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‘It’s like taking a bit of masculinity away from you’:
towards a theoretical understanding of men’s
experiences of infertility
Alan Dolan
1
, Tim Lomas
2
, Tarek Ghobara
3
and
Geraldine Hartshorne
4
1
Centre for Lifelong Learning, University of Warwick, UK
2
Department of Psychology, University of East London, UK
3
Centre for Reproductive Medicine, University Hospital Coventry and Warwickshire NHS
Trust, UK
4
Warwick Medical School, University of Warwick, UK
Abstract In the UK, nearly half of all cases of infertility involve a ‘male-factor’. Yet, little
empirical work has explored how men as men negotiate this terrain. Three
interrelated concepts; ‘hegemonic masculinity’,‘embodied masculinity’and the
linkages between ‘masculinities’and male help-seeking, provide the theoretical
framework that guided a qualitative study conducted with 22 men experiencing
infertility. The paper explores men’s propensity to delay their help-seeking in
relation to infertility despite their desire for children. It also demonstrates how, in
the context of infertility, the male body can be defined as both a failed entity in
itself (unable to father a child) and a subordinated social entity (unable to measure
up to hegemonic ideals) that characterises men’s masculine identities. The paper
also illustrates how men appear willing to accept responsibility for their infertility
and adopt aspects of hitherto subordinate masculine practice. This does not,
however, constitute the total unravelling of well understood and accepted
expressions of masculinity. Finally, the paper demonstrates how infertility is
perceived as having the potential to fracture current and even future relationships.
Moreover, regardless of how well men measured up to other hegemonic ideals,
ultimately they can do little to counteract the threat of other (fertile) men.
Keywords: men, infertility, hegemonic masculinity, embodied masculinity, men, masculinities
and help-seeking
Introduction
In the UK, it is estimated that infertility affects one in seven couples (HFEA 2013). Although
nearly half of all cases of childlessness involve a ‘male-factor’, little theoretical work has
explored how men as men negotiate this terrain. Men have variously been described as ‘miss-
ing’(Culley et al. 2013), the ‘second sex’(Inhorn et al. 2009) and ‘shadowy figures’(Mason
1993) and have failed to adequately materialise within the field of infertility research. Recent
reviews have called for more qualitative studies to access men’s perceptions and experiences
©2017 The Authors. So ciology of Health &Illn ess published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.
This is an open access article under the te rms of the Creative Co mmons Attribution License, which permit s use, distribution and
reproduction in any m edium, provided the or iginal work is properly cited.
Sociology of Health & Illness Vol. xx No. xx 2017 ISSN 0141-9889, pp. 1–15
doi: 10.1111/1467-9566.12548
of infertility, particularly their desire for children, their awareness of their infertility, their help-
seeking behaviour, and their feelings about trying to conceive through infertility treatment
(Griel et al 2010, Marsiglio et al. 2013). Whilst inroads are beginning to be made (e.g. Her-
rera 2013, Tjornhoj-Thomsen 2009) and in particular the recent text on male infertility by
Walther Barnes (2014), this research remains in its relative infancy. As researchers endeavour
to address this challenge, scholarship from the field of men’s health can offer a valuable con-
ceptual lens through which to explore men’s infertility experiences. This paper draws upon
three interrelated concepts much evident within men’s health research; ‘hegemonic masculin-
ity’,‘embodied masculinity’and the linkages between ‘masculinities’and male help-seeking,
which provides the theoretical framework for an ESRC funded project that explored men’s
experiences of infertility.
Theoretical framework
A proliferation of social science research has explored the connections between expressions of
masculinity and how men experience of a range of health problems (e.g. Chapple and Ziebland
2002, Emslie et al. 2006). One significant contribution to this has been Connell’s (1995) con-
cept of ‘hegemonic masculinity’. This relational approach to theorising gender can account
both for men’s dominance over women and over less powerful groups of men because it intro-
duces the notion of hierarchy and competition between different kinds of masculinity. Accord-
ing to Connell (1995), gender relations are not fixed but shift in historical context and are
infused with other modes of social differentiation, such as social class and ethnicity, with cer-
tain configurations of masculine practice gaining dominance at the expense of other less pow-
erful forms that become subordinated to and/or marginalised from hegemonic patterns.
Defining gender as relational and intertwined with other modes of social differentiation pro-
vides access to the social dynamics of gender relations, their construction and the possibilities
for change that emanate from the tensions and contradictions in men’s experiences over time
(Connell 2012). However, most work regarding men’s health has been devoted to how cultural
properties are transmitted to men and work as conditional influences on them rather than the
other side of the structure-agency equation, namely how they are received by men and how
new practices may be incorporated into the dominant culture causing aspects of hegemonic
masculinity to change over time (Lohan 2007).
