Some people try and tick all the boxes before they start a family, including reaching financial stability and finding a suitable partner.
Then they run up against something they couldn't plan for: infertility.
Often, female infertility is considered first. But male infertility and subfertility is very common. In fact, it affects one in 20 Australian men of reproductive age.
"It's a staggering concept. So next time you're at the MCG, look around and [consider that] one in 20 men are struggling with that," Professor David Gardner tells ABC RN's Big Ideas.
Professor Gardner is the head of Reproductive Biology and Assisted Conception Laboratories at the University of Melbourne. And, he says, despite the prevalence of infertility in men, it's not something that is talked about enough.
"There really was a reluctance in people to talk about it, but not so with women — they were very good at discussing their problems with other women and their friends — but where it was really a problem was with the men," he says.
'The perfect storm of infertility'
The terms subfertility and infertility are often used interchangeably, but they are quite different.
Infertility, according to the World Health Organisation, is the inability to conceive naturally after one year or more of regular unprotected sex.
Subfertility is delayed conception, where it takes longer than what is typically expected. For subfertile men, it is still possible to conceive naturally but it may take longer.
Clinton Archer, 46, and his wife Paula are nurses based on the Gold Coast. They first started trying to have children almost fifteen years ago.
"It just wasn't working naturally, and me coming from a male-dominated family [that] didn't talk about that stuff, I thought that's strange. I thought it just happens," Clinton says.
"You think you just enjoy yourselves, then your wife gets pregnant, but I've learnt a whole other world of things in the last decade or so."
The couple set out to find out what the issues were. Clinton describes what they discovered next as the "perfect storm of infertility".
Clinton had experienced a testicular torsion in his twenties but he believed that shouldn't have impacted his testosterone levels or sperm count. Paula was also diagnosed with having asymptomatic endometriosis and poor egg quality.
Then blood tests and genetic testing revealed more about Clinton's history.
He discovered a family history of Robertsonian translocation, a genetic abnormality that can impact male fertility.
So, after trying IVF for almost a decade, the couple decided to stop. That was six years ago.
"Also for my wife, with the IVF side of things, the hormones, the injections, it's very taxing — and financially hard," he says.
Hard to talk to others
Finding the right time to talk about his experiences with others wasn't easy at first.
"It's not the sort of thing where you and friends watch a car race and you say, 'Hey, I'm really struggling having kids'.
"I don't think I felt shame, I didn't feel not manly or anything like that," he says.
But he did feel hesitant at first about raising the subject with male friends.
Since then, Clinton has joined an online group that allows involuntarily childless men to connect. Others in the group encouraged him to talk about his experiences openly and provide support to other people.
There's another important reason for men to be talking about their fertility.
According to Professor Gardner, there are links between sperm quality and male morbidity and mortality.
"Semen quality … and your fertility status appears to be really the biomarkers of men's health. Really that could be used for early warnings for development for subsequent health problems and disease," Professor Gardner says.
Sperm counts worldwide have significantly dropped between 1973 and 2011, he says.
"It's estimated [that there] was a 50 to 60 per cent drop in sperm counts … in men from Europe, USA, Australia and New Zealand," he says.
"Perhaps what's really alarming, it's not that we've got less sperm, but the quality of the sperm is decreased as well. So whatever sperm we have left, that's not as good as they used to be."
And if men are trying to conceive later in life, there are also potentially risky health outcomes for the child.
"There's a growing number of studies that have looked at increased DNA damage and mutation rate in older men, and they certainly augment the risk of complex diseases," he adds.
"There's growing data on schizophrenia, autism and indeed even childhood cancer. So these studies are very sobering to read."
Plastic problems
Like many aspects of health, male fertility is affected by lifestyle and environmental factors.
Dr Deidre Mattiske, a research fellow at the School of BioSciences at the University of Melbourne, says diet, smoking, stress and sleep patterns can all affect fertility.
She says one of the most important factors that they've been researching in the last few decades is endocrine disrupting chemicals [EDCs].
These are substances that have the potential to interfere with the normal hormonal signalling within an individual, and they can impact reproductive health and fertility.
They include BPA and phthalates, chemicals that make plastics soft and that are found in a huge range of items.
"They're found in children's plastic toys, they're found in plastic bottles that we drink from, they are found in food packaging, cleaning products, even those … semi glossy receipts that we get, they're coated in BPA," Dr Mattiske says.
Exposure to EDCs may also be increased by heating food in plastic, she says, something she advises everyone to avoid doing.
"We all know that plastics are terrible for the environment anyway. So this is another great reason to steer away from plastics," she says.
Many pesticides and herbicides also contain EDCs.
"A lot of commercial food crops will be treated with EDCs that then become contaminated in both our food and water," she says.
Parabens, which are found in cosmetics, skincare products, shampoos, and conditioners, are another big contributor, she adds.
Clinton has taken notice of some of the recent findings, and he says he found them quite alarming.
"I feel there's an element of chemicals and dietary changes [that are needed]. They need to make food fast and cheap these days because of the ever-expanding population so quality is being hampered," he says.
"I feel like it's very alarming and it's not getting any better."
And given so many males are affected by infertility or subfertility, it's something that should be spoken about more often, he says.
"My wife talks about everything with her mum, but I find that males don't," he says.
"But once you do open up a little bit with the right group, people are more than happy to talk about it."
RN in your inbox
Get more stories that go beyond the news cycle with our weekly newsletter.
