Patterns of suffering and social interactions in infertile men: 12 months after unsuccessful treatment

Research shows that men diagnosed with male factor infertility experience more suffering than men with infertility due to other causes, and that it is socially unfavourable to be diagnosed with male factor infertility resulting in secrecy surrounding diagnosis, sometimes to the point that women take the blame for the couples' infertility. We investigated mental and physical health, support, and psychological and social stress in men (N = 256) prior to and after 12 months of unsuccessful treatment according to their diagnosis: unexplained, female factor, male factor, or mixed. Results suggest that men do not differ by diagnosis on any of the variables tested. When treatment was not successful, all men showed increased suffering in the form of decreased mental health, increased physical stress reactions, decreased social support, and increased negative social stress over time. These findings indicate that involuntary childlessness is difficult for all men, and is not dependent on with whom the cause lies. There was also a high level of agreement between couples and medical records on the cause of the couples' fertility arguing against the idea that women take the blame for male factor infertility.     

(Male) infertility: what does it mean to men? New evidence from quantitative and qualitative studies

Scientific knowledge of the emotional repercussions of infertility on men remains limited and has only recently become the focus of social science research. Firstly, the current developments in research on the psychosocial impact of infertility on men through a search of the literature over the last 10 years are outlined in this paper. In the second section, issues raised in pretreatment counselling for men and their partner who consider donor insemination are described as this treatment typically raises many emotional issues. The results of more recent studies with sophisticated methodological design show that the emotional impact of infertility may be nearly balanced, suggesting that men do suffer as well and that they have to be addressed in infertility counselling too. The emotional and clinical aspects of donor insemination support the hypothesis that the emotional repercussions of infertility affect both sexes. In general, male factor infertility seems to be more stigmatized than other infertility diagnoses. Forthcoming studies have to differentiate between the psychological impact of infertility on women and men and their respective abilities to communicate easily about this distress. More studies on infertile men in non-Western societies need to be conducted in order to understand the cultural impact on infertility.According to an American study, almost half of the women but only 15% of the men consider infertility the most upsetting experience of their lives. It would be easy to assume that infertility is predominantly a female problem. However, this assumption is likely to be based on out-dated gender stereotypes and inadequate methodology. The results of much of the formerly available research supporting women’s greater overt distress in response to infertility may well reflect differences in the ways men and women have been socialized to cope with negative affect. More recent qualitative and quantitative research indicates that the emotional impact may be nearly balanced, suggesting that men do suffer as well and that they have to be addressed in infertility counselling too. In many cultures, male infertility remains a stigmatized condition and associated with a lack of virility and masculinity. For men, this may result in secrecy surrounding diagnosis, sometimes to the point where the female partner takes the blame for the couple’s inability to conceive. Based on qualitative and of recent quantitative research, this article will outline important aspects of (male) infertility and challenge the notion of the “emotionally unaffected” male. It will also draw on typical emotional and clinical aspects of donor insemination, a family-building alternative in which many emotional issues of male infertility culminate, thus supporting the hypothesis that the emotional repercussions of infertility affect both sexes similarly.     

The Fertility Problem Inventory: measuring perceived infertility-related stress.

OBJECTIVE: To develop a reliable, valid instrument to evaluate perceived infertility-related stress. DESIGN: Prospective study. SETTING: University-affiliated teaching hospital. PATIENT(S): Consecutively referred patients (1,153 women and 1,149 men) seen for infertility treatment. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Participants' infertility-related stress was assessed by written questionnaire using the Fertility Problem Inventory. Current levels of anxiety, depression, and marital satisfaction also were determined. RESULT(S): Women described greater global stress than men and higher specific stress in terms of social concerns, sexual concerns, and need for parenthood. Both men and women facing male infertility reported higher global stress and more social and sexual concerns than men and women experiencing female infertility. Social, sexual, and relationship concerns related to infertility were more effective predictors of depression and marital dissatisfaction than expressed needs for parenthood or attitudes toward child-free living. CONCLUSION(S): The Fertility Problem Inventory provides a reliable measure of perceived infertility-related stress and specific information on five separate domains of patient concern. Patterns of infertility-related stress differed depending on gender, fertility history, and infertility diagnosis. Among patients receiving treatment, social, sexual, and relationship concerns appear central to current distress. Counseling interventions that target these domains appear likely to offer maximal therapeutic benefit.     

