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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.
Its like taking a bit of masculinity away from you:
towards a theoretical understanding of mens
experiences of infertility
Alan Dolan
, Tim Lomas
, Tarek Ghobara
Geraldine Hartshorne
Centre for Lifelong Learning, University of Warwick, UK
Department of Psychology, University of East London, UK
Centre for Reproductive Medicine, University Hospital Coventry and Warwickshire NHS
Trust, UK
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 masculinityand the
linkages between masculinitiesand male help-seeking, provide the theoretical
framework that guided a qualitative study conducted with 22 men experiencing
infertility. The paper explores mens 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 dened 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 mens 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
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 gures(Mason
1993) and have failed to adequately materialise within the eld of infertility research. Recent
reviews have called for more qualitative studies to access mens 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. 115
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 eld of mens health can offer a valuable con-
ceptual lens through which to explore mens infertility experiences. This paper draws upon
three interrelated concepts much evident within mens health research; hegemonic masculin-
ity,embodied masculinityand the linkages between masculinitiesand male help-seeking,
which provides the theoretical framework for an ESRC funded project that explored mens
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 signicant contribution to this has been Connells (1995) con-
cept of hegemonic masculinity. This relational approach to theorising gender can account
both for mens 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 xed but shift in historical context and are
infused with other modes of social differentiation, such as social class and ethnicity, with cer-
tain congurations of masculine practice gaining dominance at the expense of other less pow-
erful forms that become subordinated to and/or marginalised from hegemonic patterns.
Dening 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 mens experiences over time
(Connell 2012). However, most work regarding mens health has been devoted to how cultural
properties are transmitted to men and work as conditional inuences 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 eld of mens health has also called for mens physical bodies
to be better considered when investigating mens conceptualisations and practices in relation to
health (Oliffe 2006). Being male has been seen to be inuenced by, and have an inuence on,
mens 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
identication (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 mens apparent reluctance to access healthcare services has been seen
as a key factor inuencing 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 mens pre-diagnosis help-seeking, with a smaller body of
work having begun to explore mens help-seeking in the context of diagnosed illness, includ-
ing cancer and depression (Johnson et al. 2012, Wenger and Oliffe 2014). Specic to all of
these studies is the attempt to move beyond oversimplied assertions that men are ignorant or
not interested in their health to recognise how mens help-seeking is inuenced by broader
societal expectations that inform mens 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 eld have tended to be retrospective in nature with
men reecting on their experiences from the vantage point of having assumed a parenting role,
either through infertility treatment or adoption. Whilst this undoubtedly reects to some extent
the difculties recruiting men to such studies, mens 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 mens 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, yers
and information sheets provided within the main reception/waiting area. This presented men
with information about the study and the eligibility criteria, including self-identication 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 yers 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 difcult 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 reection, they felt they had little to say on the matter. We can only speculate as
to why so many men changed their minds, though mens 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-identied as having a male-factor prob-
lem, three as having a male and female-factor problem, and two self-identied 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 mens 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 mens experi-
ences of infertility treatment. Twelve of these men had undergone a series of tests and were
about to start their rst 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
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 mans 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 thematicreview of the data.
The mens accounts were systematically and thoroughly compared and contrasted in order to
build up categories, test emergent theory and attach meaningto 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 mens desire for children. Sub-codes were then identied 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 inductionaimed to reect the
complexity of the mens 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 ndings are generalis-
able to other groups of infertile men remains an open empirical question. However, a number
of measures were employed to establish condence in the quality of ndings (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 ndings are trustworthy.
When presenting the ndings participant condentiality is protected by the use of pseudo-
nyms. In many cases, the mens verbatim has been shortened to omit superuous 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 reect the meaning expressed by these men. An
ellipsis (...) is used to denote when this occurs. The ndings draw on those men experiencing a
male-factor problem, a male and female-factor problem, or whose infertility was unexplained.
