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Past Article of the Month Originally Published 08/02/2012
Could It Be Me? Psychological Effects of Male Factor Infertility

When it comes to a diagnosis of infertility, there is truly equality of the sexes, with men and women contributing fairly evenly to the problem. It is estimated that about 35-40% of infertility can be attributed to a male factor, 35-40% to a female factor, and the rest is either undetermined or a combination of the couple. What causes male fertility problems? Oftentimes the problem lies in the sperm itself. The number, or sperm count, may be too low; the shape, or morphology, of the sperm may be abnormal; and the speed at which the sperm moves, or motility, may be too slow. Sperm that have poor morphology may not be able to penetrate or fertilize the egg, and sperm with low motility may not be able to successfully make the journey through the fallopian tubes; they may not even be able to reach the egg. Men may also have structural problems that interfere with the sperms ability to travel. Scar tissue from surgery or infection can block pathways. Varicose veins in the scrotum, or varicoceles, which are otherwise usually harmless, can also be a cause of infertility. Men who are diagnosed with infertility must not only contend with the physical problems, but must deal with the emotional ramifications as well. They often experience low self-esteem, and feelings of guilt, sadness, and anger. They may associate their sense of masculinity with their ability to get their partner pregnant. Men often worry that they are less of a man if they have fertility issues; they may believe that a low sperm count, for example, means they are less virile. They may feel guilty that past behavior may have contributed to their current problem. The locker room joke describing men as shooting blanks becomes all too real with infertility. The inadequacy that men feel may seep into their work life, social life, and intimate sexual relationship. Indeed, many men develop performance anxiety. It is not uncommon for men to suffer from erectile dysfunction not as a cause of infertility, but as a result. Although statistically men and women share equally in the burden of infertility disorders, women often bear the brunt of the emotional weight of the diagnosis. Whether this is because of societal pressures to become a mother, or because they somehow want to protect their partner from the feelings of shame described above is not clear. Women also bear the lions share of focus during treatment needing more diagnostic monitoring and invasive testing, and often requiring hormonal injections. The focus on women in this process can often leave men feeling left out. Adding to their sense of inadequacy, they may feel that the doctor will get their partner pregnant, not them. Contributing to the embarrassment, men are asked to deliver a sperm sample on demand, and asked to masturbate in a room in the clinic. One man described the experience as humiliating: even though he was in a private room, he could hear the activities of the clinic through the door, knew that the doctors were waiting for him, felt pressured to produce, and felt entirely exposed. Because so much of the focus is on the female partner, men are often relegated to the background. It is essential for all involved the doctors, clinic staff, therapists, family, friends, indeed the couple themselves to be aware that men have intense feelings about their inability to have a family, just as women do. Because men may put their partners feelings first and want to take care of her, they may appear to be functioning better than they really are. Frequently men find themselves in the role of supportive coach, assuring his partner that: we will get through this. It is not uncommon for men to deny their feelings at least outwardly in order not to upset an already emotionally distraught partner. Unfortunately, this dynamic may backfire, as what women repeatedly ask for is open and honest communication. Sharing feelings, discussing the uncomfortable and trying process of fertility treatments, can insure that the couple will be able to whether this storm. Unlike other diseases, which affect the individual, infertility is a shared malady. The burden of an infertility diagnosis be it male or female factor can be eased if the couple addresses it as a team. * Back
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