Where are all the men? The marginalization of men in social scientific research on infertility

Exploring fertility treatment add-on use, information transparency and costs in the UK: Insights from a patient survey

This study presents the findings from a UK-based survey exploring fertility treatment add-ons, treatment costs, and information transparency. The online survey, distributed via social media, targeted current and prospective IVF patients, yielding 304 eligible responses. Results indicate an increase in the use of fertility treatment add-ons compared to previous data. Respondents primarily relied on multiple sources for information about these add-ons, with search engines being the most frequently used, followed by fertility clinic websites, the HFEA website, and medical or scientific articles. These sources were also deemed the most reliable. In contrast, social media, online forums, and blogs were less frequently used and rated as less reliable. Respondents reported significant variation in the total cost per cycle of privately funded treatment, ranging from £5,000 to £13,000, with an average of £11,950. Although there was a slight upward trend in costs with rising household income, no strong correlation was observed. Fertility clinic websites were the primary source of cost-related information, with 99% of respondents emphasising the importance of clinics providing accurate and up-to-date information on their websites. The findings also reveal respondents' views on potential policy actions to improve transparency around information and costs in the fertility sector.

Locating Men in Sexual and Reproductive Health, Rights, and Justice: Past, Present, Futures

Since the International Conference on Population and Development in 1994, global policies, and agenda-setting milestones have emphasized that universal sexual and reproductive health and rights (SRHR) are unattainable without the meaningful engagement and inclusion of men. Despite this, the field of SRHR continues to struggle with how and in what ways men can and should be included in research, programs, and policies. In this commentary, we argue that the programmatic focus of SRHR limits the capacity to produce the data and evidence needed to inform gender transformational change. For men to be meaningfully engaged with by SRHR, researchers need an analytic lens that can capture the manifestations and outcomes of gender and power. We consider the conceptual complementarities between two theoretical frameworks: hegemonic masculinities and Reproductive Justice. We contend that bringing together these conceptual approaches to men and SRHR offers an analytic framework to iterate and innovate approaches to research. Such changes will allow for a greater interrogation of gender and power and the production of data and evidence necessary to grapple with the ongoing injustices that curtail people's sexual and reproductive freedoms.

Barriers and enablers to a healthy lifestyle in people with infertility: a qualitative descriptive study

BACKGROUND

While there is a recognised role of lifestyle (diet and physical activity) in management of infertility, there is limited research exploring the perspectives of people with infertility in relation to lifestyle management. The aim of this study was to understand the barriers and enablers affecting uptake of lifestyle intervention in people with infertility who were using or seeking fertility treatment.

METHODS

A qualitative descriptive study was performed. Online interviews were conducted with people with infertility who were using or seeking fertility treatment. Interviews explored barriers and enablers to a healthy lifestyle while attempting conception. Interview questions were informed by the Capability, Opportunity, Motivation and Behaviour (COM-B) model and theoretical domains framework (TDF). Interview transcripts were analysed using template analysis. Themes were mapped to the COM-B and TDF, and suggested interventions were developed using the behaviour change wheel method.

RESULTS

Nine women and two men completed the interviews. The median age was 38 years (interquartile range 33 to 42 years). Barriers and enablers related to capability (e.g. managing whole-body health and disease), opportunity (e.g. unmet needs from the healthcare system) and motivation (e.g. interplay between lifestyle and emotional state). Suggested intervention components included delivering inclusive programs which accommodate individual needs and providing engaging information which debunks myths and explains the mechanism by which lifestyle promotes fertility.

CONCLUSIONS

Our study provides novel and rich insights into the unique needs of people with infertility, and has identified several interacting factors which influence their lifestyle behaviours. Our findings highlight that changes at the organisational and policy level are essential to overcome major barriers to lifestyle management by improving access to trustworthy resources with actionable advice, and by improving service provision to deliver multidisciplinary patient-centred care. Future studies should use these findings to co-design interventions and resources to support lifestyle management of infertility.

TRIAL REGISTRATION

Not applicable.

