Ten percent of couples trying to conceive will have difficulty. It is now taken for granted that a male factor is involved in about half of such couples experiencing a fertility problem. Yet for some reason, the public awareness of this fact appears limited, if not absent. Literature and the media have both largely ignored the torment some men go through when found to have impaired fertility. A recent review article in the August journal Fertility and Sterility discusses fertility counseling for the “forgotten male”.
The review by William Petok points out that a female bias is not new. There are several biblical references in fact, to female infertility including the stories of Sarah, Rebecca, Rachel and Hannah, all of which featured themes of female fertility issues. Even in contemporary literature, there is a relative paucity of concern for male fertility issues. In the media, there has been an increasing willingness to discuss stories of couples having difficulty conceiving; but yet these reports never seems to identify when a specific male factor is responsible other than in cases where male malignancy such as testicular cancer is involved.
Men with fertility issues even seem to be under represented in social media as well. The net effect of this lack of visibility of male infertility is to make male patients feel even more isolated, and to make resources to help vulnerable males even more scarce than their need would support.
Studies on the subject vary in their conclusions. In some studies. Men show more distress when a male factor is identified and in others, there is no difference in male distress regardless of the source of the fertility issue. On the other hand, some reports note an equation by males between fertility and their “masculinity” or “virility”. This may be more true of certain cultures which express more defined gender roles. In such cultures, findings of infertility can morph into feelings of inadequacy.
Patient advocacy organizations such a s Path 2 parenthood and RESOLVE do provide male focused materials on their websites and also provide some in person and on line support by the way of support groups However one report stated that few men valued or used infertility support groups. In fact, no matter what the health issue, men generally avail themselves of support resources less frequently than do women. Therefore, part of the issue here may be intrinsic to the male psyche.
In my practice experience, I have noticed a few common themes in this area. The first is that for many men, the greatest source of distress is not a feeling of failure or inadequacy of their own, but rather, the distress comes from their desire not to disappoint their partners. Second, for some men who are unable to overcome their reproductive difficulties, a redirection of focus upon starting one’s family in a different way (adoption, donor insemination) is sometimes helpful; unfortunately, for others, those options sometimes only add to the distress. The third theme I have noticed is a feeling that some reproductive endocrinologists (RE’s) view the male patient as essentially a sperm provider. An RE is a female fertility specialist, but is also often the doctor who first discusses the issue of a male factor with the couple; therefore, structurally, the wife is actually the patient. I must emphasize that (in my opinion) this feeling does not come from a lack of consideration on the part of the RE, but rather simply how physician patient roles are often structured. Therefore, urologists who play a role in male fertility evaluation and treatment, can often be a source of comfort and reassurance to the male infertility patient.
