Psychological Aspects of Infertility Among Men

Abstract

Investigations of the psychological and social aspects of reproductive life events, have, until quite recently, focused predominantly on women. Research has now considered in more detail the psychological aspects of desire for children, avoiding pregnancy when it is not wanted, achieving pregnancy when it is sought, and experiences of infertility among men. The research evidence has been generated predominantly in high- and upper-middle income countries; there is less evidence about these experiences among men living in low- and lower-middle income nations. Men aspire to parenthood as much as women do but they have less knowledge about fertility and the factors that affect it than women do. The gap between ideal biological and ideal social age for parenthood appears to be widening, increasing the risk of involuntary childlessness or having fewer children than planned. Male factors either alone or in combination with female factors contribute to 50% of infertility. Up to 12% of men experience fertility difficulties, with the highest rates being in countries of Africa and Central and Eastern Europe. Male factor infertility remains stigmatized, with pejorative associations with compromised masculinity. Notions that men are unaffected or unperturbed by infertility are false and reflect outdated and unhelpful gender stereotypes. While mental disorders are no more prevalent than in the general community, infertility-specific anxiety is common among men being investigated for fertility difficulties or whose partners are receiving fertility treatment. In general, men prefer to receive psychologically informed care from the infertility treatment team to specialist psychological care. Referral to a mental health professional is recommended for the subgroups of men who have not disclosed infertility to anyone apart from their spouse; appraise being infertile as hopeless or overwhelming or who are considering the use of donor sperm. Preprocedure counseling is also recommended for men considering vasectomy about its permanence and the limited potential for reversal. It is also recommended that infertility counselors are trained in the skills to manage intense psychological distress and interventions to enhance couple communication.