Infertility stigma and openness with others are related to depressive symptoms and meaning in life in men and women diagnosed with infertility

BACKGROUND

Stigma is the experience of feeling different from socially accepted norms which can lead to personal devaluation or fear of disapproval from others. For men and women experiencing infertility, stigma has been associated with psychological distress, feelings of otherness in relation to people with children, and selective disclosure with others about their infertility challenges. However, there are few studies which examine how infertility stigma and being open with others are related to depressive symptoms and meaning in life for men and women diagnosed with infertility.

METHODS

Participants experiencing infertility were recruited for this cross-sectional study during November 2023-January 2024 via announcements on infertility discussion listservs and social media accounts. Four-hundred fifty-eight women and 89 men completed an online survey. Participants were primarily from the United States (81%), followed by Europe, Canada, and Australia/New Zealand. Participants completed validated and reliable measures of infertility stigma, openness with others, depressive symptoms and meaning in life.

RESULTS

Hierarchical regression models explained substantial variance (adjusted R-squared) for depressive symptoms (41% men; 27% women), search for meaning in life (12% men; 14% women), and presence of meaning in life (19% men; 25% women). For both men and women, higher personal infertility stigma was significantly related with higher depressive symptoms and search for meaning. For both men and women, higher openness with others about infertility was significantly associated with lower levels of depressive symptoms and greater presence of meaning.

CONCLUSIONS

The current findings support prior research indicating a significant association between infertility stigma and depressive symptoms and adds to the infertility literature by offering new insights into the relationships between stigma, openness with others, and meaning in life. Health care providers can use these findings to assist individuals and couples in reducing infertility stigma through collaborative conversations that reduce feelings of personal failure. Providers can also help those with infertility challenges to reduce psychological distress and increase meaning in life through accessing existing social networks and expanding social connections with others in ways that facilitate support.

Direct-to-consumer semen analysis products: Content, accountability, and adherence to clinical guidelines

BACKGROUND

Direct-to-consumer (DTC) semen analysis (SA) products obviate barriers that deter men from clinic testing and have made strides in providing higher quality data. However, it is unclear how well these products adhere to the 2021 WHO guidelines on examination and processing of human spermatozoa as they pertain to the evaluation of male fertility.

OBJECTIVE

We investigate the content and adherence to clinical guidelines associated with consumer-facing information on DTC analysis products.

MATERIALS AND METHODS

Google search terms "at-home sperm test" and "mail-in sperm test" were used to identify commercially available products. Products that were offered to providers or were designed for use after vasectomy were excluded. We determined which semen parameters each product offered; if it was validated in subfertile men and against an established semen analysis method; and if it provided guidance in accordance with the WHO 2021 guidelines and related AUA/ASRM guidelines. The accountability and esthetic appearance of content for each product were assessed using the Silberg accountability and modified Abbott's criteria, respectively. Readability was assessed using the Flesch-Kincaid score. Descriptive statistics and two-tailed t-tests were used to compare characteristics, with p < 0.05 as statistically significant.

RESULTS

We identified 20 at-home (n = 17) and mail-in (n = 3) products. 85% of tests reported sperm concentration, with 60% and 15% of tests reporting motility and morphology, respectively. Fewer than half recommended men perform more than one test (40%), and none highlighted the need for partner evaluation. Only 25% were validated among subfertile men. Most tests lacked information on their credentials and sponsors, though were esthetically pleasing. Consumer-facing information on average required a high school level education for comprehension.

CONCLUSIONS

DTC products inconsistently provide clinical recommendations in accordance with guidelines. Additionally, while product content is on average aesthetically appealing, it may lack accountability. Formal recommendations on the content and use of such products may improve their clinical integration.

Quality of life and its determinants in women with delayed conception in low-mid socioeconomic neighbourhoods of Northern India: a cross-sectional study

Background

The inability to conceive or delay in conception has negative and multidimensional effects on health and well-being, daily functioning and societal interactions. This study assesses the impact of delayed conception on quality of life (QoL) among Indian women with delayed conception and evaluates the Fertility Quality of Life (FertiQoL) questionnaire's reliability and construct validity in this population.