Sexual,Marital, and Social Impact of a Man's Perceived Infertility Diagnosis

IntroductionMale factor infertility is a relatively common problem. This diagnosis may increase sexual, marital, and relationship strain in male partners of infertile couples.AimTo measure the personal, social, sexual, and marital impacts of a male factor infertility diagnosis among men in couples evaluated for infertility.MethodsCross-sectional analysis of 357 men in infertile couples from eight academic and community-based fertility clinics. Participants completed written surveys and face-to-face and telephone interviews at study enrollment. This interview queried each participant's perception of their infertility etiology to determine the primary study exposure (i.e., male factor only, male and female factors, female factor only, unknown).Main Outcome MeasuresPersonal Impact, Social Impact, Marital Impact, and Sexual Impact scales.ResultsAmong the 357 men, no male factor was reported in 47%, isolated male factor was present in 12%, combined male and female factors were present in 16%, and unexplained infertility was present in 25% of couples. Male factor infertility was independently associated with worse Sexual (mean 39 vs. 30, standard deviation [SD] 2.7, P = 0.004) and Personal (mean 37 vs. 29, SD 3.8, P = 0.04) Impact scores relative to men in couples without male factor infertility. These differences remained statistically significant after controlling for male age, partner age, race, religion, educational level, employment status, prior pregnancy, duration of infertility, and prior paternity.ConclusionsMale partners in couples who perceive isolated male factor infertility have a lower sexual and personal quality of life compared with male partners of couples without perceived male factor infertility. Social strain is highest among couples without a clear etiology for infertility. These findings highlight the clinically significant negative sexual, personal, and social strains of a perceived infertility diagnosis for men. Smith JF, Walsh TJ, Shindel AW, Turek PJ, Wing H, Pasch L, Katz PP, and The Infertility Outcomes Program Project Group. Sexual, marital, and social impact of a man's perceived infertility diagnosis. J Sex Med 2009;6:2505–2515.     

What every gynecologist should know about male infertility: an update

Purpose

Our article reviews the evolving concepts in the field of male infertility for gynecologists and other health professionals involved in the care of men and women experiencing difficulty in having a child. The increased knowledge will help in the better management and treatment of infertile couples.

Methods

Review of literature through Pubmed, Science Direct, Online Library.

Results

Gynecologists are often the first healthcare providers to assess an infertile couple. Because half of all infertility problems stem from male factors, it is crucial for the gynecologist to remain updated on the main conditions that cause male infertility as well as current diagnostic tools and treatment options, including conventional strategies and assisted reproductive techniques.

Conclusions

Extraordinary advances have been achieved in the field of male infertility over the past several years and many old concepts are now challenged. Therefore, it is imperative that male infertility physicians should update the gynecologists about the recent advances in the work-up of infertile men in terms of diagnosis and management. Such convention will help improve the standards of care for the infertile couple and enhance the cooperation between male and female reproductive endocrinologists.     

Women's health: the unfinished agenda.

Improving women's health and nutrition could save millions of women in developing countries from needless suffering or premature death. Cost-effective health interventions exist to prevent this loss of lives. Complications of pregnancy and childbirth are the leading cause of death and disability among women of reproductive age in developing countries. Malnutrition is a major contributory factor to women's poor health and preventable mortality. Domestic violence, sexual abuse, and female genital mutilation carry a heavy physical and mental toll, as well as constitute an intolerable violation of human rights. Women's health is influenced by complex biological, social, and cultural factors that are highly interrelated. Significant progress can be achieved by strengthening and expanding an essential package of health services for women, improving the policy environment, and promoting more positive attitudes and behavior towards women's health.     

