THE ROOM WAS dimly lit, but that was the point. On an otherwise ordinary L.A. day, the nice lady handed Colton Underwood a small cup and guided him into a room that, in many ways, looked like the place where you might get your annual physical. Except next to the chair covered in paper wrap there was a television—and a couple drawers of porn. Though this wasn’t exactly how he imagined it would go down, becoming a dad was always part of the plan. So after bouncing around a few NFL practice squads, becoming the Bachelor, publicly coming out as gay after said Bachelor season, starring in a Netflix special titled Coming Out Colton, getting married, and now taking the first step toward fatherhood, Underwood had arrived at the doctor’s office to masturbate.
His husband, political strategist Jordan C. Brown, was also in attendance. Much to the couple’s surprise, they were shown into the same room to collect their respective semen samples. “I don’t recommend it,” says Underwood, 32, of the team effort. “It’s a little distracting and also just, like, wasn’t the vibe, because from a medical standpoint you can’t do anything.” (Touching each othercould contaminate the sample.) Underwood opted to use his phone instead of the analog porn, though the situation still presented some difficulties, with patients just on the other side of the door talking to their doctors, giving blood, and getting ultrasounds. “It’s very hard to set a mood,” he says. “So for any men that like to have their setup and be specific, it’s challenging.”
After they completed the challenge—candles and music be damned!—the couple’s semen was run through an analysis, which is how they ended up in a corner office at a California fertility clinic to meet with their doctor and discuss their results. Underwood remembers it being dark, the blinds drawn. “I just figured I’d be good,” he says of his fertility. “I figured Jordan would be good. We’re healthy.”
Underwood was half right. Brown was good. He had, according to Underwood’s memory, a “crazy amount of sperm, like 50 or 55 million.”
As for Underwood?
“I had four,” he tells me. A few blond locks peek out coquettishly from his backwards black hat. His eyes are pale green, and dark stubble frames his camera-ready smile and cherubic face.
Like, four million? I ask.
“Four sperm,” says Underwood. “And three of them are dead. Word for word, what the doctor said, he goes, ‘Uh, I can maybe make this one work.’ This one?!”
UNDERWOOD IS AMONG the 15 percent of couples in the U.S. and 180 million people worldwide who will experience infertility, with male factor infertility playing a role about 50 percent of the time. In fact, male infertility rates have been on the rise globally, especially among young guys ages 30 to 34. And it’s not like things are getting better (or more fertile). A study review of more than 40,000 men found that the average sperm concentration had dropped more than 50 percent over a 38-year period, commonly referred to as Spermageddon. Though there is debate in the reproductive-health community about how alarming this finding is—sperm counts are notoriously hard to measure, and the range of a “normal” sperm count is vast, so even if it dropped, it doesn’t inherently constitute a crisis—there is consensus on one thing: Men need to be more conscious of their reproductive health.
That they haven’t been is largely due to women’s fertility getting more airtime, in part because they’re more vocal about sharing their stories, as well as the historic emphasis on women’s reproductive role in society. (See: get married, have kid, become caregiver.) “The main outcome of that, in terms of societal implications, is that there’s an entire medical specialty devoted to female reproductive health and there’s no parallel specialty for male reproduction,” explains Rene Almeling, Ph.D., a professor of sociology at Yale and the author of GUYnecology: The Missing Science of Men’s Reproductive Health. Or, as Underwood puts it, “men don’t have a dick doctor.” (No offense to the urologists out there.)
Because men aren’t accustomed to the same annual exams women are—or clearly even aware of whom they should discuss their fertility with, whether that’s a urologist or an endocrinologist or a primary-care doctor—awareness and education about male reproductive health has lagged. A high school sex-ed class is often the last time men think about their sperm count until the moment they are trying to conceive. And as you might imagine, between all the talk about how to properly put a condom on a banana and the fearmongering around venereal disease and becoming a teenage dad, there’s little room left to discuss male infertility. Boys are warned about the dangers of their sperm—not about the possibility that they might not have any. “I wish somebody had educated me about my sperm and my body, and the decisions that I made and how it would impact me,” says Underwood.