Methodology

A cross-sectional study of 1530 women aged 18-30, who had not conceived over a period of 18 months, was conducted in low-to-mid-socioeconomic neighbourhoods in Delhi, India. The 24-item core module of the FertiQoL questionnaire was used to assess participants' QoL. Researchers analysed data to identify factors associated with QoL scores and evaluated FertiQoL's internal consistency and validity. Data were collected between July 2020 and August 2021.

Result

The average FertiQoL score was 31.71 out of 100, indicating a moderately low QoL. Among the subscales, emotional (mean: 29.0) and mind-body domains (mean: 25.4) scored the lowest, while the relational domain scored the highest (mean: 50.7). Factors negatively associated with QoL included a longer duration of delayed conception (β=-0.3, 95% CI: -0.5 to -0.1), husbands fathering children with other partners (β=-1.1, 95% CI: -1.7 to -0.38), domestic violence-emotional (β=-3.5, 95% CI: -4.5 to -2.4), verbal (β=-3.2, 95% CI: -4.7 to -1.7), physical abuse by family (β=-3.6, 95% CI: -5.5 to -1.6), lack of financial support (β=-3.2, 95% CI: -5.2 to -1.2), social pressures (β=-1.6, 95% CI: -2.3 to -0.9) and physical health issues (β=-0.9, 95% CI: -1.7 to -0.2). The FertiQoL tool demonstrated acceptable reliability (Cronbach's alpha=0.64) and good construct validity (confirmatory factor analysis), confirming its utility in this population.

Conclusion

Indian women experiencing delayed conception have reduced QoL, particularly in emotional and mind-body domains, due to various psychosocial and socioeconomic challenges. The FertiQoL questionnaire proved to be a reliable and valid tool for assessing QoL in this context. Psychosocial interventions addressing emotional, social and economic stressors are urgently needed to improve their well-being. Future research should include men to better understand the holistic challenges faced by couples struggling to conceive.

Experience, access and utilisation of fertility care for infertile men within the biomedical sector in urban Bangladesh: protocol for a qualitative study

INTRODUCTION

One in six people of reproductive age experience infertility in their lifetime throughout the world, often with devastating consequences. Men are often invisible in infertility research and services, yet masculinity and reproductive agency intersect within social, cultural and religious contexts to shape their experiences of infertility and masculine expression. This study aims to provide insights into the lived experience of male infertility, the availability and access of infertility services for men within the biomedical sector in Bangladesh and the potential willingness of men to use home-based semen testing.

METHODS AND ANALYSIS

This qualitative study will be conducted in Dhaka and Khulna districts in Bangladesh over 18 months (late 2023-2025). A total of 35 biomedically diagnosed infertile men will be selected for interview using convenience sampling. Additionally, 25 key informants, including healthcare providers from public and private fertility clinics and health policymakers, will be interviewed. Service availability will be documented by creating a list of fertility clinics and cataloguing services offered in a selection of these clinics. Both inductive and deductive thematic analysis will be used.

ETHICS AND DISSEMINATION

The study has been reviewed and approved by the Brighton and Sussex Medical School's Research and Governance Ethics Committee (RGEC: ER/BSMS9E3G/1), Institutional Review Board of icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh) and the WHO Ethics Review Committee (WHO ERC, AID: A66040). A comprehensive participant information sheet containing the study aims, objectives and data collection procedures will be provided to eligible participants and informed consent obtained. Two dissemination workshops will be held, one with the community at the field level and another with the key stakeholders, that is policymakers, health service and clinical stakeholders to disseminate the results of the study and its implications for fertility care for men with infertility in Bangladesh and other low- and middle-income countries. Scientific manuscripts will be published in open-access journals to inform the global community.

Assessing psychological health and reproductive function: Depression, anxiety, and stress in infertile men compared to controls: A case-control study

Background

With the increasing prevalence of infertility and its links to depression, anxiety, and stress, it is essential to compare these mental health levels between infertile men and a control group.

Objective

This study aimed to compare depression, anxiety, and stress among infertile and fertile men. Also, assessing demographic factors affecting these challenges among both groups.