Mapping men’s anticipations and experiences in the reproductive realm: (in)fertility journeys

This paper examines men’s experiences of fertility/infertility against a backdrop of changing understandings of men’s role in society and medical possibilities. It presents findings from two qualitative research projects on men’s experiences of engagement with reproductive health services as they sought to become fathers and anticipate impending fatherhood. The findings from both projects provide insights into men’s experiences of (in)fertility and their engagement with services set against cultural ideals of masculinity. Discussions of reproduction have historically focused most centrally upon women’s bodies and maternal processes, leaving little space for consideration of men’s experiences and perspectives. While women’s experiences of infertility/fertility have been characterized in relation to productive or faulty biological processes, male infertility has been largely invisible and male fertility typically assumed. This context provides a difficult terrain for men in which to contemplate the potential of not being able to father a child. The findings discussed in this paper illuminate the ways in which men talk about and make sense of their reproductive journeys. In doing so, it challenges current understandings of masculinity and reproductive bodies and highlights the need to rethink how men are treated in reproductive spheres and how services to men are delivered.This paper examines the results of two interview studies that explored men’s experiences of fertility and infertility against a backdrop of changing understandings of men’s role in society and rapidly changing medical possibilities. It draws together two separate qualitative research projects that explored men’s experiences of seeking to become fathers. One followed men as they became fathers for the first time, the other was a study of men’s experiences of infertility. The findings from both projects are analysed to provide insights into men’s experiences of fertility and infertility and their engagement with health services, set against current social and cultural ideas of masculinity. Before the advent of fertility treatment, discussions of reproduction focused almost exclusively on the woman’s body. Pregnancy and childbirth was women’s business. There was little consideration of men’s experiences and perspectives. Although male factor infertility is now a leading cause of couples seeking treatment, the focus remains the woman. As assisted reproduction treatment has developed over the last half-century, most social and psychological research has explored the woman’s perspective. The findings discussed in this paper illuminate the ways in which men try and make sense of their own successful or unsuccessful reproductive journeys. In doing so it challenges current understandings of masculinity and reproductive bodies. It also highlights how we need to perhaps rethink how men are treated in reproductive spheres and how services to men are delivered.     

The factor structure of prenatal psychological and psychosocial functioning in first-time expectant parents

To evaluate the psychological and psychosocial functioning of couples undergoing their first pregnancy, 327 couples from Melbourne, Victoria completed measures of depression, anger, anxiety, positive and negative affect, current social support, perceived quality of couple's relationship, and recalled childhood family relationships during the early third trimester of pregnancy. To examine the nature of the pregnant couples' experience of pregnancy, an exploratory factor analysis was conducted separately for males and females. Four similar but not identical clusters were identified for both the men and women. The first large general factor for both sexes was concerned with psychological dysphoria (anxiety, anger and gender role stress). Three group factors were concerned separately with the individual's relationship functioning, their social support from family and friends, and the quality of their recalled childhood family relationships. Confirmatory factor analysis indicated these four-dimensional solutions showed good fit to the data and indicated differences between the female and male underlying structures. The differences between the men and women's factor structure are examined and implications of these findings are discussed.     

Men at risk: occupation and male infertility

There is accumulating evidence that workplace exposure to toxic substances contributes to male infertility. Men suffering from infertility problems may do well to look at their occupations, where exposure to certain substances may be a contributory factor, if not a direct cause, of infertility. Most of the studies to date are either case reports or epidemiological studies (population-based, case-control, or cohort studies). Additional, controlled studies need to be done to ascertain the effects of occupational toxins on male infertility. Until then, men and their employers should work together to minimize exposure to these substances.     

Trichomoniasis: under control or undercontrolled?

Aside from human papillomavirus, trichomoniasis is the most common sexually transmitted infection in the United States today, yet it has long been regarded as a sexually transmitted infection of minor importance. Medical opinion has traditionally held that it plays little role in health complications in women, and it is rarely seen in men. However, evidence has recently accumulated implicating Trichomonas vaginalis as a contributor to a variety of adverse outcomes among both sexes. Among both women and men, the association of T vaginalis with human immunodeficiency acquisition and transmission has been shown in multiple studies. Among women, trichomoniasis may play a role in development of cervical neoplasia, postoperative infections, and adverse pregnancy outcomes and as a factor in atypical pelvic inflammatory disease and infertility. Among men, trichomoniasis has emerged as a cause of nongonoccocal urethritis and as contributing to male factor infertility. As evidence continues to accumulate, the time has come to increase diagnostic efforts beyond traditional sexually transmitted disease clinic settings.     