Theoretical work within the field of men’s health has also called for men’s physical bodies
to be better considered when investigating men’s conceptualisations and practices in relation to
health (Oliffe 2006). Being male has been seen to be influenced by, and have an influence on,
men’s bodies through the notion of ‘embodied masculinity’(Robertson 2007). Embodiment
has become a way of conceptualising the body as more than simply ‘the body we have’; the
physiological vessel open to the scrutiny of others. The notion that people are ‘embodied’
widens our understanding to include ‘the body we are’; a vehicle for how people perceive and
experience their surrounding environments and is therefore a crucial factor in processes of
identification (Hall et al. 2011: 79). Clearly, the physical/material and social/representational
aspects of male embodiment can be threatened when men experience health problems (Robert-
son et al. 2010). Just as the body provides men with a vehicle to demonstrate masculinity,
denoting activity, independence, and achievement, it also has the ability to render men vulner-
able, passive and dependent.
Since the early-1990s men’s apparent reluctance to access healthcare services has been seen
as a key factor influencing gender differences in health (Broom and Tovey 2009; Meryn and
Shabsigh 2009). Although the relationship between gender and help-seeking is complex, the
©2017 The Authors. Sociology of Health &Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.
2 Alan Dolan et al.
headline evidence that men commonly use healthcare services less than women has reinforced
the presumption that men delay consultation and present with serious disease at a later and
potentially less treatable stage (Wang et al. 2013). The majority of research conducted in this
area has tended to concentrate on men’s pre-diagnosis help-seeking, with a smaller body of
work having begun to explore men’s help-seeking in the context of diagnosed illness, includ-
ing cancer and depression (Johnson et al. 2012, Wenger and Oliffe 2014). Specific to all of
these studies is the attempt to move beyond oversimplified assertions that men are ignorant or
not interested in their health to recognise how men’s help-seeking is influenced by broader
societal expectations that inform men’s experiences and decisions.
The outlined theoretical framework has been used to guide a qualitative research study
undertaken with a group of men experiencing infertility. Barring a few exceptions (e.g. Hinton
and Miller 2013), qualitative studies in this field have tended to be retrospective in nature with
men reflecting on their experiences from the vantage point of having assumed a parenting role,
either through infertility treatment or adoption. Whilst this undoubtedly reflects to some extent
the difficulties recruiting men to such studies, men’s expressions of active desire for a child
and the potential for pain regarding childlessness may be missing from such studies (Culley
et al. 2013). This paper has also made a conscious decision to concentrate on men’s experi-
ences of infertility as a means of distinguishing the impact of the condition from the impact of
its treatment.
Research design
The analysis presented in this paper arose from a qualitative study conducted with 22 men
experiencing infertility. Ethical approval for the study was obtained via the standard NHS
Research Ethics (REC) process. The recruitment site for this study was an assisted conception
centre in the UK. Men attending the centre were alerted to the study through posters, flyers
and information sheets provided within the main reception/waiting area. This presented men
with information about the study and the eligibility criteria, including self-identification as hav-
ing a male-factor infertility problem. Men were encouraged to contact the researcher directly
either by telephone or by email to discuss their participation. Men were also informed about
the study by three different healthcare professionals. A consultant leading a male-factor infer-
tility clinic presented men with flyers and information sheets and encouraged men to contact
the researcher. A designated research nurse and an embryologist also provided men with infor-
mation and recorded the name and telephone/email details of men who expressed an interest
in participating that were passed to the principal researcher. The principal researcher then con-
tacted potential recruits by telephone and/or email in order to discuss their participation.
Recruiting men into a study that asked them to share their thoughts and feelings about infer-
tility proved to be difficult and time consuming. Very few men contacted the principal
researcher directly and although over 50 men passed their contact details to the research nurse
and embryologist well over half of these men decided not to participate when contacted by the
researcher. The main reasons given related to family illness, being too busy at work or
because, on reflection, they felt they had little to say on the matter. We can only speculate as
to why so many men changed their minds, though men’s anxieties regarding infertility were
undoubtedly a factor. This adds to the general view that male infertility is under-researched, at
least in part, because of a strong reticence among men to talk to researchers about the subject
area (Culley et al. 2013).
Twenty-two men were recruited to the study; 13 self-identified as having a male-factor prob-
lem, three as having a male and female-factor problem, and two self-identified their infertility
©2017 The Authors. Sociology of Health &Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.
A theoretical understanding of men’s experiences of infertility 3
as ‘unexplained’. In addition, two men undergoing treatment as a result of vasectomy and two
regarding a female-factor problem were recruited to provide further insight into men’s experi-
ences of infertility treatment. Twelve of these men had undergone a series of tests and were
about to start their first cycle of IVF treatment and ten had received at least one cycle of IVF
treatment. These men ranged in age from 25 years to 50 years. Eighteen of the men reported
their ethnic category as ‘White English’, three as South Asian and one as Southeast Asian.
Eighteen of the men were married and four lived with their partners. With the exception of
one man, all of the men were in paid employment that ranged from IT consultant to machine
operator.
