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Despite the fact that approximately 30% of infertility is attributed to male factors, in many cases it appears that men are not as willing or as able as their female partners to talk about their experience. Perhaps this is because we traditionally think of children as a woman's province, or because over the ages, conception has been thought of as the woman's responsibility.
Many conditions contribute to the apparent disparity in male and female responses to infertility. Unlike women, men are not reminded on a monthly basis of their fertility or lack thereof thus exacerbating the feelings that men may appear less sensitive and distressed by childlessness. Monitoring ovulation is a woman's task, and contraception is often a female's responsibility. In contrast to women, men are removed from regularly being aware of fertility. Frequently the initial diagnosis of infertility is the result of the woman initiating diagnostic procedures with her gynecologist and her male partner often is not included in these office visits. Consequently they come into the diagnostic picture later on. The range of diagnostic procedures tends to be more invasive and complicated for women than for men. In addition, men often think of their reproductive system as uncomplicated and relatively simple with little that can disrupt its function. Of course this is untrue but it can distance men from the initial shock of infertility.
Why do men seem to lack significant emotion about their diagnosis of male infertility? Several factors probably come into play. Our culture is not replete with images of fathering in the same way it is with descriptions of women as mothers. A quick look through traditional men's magazines reveals very few articles on how to be a great dad. The exact opposite is true when we glance at women's publications where articles abound on how to make special clothing, costumes for Halloween and what to watch for with regard to childhood illness. Our culture shields men from developing expectations of their role as a parent. This may account for many men's seeming detachment when they discover that childlessness may be in their future. Additionally, our culture expects men to be strong in the face of adversity and deems emotional responses to events as weak. For men, strength almost requires emotional detachment. Furthermore, the very nature of men's involvement in pregnancy intensifies emotional detachment. For most men, pregnancy is a social experience. Contrast this with the very biological event of pregnancy for women and the discrepancy in emotional involvement is more easily understood.
Of course, the impact of an infertility diagnosis on men can be great, especially if they have long held ideas about becoming a parent. The same issues that confront women are present for men, and both sexes cope with having taken parenthood for granted. The failure of their procreative body functions is often devastating for men, especially since they are so closely linked with sexuality. Men may consider it an assault on their masculinity if they are the cause for the failure to conceive.
The notion of continuing a genetic line has strong emotional connections for many men, particularly those who are only sons. Infertility can mean not only the inability to pass along the family name but also the family genes. One result may be a man's retreat into silence about his infertility. This might be a gender specific response to stress, not necessarily a lack of feeling about the situation. In some cultures where masculinity or machismo is very important it is common to find the female partner taking public responsibility for the infertility as a way of protecting the man from the perceived shame of being the cause.
Sexual problems can surface with a diagnosis of male factor infertility. Erectile dysfunction and loss of desire can occur. If he feels that his masculinity is compromised a man may worry so much about his ability to function as a "man" that he finds himself unable to achieve or maintain an erection. Or, the same feelings can rob him of desire for sex. Treatment, which tends to remove the privacy of sex because diagnostic procedures can require "sex on demand", further exacerbate these problems, even when a couple is being sexual for other than procreative reasons. The fun and intimacy can leave the process due to worry and frustration. Some may feel that making love is pointless because it can't result in a pregnancy.
Marriages can suffer too. Some men react to their infertility by telling their wives that they would be better off with a "real" man who can impregnate them "naturally". They feel as though they have let their wives down. The stress can spill over into the marital relationship. Small disagreements can get blown out of proportion. And the opposite may happen just as easily. Some men may seek sex outside a marriage as a way of affirming their masculinity and desirability to a woman. On the other hand, a man can see infertility as a challenge to his relationship and find ways to improve it. Clearly some couples are drawn closer by the experience of infertility, particularly when each person sees it as a problem to be overcome by a team effort.
In addition to the marriage, other relationships may be strained by male factor infertility. Men may avoid relatives and friends who have children of their own. Holiday family celebrations can become difficult because the young children present are uncomfortable reminders of infertility. Since men are less likely to discuss their emotions with friends and co-workers, these interactions tend not to provide supportive outlets for frustrations.
The emotional responses of men to a diagnosis of infertility can be varied. The initial shock and pain of the diagnosis can be overwhelming and men might feel inadequate and defective. Additionally, failure and a sense that an important life experience will be missing could also occur. However, because men are less likely to show feelings of depression and sadness, their outward emotional reactions may be expressed in the form of verbal anger, a more socially acceptable mode of expression for men. In fact, anger may be a reaction to the grief that men feel about their infertility. As anger changes to other emotions that are less comfortable, men may retreat and repress any overt emotional responses. . It is not uncommon to hear men refer to themselves as "losers" or as being "less than a man."
Men utilize a variety of coping strategies to deal with their infertility. Often they will overcompensate in the other areas of their lives that enhance their self-esteem and in which they receive lots of attention. For example, men may throw themselves into work, sports, or problem solving activities. Positive feedback from employers, teammates or others who recognize their accomplishments may ease the pain of infertility. Men may also engage in activities to improve their marriages as a method to compensate for their biological "failure." Engaging in problem solving activities related to infertility treatment, and planning for alternative family building strategies, can also be a means of coping. Some men turn to support groups to reach out to others for emotional comfort.
It is important to note that infertility is a very personal experience. Consequently, not all men will experience every situation described in this article, as all men are individuals. Some men will bounce back more quickly than others, and some will seem unaffected by infertility. Regardless, it is important to understand that men's reactions fall within a range. While their coping styles may differ from their female counterparts, men nevertheless have much to cope with when they are diagnosed with infertility.