Materials and Methods

This case-control study was conducted on 120 men at Milad Infertility Research Center, Mashhad, Iran from January 2023 to February 2023. Participants were divided into 2 groups: 60 infertile men and 60 healthy men who did not have fertility problems. Demographic information such as age, education, occupation, duration of the marriage, and duration of infertility was collected from their medical records, and they also completed the depression, anxiety, and stress scale 21 questionnaire through a telephonic interview. Finally, the findings were statistically analyzed.

Results

Severe and very severe depression, anxiety, and stress were observed in 65%, 60%, and 43.4% of infertile men and 16.7%, 23.3%, and 11.7% of fertile men, respectively. Which was significantly more than the fertile group, and there was a significant relationship between depression (p ≤ 0.001), anxiety (p = 0.001), stress (p ≤ 0.001), and infertility. Also, a significant relationship was observed between the duration of infertility and depression (p = 0.031).

Conclusion

Our study found infertile men had higher stress, anxiety, and depression than the control group. Limitations included phone-based data collection and the depression, anxiety, and stress scale 21 questionnaire's screening nature. Future studies should involve larger populations and consider economic status as a variable related to mental health.

Barriers and enablers to a healthy lifestyle in people with infertility: a mixed-methods systematic review

BACKGROUND

While there is a recognized role of optimizing lifestyle (diet and physical activity) behaviours in the management of infertility, the best practice remains unknown and factors influencing the lifestyle of people with infertility are not well understood.

OBJECTIVE AND RATIONALE

This systematic review evaluated barriers and enablers to a healthy lifestyle in people with infertility, from the perspectives of people with infertility and health professionals, in order to inform optimal behavioural change strategies.

SEARCH METHODS

Ovid MEDLINE(R), PsycINFO, EMBASE, EBM Reviews, and CINAHL were searched from inception to 28 August 2023. Eligible studies were qualitative and quantitative primary studies that explored barriers and/or enablers to lifestyle for infertility management. Quality assessment was performed using the Centre for Evidence-Based Management Critical Appraisal of a Survey Tool and the Critical Appraisal Skills Programme Qualitative Checklist. Data were analysed by thematic analysis with themes mapped to the Capability, Opportunity, Motivation and Behaviour (COM-B) model and Theoretical Domains Framework (TDF).

OUTCOMES

After screening 12 326 abstracts and 99 full-texts, 27 studies were included (12 quantitative, 6 qualitative and 9 mixed-methods) with 22 studies of women with infertility (n = 2524), 11 studies of men with infertility (n = 1407), and 6 studies of health professionals (n = 372). We identified barriers and enablers relating to capability (e.g. strategies for behaviour change), opportunity (e.g. limited time, resources, and money), and motivation (e.g. interplay between lifestyle and emotional state). Based on the identified themes, suggested intervention components to integrate into lifestyle management of infertility include facilitating development of self-management skills to support lifestyle change (e.g. self-monitoring, action planning, and goal setting) and incorporating mental health strategies (e.g. providing information about the benefits of healthy lifestyle behaviours for mental health and encouraging patients to reframe healthy lifestyle behaviours as self-care strategies).

WIDER IMPLICATIONS

The findings have identified important factors that influence lifestyle management in people with infertility and have suggested relevant intervention components to consider when designing interventions. Given the paucity of qualitative studies identified, more research is needed to further understand the complex and interacting factors that shape lifestyle during the fertility journey.

Feldenkrais method and clinical psychology: A systematic literature review exploring the potential of Feldenkrais Method in psychiatric care

BACKGROUND

In psychotherapy, physical exercise has gained recognition and extensive research attention, displaying promise in various mental health conditions. Practices such as yoga, tai chi, and the Feldenkrais Method® (FM) have also emerged as effective mental health interventions.

OBJECTIVES

This systematic literature review (SLR) explores the applicability of FM, a somatic practice, in psychiatric care and emotional regulation, as it emphasizes the interplay between bodily sensations, action patterns, and cognitive processes.

METHODS

Following PRISMA guidelines, a systematic search was conducted across selected databases from 2000 to 2022, identifying 14 articles, including randomized controlled trials, cohort studies, narrative papers, and SLRs. Thematic analysis was conducted.

