Courtney Freeman first met her husband Jake when he visited her mom’s house for a holiday gathering in 2020. Their moms were friends, and all she knew about her future spouse was that he was a welder whose work took him constantly on the road.

The two clicked almost immediately and married the following year, making a home near The Woodlands, a leafy, master-planned community in the north Houston suburbs. They were ready to build a family. But after a year of unsuccessful attempts, the couple learned Jake struggled with male infertility, a diagnosis medical professionals say has become increasingly common.

The couple is now overjoyed to mark Jake’s first Father's Day as a dad. After pursuing fertility treatment, they'll be celebrating the gift they thought they might never have: their son, Walker, who was born in April.

“It’s amazing,” said Courtney, a 27-year-old ICU nurse. “I can’t even put into words how lucky and blessed we are. We’re so thankful for him every day.”

Infertility is a global health issue, according to the World Health Organization, thought to affect at least one in six people during their lives.

Couples are generally deemed infertile after they've tried for a year without success to conceive, said Jason Griffith, a reproductive endocrinologist in Houston and board member of RESOLVE: The National Fertility Association.

About 80% of infertility cases can be pegged to an identifiable diagnosis, Griffith said, and men's health accounts for or contributes to roughly half of cases. One study published by Canadian researchers in 2019 found that one in 20 men worldwide faced reduced fertility.

Causes of male fertility tend to fall into two categories, according to Griffith – it's either a problem with sperm production or obstruction of the reproductive tract. Diagnoses are determined through bloodwork, imaging or exploratory medical procedures.

For some men, learning they have a low sperm count or they’re unlikely to be able to father biological children prompts self-doubt and questions about their manhood.

“It is a direct challenge to how they view themselves, and that can be difficult,” Griffith said.

However, the conversations that follow the diagnosis have evolved in recent years. The medical profession increasingly views infertility as a disease, and a growing willingness to discuss the issue, aided by personal testimonies on social media, has nudged it out of the shadows, gradually erasing the stigma the issue once had.

Earlier this year, former “Bachelor” star Colton Underwood opened up about his struggles with low sperm counts as he and husband Jordan Brown looked to become fathers. Similar issues plagued chef Gordon Ramsay and wife Tana, who eventually turned to in vitro fertilization (IVF) to become parents.

Other celebrities who have gone public with their infertility challenges include actor Tom Arnold, whose struggles with low sperm counts date back to his college days; and British speedster Toby Trice, who now fights to decrease the stigma of male fertility by driving race cars featuring the logo of fertility organization TestHim.

“A lot has changed for the better when it comes to perception of infertility,” Griffith said. “It’s less of a private issue. People realize they’re not struggling alone with this.”

Sharing his story to 'pay it forward'

Jake Freeman, 34, is a man of few words but hasn’t shied away from discussing his experience. “It is what it is,” he said.

He hopes his story will inspire other men struggling with male infertility.

“His exact words, were, ‘to pay it forward,’” wife Courtney said. “He’s always been very open about it, as in it’s just our journey and that’s how we got our gift.”

When they first started trying to get pregnant, Courtney, who is a nurse, tracked everything closely – circling dates on calendars, noting peak times to have sex or not to have sex.

Jake had already started to feel resigned to not having kids; fatherhood had never really been a priority for him, he said, and it wasn’t until marriage that he began to consider it seriously.

When they disclosed what they'd learned to Jake’s parents, they discovered something Jake never knew about himself: Around the time he was finishing high school, he developed a painful kidney stone requiring surgery. In the process, doctors noticed he had a varicocele, in which veins swell around a testicle and block proper blood drainage, a condition that can hamper sperm production.

As Jake describes it simply as: “There’s too much heat for the sperm.”

Doctors had told his parents the condition might cause fertility issues later, but they never shared that news with him. Still, the couple had suspected something was wrong.

“Really, we knew,” Courtney said. “You can tell his testicle is different. It feels like a ball of veins.”

The growing causes of male infertility

Varioceles are one of the more common causes of male infertility, said Laura Detti, chief of fertility services at the Family Fertility Center operated by Texas Children’s Hospital in Houston, where the Freemans found help. Others include retrograde ejaculation, in which semen travels backward into the body, and rarer conditions linked to cystic fibrosis.