Conceptualising mens 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 mens experiences of infertility. All of the
men in this study had envisioned becoming fathers and tended to dene their procreative
desires in terms of a taken-for-granted expectationand part of being human:
Its almost programmed into you ... Even though its different for a man, theres 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 dont have the same driveas 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 exaggeratedor stereotypicalassumption 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 its a bit different but deep down its the same ... I want children as much
as my wife does. But ... amongst men, its 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, mens assumed reproductive capabilities were clearly tied to cer-
tain masculine norms and expectations:
Its such a primitive thing that you just take for granted ... Its just a basic thing, a kind of
given that you can have children ... and its spoken about in a real masculine way ... In
crude ways about getting people pregnant. (Max, 32, male-factor)
Mens 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 ve
years before approaching his GP. In making sense of their delay, it was clear that men had a
difcult time coming to terms with the fact they may have a problem, Youve got to accept it
rst ... 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 mens experiences of infertility 5
concerns that men may hide or face in isolation, infertility was a health problem that uniquely
intertwined men and womens help-seeking. The necessity for joint investigations put men
under particular sets of pressures. For example, indirect pressure related to the upsetand
painmen 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, mens 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 ... theyll allow something to grow and they wont say anything until its 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 difcult for men. Not
only because it was associated with weaknessand 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 ne you would just have got your partner
pregnant ... it wouldnt be like youd 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 nding 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 wed decided to do something about it. Because for so
long wed been trying but been disappointed ...So there was the sense of being energised
... were 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 ring 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
mens ability to deliver what is expected in the way of conception. Clearly, strong representa-
tions of masculine bodily power made a signicant contribution to the kind of men they
thought themselves to be:
I always thought it would be almost like icking 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 signicance of
their defective sperm or thought it easily rectiable 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 bodys reproductive capability:
I know that the whole thing is my fault and I cant really blame anybody but ... Ive never
done any extreme sports, Ive never took drugs, Ive never drunk excessively ... Its just
bad luck. (Max, 32, male-factor)
Mens demolished their sense of bodily power was evident in phrases such as You almost feel
as if youre 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 mens crisis of condence regarding their ability to live up to dominant cultural expec-
tations of men:
Obviously thats part of being a man is being able to produce children ...When they tell
you that you cant, that your semens no good, its 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 forand
he compared himself favourably to other men with more threatening diagnoses:
It wasnt a major emotional thing for me. The fact that they were saying to me that I wasnt
... not producing any good sperm. Had that been the case Id 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
Im not upset about it. But its not something you want to hear ... that I couldnt provide
what she needed to create a baby ... Its 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 guttedto 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 mens 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
signicant source of guilt and reason why men deemed it wrong to voice their own concerns,
I dont want to give away how worried I am to my wife ...I just dont want to ... add it to
her burden(Arnel, 41, male-factor). Other emotions, such as men feeling embarrassedand
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 its not that I
dont want to give a response, its just that I cant give a response(Charles, 43, male-factor).
This led one man to suggest that women should be told about the difculties facing men when
diagnosed with infertility:
If it is the male thats at fault I think the female needs to go and see somebody and get it
explained how the male feels ... because its hard for you to explain to your partner how
youre 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, Youre limited to what you can do. Because
the procedure ... its happening to the woman isntit(Charles 43, male-factor) (cf. Hinton
and Miller 2013). Mens 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 womens optimism and prepare women emotionally for the possibility of failure:
It hit her really hard ... Shed built up an expectation that it was just going to work ...
choosing names ... I was like, dontdoit... 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 assessmentas 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 ipside 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 conde there was little
sense that they expected expansive discussions with other men. As they predicted, other men
responded in matter of factways 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 dont know what youd expect their response to be. Its like a friend coming up and say-
ing theyre gay. Youd go OK [laugh] what am I going to do about it. Its 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 lets just move forward ... if you need to talk then ne, but ... just move
on. (Nathan 25, male-factor)
Three main reasons were apparent for why men chose not to discuss their infertility. The rst
related to men not wanting to be the focus of attention or the subject of pity and that others
feel sorryfor them. The second related to mens 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 thats funny. ... Its only when its 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, Thats 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 difcult, even
with men in similar circumstances:
My best friend mentioned it to me about two weeks ago ... Its doubtful that they can have
children. So even with him saying that to me, I still couldnt bring myself to say, I know
how you feel... I just couldnt. (Max 32, male-factor)
This did not mean that other men were unaware of their diagnosis. Mens 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 ... denitely know whats going on but its 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 whats going on
with our IVF ... Its just something I dont discuss with them ... its not a conversation Id
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
deect 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 havent kids yet?Ill normally just say ...
