David Coleman: The impact of infertility on Irish men
David Coleman on age-old male problems
In about 30pc to 40pc of couples who cannot conceive a child, the infertility is due directly to the man. It's a similar percentage for woman and in about 20pc of cases it is due to both of them, or cannot be determined.
Despite that, the vast majority of research looking at the impact of infertility has focused on how the experience affects women. Simple reasons given for this are that men don't seem to talk as much about infertility and seem to be more stoic in their reaction to discovering that they are infertile.
But this typically male response of grinning and bearing it underlies a much deeper, and more distressed, response in men.
For a start, men and women of child-bearing age have been found to have similar levels of desire to produce children. Childless men and women aged between 30 and 40 years have the most similar desire to have children.
So, men are certainly not necessarily less bothered about being unable to conceive because they don't really want children. Men do want children.
That said, there is lots of research that backs up the claims that women seem to be more psychologically upset and distressed than men, when a couple discovers that they are infertile and seek help.
Those research studies that have looked, for example, at the reactions of infertile couples to the infertility diagnosis (without indicating whether it was a male or female factor leading to the infertility) found that men tended to report lower levels of depression and anxiety than their partners. The differences weren't always large, but were consistent.
As an example, one study found that men in infertile couples had lower levels than women of "infertility-related concerns" about life satisfaction, sexuality, self-esteem and social participation.
But psychological distress amongst men has been found to be somewhat higher when men discover that it is some problem of theirs that is the cause of the infertility. The rate of such psychological distress, however, is not clinically any more significant than the rates of depression or anxiety amongst men generally.
The underlying distress that infertile men experience, then, isn't particularly in the realm of mental health as we usually construe it. Men, generally, don't become more depressed or anxious because they can't conceive.
What does seem to happen, though, is that their infertility may hit hard at their sense of masculinity. Many men see their reproductive system as pretty simple and uncomplicated. It comes as a real shock, therefore, to discover that there is some issue with their sperm and their capacity to fertilise their partner's eggs.
That shock may in fact be what leads some men into silence about the issue. The withdrawal into silence may be stress, or a coping response.
In some cultures, where "machismo" or masculinity is especially valued, it is not uncommon to find women taking public responsibility for the man's infertility to protect him from a perceived shame at being unable to procreate. Some men will label themselves as less of a man if they discover that they are infertile.
Indeed, the link, for many men, between their fertility and their sexuality is so significant that this is the area that can, most often, be compromised. For men, recognising that you are infertile can lead to strong feelings of inadequacy.
It isn't uncommon to find many infertile men experiencing short, or long, periods of erectile dysfunction.
Sometimes this is due to underlying, almost unconscious, anxieties about not functioning as a man that translate into a physical difficulty getting or maintaining an erection.
Sometimes the difficulty with erections comes as a result of the infertility treatment plan that may seem to require sex on demand, at very specific windows of opportunity, removing some of the spontaneity or making it almost seem like a task rather than a pleasure.
Some men will feel like they have let their wives or partners down, because they can't impregnate them "naturally". They may feel that their partners would be better off with a "real man" rather than a non-functioning one.
Other men who experience infertility choose to have other relationships outside their marriage or long-term relationship, almost as if to prove their masculinity and attractiveness to women.
These potential threats to long-term relationships or marriages are usually reduced when the couple see the problem with infertility as neither person's fault, but rather a challenge for the couple to overcome as a team. Achieving that level of cohesion, though, requires openness and lots of talking about infertility. This in itself is often a challenge for the man.
There also seems to be evidence that men don't look for social support to deal with their struggles, however those struggles manifest. This, again, is where the perceived stoicism of men appears to be true.
Unlike their wives or partners, who may talk to close friends or family, men will rarely broach the issue of their infertility, perhaps because of their own feelings of inadequacy or from a fear of being judged inadequate.
While research shows that men may prefer to get their emotional support and information from medical experts, it is better that they at least talk to their doctors than talk to no one at all.