For many couples, having children is an important life goal. Yet when pregnancy does not happen, the question often asked is not what could be affecting the couple, but what is wrong with the woman. This assumption remains common despite overwhelming evidence that infertility is not solely a woman's problem.

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Infertility is the inability to achieve pregnancy after 12 months or more of regular, unprotected sexual intercourse. It is a disease of the reproductive system that can affect women and men. Globally, male factors contribute to about half of all infertility cases, either alone or alongside female factors.

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Rwandan research tells a similar story. Research done on couples attending infertility services found that male-factor infertility was identified as frequently as, and in some cases more frequently than, tubal infertility in women. Yet awareness remains low. Fewer than one-third of men (28%) and only 10% of women knew that infertility could originate from the male partner. Unsurprisingly, women are more than three times as likely as men to seek medical care first, even though infertility is a condition that should be investigated as a couple.

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One reason for this is the widespread misconception that a man who is sexually active or has no problems with sexual performance must also be fertile.

Fertility cannot be judged by appearance, libido, or masculinity. Male fertility is assessed through a semen analysis, a simple investigation that is often delayed because men are less likely to present for evaluation.

The consequences of this misconception extend far beyond delayed diagnosis. Research conducted in Rwanda found that infertile couples experienced significantly higher levels of domestic violence, relationship breakdown, and sexual dysfunction than fertile couples. While women carried the greatest burden of blame and social exclusion, men also experienced stigma, particularly within their communities. Studies have found that the psychosocial consequences differed depending on whether infertility resulted from male or female factors, highlighting the need to understand infertility as a shared health condition rather than assigning blame to one partner.

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Beyond awareness and stigma, biomedical factors also shape outcomes. Evidence shows that complications related to pregnancy and childbirth, HIV and other sexually transmitted infections, and bacterial vaginosis were major contributors. Together, these factors account for a substantial proportion of infertility cases.

Strengthening antenatal care, preventing and treating HIV and other STIs, expanding access to family planning, and improving the quality of obstetric care could reduce infertility in Rwanda.

The good news is that infertility care in Rwanda has evolved considerably. Over the past few years, Rwanda has expanded specialized reproductive health services, including fertility investigations, intrauterine insemination (IUI), and in vitro fertilization (IVF). Rwanda Military Hospital has pioneered publicly supported assisted reproductive services, making fertility treatment more accessible. Our new healthcare law formally recognizes and regulates assisted reproductive technologies, including IVF and surrogacy, providing a clearer legal and ethical framework for patients and healthcare providers.

These advances are encouraging, but they will only achieve their full impact if public attitudes change as well.

Couples who have not conceived after one year of regular, unprotected intercourse, or after six months when the woman is 35 years or older, should seek medical evaluation together. Early assessment of both partners improves the chances of identifying the cause and choosing the most appropriate treatment.

Infertility is not a woman's burden to carry alone. It is a shared medical condition that deserves compassion instead of blame, timely healthcare instead of stigma, and support for both partners. By replacing myths with evidence, Rwanda can continue making progress toward reproductive healthcare that is equitable, respectful, and inclusive.

The writer is a global health specialist and healthcare mission curator at African Leadership University (ALU).