its not our priority at the moment or I change the subject ...That is one of my strategies
... changing the subject ...But I cant do that forever [laugh]. (Arnel, 41, male-factor)
There was nothing to suggest that men sought to deect 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 mens 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 well have a happy life, though this man immediately
went on to say, I dont know if my wife sees it that way(Joseph 38, unexplained). In short,
mens attempts to reconcile their situations were not perceived to be shared by their partners:
My world doesnt stop and end with this. Ive 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 ... shed be devastated. (Zackery 44, male and
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 dont know how its going to affect our relationship when it doesnt
work(Leonard 25, male-factor). A signicant 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 its my fault and its my problem and my partner could have kids with somebody
else ... Even though shes not going to go and have a baby with nobody else, but she
could. Shes got the option. Whereas I havent got the option to do that. (Leonard 25,
Discussion and conclusion
Relatively little research has explored mens 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, mens 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 healthand ill-healthwhen 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 mens lack of knowledge about their health and
bodies, can help to explain these mens propensity to delay seeking help (Gough and Roberson
2010). Whilst the necessity for joint help-seeking may bring a unique complexity to mens
decision-making around infertility, the known obstacles men face when considering whether to
access health services appear to be amplied 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 orientatedwhen it comes to infer-
tility (Slepickova 2010). Indeed, the men themselves sought to question what they considered
to be over-inated claims of gender differences in procreative desires that reied 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 difcult 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). Mens descriptions of their
sperm as weak,lazyand deadwas 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 reection on them as men (they were not implicated in the cause) and
it did reect something about them as men (they had lost the presumed basis of manhood). It
is perhaps also not surprising that some men sought to dene their diagnosis in less threaten-
ing terms; that is, not as bad as other mens, which enabled them to maintain certain aspects
of masculine self-esteem. Nonetheless, regardless of how they reected 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 Connells thesis that masculinity is best understood as a conguration 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 inuenced mens 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 signicantly
heightened in relation to infertility. Their actions at this time may, therefore, be conceptualised
as men being let down by their bodies, which suddenly dened them as incapable of living up
to certain dominant expectations, who then draw on other identiable markers of masculine
practice to enable them to enact a masculine form congruent with hegemonic masculinity. Fur-
thermore, mens 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,
mens 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 redened 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 mens experiences of infertility 11
that infertility should be faced as a couple; that is, manliness was demonstrated through atten-
tiveness, selessness 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 superciality 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-condence (Courtenay 2011). In many ways, these themes echo
mens experiences during pregnancy and childbirth (e.g. Dolan and Coe 2011), which may
stem from the fact that it is womens bodies that are centre of attention in both arenas.
Unlike pregnancy, however, mens actions may also be inuenced by their sense of guilt
regarding their infertility and they felt forced to curb womens enthusiasm regarding the
chances of them conceiving a child, which is evidently not the case with pregnancy. Whilst
mens stoical role in the face of disappointment regarding infertility has been documented
(Hinton and Miller 2013), this study suggests that men may dene themselves as the voice of
reasonthroughout the process. Although men sought to characterise this in terms of masculine
rationality over feminine emotionality, it undoubtedly limited mens ability to disclose their
own concerns and aspirations. It also underpinned mens 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).
Mens 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 condent that other men would
respond in supportive, if unemotional ways. Their disclosure was not dened in terms of
psychological relief and there was no sense that they wished to communicate aspects of their
inner-selves. Menslack of communityregarding 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, mens 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
camaraderieand shared understanding that permeates mens 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 mens 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 investmentof 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)
In summary, this paper has explored mens experiences of infertility via a theoretical frame-
work fashioned from within the eld of mens health. It has demonstrated how hegemonic
norms, that reject weakness and vulnerability, coupled with mens lack of knowledge about
their bodies, help to explain mens propensity to delay help-seeking despite their desire for
children. It has also illustrated the role of the male body in mens experiences of infertility.
Their body can be dened 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:
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A theoretical understanding of mens experiences of infertility 15
... The latter topic is intertwined with men's generalized attitudes about health care seeking [12,13], and as such one might anticipate there being a plethora of studies given the global pervasiveness of infertility and the prominent profile of the MAR industry. However, very few investigations explored infertility-associated feelings, and all were comprised of small subject sample sizes, e.g., less than 50 subjects, and with isolated demographics, e.g., single region with a country, and lack of diversity [11]. ...
... The emotions of weakness and fear may be labeled 'negative' whereas the opposite qualities of strength and courage as 'positive'. In focusing on male infertility, a diagnosis of poor semen quality or poor sperm parameters might carry additional emotions of lacking in virility or feeling pitied because of their infertility [13], and these emotions might be labeled as negative. Our study revealed that slightly more than half of respondents feel open and matter of fact about their infertility, and for our study those feelings were considered as positive. ...
... These results of being unlikely to talk about infertility with friends or family are seemingly disjointed from the responses of feeling matter of fact and open about infertility. There are several conclusions that can be drawn (1) men feel accepting and open within themselves about infertility but are reluctant to share with family and friends for fear of ridicule or more [13], (2) men share their feelings only with their significant other or not at all [13], (3) men are not honest with themselves about their feelings, or (4) men are unaware of male-specific infertility support groups to meet with other 'like' men to share the gamut of feelings that are a part of being a man afflicted by the disease of infertility. ...
