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Male Infertility and the Psychological Impact

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About 15% of all couples in their reproductive years' experience infertility. The feelings and emotions that manifest can be extremely difficult to come to terms with and accept. Whilst there is a fairly even split between female / male / couple infertility cases, very little research exists on how infertility affects a male.

When couples come to the crossroads in their fertility journey and are making the transition from trying to conceive naturally to that of assisted conception, this can include the more complex decisions around using a donor, be that egg, sperm or even embryo. During 2012-2013, the HEFA estimated that one in 10 fresh cycles of IVF/ICSI were carried out using donor egg or sperm.

Accepting a donor can be a very tough prospect for couples, particularly those who have always harboured fixed ideas of how their precious baby would come into the world. The natural assumption of most couples is that their child will be biologically related to both of them. The devastating news of infertility will usually have come after many years of trying to conceive naturally. To leave the dream of having your own child, is not easy.

A diagnoses of infertility can have very serious psychological effects on both the male and the female. Both partners may become overwhelmed by feelings of depression, anxiety, guilt, and grief. Embarrassment is also frequent as infertility brings into question femininity, or masculinity and can lead to feelings of inadequacy, low self-confidence and low self-esteem. People will often feel that they are 'damaged' or 'worthless'.

Men and women communicate these feelings very differently. Women often share their problems feeling more comfortable in seeking help, looking for solutions that feel ok for them, whilst men tend to shut down and withdraw. These very real feelings of being disconnected and isolated may also lead men to feel alienated and 'not one of the man tribe'. Many times men are required to fit into the process, relegated to the position of handholding and supporting their partner. But, bottling-up these very deep seated emotions can lead to tremendous difficulties within the relationship. In worse case scenarios leading to a break down in the marriage, shattered dreams and lives.

The road to making the decision to use donor sperm can be complicated and psychologically fraught. Fairly early on in discussing this route, couples will need to address some of the wider issues, for example: who should we tell - our parents, the child's prospective grandparents; will we tell the child, how, when, and in what detail should this be shared with him or her; will we choose an known or anonymous donor. All of these questions have ramifications for the couple, child and extended family.

The science behind infertility has developed so quickly that there are a great many assisted solutions available. If it is diagnosed that there is zero chance of successful treatment using the partner's sperm a doctor may quickly suggest a donor as an option. But, donor conception still remains a taboo and a psychological minefield. The couple need to be given room to explore their feelings and enough space to examine what issues may arise. It is vital that couples seek counselling when faced with such huge decisions. Dealing early on with the psychological impact will prepare them both for the journey ahead.

References :
Chan, P. Methods of Improving Male Fertility, In Men and ART: The missing voice. Fortieth Annual Postgraduate Program, American Society for Reproductive Medicine, 2007.

Klock, S. To tell or not to tell. The issue of privacy and disclosure. In S. Leiblum, (ed.) Infertility; Psychological issues and Counselling Strategies. New York: Wiley and Sons, 1997; 167-88.

Schover, L. R., S. Richards & R. L. Collins. Psychological aspects of donor insemination: Evaluation and follow-up of recipient couples. Fertil Steril, 1992; 57: 583-90.

Thorn, P. Recipient counseling for donor insemination. In Covington, S & Hammer Burns, L, (eds.) Infertility Counselling: A Comprehensive handbook for clinicians: 2nd Edition. New York: Cambridge University Press, 2006; 305-18.

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