RESULTS

The findings indicate global FM adoption, primarily in studies related to pain conditions, musculoskeletal disorders, and neurological disorders. Various measures were used, covering quality of life, psychological dimensions, self-image, self-efficacy, mindfulness, and interoception. However, direct application of FM in psychiatric care remains limited, with few studies addressing psychological issues. This review calls for more comprehensive investigations of FM's potential in psychiatric contexts, advocating precise measures and a dimensional approach to assessing psychological outcomes.

CONCLUSION

Further research is needed to explore the application of FM in psychiatric care. While existing research suggests potential benefits, especially in enhancing body awareness and emotional regulation, robust studies are necessary to establish its effectiveness in treating specific mental health conditions. This review serves as the foundation for future research into the potential role of FM in enhancing psychiatric care and emotional well-being.

Intersectional analysis of the experiences of women who fail to conceive in low and middle income neighbourhoods of Delhi, India: Findings from a qualitative study

BACKGROUND

Experiences of delayed conception and infertility have been reported among women. However, the concept of intersectionality is rarely utilised in studies of infertility, and it is particularly uncommon in research from low- and middle- income countries.

RESEARCH QUESTION

What are the lived experiences of women with delayed conception in low to -middle income neighbourhoods of Delhi, India?

METHODS

This was a qualitative study (n = 35) that recruited women who had failed to conceive after 18 months of regular unprotected sexual intercourse. Data were collected between February and July 2021. Data were collected through focus group discussions in low income to middle income neighbourhoods of Delhi, India. Analysis identified themes related to intersecting axes of inequality.

RESULTS

The results showed that gender intersected with economics, masculinity, patriarchal norms and class to influence the experiences of women. The intersection of gender, economics and patriarchal norms compromised women's agency to be active generators of family income, and this dynamic was exacerbated by patrilocal residence. In addition, masculinity contributed to stigmatisation and blaming of women, due to the inaccurate perception that men did not contribute to a couple's infertility. The intersection of gender and social class in medical settings created barriers to women's access to medical information.

CONCLUSION

Findings from this study provide representative examples of the variety of axes of inequality that shape women's experiences in the study setting. Although these findings may not be generalisable to all women who are experiencing delayed conception, they highlight a need for improved awareness and education on infertility, as well as a need to ensure the availability and accessibility of fertility care for couples in need.

The Role of Male Consent in Assisted Reproductive Technology Procedures: an Examination of Japanese Court Cases

With the development of assisted reproductive technologies, medical, ethical, legal, and social issues have arisen that did not exist when natural conception was the only means of childbirth. In Japan, men tend to believe that assisted reproductive technologies are not directly related to them, with the literature showing that men are often reluctant to be involved in fertility treatment processes. To better understand this situation, this study analyzes the role of male consent during assisted reproductive technology procedures in Japan. First, we examined Japanese court cases that dealt with issues related to male consent during assisted reproductive technology procedures and identified three situations in which problems related to male consent during such procedures may arise. Next, we analyzed the background of such issues and the implications of the lack of consent regarding men's reproductive rights. Finally, we explored the need for legislation on assisted reproductive technologies. The study concludes that discussions on the scope of male partner rights in assisted reproductive technology procedures are key for minimizing unnecessary conflict between partners, thus ensuring both the rights of women who wish to have children and the welfare of their children.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41649-023-00274-1.

The psychosocial impact of male infertility on men undergoing ICSI treatment: a qualitative study

BACKGROUND

Male infertility is in 20-70% of cases the cause of a couple's infertility. Severe forms of male infertility are best treated with Intracytoplasmic Sperm Injection (ICSI). The psychosocial impact of infertility and ICSI on men is unclear because the focus is socially, clinically, and scientifically on women. However, there is evidence that it can affect the psychological well-being of men, but these studies are mainly quantitative. Qualitative research needed to explore the experiences of infertile men in-depth is limited. Therefore, the objective of this study was to clarify the psychosocial consequences of male infertility on men undergoing ICSI to understand their experiences with reproduction problems more comprehensively.

METHODS

In this generic qualitative study, men who were undergoing or had undergone ICSI after a male factor infertility diagnosis were included. A purposive sample with maximum variation was sought in a fertility clinic of one university medical centre in the Netherlands. Data were collected through individual face-to-face semi-structured interviews. Thematic analysis was used to identify themes from the data.