Full-text available
Purpose: In general, men are less likely to seek health care than women. Infertility is a global disease that afflicts approximately 15% of reproductive age couples and the male contributes to 40% of the diagnosable cause. Remarkably, no large or multi-national population data exist regarding men’s perceptions about their infertility. The purpose of this study was to advance our knowledge about the infertile male’s social experience regarding: (1) how they feel about their infertility, (2) what motivated them to seek health care, (3) how likely are they to talk with others about their infertility, (4) their awareness of male infertility support groups, and (5) what their primary source for information is regarding male infertility? Based on the results from this study, these simple questions now have clearer definition. Materials and Methods: An Institutional Review Board-approved, male-directed, anonymous questionnaire translated into 20 languages was made globally available through the Fertility Europe website ( Males (n=1,171) age 20–49 years were invited to complete the online survey after informed consent. Results: Most respondents were European (86%). Of European men
... Böylesi bir sosyal ortamda erkeğin çocuk sahibi olamamasının, hele ki kısır olmasının yaratacağı kriz durumu araştırma konusu olarak daha fazla incelenmiştir.Erkek kısırlığıyla ilgili yapılan çalışmalarda erkeklerin kullandıkları kelimeler bir çok düşünceyi ortaya koymaktadır. "Eşlerine bir çocuk vermeyi başaramayan" erkekler kendilerini başarısız, yararsız, fiyasko, yetersiz, gerçek bir erkek değil, çöp, kaybeden ve kusurlu gibi pek çok sıfatla tanımlamışlardır(92). Başka bir araştırmada(114) erkeklerin spermlerini tanımlarken zayıf, tembel ve ölü kelimelerini kullanmaları azalan otoritelerinin bir göstergesi olarak yorumlanmış ve hızlı, güçlü ve başarılı gibi hegemonik erkeklikle ilişkili kavramlara tezat oluşturduğu vurgulanmıştır. Bizim araştırmamızda da erkekler spermlerinin "kaliteli" olup olmadıklarından endişelendiklerini söylemiş, düşük sayıda spermi olan bir katılımcı "erkeksin ya, erkeklik olayı var işte, kötüymüşüm, sağlıklı değilmişim dedim" ...
... Kanada ve İsrail'de yapılan bir araştırmada (173) kısırlık durumları eğer arkadaşları ve aileleri tarafından bilinirse erkeklerin "alay konusu" olabileceklerinden kaygılandıkları sonucu çıkmıştır. İngiltere'de IVF kullanan erkeklerle yapılan başka bir araştırmada(114) ise erkeklerin tedaviyi etraflarıyla konuşmayı tercih etmedikleri, arkadaşlarının onları algılayamayacaklarını düşündükleri, bu çekincelerin arkasındaki nedenlerin kimsenin onlara acımasını istememeleri, alaya alınmaktan korkmaları ve kültürel olarak iktidarsızlık ve yetersizlikle tanımlanmak istememeleri olduğu sonucu çıkmıştır. Bizim bulgularımızda da bazı erkeklerin bu konuyu hassas ve özel buldukları için başkalarıyla paylaşımda bulunmadıkları gözlenmiştir fakat erkek faktörlü kısırlık ile paylaşımsızlık arasında bir bağa rastlanılmamıştır.Kısırlık tedavisi görüyor olmak, özellikle YÜT kullanımı yaygınlaştıkça dünyanın pek çok yerinde daha normalleşen bir süreç olarak algılanmaya başlamıştır.Inhorn'ün(89) araştırmalarında da zaman geçtikçe bu süreçlerin "büyük sır" olmaktan çıkıp çevreyle paylaşıldığı, doktor tavsiyeleri alındığı ve yakın çevreden tedavi için maddi destek alındığı ortaya çıkmıştır. ...
... Bütün bu farklılıklar tedavinin erkekleri daha az etkilediği anlamına gelmemekte, son yıllarda yapılan araştırmalarla erkekler duygusal olarak çok daha az ifade etseler de bu sürecin hayatlarında büyük bir kriz olarak deneyimlendiği ortaya çıkmaktadır(87). Erkekler bu krizi kadınların yaşadığı aciliyet duygusuyla deneyimlememekte ve endişelendiklerinde rahatlamak ya da kendi depresif duygularını açıkça ifade etmek için başkalarıyla konuşmamaktadırlar(127).Duygularını başkalarıyla paylaşmayan erkekler bir de "eşleri için" sürekli güçlü durmaya çalıştıklarını bir araştırmada şu sözlerle ifade etmişlerdir: " Asıl düşüncelerim partnerimle birlikteydi, onun için güçlü olmak zorundaydım, bu konu hakkında üzülmüş gibi gözükmemem gerekiyordu…Eşime ne kadar endişeli olduğumu belli etmek istemedim, onun yüküne bir de bunu eklemek istemedim"(114).Bizim araştırmamızda da pek çok erkek endişeli olsalar da bunu eşleriyle paylaşmadıklarını, eşleri için güçlü durduklarını söylemişlerdir. "Erkekliğin" verdiği bir görevmişçesine güçlü durmaya çalışsalar da erkeklerin de süreçte yıprandıkları ve kaygılandıkları anlaşılmaktadır ve eşleri de aslında duygularını onlarla paylaştıklarında bir karşılık almak istemektedirler. ...