Given the sensitive nature of the research and as a means of encouraging men to take part,
participants were offered the choice of either a face-to-face or telephone interview (cf. Sturges
and Hanrahan 2004). All except one man chose to be interviewed via the telephone. The main
reasons given were that it was easier to arrange a time for the interview, they did not have to
meet with the researcher and they could remain relatively anonymous. Telephone interviews
were conducted at a time and place chosen by the interviewee with a number of the men
choosing to be interviewed when sitting in their parked cars and/or driving home from work
as a conscious means of ensuring their privacy. The face-to-face interview was carried out in
the man’s own home at a time chosen by him.
Each interview lasted between 45 and 75 minutes. All participants were advised that the
interview was not intended as a form of counselling/therapy but an opportunity to learn about
their perceptions and experiences of infertility, including how these linked to their understand-
ings of being male and their experiences with healthcare providers. The majority of interviews
were audio recorded with the permission of the interviewee and fully transcribed. Otherwise,
extensive interview notes were taken and dictated to tape immediately afterwards.
Following transcription, the principal researcher carried out a ‘thematic’review of the data.
The men’s accounts were systematically and thoroughly compared and contrasted in order to
build up categories, test emergent theory and attach ‘meaning’to the data (Russell Bernard
and Ryan 2009). The process of reviewing the data began during the data collection period,
which enabled the researcher to explore new avenues of inquiry during succeeding interviews.
Once all of the interviews had been reviewed, excerpts were labelled with key themes relating
to the main ideas and repeated experiences of the men, which were then coded in terms of
broader categories, such as men’s desire for children. Sub-codes were then identified within
and across each of the main categories. In these ways, the coding scheme was generated both
by the broader categories that informed the topic areas contained within the interview schedule
and by the emerging empirical data. This process of ‘analytic induction’aimed to reflect the
complexity of the men’s accounts and provided a framework to help make sense of this com-
plexity as well as the social context in which these accounts are located (Bendassolli 2013).
Before moving on it is pertinent to acknowledge that this study, as with all research, has
certain limitations. The number of men recruited was relatively small and all were attending
the same assisted conception centre. Therefore, the extent to which the findings are generalis-
able to other groups of infertile men remains an open empirical question. However, a number
of measures were employed to establish confidence in the quality of findings (cf. Mays and
Pope 1995). The informal nature of the interview process helped establish rapport and to build
fruitful relationships with respondents. The researcher used extensive notes to capture his
thoughts during and after interviews and the data was analysed in a thorough and exact fash-
ion. Thus, alongside ongoing theoretical contemplation, the study continually sought to
enhance validity and to ensure that the findings are trustworthy.
When presenting the findings participant confidentiality is protected by the use of pseudo-
nyms. In many cases, the men’s verbatim has been shortened to omit superfluous expressions
©2017 The Authors. Sociology of Health &Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.
4 Alan Dolan et al.
and pauses though it continues to accurately reflect the meaning expressed by these men. An
ellipsis (...) is used to denote when this occurs. The findings draw on those men experiencing a
male-factor problem, a male and female-factor problem, or whose infertility was ‘unexplained’.
Conceptualising men’s desires for children and help-seeking behaviour
The interviews began by asking men about their desires for children along with their help-
seeking behaviour as a means of contextualising men’s experiences of infertility. All of the
men in this study had envisioned becoming fathers and tended to define their procreative
desires in terms of a ‘taken-for-granted expectation’and ‘part of being human’:
It’s almost programmed into you ... Even though it’s different for a man, there’s still a sort
of biological urge to have your own children. (Henry 42, male and female-factor)
As in this extract, the notion that men ‘don’t have the same drive’as women to have children
was often apparent. Distinct embodied processes, linked to menstruation, pregnancy and meno-
pause, enmeshed within notions of a female ‘biological clock’, were used to explain why
women desire children in ways not applicable to men. The strong cultural associations between
women and motherhood may have led some to dilute their expressions of desire for children
and dictate who they report as the more interested partner. However, many men also ques-
tioned the ‘exaggerated’or ‘stereotypical’assumption that men are not as interested in having
children as women, though it was clear that men may not express or act on their desires in the
same ways as women. Thus, even though men may experience something akin to a ‘biological
urge’, being explicit about these desires did not align with certain hegemonic characteristics,
such as the concealment of emotional needs, which dictated why men may hide such feelings:
On the surface it’s a bit different but deep down it’s the same ... I want children as much
as my wife does. But ... amongst men, it’s obviously not as gushing or as ... maternal or
however you would describe it. (Max, 32, male-factor)
All of these men described themselves as involved in the decision-making process and efforts
to conceive a child. In hindsight, men often expressed a sense of regret that they had simply
assumed themselves to be fertile, particularly the older men whose partners were also at
increasing risk of age-related infertility. Most were fearful that they may have missed the
opportunity to start a family though their lack of agency could also cause some to question
their desire for children; that is, if having a child was so important to them, why had they
waited? Whatever their age, men’s assumed reproductive capabilities were clearly tied to cer-
tain masculine norms and expectations:
It’s such a primitive thing that you just take for granted ... It’s just a basic thing, a kind of
given that you can have children ... and it’s spoken about in a real masculine way ... In
crude ways about getting people pregnant. (Max, 32, male-factor)
Men’s reported desire for children was also somewhat at odds with the fact that all had
delayed seeking help when their partners failed to conceive with one man waiting for five
years before approaching his GP. In making sense of their delay, it was clear that men had a
difficult time coming to terms with the fact they may have a problem, ‘You’ve got to accept it
first ... that there is something wrong’(Arnel, 41, male-factor). However, unlike other health
©2017 The Authors. Sociology of Health &Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.