RESULTS

Nineteen Dutch men were interviewed. The mean duration of the interviews was 90 min. An everyday contributing backpack was identified as the main theme, as men indicated that they always carried the psychosocial consequences of infertility and ICSI with them. Different world perspective, Turbulence of emotions, Changing relation, and Selective sharing were the psychosocial consequences that men were most affected by. Moreover, men indicated that they were Searching for contribution during ICSI because the focus was entirely on the woman.

CONCLUSION

Men with male infertility experience psychosocial problems due to infertility and ICSI treatment. Healthcare professionals need to recognize the impact of infertility on men and create room for a role for them during ICSI.

How Individuals Use Metaphors to Negotiate Fertility Treatment Decision-Making with Their Romantic Partners

Fertility problems, or the inability to conceive or carry a pregnancy to term for a period of over 12 months while engaging in unprotected sex, affects 12% of women and 9% of men of childbearing age. To answer calls for more research about individuals' fertility decision-making (DM) with their partners, we conducted in-depth, semi-structured interviews with 53 individuals who have experienced fertility decision-making with a romantic partner at some point in their lives. Our findings indicate at least three primary ways individuals and their partners navigated their decision-making communication in their infertility "journeys:" (1) the Driver-Navigator, (2) Driver-Passenger, and (3) Driver-Backseat Driver approaches. All decision-making communication approaches were viewed by individuals as collaborative (i.e. shared), but varied in degrees of "togetherness" (high, moderate, low) in how they communicated with each other about treatment decisions. Implications include helping couples and their clinicians to be aware of their DM approach(es) and offering alternative DM approaches based on understanding how and why certain approaches may (not) be effective in addressing goals, needs, and identities.

"No One Asked Me If I'm Alright": A Mixed-Methods Study Exploring Information/Support Needs and Challenges Engaging Men Diagnosed With Male-Factor Infertility

There is limited research exploring men's experiences of infertility, and fewer previous studies have examined what information and support men desire after being diagnosed specifically with male-factor infertility. We conducted a mixed-methods study utilizing a combined sequential, concurrent design (online survey/semi-structured interviews). Survey outcomes (N =12) were analyzed using quantitative data analysis, while qualitative survey data (N = 5) was analyzed by reflexive thematic analysis. Heterosexual men (>18 years), fluent in English, diagnosed solely with male-factor infertility/sub-fertility, who required assisted reproductive treatment within Australia in the past 5 years were recruited online and through fertility clinics Australia-wide. Most men reported that their information and support needs were only somewhat, slightly or not at all met. Preferred information sources on male infertility were a dedicated online resource, app, or fertility doctor/specialist, while support was preferred from fertility specialists and partners. Three themes were identified from the qualitative analysis about men's experiences and support needs when diagnosed with male infertility (a) Ultimate threat to masculinity; (b) Holistic care, and (c) the power of words. The information-rich data collected provided valuable insights into men's experiences of male-factor infertility and important considerations to improve recruitment for future research. A diagnosis of male-factor infertility has the potential to be deeply impactful and difficult to navigate for men. Adequate and holistic information, recognition of emotional impacts, proactive offers of support and sensitive language are needed to improve men's experiences when undergoing assisted reproductive technology.

Exploring the Landscape of Social Egg Freezing: Navigating Medical Advancements, Ethical Dilemmas, and Societal Impacts

This narrative review article comprehensively explores the multifaceted landscape of social egg freezing, delving into its medical, ethical, societal, psychological, legal, and cultural dimensions. Oocyte cryopreservation, a developing procedure, gives women the chance to match their life goals with fertility goals. Informed decision-making, morally sound guidance, and open communication are all stressed by ethical considerations. Family planning practices, workplace cultures, and gender equality all have an impact on societal dynamics. The process's emotional toll and associated coping mechanisms are highlighted by psychological elements. Legal and policy frameworks need constant ethical reflection and understanding of the regulatory environment. Religious and cultural views highlight the variety of perspectives that influence attitudes toward this practice. For responsible practice to ensure individual liberty while navigating the evolving landscape of reproductive options, it is essential to comprehend how these aspects interact.