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Bu araştırma sosyal hizmetin temel müdahale alanlarından aileyi, Eleştirel Erkeklik Çalışmaları’nın bakış açısıyla incelemiş ve alana dair farklı bir yaklaşım sunmak istemiştir. Araştırmanın amacı görüşülen erkek katılımcıların “erkeklik” algılarının baba olarak sahip oldukları roller üzerindeki etkisini temel alarak babalık istencinin altında yatan nedenleri bireysel ve toplumsal boyutuyla ele alıp Türkiye’deki aile politikalarıyla ilişkisini kurmaktır. Aynı zamanda haklarında çok az araştırma yapılan tüp bebek yöntemiyle baba olmuş erkeklerle çalışılarak onların yeniden üretim alanındaki deneyimlerinin aktarılması ve erkeklerin babalık pratiklerinin “erkekliğin” dönüşümündeki olası etkilerini tartışmak da hedeflenmiştir. Araştırmanın amaçları doğrultusunda nitel araştırma yöntemlerinden fenomenoloji deseni kullanılmıştır. Katılımcılar amaçlı örnekleme yöntemlerinden benzeşik örnekleme tekniğiyle belirlenmiştir. Tüp bebek yöntemiyle baba olmuş, 8 farklı şehirden 23 erkekle derinlemesine görüşmeler gerçekleştirilerek veriler toplanmış ve bu veriler Maxqda 2020 Project analiz programıyla betimsel analize tabi tutulmuştur. Çalışmanın bulguları “Kurucu bir unsur olarak erkeğin kendi babası”, “Babalık öncesi evlilik hayatı”, “Babalık istenci”, “Tüp bebek süreci”, “Gebelik süreci”, “İlk babalık dönemi”, “Babanın çocuğun hayatındaki yeri”, “Erkeğin kendine dair değerlendirmeleri” ve “Erkeklik” ve “Babalıkla ilgili sosyal politikalar” temaları altında toplanmış, her bir başlıkta katılımcıların deneyimleri aktarılmıştır. Araştırmada katılımcıların deneyim aktarımları sonucunda toplumdaki erkeklik ve babalık algılarının bir değişim sürecinde olduğu, erkeklerin –özellikle tüp bebek deneyiminin aracılığıyla- birer özne olarak yeniden üretim alanında daha çok bulunmaya başladıkları fakat kendilerini bu alana yeterince dahil hissetmedikleri anlaşılmıştır. Toplumsal dönüşümün kadın-erkek eşitliği üzerinden gerçekleşebilmesi için öneriler sunulmuş, babalık rolünün egemen erkeklik formunu olumlu yönde değiştirebilme kapasitesi sorgulanmıştır. This research examined the family, one of the main intervention areas of social work, from the perspective of Critical Study of Masculinities and wanted to present a different approach to the field. The aim of the study is to deal with the individual and social dimensions of the reasons underlying the desire to become a father based on the effect of “masculinity” perceptions of male participants on their roles as fathers and to establish a relationship with family policies in Turkey. At the same time, it was aimed to work with men who became fathers with the IVF method, for which little research has been done, to convey their experiences in procreative realm and to discuss the possible effects of men’s fatherhood practices on the transformation of “masculinity”. Phenomenology design, one of the qualitative research methods, was used in line with the aims of the study. Participants were determined using homogeneous sampling technique, one of the purposeful sampling methods. Data were collected by conducting in-depth interviews with 23 men from 8 different cities who become fathers through IVF method and these data were subjected to descriptive analyses with the analyses program of Maxqda 2020 Project. The findings of the study were collected under the themes of “the men’s own fathers as a founding element”, “marriage life before fatherhood”, “the desire to become a father”, “IVF process”, “pregnancy process”, “first paternity period”, “father’s place in the child’s life”, “man’s self-assessments”, “masculinity” and “social policies about paternity” and the experiences of the participants were conveyed under each title. In the study, it was understood that the perceptions of masculinity and fatherhood in the society were in a process of change as a results of the experience transfer of the participants, and men –especially through the IVF experience- started to be more involved in procreative realm as subjects but they did not feel sufficiently involved in this field. Suggestions were made fort the realization of social transformation through gender equality and the capacity of the fatherhood role to positively change the dominant form of masculinity was questioned.
... 244). Webb and Daniluk (1999), Shirani and Henwood (2011), Hinton and Miller (2013), Herrera (2013), Dolan et al. (2017), Harlow et al. (2020), Hanna and Gough (2020) Social and cultural norms, values, and expectations Having children is a man mandate from society. "The reason I wouldn't want to tell someone was this weird stigma in our culture that, if a man doesn't produce sperm, he's less of a man . ...