A theoretical understanding of men’s experiences of infertility 5
concerns that men may hide or face in isolation, infertility was a health problem that uniquely
intertwined men and women’s help-seeking. The necessity for joint investigations put men
under particular sets of pressures. For example, indirect pressure related to the ‘upset’and
‘pain’men witnessed, but did not embody, when their partners failed to conceive. Direct pres-
sure included a number of women initiating their own clinical examinations independent of
their partners; ‘My wife had her checks done and she was OK ... I was sort of putting it off
... going to have a semen analysis done’(Masud, 31, male-factor). In part, men’s lack of
acceptance and delay in seeking help appeared to stem from them confusing the production of
semen with that of sperm and the fact their bodies seemed to be working normally. It was also
located in wider notions of how men deal with health problems:
Most men ... they’ll allow something to grow and they won’t say anything until it’s hurting
them really bad ... I think a lot of men think they can get over things and it will change.
(Paul, 28, male-factor)
Accessing help regarding reproduction was characterised as particularly difficult for men. Not
only because it was associated with ‘weakness’and negated their status as a ‘strong alpha
male’, but also because reproduction was usually determined through biological processes/bod-
ily action not conscious thought, ‘If everything was fine you would just have got your partner
pregnant ... it wouldn’t be like you’d have to make a decision about having a baby’(Nathan,
25, male-factor). In overcoming these hurdles, men positioned themselves as courageous and
as proactive and engaged in the process of seeking help. Their willingness to undergo tests
was presented as indicative of their motivations to become fathers and part of a positive and
active attitude towards finding a solution, though it was also evident that these men had not
come to such decisions on their own:
It was quite a release in a way that we’d decided to do something about it. Because for so
long we’d been trying but been disappointed ...So there was the sense of being energised
... we’re going to take control of this. (Colin, 36, male-factor)
Men, masculinity and diagnosis of infertility
All of the men were willing to discuss their diagnosis. When doing so, men demonstrated
detailed knowledge and often exhibited a degree of self-deprecating humour. For example,
men made the distinction between sperm count and sperm motility, used terms such as
azoospermia, and referred to themselves as ‘firing blanks’. Prior to diagnosis, few men had
considered infertility as a personal concern or risk. Their sense of shock often related to the
lack of fertility problems amongst their parents and/or siblings. Their surprise also related to
notions of the super-potent male, which was associated with a certain arrogance regarding
men’s ability to deliver what is expected in the way of conception. Clearly, strong representa-
tions of masculine bodily power made a significant contribution to the kind of men they
thought themselves to be:
I always thought it would be almost like flicking a light switch ...So never had a clue ... I
never expected it to be me. (Colin 36, male-factor)
Unlike other studies (e.g. Walther Barnes 2014), men did not downplay the significance of
their defective sperm or thought it easily rectifiable and none suggested that the majority of
©2017 The Authors. Sociology of Health &Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.
6 Alan Dolan et al.
the problem lay with their partner. Instead, their accounts were saturated with expressions of
responsibility though they often sought to balance this by stating that they had not knowingly
damaged their body’s reproductive capability:
I know that the whole thing is my fault and I can’t really blame anybody but ... I’ve never
done any extreme sports, I’ve never took drugs, I’ve never drunk excessively ... It’s just
bad luck. (Max, 32, male-factor)
Men’s demolished their sense of bodily power was evident in phrases such as ‘You almost feel
as if you’re not a man. You cannot do the biological thing’(Nathan 25, male-factor). Their
bodies, which had been assumed to function normally, were suddenly altered and emerged to
trigger men’s crisis of confidence regarding their ability to live up to dominant cultural expec-
tations of men:
Obviously that’s part of being a man is being able to produce children ...When they tell
you that you can’t, that your semen’s no good, it’s like ... taking a bit of masculinity away
from you. A bit of being a man. (Leonard, 25, male-factor)
In some cases men sought to deliberately separate masculine self-esteem from the quality of
their sperm. One man described his low sperm count as ‘not badly down’, though he went on
to say ‘that might be me trying to make myself feel better [laugh]’(Nathan, 25, male-factor).
In a similar vein, Zackery, who experienced poor sperm motility, felt the large quantity of
sperm he produced was important ‘because they had more of the good stuff to look for’and
he compared himself favourably to other men with more threatening diagnoses:
It wasn’t a major emotional thing for me. The fact that they were saying to me that I wasn’t
... not producing any good sperm. Had that been the case I’d have been devastated ... The
fact that there was actually some good sperm let me have a little bit of self-respect’.