Low sperm counts are another cause, the condition that can result from long-term illness, chromosome issues or childhood infections such as mumps, according to the Urology Care Foundation.

Doctors have also begun to see more sperm abnormalities caused by testosterone products men use to build muscle or treat sexual dysfunction, Detti said.

“These products cause testes to function less, and they will not produce good quality sperm for as long as the products are taken,” she said.

The first step in diagnosing infertility is doing a semen analysis that looks at the volume of the ejaculate and concentration of sperm, as well as their structure and mobility, Griffith said. If irregularities appear in successive tests, providers can do additional testing depending on the severity of the abnormality.

Across the board, sperm counts have been dropping over the generations, a phenomenon researchers can’t fully explain. In 2022, epidemiologist Hagai Levine of Hadassah University Medical Center in Jerusalem found that counts dropped by more than 1% annually from 1973 to 2000 and 2.6% between 2000 and 2018, which he characterized as “an amazing pace.”

The underlying reasons for this phenomenon, Griffith said, could involve a combination of environmental pollutants, hormone-treated food products or struggles with obesity and chronic disease. But no one is really sure.

Deciding to see a fertility specialist

In late 2022, after a year of trying, the Freemans decided it was time to see a fertility specialist. Tests confirmed that Jake’s sperm count was severely low.

The first doctor they saw said they had little chance of conceiving naturally and that their only option was IVF, a procedure they preferred to avoid.

For Courtney, in her mid-20s, the diagnosis hit hard, and she knew Jake felt bad for her as well.

“From the time I was a little kid, I always wanted to be a mom,” she said. “I was hopeful, but there was also this feeling of, ‘Is this ever going to happen?’ I kind of doubted it.”

Ultimately, the Freemans learned that Texas Children’s, the sprawling medical system where Courtney worked, also had a fertility center.

A new set of lab tests showed that Jake’s sperm count was just high enough to pursue intrauterine insemination, or IUI. The procedure involves a health care provider inserting sperm directly into the uterus, reducing the obstacles it would normally have to overcome to reach ovulating eggs through the fallopian tubes.

“The cervix is a great filter mechanism,” Griffith said. “Only thousands of sperm make it to the uterus, and only hundreds make it to the tubes. With IUI, you’re getting millions of sperm into the uterus so that thousands make it into the tubes.”

The treatment is recommended for couples if the man's sperm count is high enough for insemination and the woman is under 35 with no obstacles to fertility. For men with extremely low sperm counts, IUI is unlikely to overcome that deficit.

“Sperm quality is enhanced, but the sperm still needs to do its job,” Detti said. “It needs to activate once it finds the egg and it has to penetrate the shell surrounding the egg.”

Courtney took Clomid and Ovidrel, medications designed to induce and boost ovulation. A doctor later inserted Jake’s sperm into her cervix using a catheter. Then the couple went home and waited.

When Courtney got her period as scheduled, the two repeated the process the next month. Again, it didn’t take.

A third attempt was delayed because Courtney developed a cyst on her ovary. Nearly five months after they'd begun the process, the Freemans decided if Courtney didn't get pregnant after the third attempt, they’d take a break.

Despite the couple's growing dismay, Courtney said the experience strengthened her relationship with Jake.

“I could see he cared about me,” she said. “He was doing everything he could to make our dream come true.”

'You don't really want to get your hopes up'

In July 2023, Courtney's period failed to come on time. As she prepared to administer a home pregnancy test, she tried not to get excited.

Jake was at work when the test read positive. She called the fertility center, where staff immediately summoned her to the lab for bloodwork. She didn’t want to say anything to Jake until she knew for sure.

The confirmation came back an hour later. The third time had worked.

“I was freaking out,” she recalled. “But until we saw the ultrasound, you don’t really know, you don’t really want to get your hopes up. That’s when it hit us – that we were really pregnant.”

Seeing those images was life-altering, Jake said. “I was like, this is for real now.”

While their journey was physically and emotionally difficult, Courtney said they’d do it all again for the incomparable reward.

Having an infant son, Jake said, makes it even harder to be away at work 10 to 12 hours, but he’s looking forward to celebrating his first Father’s Day as a parent.

“We’ll probably have the family over and cook some ribs or brisket and hang out,” he said. “It feels good. It’s like, ‘Yeah. I’m a dad.’”