Background : The rate of infertility is increasing day by day. According to studies conducted worldwide, 30 million men are diagnosed with infertility. Cases of infertility are often associated with a failure to become male in society. Procreation and gender roles are often closely linked so that infertile men are often considered the second sex. Sometimes, this condition makes men question their masculinity. Methods : We performed a systematic review and metasynthesis with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline procedure on qualitative studies on ten databases exploring the experience of infertile men and their association with masculinity. Results : Twenty-four studies matched our question, and there are two major themes with eight subthemes that were obtained from the results of the metasynthesis of these studies. The impact of this gender issue is huge on men’s health and their social interactions. As a result, gender issues provide a space for debate and a burden on men. Sometimes, men develop mental health problems. The topic of masculinity and infertility is at odds with feminism and is susceptible to the societal stigma that results from the hegemonic conception of masculinity. Interestingly, the men must accept reality and follow the treatment process for infertility, although it affects their psychological well-being. Conclusions : These findings provide insight for physicians, as treating infertility requires a multidisciplinary team that does not only address procreation issues. Social issues related to gender roles often bring patients into harmful and dangerous conditions. To address the gender issue in men globally in several dimensions, however, a large study in various populations is still required.
... They often compared themselves with other people who had children and they fabricated the truth before the people who asked very personal questions. Many researchers (Dolan, Lomas, Ghobara, & Hartshorne, 2017;Wischmann & Kentenich, 2017) have established that people start gossiping about infertile people, create social pressure and express pity for them. Batool and de Visser (2014) in a cross cultural study reported that social pressure from society and extended family was more intense in Pakistan as compare with the infertile people in Britain. ...
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The study was conducted to explore the 'psychosocial problems' of infertile men and women in Lahore, Pakistan. Semi-structured interviews were used to collect the data from thirty participants (10 infertile men and women, 10-spouses and 10 infertility experts). The purposive sampling technique was used to collect the data from the participants selected from the infertility departments of four hospitals. Interviews were audio recorded and transcribed for thematic analysis. After analyzing the data, eight major themes emerged that highlighted the problem areas; 1) social problems, 2) family pressure, 3) personal concerns, 4) psychological problems, 5) sexual problems, 6) marital conflict, 7) treatment related concerns, and 8) coping. Despite the fact that both men and women were experiencing comparable psychosocial problems (e.g., curious and pinching questions by family and society); emotional disturbance (e.g., depression, anxiety and stress); personal problems (e.g., self-desire to become parents); marital conflict (e.g., the threat of separation and dominant attitude of partner), the data also revealed gender-specific infertility related problems. Men predominantly reported disorientation about the problem, masculinity ego, hiding their infertility, and showing resistance to treatment. Whereas; the women reported to be undergoing family and social pressure, social maladjustment, the agony of diagnosis and treatment procedures, and stress related to the monthly cycle. The results suggest gender-specific problems to be taken into account while dealing with infertility-related issues. It was concluded that the understanding of the social and psychological context of infertility-related problems will, later on, provide the basis for an effective psychosocial intervention plan.
... 7 People start to gossip about infertile people thus creating social pressure and show pity for them. 8 Family pressure in the form of stigmatization, blaming and taunting of in-laws, multiple medications by the family, certain enquiries by relatives, and property issues starts on infertile couples soon after marriage. 9 Awareness about infertility is insufficient in many parts of the world. ...
Background and Objective: Globally infertility affects between 60 million and 168 million all over the world. Regardless of the fact that Pakistan being currently among the most overpopulated nations of the globe and a populace development pace of around 2%, confronts with the higher pace infertility (21.9%); 3.5%primary and 18.4% secondary. The aim of the study was to assess the understanding of gynecologist of Pakistan regarding Assisted Reproductive Techniques (ART). Methods: It was a descriptive study, conducted only for gynecologists who attended the “Asia Pacific Initiative on Reproduction” (ASPIRE) conference held in Lahore, Pakistan, from 29th Nov to 1st December 2019. Data was collected from the n = 252 gynecologist who were attending the conference. Results: Out of n = 252 doctors, 82.9% participants considered test tube baby a social norm and acceptable option while 55.6% participants were in the opinion of basically a stigma attached to society. According to 77.8% participants, socially and legally involvement of 3rd party like donor eggs, sperms and gametes cannot justify. Conclusion: Pakistan, gynecologists are the mainstream dealing with infertility. Apart from general population, there are certain myths and controversies among the gynecologist as well. So that gynecologists' knowledge and perception is the most important point regarding infertility and ART.