(Zackery 44, male and female-factor)
All men reported hiding their feelings when given their diagnosis primarily as a means of sup-
porting their partners who were characterised as less emotionally robust. Indeed, many
reported that the hardest part of receiving their diagnosis was dealing with the emotions of
their partners. Thus, even though their diagnosis was likened to a ‘sledgehammer blow’, they
described how they deliberately pushed their own sense of shock and anxiety into the back-
ground and, therefore, their lack of emotion should not be equated with an absence of distress:
My main thoughts was with my partner ...I had to be strong for her ...I might look like
I’m not upset about it. But it’s not something you want to hear ... that I couldn’t provide
what she needed to create a baby ... It’s sort of what men are meant to be able to do.
(Paul, 28, male-factor)
Men, masculinity and living with infertility
Not being able to start a family precipitated a range of negative emotions (cf. Griel et al 2010,
Marsiglio et al. 2013). Men used phrases such as ‘a bit gutted’to indicate how they were feel-
ing, but often compared themselves favourably to other men with more serious, often life-
©2017 The Authors. Sociology of Health &Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.
A theoretical understanding of men’s experiences of infertility 7
threatening, health problems. Men also compared themselves to their partners who faced both
the emotional impact of infertility and the physical trauma of infertility treatment, which was a
significant source of guilt and reason why men deemed it wrong to voice their own concerns,
‘I don’t want to give away how worried I am to my wife ...I just don’t want to ... add it to
her burden’(Arnel, 41, male-factor). Other emotions, such as men feeling ‘embarrassed’and
‘ashamed’, could also prevent them from talking to their partners about their infertility. This
was despite the fact that many men acknowledged how their partners were often left frustrated
by their inability to discuss their situation; ‘She wants to see a response and it’s not that I
don’t want to give a response, it’s just that I can’t give a response’(Charles, 43, male-factor).
This led one man to suggest that women should be told about the difficulties facing men when
diagnosed with infertility:
If it is the male that’s at fault I think the female needs to go and see somebody and get it
explained how the male feels ... because it’s hard for you to explain to your partner how
you’re feeling. (Leonard 25, male-factor)
Nonetheless, these men felt they were doing all they could to support their partners, which
they demonstrated through their actions rather than emotional expression. Moreover, their sup-
portive activities appeared to be a change from their normal practices as husbands/partners and
were not necessarily an easy option. For example, all of the men felt awkward and vulnerable
within the clinic but made a point of making numerous visits with their partners. They also
provided practical help with their partners treatment regimens though their aversion to medical
procedures was evident, ‘I help her take her injection. But I really hate it. I really hate it
[laugh]’(Leonard 25, male-factor). Men were also keen to point out that this was not simply
at the behest of their partners. In describing themselves as active and purposeful they chal-
lenged notions that they were disinterested or coerced into such actions, though it was also
clear that they often felt restricted in their role, ‘You’re limited to what you can do. Because
the procedure ... it’s happening to the woman isn’tit’(Charles 43, male-factor) (cf. Hinton
and Miller 2013). Men’s role as agents of support was also characterised by elements of enthu-
siasm and hopefulness alongside cautiousness and control. Although men sought to be opti-
mistic regarding treatment, they were far more sceptical of success than their partners and tried
to reign in women’s optimism and prepare women emotionally for the possibility of failure:
It hit her really hard ... She’d built up an expectation that it was just going to work ...
choosing names ... I was like, ‘don’tdoit’... I was more wary. (Colin 43, male-factor)
Most made the decision not to discuss their infertility with other men. Paul (28, male-factor),
for example, likened his internal conversation to a ‘risk assessment’as he sought to predict
what he stood to gain and how other men might react, ‘Could I talk to this person? Yes or
no? ... If I step over the edge here will I get hurt?’There was also the flipside in that they
wanted to protect other men. As such, they would not simply announce their infertility as it
put other men in vulnerable positions. Among those men who did confide there was little
sense that they expected expansive discussions with other men. As they predicted, other men
responded in ‘matter of fact’ways and were not proactive in terms of initiating conversations.
One man used the analogy of a friend revealing their sexuality to contextualise the nature of
these interactions:
I don’t know what you’d expect their response to be. It’s like a friend coming up and say-
ing they’re gay. You’d go OK [laugh] what am I going to do about it. It’s not going to
©2017 The Authors. Sociology of Health &Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.
8 Alan Dolan et al.
change things. So let’s just move forward ... if you need to talk then fine, but ... just move
on. (Nathan 25, male-factor)
Three main reasons were apparent for why men chose not to discuss their infertility. The first
related to men not wanting to be the focus of attention or the subject of pity and that others
‘feel sorry’for them. The second related to men’s fears that they could become the subject of
ridicule (cf. Throsby and Gill 2004). Although none experienced name calling or other forms
of derision they knew of the pejorative terms, such as ‘Jaffa’, that are used to ridicule infertile
men, ‘You think that’s funny. ... It’s only when it’s you, you think aaah [laugh]’(Colin 36,
male-factor). The third reason related to cultural associations between virility, impotence, and
infertility and that people would think them ‘incapable’(cf. Herrera 2013). Although, intu-
itively, they did not perceive that their friends would think in such terms the possibility
clouded their decision-making, ‘That’s at the back of my mind. Even though on one level ...