Infertility and perceived chance of conception among men in Malawi

Infertility is a common experience among individuals and couples worldwide, but few studies focus on men's reports of infertility or perceived chance of conceiving, particularly in high-fertility, pronatalist contexts where infertility is highly stigmatized. Using data from the fourth wave of the Umoyo wa Thanzi (UTHA) cohort study in rural Central Malawi (2017-2018), we examine the relationship between self-reported infertility, the perceived chance of conceiving within one year, and sociodemographic characteristics among men (N = 484). While 13% of men reported that they had experienced infertility, just 4% of men perceived that they were unlikely or there was no chance they would conceive with their partner within one year of having sex without contraception. In multivariable logistic regression models, older age was associated with experienced infertility (AOR: 1.06, p < 0.05) and higher parity was associated with lower odds of reporting that conception was unlikely or there was no chance of conception (AOR: 0.08; p < 0.05). We argue that additional research on infertility focusing on men is critical in gaining a more holistic and gender-equitable understanding of infertility. Including men in infertility research may also contribute to destigmatizing infertility among both women and men by acknowledging men's roles in infertility.

"Husbands Are Pregnant, Too": Caring Masculinities in Pregnancy Books for Men

This article studies pregnancy books that are written largely by men for men and that account for men's roles in pregnancy. Drawing on an analysis of the texts themselves, this study shows recurring themes across these books, which include: Expecting, too! which frames men as having a role in pregnancy beyond fertilization; fatherhood as a rite of passage; Unlike our dads, in which men are taught to be different from their fathers recognizing that expectations of fathers have changed; and, expectations of expectant fathers, namely, how men are to be caring partners. This article explores how these books frame masculinity and the roles men play in pregnancy. This article thus shows how these books contribute to a growing body of scholarship interested in "caring masculinities."

Blurring the divide: Navigating the public/private landscape of fertility treatment in the UK

It is widely assumed that fertility patients in the UK are either privately funded or publicly funded through the National Health Service. This article challenges this distinction and demonstrates how the boundaries between public and private fertility treatment provision are increasingly blurred. It draws on interviews with 42 fertility patients and partners who had accessed in vitro fertilisation (IVF) through both the National Health Service and private providers, to demonstrate how participants were compelled to engage with a consumerist model of healthcare, even when they had access to publicly funded IVF cycles. Patients' experiences of navigating fertility treatment revealed a hybrid public/private consumption landscape, which reflects the uneven process of privatisation across the fertility sector. This article demonstrates how healthcare privatisation has had profound consequences for all IVF patients.

Moving toward smart biomedical sensing

The development of novel biomedical sensors as highly promising devices/tools in early diagnosis and therapy monitoring of many diseases and disorders has recently witnessed unprecedented growth; more and faster than ever. Nonetheless, on the eve of Industry 5.0 and by learning from defects of current sensors in smart diagnostics of pandemics, there is still a long way to go to achieve the ideal biomedical sensors capable of meeting the growing needs and expectations for smart biomedical/diagnostic sensing through eHealth systems. Herein, an overview is provided to highlight the importance and necessity of an inevitable transition in the era of digital health/Healthcare 4.0 towards smart biomedical/diagnostic sensing and how to approach it via new digital technologies including Internet of Things (IoT), artificial intelligence, IoT gateways (smartphones, readers), etc. This review will bring together the different types of smartphone/reader-based biomedical sensors, which have been employing for a wide variety of optical/electrical/electrochemical biosensing applications and paving the way for future eHealth diagnostic devices by moving towards smart biomedical sensing. Here, alongside highlighting the characteristics/criteria that should be met by the developed sensors towards smart biomedical sensing, the challenging issues ahead are delineated along with a comprehensive outlook on this extremely necessary field.

Direct-to-consumer fertility testing: utilization and perceived utility among fertility patients and reproductive endocrinologists

RESEARCH QUESTION

What is the utilization of direct-to-consumer fertility tests (DTCFT) among fertility patients? How does the perceived utility of DTCFT differ between patients and reproductive endocrinologists (REI)?