One thing he recently learned: “I didn’t know the difference between semen and sperm,” Underwood says. “If you’re [ejaculating], you just assume you have sperm.” Semen is the fluid that carries the sperm, which is typically present in about 5 percent of the entire volume. This is why a semen analysis uses a few different measurements: total volume of semen, sperm concentration (measured by the amount of sperm per milliliter, with “normal” defined as 20 million or higher), and motility (which measures how well the sperm can swim). Bobby B. Najari, M.D., a urologist at NYU Langone, tells me the factor he’s most interested in when predicting potential fertility is the “total motile count,” which combines volume with sperm concentration and motility. If you have a lot of semen, and your sperm are swimming like an Olympic medley team, you’re in good shape. If, like Underwood, you’ve got four and one is dog paddling with floaties on? Not as ideal.
“There’ll be men with a normal amount of semen, and they’ll have zero sperm in that semen,” explains Dr. Najari. “It comes as a total shock to them. They just assumed because a normal amount of semen was coming out that there is a healthy amount of sperm in that semen, but that’s not necessarily the case.”
Dr. Najari says the most common causes of infertility are varicoceles (swollen veins inside your testicles), difficulties with ejaculation (which can lead to a weaker orgasm, resulting in a lower volume of semen), and hormonal issues (like imbalanced testosterone and estrogen levels). Infertility can also be due to genetics, or it can be a result of environmental and lifestyle factors. On the environmental front, our world is littered with man-made chemicals that negatively impact the body’s ability to produce sperm. They’re known as endocrine-disrupting chemicals (EDCs). Though they include the nano- and microplastics that get so much media coverage, according to Shanna Swan, Ph.D., an environmental and reproductive epidemiologist, there are many others, too—like the chemical that keeps your jacket waterproof or your pizza box oilproof. On the lifestyle front, the most harmful behaviors are somewhat obvious, because they’re the same things your cardiologist would tell you to avoid: eating like crap, smoking, being extremely stressed out, getting smashed every weekend.
Except Underwood didn’t have any of these issues. Though his low sperm concentration was due to behavioral factors, it was—ironically—mostly a side effect of his healthy routine. Between hitting the hot tub for 30 minutes daily with his morning coffee, the sauna after working out, and baths at night to unwind, he was exposing his balls to too much heat. (This is why the scrotum is outside the body: Optimal sperm production happens at a temperature lower than the core body temperature.) He was also exercising too vigorously. “If your body undergoes stress, it diverts resources away from reproduction,” explains Dr. Najari. This is why activities like training for a marathon can make it more difficult to conceive.
On top of the exposure to heat and the exercise, Underwood also took testosterone to offset some damage he’d done by taking supplements when he played football. At the time, his T level tanked to 200 nanograms per deciliter (a healthy range is between 350 and 1,000 ng/dl), and the T boosted him up to 850 ng/dl. One of the effects of being on testosterone-replacement therapy, however, is that your pituitary gland senses it’s getting testosterone from another source and tells your testicles, the natural source of testosterone, to stop producing it. That’s bad news, since a man’s rocks need a large amount to make sperm. (The scrotum has about 100 times the amount found in the blood.) Apparently, nobody told him this. So Underwood and his doctor created a game plan for him to change his lifestyle and get his sperm count back up. They’d test him at three months—that’s how long it takes to complete spermatogenesis, which is the full cycle of sperm production and maturation—and then again three months later.
