Four Lessons on Fatherhood and the Emotional Consequences of Male Infertility
Note: This blog relies heavily upon research titled “Emotional Consequences of Male Infertility” by Dr. Ajay K. Nangia MBBS and his colleagues Vassili Glazyrine MD, Dane Stephens MD, Emily Wentzell PhD, Kimberly Wallace-Young PhD.
Across the world, 15% of couples suffer from infertility. As a practicing Urologist, Male Infertility Specialist, and researcher for over 20 years, I have seen the full spectrum of infertility: from the effects of a young man taking anabolic steroids to make his body stereotypically “masculine,” to couples who spent years focusing on the female’s ability to have a child without examining the male, to my own journey of becoming a father after years of trying to conceive with my wife.
Over 25 years ago, my wife and I first tried to have children. We started with “the usual way,” but after months of trying, we remained unsuccessful. For the next three years, we just carried on, not knowing why we weren’t succeeding but hoping that our luck would change anyway. The emotional impacts of trying and failing to become pregnant was hard for both me and my wife. However, I focused on supporting her through this hard time, often ignoring my own emotional well-being and experience as a man who was also struggling to have children. As Brits, we were taught to "keep a stiff upper lip,” and this was especially true for boys and men.
While my wife had the understanding and emotional support from women like her, I – like a lot of men – was left to deal with my emotions on my own, only recognizing the negative impact that had on my well-being many years later.
When we finally sought help, we had reached 30 years of age. We knew my wife’s age, more than mine, would soon become a complicating factor if it wasn't already. The process of getting fertility support began with my wife receiving gynecological care and finding out that she had Endometriosis. As a man, I got the proverbial “cup” for a specimen. I obliged and reportedly the numbers could populate the “whole of Pittsburgh” (which is where we lived, by the way!). Of course, in one way I felt quite masculine, but in other ways I felt pain and anguish as a couple – and for my wife. Our struggles continued until after my wife’s Endometriosis treatment when we finally got pregnant naturally and had our first born, Serena.
Our journey didn’t stop there. My wife and I tried to get pregnant again, and, alas, she had an early miscarriage. Still, we were told that we didn’t need assistance at that time. We moved to Cleveland, continued on with our lives, and hoped that we could soon provide our daughter with a sibling. And still we didn’t get pregnant. It was at that point that we reached out for additional fertility support - assisted reproduction, intrauterine insemination with ovulation induction to be exact. Basically, those are a bunch of big words that mean you may or may not end up with triplets…and, surprise! My wife was pregnant with three squirming babies. 22 years later, all the triplets are doing well, and my wife and I have aged 3-4 years for every 1 year.
As I explored life as a new father of four, I also continued to explore fertility, but this time from a medical point of view. When we had first struggled conceiving with Serena, I was in the later years of my Urology fellowship. Through our processes, I learned that our experiences with infertility were not uncommon, and yet, there were also so many men who, like me, wanted children but were unable to conceive and did not receive support. I credit our fertility struggles as one of the turning points in my career, as my specialization in male infertility led me into private practice and then to become one of few male infertility specialists in New Hampshire at Dartmouth Hitchcock Medical Center.
As a father of someone who struggled with an eating disorder, and as a doctor who supports infertility in men, I can say that the overlap between infertility struggles and body image are undeniable.
Over the years, I have become more familiar with eating disorders and their impacts on the male population. My daughter Serena and I often have conversations about how often men are left out of the body image conversation - and how harmful that can be within the eating disorder world and within my specialty.
I wanted to better understand and document the emotional consequences of infertility in men, especially how body image and eating disorders can play a role in the process. As a result, in 2022, my colleagues and I explored some of the themes we’ve witnessed in our practices and the data. In part, our findings show that our medical system overemphasizes the role women play in reproduction, while also failing to properly address the very real impacts of mental health stigma, masculinity ideologies, unrealistic standards of beauty, and the general lack of psychological education and care for those who need fertility support. There are some overarching lessons to be learned, so here are four!
Lesson 1: Infertility isn’t a “female issue.”
We know infertility is an issue that all genders experience, but reproduction is often seen as only a women’s issue. Women have long been the focus of parenting and home life, creating an overwhelming lack of research and cultural awareness about the impact men’s fertility has on the ability to have children. In fact, male infertility impacts about half of couples who are trying to get pregnant, with 30% of infertility cases solely dependent on the male and 20-30% due to both male and female partners. Shortly, we’ve got a lot of work to do to change the gendered narratives around fertility.
Lesson 2: Infertility and body Image can be connected.
In my field, I’ve found a number of issues that affect men looking to become fathers, especially regarding body image. Among them is hair loss, the removal of both or one testicle due to testicular cancer, associated depression, and withdrawal from dating. We as fertility physicians are often concerned with things like STIs, addiction, mental health issues with long-standing body image issues, hyperfocus on sports-related abilities, refusal to stop anabolic steroids, poor recovery of reproductive potential, and illegal drug behavior. Athletes of all levels often feel a lot of pressure to be the best, and this can create a toxic equation for when those people want to have children naturally.
We also see the “same psychological patterns with men who abuse anabolic steroids and patients with eating disorders. Both result in rigid thought processes. Examples of these thought processes include ‘tunnel vision’ about needing a body to look a certain way despite evident medical consequences, a truncated ability to problem solve or consider long-term consequences, and a deep need for control in one area of life because other areas feel so out of control” (source).
Lesson 3: Societal masculinity ideologies impact the process of becoming a father.
The process of conceiving and becoming a father often reveals a lot about people. Men experience changes in their identity, self-esteem, lifestyle, and emotional well-being. Normalized ideas of masculinity, manliness, and fatherhood can keep some men trapped in detrimental cycles of guilt and hyperfocus on imposed “responsibility” ideals. The process of communicating about infertility can be awkward and uncomfortable for male patients. Often they haven’t had these types of conversations with anyone before, and the stigma around what it means to be a man who struggles with reproduction (and the emotional consequences of that) can lead to delays and distress in the process of receiving fertility support (source). It is common that men do not want to acknowledge that they need help or that they cannot accomplish something their bodies “should be able to do” without support. Societal ideologies of what it means to be a man can stand in the way of becoming a father when we consider these common situations.
Lesson 4: We need more psychological support for men (and everyone).
Men often don’t receive the psychological or emotional support that they need during fertility struggles, in conjunction with their wives or other relevant parties, and their struggles can negatively impact their views on themselves and their value in relationships. As men experience emotional hardship, they often keep it hidden, especially when they believe their sadness will make them seem less “manly.” Emotional distress also affects the body, which can further impact a person’s fertility. We need clinicians supporting couples and men throughout the infertility process, but there is still a lack of resources and training on what type of support that may be (source).
About a decade ago, I was able to support the creation of a department of Andrology and became a Professor of Urology at the University of Kansas Medical Center where I spend my days helping people have children. Those people are like me, desperately wanting to start a family and unable to do it alone. It is one of the joys of my life when I receive updates from past patients on their child’s fifth birthday, violin recital, and even high school graduations. Fertility medicine isn’t just about the struggles - though those are very real. Fertility medicine can be like recovery from an eating disorder: healing, life-giving, and abundant (at least that’s what my daughter says).