Infertility in rural Ghana.

OBJECTIVES: This study measured the prevalence of self-reported infertility, as well as the level of knowledge of causes of infertility. Infertility was defined as failure to achieve conception after a minimum of 12 months of exposure. METHODS: Prevalence and knowledge of infertility were assessed in a representative community-based survey using a structured questionnaire in a rural district in Ghana among a random sample of 2,179 men and women from 15 to 49 years. RESULTS: The prevalence of infertility was 11.8% among women and 15.8% among men. The knowledge of causes of infertility was limited; only 46.5% of the respondents reported any cause. Most respondents failed to identify reproductive tract infections as causes of infertility. CONCLUSIONS: Infertility in Ghana and other sub-Saharan countries deserves more recognition as a public health problem. Prevention and treatment of infertility should be incorporated in reproductive health programs, while male participation in reproductive health programs and research needs to be encouraged. Public education about the causes of infertility is recommended.     

Effects of reproductive morbidity on women's lives and costs of accessing treatment in Yemen

Research on the consequences of reproductive morbidity for women's lives and their economic and social roles is relatively under-developed. There is also a lack of consensus on appropriate conceptual frameworks to understand the social determinants of reproductive morbidity as well as their social and economic implications. We report here on an exploratory study in Yemen using quantitative (n=72 women) and qualitative methods (n=35 women), in 2005 and 2007 respectively, with women suffering from uterine prolapse, infertility or pelvic inflammatory disease (PID). It explored women's views on how reproductive morbidity affected their lives, marital security and their households, and the burden of paying for treatment. We also interviewed six health professionals about women's health care-seeking for these conditions. Sixty per cent of women reported that treatment was not affordable, and 43% had to sell assets or take out a loan to pay for care. Prolapse and PID interfered particularly in subsistence and household activities while infertility created social pressure. Reproductive morbidity is not a priority in Yemen, given its multiple public health needs and low resources, but by failing to provide comprehensive and affordable services for women, the country incurs developmental losses.     

Perceptions of infertility and treatment stress in females as compared with males entering in vitro fertilization treatment.

OBJECTIVE: To determine gender similarities and differences in perceptions of infertility and anticipated treatment stress in couples enrolling for in vitro fertilization (IVF) treatment. DESIGN: Both partners were evaluated at enrollment of IVF treatment. The evaluation was part of the screening procedure. SETTING: The Department of Obstetrics and Gynecology at a teaching hospital. PATIENTS, PARTICIPANTS: Two hundred consecutive couples who entered an IVF treatment program. MAIN OUTCOME MEASURES: Self-report questionnaire included items on the duration of infertility, degree of social support, effect of infertility on sexual relationship, expected likelihood of achieving pregnancy, anticipation of stress during treatment, and a self-rating scale of emotional reactions to infertility. RESULTS: The women anticipated more stress in IVF treatment but also rated greater degree of social support than the men. Both partners overestimated their chances of a successful treatment outcome. Factor analysis of the Infertility Scale produced three factors that were similar for both sexes. The first factor represented the desire to have a child as a major focus of life with inadequacy of the male role, social functioning and work efficiency, and pressure to have a child following. CONCLUSIONS: Women reported more stress, but the factors affecting stress of infertility were very similar for both partners. The intense focus on having a child was the predominant factor in anticipated stress of IVF treatment for both males and females.     

Women still bearing the blows in reproductive health

Only women can experience the health threats of pregnancy and childbirth. Responsibility for the survival, growth, and development of children falls mainly on their shoulders. Sexually transmitted diseases cause more severe effects in women than men. Women are 3 times more likely to use contraceptives than men Yet female contraceptive methods are more of a threat to health an are male methods. Even though infertility occurs in both men and women, in most countries, women face its negative social and psychological effects more often than do men. Besides, almost everywhere, social and economic indicators show women to be of lower status than men. For example, female literacy rates in developing countries are 33% lower than those of male, even though leaders have known for a long time that female education improves use of health care and family planning services. Furthermore, females are at a disadvantage from birth in terms of education, nutrition, and society which places them at high risk of adverse health. Some societies even endorse method to prevent women from enjoying sexual intercourse. Premarital sex and adolescent pregnancy are increasing worldwide, which adds to women's already high burden. In Argentina, women less than 18 years of age, especially those in rural areas and little education, have higher fertility rates than those older than 18 years. They tend to be ignorant of reproductive processes, but familiar with contraceptives; yet, only 40% of sexually active adolescents had ever used them. Besides, teenage males think that concern about becoming pregnant is the female's responsibility. Indeed, women's status and reproductive health are interrelated. Ability to regulate their own fertility strengthens women's status, but if they cannot do so, they cannot go to school, be employable, or make their own decisions.     