I think that is slightly ridiculous’(Henry 42, male and female-factor). Whatever their reason-
ing, many men viewed the prospect of discussing their infertility as extremely difficult, even
with men in similar circumstances:
My best friend mentioned it to me about two weeks ago ... It’s doubtful that they can have
children. So even with him saying that to me, I still couldn’t bring myself to say, ‘I know
how you feel’... I just couldn’t. (Max 32, male-factor)
This did not mean that other men were unaware of their diagnosis. Men’s work colleagues
might know because men required time off work to attend appointments, whilst other men
knew because of the nature of their social relationships. But, this did not mean that men spoke
about such matters:
My male friends ... definitely know what’s going on but it’s not something anybody dis-
cusses ... It goes back to that typical thing about what men talk about to other men and
what women talk about ... At the top end of the room ... me and my friend were talking
probably about work or cars ... and my wife was discussing with his wife what’s going on
with our IVF ... It’s just something I don’t discuss with them ... it’s not a conversation I’d
want to have. (Joseph 38, unexplained)
There were occasions when men came under pressure to explain why they did not have chil-
dren or faced questions regarding their plans for fatherhood. In these cases men tended to
deflect attention away from the present by suggesting that they would have children in the
future. Whatever their individual strategy, men were aware that their explanations were time
dependent, in the sense they were not acceptable longer-term life-stories and would have to be
rethought if the outcome was not successful:
Sometimes you can get a question; ‘Why you haven’t kids yet?’I’ll normally just say ...
it’s not our priority at the moment or I change the subject ...That is one of my strategies
... changing the subject ...But I can’t do that forever [laugh]. (Arnel, 41, male-factor)
There was nothing to suggest that men sought to deflect the cause of their childlessness onto
their partners, perhaps because biological fatherhood was still within their grasp. Nonetheless,
because they did not see their infertility as easily remedied, the thought they may never have a
biological family was a continual concern. When discussing the future, men often described
themselves as more rational than their partners and more ‘accepting of the situation’.
©2017 The Authors. Sociology of Health &Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.
A theoretical understanding of men’s experiences of infertility 9
Moreover, although problematic, all of these men could envisage life without children, ‘It will
obviously be tough ... but I still think we’ll have a happy life’, though this man immediately
went on to say, ‘I don’t know if my wife sees it that way’(Joseph 38, unexplained). In short,
men’s attempts to reconcile their situations were not perceived to be shared by their partners:
My world doesn’t stop and end with this. I’ve said to my wife on numerous occasions we
are so lucky to have each other. I see anything that we get as icing on the cake ... Now
what it would actually mean for my wife ... she’d be devastated. (Zackery 44, male and
female-factor)
Men were also concerned about the potential sustainability of their relationships should they
not have children (cf. Tjornhoj-Thomsen 2009). One man presented this as his ‘biggest worry’
and went on to say, ‘I don’t know how it’s going to affect our relationship when it doesn’t
work’(Leonard 25, male-factor). A significant element of their concern was the implicit threat
that another (fertile) man could take their place, ‘there is that bugging away in the back-
ground’(Colin 36, male factor). In short, infertility damaged their attractiveness as men and
jeopardised their ability to maintain their place in the social world:
I know it’s my fault and it’s my problem and my partner could have kids with somebody
else ... Even though she’s not going to go and have a baby with nobody else, but she
could. She’s got the option. Whereas I haven’t got the option to do that. (Leonard 25,
male-factor)
Discussion and conclusion
Relatively little research has explored men’s views regarding infertility, particularly from the
perspective of men who retain hope of becoming biological fathers (Culley et al. 2013). Draw-
ing upon a theoretical framework that encompassed the relationship between masculine iden-
tity, men’s bodies and their help-seeking behaviour, and using in-depth interviews, this study
has demonstrated the challenging and often paradoxical experiences men face at this time.
The linkages between expressions of masculinity and the way men conceptualised their bod-
ies and health were evident when these men sought to explain why they delayed seeking help
in their bid to become fathers. In making sense of this delay, their accounts resonate with the
distinction men often make between ‘health’and ‘ill-health’when deciding whether to access
health services (Robertson 2007). Biologically, men were able to perform and had no symp-
toms and so lacked a legitimate reason to seek help. Added to which, their concerns regarding
the nature of consultations/investigations made them extra fearful of approaching their GP. In
short, hegemonic masculine norms, which encourage emotional and physical strength and
reject weakness or vulnerability, coupled with men’s lack of knowledge about their health and
bodies, can help to explain these men’s propensity to delay seeking help (Gough and Roberson
2010). Whilst the necessity for joint help-seeking may bring a unique complexity to men’s
decision-making around infertility, the known obstacles men face when considering whether to
access health services appear to be amplified when men are faced with the possibility of such
a diagnosis. Thus, any delay should not simply be equated with a lack of desire among men
to have children or signal that women are more ‘treatment orientated’when it comes to infer-
tility (Slepickova 2010). Indeed, the men themselves sought to question what they considered
to be over-inflated claims of gender differences in procreative desires that reified the stereotype
©2017 The Authors. Sociology of Health &Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.
