talk about a lot of things they’re dealing with, maybe as much as women talk about their issues.”

Infertility affects about one in eight couples in the U.S. About one-third of the issues have to do with male reproductive issues, another third with female reproductive issues and the remainder either a combination of both or unknown reasons.  

Yet, despite the seeming parity of problems on either the male or female side of infertility, it’s clear that most treatments are focused on women, and most discussion of infertility revolves around the woman’s experience. And depending on where the couples live and how entrenched patriarchal culture can be, there can even be a societal reluctance to acknowledge that male infertility even exists at all. 

This phenomenon isn’t restricted to developing countries, writes sociologist Arthur Greil in a 2010 review of infertility studies: “Husbands feel that infertility threatens their masculinity; while wives are pitied, husbands are teased,” he wrote. “Men respond … by casting blame on their wives.”

Rodriguez never blamed his wife for his medical condition, but did feel like the diagnosis damaged his own sense of his masculinity. 

“It definitely affects your kind of core identity as a man,” said Rodriguez, adding that the threat of not having children “shakes your identity quite a bit.”

When the couple spoke to HuffPost in mid-March, they were in the middle of their fifth and hopefully final cycle of in vitro fertilization. In total so far, the couple has spent about $50,000 out of pocket and reimbursements are not assured, as their primary insurance company doesn’t cover infertility benefits — something the couple is trying to fight.

Rodriguez and his wife soon discovered they fell into that third category of couples with infertility, in which the medical condition is caused by both male and female factors. Additional testing revealed that Rodriguez’s wife is a carrier for fragile X, a genetic condition that can increase a female carrier’s risk for premature ovarian failure and her risk of giving birth to a child with developmental problems like autism. 

In order for the couple to make sure they didn’t pass fragile X onto their children, they had to first make embryos and genetically test them for the condition before attempting to implant them. And because the genetic testing is expensive, they had to try to “bank” blastocysts (fertilized eggs that develop normally for five to six days) until they had enough to make the expense worth it. 

Rodriguez has his own advice for men dealing with infertility diagnoses, either for themselves or for their partners. The first is to reach out to your partner or a close friend about your news. 

“Be open about what’s going on in your head as much as possible if you find out news that there’s something wrong,” he said. “Because you’re going to get in your head a lot, and you’re going to have a lot of anger at yourself and the world, and it’s going to get very difficult to think clearly.”

And if it turns out that your partner needs support with her infertility diagnosis, focus on being as involved in the process as she has to be, every step of the way.

“Make sure you’re always a team in this, because if you get too isolated, you’re going to fall into a vortex of doubt and anger,” Rodriguez said. “And you’re going to get lost in yourself.”

Listen to Part 4 of IVFML below:

IVFML is a HuffPost Podcast hosted by Anna Almendrala and Simon Ganz and produced by Nick Offenberg. Send us an email at IVFML@huffpost.com.

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