FOR THE NEXT six months, Underwood went to “sperm rehab.” He got off the testosterone, which ended up making him grumpy and left him with little sex drive and energy. He worked out four days a week instead of seven. He threw his Peloton into the garage to collect some dust. He replaced his morning hottub sit with walks first thing in the a.m., trying to get sunlight within ten minutes of waking up. (Thank you, Andrew Huberman.) He flirted with the idea of buying a Kiwi Kooler, an ice pack that looks like a kicker’s tee and slides under your balls to keep them cool. It’s meant for men recovering from vasectomies but can also apparently be used by relapsing hot-tub and sauna addicts. Ultimately, he opted not to. “Once I’m in, I’m in,” he says of his ability to stick to a routine, honed, in part, during years of operating with a meticulously micromanaged schedule when he was playing football in college and the NFL. So he stuck with the protocol. He started noticing his semen was more voluminous. “There was a lot more than normal,” he says.
By the end of the six months, Underwood’s sperm count was back up in the millions, and he and Jordan were able to resume their journey to fatherhood. For them, that meant pursuing in vitro fertilization (IVF) through a surrogate—a process that would lead them to have a fertility team of up to nine people, with a price tag of around $350,000 (that includes paying for the egg, which is priced by the donor). They found an egg donor by using a concierge service that sounds a lot like online dating: Brown and Underwood were presented with profiles featuring pictures and multiple pages of information, including everything from where the donor went to school to her STD history. They were looking for someone spontaneous and adventurous; someone who had traveled abroad. “Some people want blue eyes and blond hair,” he says. “We want somebody deep and cool. I believe in nature versus nurture. So give us the basics and we can show this kid love.”
When Underwood and Brown matched with an egg donor six months later, they met with her virtually using black screens and aliases. That anonymity almost went out the window when, in the months after, Underwood hopped on an elevator at his doctor’s office for a routine physical, only to find his egg donor in the same elevator. Underwood knew her identity, but she had no idea of his—and luckily didn’t recognize him from TV. She was going in for her final round of hormone tests before her egg retrieval at the fertility clinic, which was in the same building. “What was cool about it is that there’s not a lot of humanization in the [egg donor matching] process,” he says. “So for me to share an elevator ride, as silly as it sounds, was such a bonding thing and also just such reassurance that we were on the right path.”
Brown and Underwood ended up receiving 22 eggs from her, which their sperm was divided into evenly. Eventually, three embryos were fertilized, and the healthiest one was transferred into the surrogate. (The couple plans to have two children, and whoever’s sperm wasn’t used this time will be used the second time.) Brown and Underwood knew when the embryo transfer was happening and opted to use that time to be intimate together, to have the “sexy time” they did not have in the decidedly clinical setting in which they’d handed over their sperm. “We just thought that, as the transfer is happening, it’s really important that we feel a part of it somehow,” Underwood says. “Because we’re building our family in love.”
Ten days later, while they were driving Underwood’s black Defender down to Palm Springs, they got the news: The transfer had worked. They are expecting a baby boy this October. Though they don’t know whose sperm was used, they don’t think it’ll be that hard to tell.
WHEN UNDERWOOD TELLS me about his impending fatherhood—his hopes, his fears—we’re sitting on the back patio of the house he shares with Brown, not too far from the room upstairs that will eventually become the nursery. The sun falls across a long wooden table, where Underwood holds a green coffee mug. He says he made the decision to document his path to fatherhood a couple years ago, in part because he grew up in a small town in Illinois and saw an opportunity to answer questions that he believed parts of America might have about a gay couple entering fatherhood. He also thought it’d be fun because, well, “I love sharing my life.”
“I had my own family asking me how this process works, like, Who’s the mom and who’s the dad in the relationship? Who’s the boy and who’s the girl? How does the mom work? Are the egg donor and surrogate the same?” So he built out the concept to do a podcast about becoming a father called, slyly, Daddyhood. “I’m only 32, but people weirdly comment ‘daddy’ on my photos, and I’m like, I’ll enter my daddyhood for you,” he jokes.