10 Alan Dolan et al.
of women as mothers and made men believe they could not have comparable desires as
fathers. Moreover, in accessing help, men (re)established themselves as motivated and
unequivocal in their quest for fatherhood. They also sought to align themselves with certain
hegemonic masculine ideals, such as control and determination, evidenced by their willingness
to undergo difficult consultations and tests, and positioned themselves as knowledgeable
regarding their diagnosis and the functioning of their bodies (Noone and Stephens 2007). As
such, their accounts contrast with other studies which suggest that men are often pressured into
a process in which they remain passive and uninterested and where the validity of the diagno-
sis is often questioned (e.g. Herrera 2013).
Whilst there was no sense of denial or scepticism regarding their diagnosis, it was clear that
it could destabilise the ontological connections between a prized masculine identity, the male
body and biological fatherhood. In short, as the suboptimal biological properties of their bod-
ies emerged and they lost reproductive power, they were forced to re-construct embodied
notions of themselves as men (cf. Robinson and Hockey 2011). Men’s descriptions of their
sperm as ‘weak’,‘lazy’and ‘dead’was indicative of their diminished authority, and contrast
with the more usual depictions of sperm as fast, strong, and successful that are also terms irre-
vocably associated with hegemonic masculinity (Tjornhoj-Thomsen 2009). In making sense of
the resulting existential crisis, men would often oscillate between two contradictory subject
positions; it was not a reflection on them as men (they were not implicated in the cause) and
it did reflect something about them as men (they had lost the presumed basis of manhood). It
is perhaps also not surprising that some men sought to define their diagnosis in less threaten-
ing terms; that is, not as bad as other men’s, which enabled them to maintain certain aspects
of masculine self-esteem. Nonetheless, regardless of how they reflected upon their situation,
the masculine identities these men once conferred upon themselves were revised or rescinded
as their bodies were found to be constitutionally incapable of accomplishing what is valued in
terms of masculine identity/male embodiment (cf. Oliffe 2006).
Consistent with Connell’s thesis that masculinity is best understood as a ‘configuration of
practices’, these accounts also demonstrate how the formation of their self-identities as men
was constructed within the social context in which these men found themselves. It was clear,
for example, that aspects of hegemonic masculinity strongly influenced men’s philosophical
resolve not to show or discuss the emotional impact of their diagnosis, which they equated
with gendered expectations about how men are supposed to behave in such situations (cf. Con-
nell 1995). Although it is common for men to remain stoical when presented with bad news
regarding their health (e.g. Emslie et al 2006), these expectations appear to be significantly
heightened in relation to infertility. Their actions at this time may, therefore, be conceptualised
as men being let down by their bodies, which suddenly defined them as incapable of living up
to certain dominant expectations, who then draw on other identifiable markers of masculine
practice to enable them to enact a masculine form congruent with hegemonic masculinity. Fur-
thermore, men’s on-going silence regarding the impact of infertility, despite the imploring of
their partners, can also be interpreted as a means by which these men maintained a masculine
self. Thus, whilst men framed their silence in terms of their feelings of guilt and humiliation
or the lack of an ‘emotional script’, which precluded men from explaining how they truly felt,
men’s suppression of emotion and the shielding of women from their insecurities and sense of
powerlessness can also be linked to how men restore threatened gender identities (cf. Schrock
and Schwalbe 2009).
These men reportedly worked hard to transform their practices in the interests of their part-
ners, which demonstrate that masculine identities are not static. For example, they sought to
incorporate an increased sense of sensitivity and willingness to support and care for their part-
ners through their treatment. They also redefined masculine values to accommodate the view
©2017 The Authors. Sociology of Health &Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.
A theoretical understanding of men’s experiences of infertility 11
that infertility should be faced as a couple; that is, manliness was demonstrated through atten-
tiveness, selflessness and unity with their partners. Infertility, therefore, appeared to usher in
new and possibly less restricted thinking regarding their roles as men, which could also chal-
lenge hegemonic norms; namely, they adopted attitudes and behaviours ordinarily considered
to be feminine and/or associated with subordinated groups of men (Connell 2012). Though
change was apparent, men also conveyed a sense of ineptitude and superficiality regarding
their contribution (cf. Hinton and Miller 2013), which is at odds with traditional demonstra-
tions of hegemonic masculinity that is usually solution-focused and displayed in terms of tech-
nical competence and self-confidence (Courtenay 2011). In many ways, these themes echo
men’s experiences during pregnancy and childbirth (e.g. Dolan and Coe 2011), which may
stem from the fact that it is women’s bodies that are centre of attention in both arenas.