Support from health care providers and the psychological adjustment of individuals experiencing infertility

OBJECTIVE: To examine the relationship between support from health care providers and psychological adjustment for men and women experiencing infertility. DESIGN: Survey research using confidential self-administered questionnaires. PARTICIPANTS: One hundred twenty individuals experiencing infertility within their couple relationship participated in this study (60.8% women; 29.3% men). MAIN OUTCOME MEASURES: Perceived support from health care providers was hypothesized to be related to stress, anxiety, and depression. Various treatment variables were held constant in the regression analyses. RESULTS: For women, perceived support from health care providers did not predict levels of stress, depression, or anxiety. For men, greater levels of perceived support from health care providers predicted lower levels of stress (FChange = 4.90, p < .05) and anxiety (FChange = 4.81, p < .05) but not depression. CONCLUSION: Much research exists indicating that friend and family support is a buffer to negative psychological adjustment for women. The results of this study emphasize that the study of support from nurses and other health care providers might provide greater understanding of ways to buffer negative psychological adjustment for men experiencing infertility in the couple relationship.     

The Association of Physical and Mental Health with Sexual Activity in Older Adults in a Retirement Community

IntroductionUnderstanding sexual behavior is important when evaluating the health needs of older adults. Little research has addressed the effect of specific health conditions on sexual inactivity in this growing population.AimThe study aims to assess the association of mental and physical health conditions with sexual inactivity among adults 55 and older living in The Villages, Florida.MethodsExposure data for 22 self‐reported health conditions were assessed in relation to sexual inactivity in 22,654 participants ages 55 and older, including 1,879 participants over age 80 in a community‐based cross‐sectional study. Logistic regression analyses were conducted separately for men and women to evaluate the likelihood of being sexually active for each health condition. Covariates included age, race, education, income, self‐reported overall health, and marital status.Main Outcome MeasuresThe odds ratio and 95% confidence intervals for sexual activity status were calculated separately for men and women.ResultsFifty‐five percent of men and 45% of women reported being sexually active. Significant positive correlates of sexual activity included walking at least 1–2 times per week, participating in at least two registered clubs, engaging in physical and social activities, no tobacco use, fewer medications, increased alcohol consumption, and reporting a good quality of life, psychological well‐being, or social support. Sexual inactivity was significantly related to cancer, bladder/bowl problems, major surgery, poor vision, mental health conditions, and cardiovascular disease and its risk factors including diabetes, hypertension, and high cholesterol. Additional associations with sexual inactivity included hearing loss and dementia for men, and dermatologic conditions, problems with the joints, bone or back, gastrointestinal problems, alcohol misuse, chronic wound care, and gum disease in women.ConclusionsMental and physical health conditions have very similar associations with sexual inactivity in men and women. Increased sexual activity was associated with positive physical, social, and emotional health indicators. Bach LE, Mortimer JA, VandeWeerd C, and Corvin J. The association of physical and mental health with sexual activity in older adults in a retirement community. J Sex Med 2013;10:2671–2678.     

Assisted reproductive technologies for male factor infertility

Experience in the diagnosis and treatment of infertility has led to an increased understanding of the prominent role male factors play in many couples' inability to conceive. While many forms of male factor infertility are amenable to treatment, for some patients there is no corrective therapy available. For this reason, a great deal of attention has been focused on developing technologies for semen processing and sperm utilization in cases of decreased semen quality. One area of research is the development of more sophisticated methods of assessing sperm function, as well as methods of sperm preparation. Progress is also being made in the application of technologies such as intrauterine insemination and in vitro fertilization in the treatment of male factor infertility. Such developments have improved prospects for fertility among patients suffering from decreased semen quality, as well as those suffering from such disorders as ejaculatory failure and congenital vasal agenesis. Current research also offers promise for future applications such as gamete micromanipulation. This technology holds potential for improving fertility even among patients suffering from profound male factor disorders. The following is a summary of recent publications pertaining to the application of these assisted reproductive technologies in the management of male factor infertility.     

