Over their lifetimes, approximately one in every five couples in the United States seeks infertility care and male infertility accounts for half of these cases.  Despite the relative importance of infertility due to the male factor; research on psychological implication and emotional coping during infertility diagnosis and treatment has traditionally focused on women.  Here is some information to consider when helping your patients as they face infertility due to male factor.

What is behind the Psychological stress?

In men the stress of not being able to procreate has been associated with emotional sequelae such as anger, depression, feelings of worthlessness and anxiety concerning potency, masculinity, and sexual inadequacy.  Additionally, marital problems and guilt can cause or worsen erectile dysfunction, which in turn, increases the feelings of inadequacy that already accompany infertility.

The diagnosis of infertility causes many males to question their masculinity. Male factor infertility is frequently associated with high levels of stigma, as male infertility is frequently seen as arising from sexual dysfunction.   Many people assume that infertile men cannot perform sexually. This stigma adds to the heightened insecurities in males with infertility.   Male factor infertility has such a social stigma and a culture of secrecy that women sometimes even take the blame for the couple’s struggles, thus, perpetuating the cycle of guilt and insecurity.

Implications for Couples

Men are in fact equally affected by the unfulfilled desire for a child, but are less open about their feelings and  often do not show emotional stress, in an attempt to be the emotional stability within the relationship.  This leaves the man feeling alone in the relationship and isolated from a support network.  Furthermore, couples with long term infertility, which have faced much treatment failure, report higher levels of depression, low satisfaction with their sex lives, and low levels of well being. Partners may become more anxious to conceive, ironically increasing sexual dysfunction and social isolation. Marital discord often develops in infertile couples, especially when they are under pressure to have timed sex or they need to make timely medical decisions.

Couples can also experience stigma, sense of loss, and diminished self-esteem as they compare themselves with their peers and family members.  Both men and women experience a sense of loss of identity and feelings of defectiveness and incompetence.  Also, couples undergoing IVF face considerable stress and the emotional stress and marital difficulties are greater in couples where the infertility lies with the man. Therefore the psychological impact of infertility can be devastating to the infertile person and to their partner.

 What can we do?

On average, psychological burden appears to be the number one reason to discontinue infertility treatment.  In light of this data it is in the patient’s best interest that these issues are addressed during consultation and treatment. Some interventions designed to alleviate the symptoms of stress, depression, and anxiety in infertile men have been researched. The most prevalent psychological treatment is counseling and marriage therapy.   However, some men are still reticent to seek psychological treatment despite its potential benefits.  Therefore an open discussion with the patient about the benefits of therapy could help demystify psychological counseling and encourage patients to seek services.

What is the focus of psychological counseling in these cases?

The primary goal of infertility counseling is to help the man acknowledge infertility, articulate the sources of his anxiety, express his loss of confidence in sexual adequacy, deal openly with his partner’s disappointment and anger, and consciously redefine his male and marital roles.  He will also learn how to cope with the emotional challenges associated with infertility.  By teaching patients problem-solving strategies in a supportive environment, infertility counselors help people work through their grief, loss, guilt, shame, disappointment, anxiety, depression, and isolation.

Additionally, he will strengthen already present coping skills and develop new ones.  If the couple is present one of the goals will be to maintain trust and positive communication in the relationship.

If sperm donation is the next step in treatment, it is necessary for every gamete recipient individual and couple to engage in a psychological assessment and counseling session. It is a way to successfully prepare the participants for treatment.  The goal of counseling for the gamete recipient is assessing the recipient’s readiness to proceed with treatment, as well as, providing support and psychoeducation. This type of counseling enables all participants to consider the psychological consequences of the procedure.  The aim of this consultation is to clarifying feelings about sperm donation and expectations for the future. It is essential that both partners feel comfortable with the decision and that all fears and questions be openly discussed.  Common topics include: exploring questions about donor selection, and whether to be open about the decision to utilize sperm donor, and whether to tell a child conceived how they were conceived.

In summary, medical and mental health professionals can provide appropriate interventions to alleviate stress and improve patient care through emotional support and appropriate referrals.  Male infertility brings pain and shame to our patients. If we help them increase their coping skills we may increase the likelihood of men and couples staying in treatment.  It can also help when making the choice to peruse third party reproduction, adoption, or to have a child-free life.

Resources for your patients

Donor Conception Network www.dcnetwork.org
Resolve – The National Infertility Association www.Resolve.org