Unlike pregnancy, however, men’s actions may also be influenced by their sense of guilt
regarding their infertility and they felt forced to curb women’s enthusiasm regarding the
chances of them conceiving a child, which is evidently not the case with pregnancy. Whilst
men’s stoical role in the face of disappointment regarding infertility has been documented
(Hinton and Miller 2013), this study suggests that men may define themselves as the ‘voice of
reason’throughout the process. Although men sought to characterise this in terms of masculine
rationality over feminine emotionality, it undoubtedly limited men’s ability to disclose their
own concerns and aspirations. It also underpinned men’s belief that infertility exacted more of
an emotional toll on women because they were perceived to be beyond such reason and con-
trol (Petersen 2004).
Men’s decisions regarding disclosure of their infertility illustrate the ways in which the
maintenance of masculine identities is inherently relational and inescapable (Connell 2012).
Those men who chose not to disclose their infertility tended to focus on key elements of
the ‘patriarchal dynamic’, particularly how men use humiliation and ridicule to assign other
men to subordinated masculine positions (Connell 1995). Given that men often avoid dis-
cussing health-related problems because they fear accusations of fragility and weakness (e.g.
Dolan 2014) it is perhaps not surprising that such fears may be heightened in relation to
infertility. They appeared highly attuned to their perceived inadequacy and their wish to
avoid potential embarrassment and stigmatisation often characterised their decision-making.
Those men who did disclose their infertility were relatively confident that other men would
respond in supportive, if unemotional ways. Their disclosure was not defined in terms of
psychological relief and there was no sense that they wished to communicate aspects of their
inner-selves. Men’s‘lack of community’regarding health or procreative matters may also
have prohibited men from discussing their experiences concerning infertility (cf. Tjornhoj-
Thomsen 2009). Overall, there was little evidence that men sought to challenge those aspects
of hegemonic masculinity that pervade the terrain of infertility or that they were able to
champion their supportive practices around their partners. In short, whilst there was evidence
of an ‘emergent masculinity’; that is, men’s attitudes and actions appear to have changed
(cf. Inhorn 2012), there was little evidence that this was explicitly driven by male agency in
relation to infertility. Instead, men appear to draw upon contemporary notions of the sensi-
tive and involved father-to-be, which was extend to encompass infertility, albeit without the
‘camaraderie’and shared understanding that permeates men’s experiences of pregnancy (e.g.
Dolan and Coe 2011).
Although none of these men were at the stage of having to (re)construct a masculine iden-
tity as a permanently childless man, their accounts demonstrate the temporal dimensions of
such constructions (Connell 2012). Not only did men’s explanations for their childlessness
have to encompass the present and the past, they also have to extend into the future, and illus-
trate the relentless and inescapable challenge infertility can pose to masculine identities.
©2017 The Authors. Sociology of Health &Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.
12 Alan Dolan et al.
Alongside this were the ways in which men characterised their current relationships and
whether they, rather than another man, were worth the ‘investment’of their partners (Buch-
binder 2013). Whilst they could provide their partners with a loving relationship and a desir-
able lifestyle, this was dependent on women accommodating their vision of a potential life
without children. Time and again, men sought to construct valued masculine identities and
worthwhile futures, whilst voicing concerns regarding the sustainability of their relationships
(cf. Tjornhoj-Thomsen 2009). Infertility was, therefore, perceived as having the potential to
fracture both current and future relationships because, regardless of how well they measured
up to other hegemonic ideals, ultimately they could not counteract the threat of other (fertile)
men.
In summary, this paper has explored men’s experiences of infertility via a theoretical frame-
work fashioned from within the field of men’s health. It has demonstrated how hegemonic
norms, that reject weakness and vulnerability, coupled with men’s lack of knowledge about
their bodies, help to explain men’s propensity to delay help-seeking despite their desire for
children. It has also illustrated the role of the male body in men’s experiences of infertility.
Their body can be defined as both a failed entity in itself (unable to father a child) and a sub-
ordinated social entity (unable to measure up to hegemonic ideals) that characterised how men
negotiated and enacted their identities as men. Their accounts also illustrate the possibilities
for change in masculine practice. In taking responsibility for their infertility and through their
active involvement and support, men appeared willing to adopt aspects of hitherto subordinate
masculine practice though this did not constitute the total unravelling of well understood and
accepted expressions of masculinity. Finally, in demonstrating how men live with the uncer-
tainty of infertility, it demonstrates that men could do little to dampen their own fears regard-
ing the future and the possibility that their partners choose the chance of motherhood with
another man.
Address for correspondence: Alan Dolan,Division of Health Sciences,Warwick Medical
School,University of Warwick,Coventry CV4 7AL.E-mail: a.dolan@warwick.ac.uk
Acknowledgement
Study funded by ESRC –Grant No –ES/I02834X/1.
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