... Anthropologists have further discussed how men and their social and embodied experiences were 'ignored,' for instance in theorizing medicalization (Rosenfeld & Faircloth, 2006), considered as 'second sex' (Inhorn, Tjørnhøj-Thomsen, Goldberg, & Mosegaard, 2009) and 'missing' (Culley, Hudson, & Lohan, 2013) subjects. Men's biological, social and embodied 'marginalization' and invisibility was seen as an expression of how and to what extent men attempted to reflect 'hegemonic masculinities' (Connell & Connell, 2005) or deal with cultural and biomedical norms about reproduction, sexuality, and ART's both in clinical and social-conjugal settings (Inhorn, 2003;Thompson, 2005;Inhorn et al., 2009;Dudgeon & Inhorn, 2003;Culley et al., 2013;Marsiglio, Lohan, & Culley, 2013;Reimann, 2016;Dolan, Lomas, Ghobara, & Hartshorne, 2017). Scholars demonstrated how medical science, institutional structures, and culturally shared gender stereotypes have consistently contributed to the constitution of men's role and reproductive bodies as 'peripheral' (Barnes, 2014), thereby justifying and shaping how men occupy those peripheral positions, often with little objection or complaint (Barnes, 2014;Bell, 2016). ...
This paper explores the ways how heterosexual middle-class men negotiate and readjust their role in the context of reproductive technologies, which are often seen as stereotypically a female terrain. Based on ethnographic research between 2009 and 2013 in three fertility clinics in Istanbul and on a digital self-help platform I pay close attention to men’s emerging practices in the context of Turkey, where the neoliberal-authoritarian JDP (Justice and Development Party) has reinforced patriarchal and traditional gender identities and roles over the last two decades. I draw upon anthropological perspectives on new and emergent masculinities, and also examine how these are constructed, performed and renegotiated both online and offline. This I do by focusing on men’s narratives of what I call biosocial exclusion and counterstrategies, when men designated their role as ‘outsiders’ and/or ‘sperm providers’ during treatment. I use this concept to discuss men’s understandings of themselves as reproductive actors and as parts of biosocial relations – the couple, family and society. I argue that there are transformations in practices of male biosocial subjects. I aim to capture the effects of the new biosocial relations of self-help, advocacy and activism of concerned people – both online and offline.
The second edition of the essential guide for reproductive professionals is now available in a Clinical Guide and a Case Studies Guide, presenting the most current knowledge on counseling diverse patients amidst rapidly advancing modern technology. Follow an in-depth presentation of clinical concepts in this Clinical Guide for a foundational understanding of the medical and psychosocial experience of fertility treatment. Explore the areas of reproductive psychology, therapeutic approaches, assessment and preparation in assisted reproduction, addressing the needs of diverse populations, and clinical practice issues. Featuring new topics such as transgender ART, recurrent pregnancy loss, post-partum adjustment, and the pregnant therapist. Then in Case Studies, discover the accessible, real-world experiences and perspectives as leading international practitioners share their stories applying clinical concepts to treatment practice. An essential aid for medical and mental health professionals, this comprehensive guide allows clinicians to develop and refine the skills required to address the increasingly complex psychosocial needs of fertility patients.
Men are often considered by the health care system to be a disengaged accessory when it comes to family planning. In reality they act as an equal part in the reproductive equation. Despite qualitative research suggesting some men currently do take primary responsibility for family planning, men are further marginalised being classed as an irrational variable in large national datasets. Reports ignore men in general by failing to record basic demographics, for example, age is not captured and ethnicity has two options: white and non-white. This leaves little ability to analyse men's family planning knowledge, attitudes and beliefs. Technological advancements have resulted in new forms of male contraceptive methods reaching phase III testing (from pills to gels), and the market is moving towards diversified options that will allow even more men to take primary contraceptive responsibility. Other advancements include the sexual enhancement product Viagra becoming available over the counter, and reproductive wellbeing apps have been created to allow men to test their fertility at home. Without research to understand the ever-changing landscape for men we are ill-prepared to understand what these new products and advancements mean for men's role. Using various forms of publicly available online data and previous empirical research, this chapter will review men's response to new contraceptives, sexual enhancement products, and reproductive wellbeing apps. The results will be discussed in relation to updating the Subjective Expected Utility (SEU) Theory, the Theory of Planned Behaviour and the integrated developmental and decision-making contraceptive models used by health psychologists.