But that was before he had his sperm tested. After getting the results, he contacted his team to let them know that the show would have to be called off. “The whole point of me doing a podcast and not putting cameras in my house, besides the fact that Jordan would never do that, was to protect myself a little more, to not let people in,” he says. Discussing his infertility felt like letting people in. Then he talked to friends who had gone through the same thing but didn’t have an outlet to discuss it. “I was like, Oh, I should talk about this publicly,” says Underwood. “Because nobody talks about this publicly.”
That men have been reluctant to discuss their infertility is directly related to what it implies about one’s “manhood.” Culturally, we describe impotence as “shooting blanks,” stigmatizing infertile men as less than capable. “I definitely get a sense of shock, embarrassment, and disappointment in many men who are told that their sperm count is low,” says Dr. Najari. “There is an emotional component that is very tough for men.” Underwood experienced this, too. “There’s such shame,” he says. “Women have too many responsibilities when it comes to giving birth, so for men to have literally one responsibility—have sperm that works to get to the egg—and you can’t even do that? That’s why it’s a blow to your ego.”
All the experts I spoke to for this story stressed the importance of guys caring about their sperm health, regardless of whether or not they want to have kids. “We think of sperm as a sexual or reproductive fluid,” says Almeling, the sociologist from Yale. “There is an emerging awareness among physicians and scientists, and they’re making the argument that sperm should also be used as a biomarker. Sperm is a very easily accessible bodily material, and they’re able to do assessments of sperm now that give insights into a person’s future health.” Case in point: Some studies have even linked low sperm count to heart disease. So male fertility isn’t just about reproduction; it’s about, well, health.
“Any man, whether he’s worried about having a child or not, would benefit from getting his sperm tested,” says Swan. “It tells him something about his health, about his chance of conceiving accidentally or deliberately. A single man would want to know that, too.” At-home semen-analysis kits have become more widely available due to the shame and embarrassment guys often feel surrounding the in-person semen collection process, though experts still recommend making an appointment with your doctor for the most accurate lab results and to prevent any potential delays in treatment.
Such a shift in the way we think about male fertility will require a different type of societal discussion around male reproductive health—which brings us back not just to Underwood but also to the boy he’s getting ready to raise. I ask Underwood how his infertility affected the way he thought about manhood and masculinity and shaped how he wanted to pass those thoughts down to his son. He says those ideas are ones he’s been thinking about more since he came out as gay in 2021. Since then, he’s been getting more in touch with his “feminine side and feminine energy” and trying to figure out what he wants to keep from who he used to be, knowing that many of the identities he’s occupied—devout Christian, football player, the Bachelor—have circumscribed a type of heteronormative maleness that wasn’t authentic to him.
“For me, having the experiences that I have from both the church and football, I’ve dealt with a lot of the toxic masculinity,” he says. “I know that phrase gets overused quite a bit, but there’s very much still stigma and things that go on in the sports culture, specifically. Just giving our child the freedom to express themselves and to be pure is what I want.”
He continues, “I still have a lot of conservative people in my life, and I hear it on the news like, Everybody’s bi or gay now, and it’s like, I would much rather somebody label themselves bi while they’re figuring it out than label themselves straight like I did and cause harm to themselves or to the people in their lives because they put themselves into a corner that they couldn’t get out of. That’s what happened to me at such a young age. That all ties into the masculinity conversation that men should be having.”
It also plays into Underwood’s decision to share how he got here—infertility and all. He wants to put an image of a gay, Christian dad into the world that he wishes he had seen as a second grader. A second grader who, when his teacher asked him what he wanted to be when he grew up, said “stay-at-home dad” after the teacher told him “NFL player” wasn’t realistic. Those roles felt incongruent growing up—but maybe they won’t have to for his son.
I ask him what he’d say to that second grader, sitting here now as an expectant father.
“Buckle up,” he says with a laugh. “It’s gonna feel rough at times, it’s gonna feel confusing, and it’s gonna be really, really hard.” He tells me he can’t stand when people say they have no regrets, because he has “a million” of them. “But it’s worth it, and once the baby’s here, it’s gonna be so rewarding—and I just appreciate the journey that much more.”