Laparoscopy for the treatment of unexplained infertility

Aim:  To determine the best treatment for unexplained infertility.
Methods:  A retrospective study was used to examine Japanese women with unexplained infertility that had undergone laparoscopy. The main outcome measure of the study was the rate of pregnancy after laparoscopy.
Results:  One hundred and thirty-eight women diagnosed with unexplained infertility received laparoscopy and as a result 55 women had their diagnosis of unexplained infertility confirmed. There were no statistically significant differences between the women who became pregnant after laparoscopy in terms of duration of infertility, duration of treatment or age. The pregnancy rate of women with unexplained infertility was 56.4%, with 90% of these pregnancies achieved within the first 6 months. There were 64 women with minor endometriosis considered to be suffering from unexplained infertility before laparoscopy. The characteristics of the patients in the unexplained infertility group and in the minor endometriosis group were similar, but patients with minor endometriosis were found to have a lower pregnancy rate compared to those with unexplained infertility (35.9% vs 56.4%; P  = 0.02).
Conclusions:  The effective period after laparoscopy appears to be 6 months. Assisted reproductive technology should be considered after that time. Pregnancy rates were low in women with minor endometriosis compared with unexplained infertility. It is important to clarify the cause of infertility using laparoscopy. (Reprod Med Biol 2006; 5 : 59–64)     

Survey of psychological health in women with infertility

The aims of this study were to assess mental well-being in women undergoing investigation and initial management of infertility and to determine any specific factors, such as the duration or type of infertility, that might be associated with an increased risk of psychological morbidity. A postal survey was sent to 1080 women with infertility attending gynecology outpatient departments in 12 Scottish centres. The survey included the Twelve-Item General Health Questionnaire (GHQ-12) and three multi-item scales from the Short Form Health Survey Questionnaire (SF-36). The response rate was 47.4% (512/1080) of which 507 completed the GHQ-12. Of the 507 GHQ-12 responders, 32.5% had a GHQ-12 score of > or = 8/12 suggesting they were at risk of clinically significant psychological disturbance. There were no significant associations between GHQ-12 scores and duration of infertility, the presence of existing children, or the cause of infertility. GHQ-12 scores significantly increased with the number of clinic attendances and decreased as the patient's age increased. Responders scored significantly lower on all aspects of the selected SF-36 questions as compared to published population data, suggesting poorer mental health. These standardized psychological instruments suggest that approximately 32% of women in the early stages of infertility management may be at risk of developing clinically relevant mental health problems. Psychological aspects of infertility should be addressed as part of a more holistic approach to management of these patients.     

Psychosocial, treatment, and demographic predictors of the stress associated with infertility.

OBJECTIVE: To determine which psychosocial, treatment, and demographic factors relate to the amount of perceived stress that infertile women and men experience. DESIGN: A cross-sectional, structured interview research design was used. SETTING: In-person interviews were conducted in study participants' homes. PARTICIPANTS: Wives and husbands from 185 couples in Southeastern Michigan with primary infertility were studied. MAIN OUTCOME MEASURES: A nine-item rating scale of perceived stress associated with infertility was the outcome measure. RESULTS: For both women and men, stress was significantly positively correlated with treatment costs and number of tests and treatments received; stress was significantly negatively correlated with confidence that one will have a child and perceived control. For women only, attitudes about infertility treatments, importance of children, attributions of responsibility to physicians, and social support also significantly related to perceived stress. For men only, income, number of physicians seen, and self attributions of responsibility also significantly related to perceived stress. CONCLUSIONS: As hypothesized, a variety of treatment characteristics and psychosocial factors were related to experienced stress. Contrary to expectation, demographic factors such as age and number of years married were not related to experienced stress. This study's results suggest that attempts by health care providers to increase patients' sense of control, optimism (within realistic limits), and social support should reduce stress.