Historically, sperm donation was shrouded in secrecy to protect the normative family and the perceived vulnerability of infertile men. However, openness about donor conception is increasingly encouraged, in acknowledging that donor-conceived people may benefit from having access to information about their biogenetic origins. Since 2017 in the state of Victoria, Australia, donor-conceived people have been able to access previously anonymous donor records. Drawing on interviews with 17 donor-conceived adults who have come to know their donor through the new laws, this article explores the impact of finding out about the donor on relationships with mothers and fathers, and points to the persistent effects of stigma and shame about donor conception within families. Most of the donor-conceived participants were told about their donor conception in early adulthood. The age range for time of disclosure was mid-teens to early 40s. Most reported that their fathers did not want them to know. In some cases, mothers had disclosed, but sworn them to secrecy. Sensitivity to fathers’ feelings fostered a desire among participants to maintain secrecy about his infertility, especially in relation to wider family and friendship networks. Our findings revealed that secrecy about men’s infertility is heavily reliant on women’s emotional labor to protect ageing infertile fathers’ sense of manhood. Coupled with fathers’ overt resistance to openness, intergenerational secret keeping is perpetuated in families. Laws supporting openness potentially exacerbate the historical stigma associated with male factor infertility in a culture that continues to conflate virility, fertility, and masculinity.
This article explores the involvement of doctors, men, and men’s partners in the clinical setting of male infertility in France and French-speaking Switzerland from the 1890s to the 1970s. Drawing from medical literature, press articles, media archives, and patient records, this paper questions the gendered construction of medical and patient work. It argues that in medical encounters, doctors, men, and men’s partners did not only engage with infertility but also with patients’ masculinities. The association between fertility and masculinity meant that men, but also doctors, were sometimes reluctant to explore the male factor of reproduction. Therefore, physicians elaborated specific strategies – such as referring to traits stereotypically associated with masculinity, attenuating fertility diagnoses or delegating information to men’s partners – to either include or dismiss men from the clinical setting, and to avoid harming their feelings of masculinity. In the meantime, women were made responsible for men’s reproductive health, reproducing a gendered division of reproductive work. This paper highlights partners’ work, such as consulting first, persuading their partners to undergo fertility exams, and mediating the relationship with physicians.
Congratulations to H. Russell Bernard, who was recently elected as a member of the National Academy of Sciences"This book does what few others even attempt—to survey a wide range of systematic analytic approaches. I commend the authors for both their inclusiveness and their depth of treatment of various tasks and approaches." —Judith Preissle, University of Georgia "I appreciate the unpretentious tone of the book. The authors provide very clear instructions and examples of many different ways to collect and analyze qualitative data and make it clear that there is no one correct way to do it." —Cheryl Winsten-Bartlett, North Central University "The analytical methodologies are laid out very well, and I will definitely utilize the book with students regarding detailed information and steps to conduct systematic and rigorous data analysis." —Dorothy Aguilera, Lewis & Clark College This book introduces readers to systematic methods for analyzing qualitative data. Unlike other texts, it covers the extensive range of available methods so that readers become aware of the array of techniques beyond their individual disciplines. Part I is an overview of the basics. Part II comprises 11 chapters, each treating a different method for analyzing text. Real examples from the literature across the health and social sciences provide invaluable applied understanding.
Engendering Emotions examines the production and promotion of the idea of sex/gender difference in emotional experience and expression in the contemporary West. Focusing on the psychology of emotions and on the spheres of aggression and war, and love, intimacy and sex, it explores how the idea of emotional difference serves to define and govern relations between men and women. The book draws on diverse theoretical work and recent empirical data to chart new territory in the study of sex/gender differences.
This chapter introduces the book’s first part where our theoretical and substantive approach to transition is laid out in relation to the three occupational contexts we outlined in our Introduction; that of hairdressing, fire fighting and estate agents. Transition is also conceptualised in relation to how the nature of masculinity can be conceived, for example, as processual and fluid and in terms of the practices and the ‘doing’ of masculinity across spheres and across the life course, that is, men in motion. What it argues is that transition can be as much about connection and continuity, as separation and difference. Thus, the nature of the boundary between public and private spheres can be seen as constituted differently for men and women of different ages and social class backgrounds (Whitehead, 2002). Furthermore, within individual men’s lives, ‘key’ transitional moments can encompass first entering employment, career progression and retirement, through to becoming or being single, divorced or separated, becoming a couple or having a family. How men situate themselves in time, therefore — the role of memory and imagination, of subjective notions of the past and future — are all under-theorised aspects of the masculine experience.
In Conceiving Masculinity, Liberty Walther Barnes puts the world of male infertility under the microscope to examine how culturally pervasive notions of gender shape our understanding of disease, and how disease impacts our personal ideas about gender. Taking readers inside male infertility clinics, and interviewing doctors and couples dealing with male infertility, Barnes provides a rich account of the social aspects of the confusing and frustrating diagnosis of infertility. She explains why men resist a stigmatizing label like “infertile,” and how men with poor fertility redefine for themselves what it means to be manly and masculine in a society that prizes male virility. Conceiving Masculinity also details how and why men embrace medical technologies and treatment for infertility. Broaching a socially taboo topic, Barnes emphasizes that infertility is not just a women’s issue. She shows how gender and disease are socially constructed within social institutions and by individuals.