DESIGN

Infertility patients visiting the Duke Fertility Center between December 2020 and December 2021 were sent an electronic invitation to participate in a patient survey. Members of the Society of Reproductive Endocrinology and Infertility were also sent e-mail invitations to participate in the REI survey. DTCFT were defined as tests not ordered by a physician or performed at a physician's office, including calendar methods of ovulation prediction, urinary ovulation prediction kits, basal body temperature (BBT) monitoring, hormone analysis, ovarian reserve testing and semen analysis. Patients and REI were asked how likely they were to recommend a given DTCFT, on a 0-10 Likert scale.

RESULTS

In total, 425 patients (response rate 50.5%) and 178 REI (response rate 21.4%) completed the surveys. Patients reported the utilization of calendar methods of ovulation prediction (83.8%), urinary ovulation prediction (78.8%), BBT monitoring (30.8%), hormone analysis (15.3%), semen analysis (10.1%) and ovarian reserve testing (9.2%). REI rated the utility of all DTCFT significantly lower than patients did (average discordance -4.2, P < 0.001), except for urinary ovulation prediction, which REI gave a significantly higher score (discordance +1.0, P < 0.001). Prior pregnancy was significantly associated with home ovulation prediction utilization among patients (adjusted odds ratio 3.21, 95% confidence interval 1.2-9.83).

CONCLUSIONS

Methods of ovulation prediction are commonly used by fertility patients. Significant discordance exists in the perceived utility of DTCFT between patients and REI. Patient education and guidelines are needed to better inform individuals considering DTCFT.

Patient informed choice in the age of evidence-based medicine: IVF patients' approaches to biomedical evidence and fertility treatment add-ons

With the increasing offer of fertility treatment by a largely privatised sector, which has involved the proliferation of treatment add-ons lacking evidence of effectiveness, In-Vitro Fertilisation (IVF) patients are expected to make informed choices on what to include in their treatment. Drawing on interviews with 51 individuals undergoing fertility treatment, this article explores patients' approaches to medical evidence interpretation and its role in their decisions to include add-ons. While most IVF patients share understandings of what counts as medical evidence, our findings show how their approaches also differ. Our analysis focuses on how patients negotiate the notion of medical evidence and its relation to other forms of experience or knowledge. We present four different approaches to evidence in IVF: (1) delegating evaluations of evidence to experts; (2) critically assessing available evidence; (3) acknowledging the process of making evidence; and (4) contextualising evidence in their lived experience of infertility. We suggest that patients' choice to include add-ons is not due to a lack of information on or understanding of evidence, but rather should be interpreted as part of the complexity of patients' experiences of infertility.

Men of refugee and migrant backgrounds in Australia: a scoping review of sexual and reproductive health research

Australia's National Men's Health Strategy 2020-2030 identifies refugee and migrant men from culturally and lingustically diverse backgrounds as priority groups for sexual and reproductive health (SRH) interventions. The paucity of SRH research focusing on refugee and migrant men is a significant gap to advance men's health and policy. Hence, this review aimed to synthesise the available evidence on refugee and migrant men's SRH needs, understandingsand experiences of accessing services after resettlement in Australia. A systematic search of peer reviewed literature in PubMed, Scopus, and PsyInfo was made. A World Health Organization framework for operationalising sexual health and its relationship with reproductive health was used to map the identified studies. The socio-ecological framework was applied to thematically synthesise data extracted from individual studies and identify factors that influence the SRH of refugee and migrant men. We included 38 papers in the review. The majority of sexual health studies (16) were about sexually transmitted infections (STIs), mainly HIV (12), followed by sexual health education and information (5) and sexual functioning (3). Reproductive health studies focused on contraceptive counselling and provision (3), antenatal, intrapartum and postnatal care (1) and safe abortion care (1). Several factors influenced refugee and migrant men's SRH, including a lack of access to SRH information, language barriers and stigma. We found that SRH literature on refugee and migrant men focuses on STIs, meaning other areas of SRH are poorly understood. We identified key gaps in research on experiences of, and access to, comprehensive SRH care.

Male Attitudes towards Infertility: Results from a Global Questionnaire

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 (https://fertilityeurope.eu). 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, <15.8% were self-motivated to seek medical help. Further, their physician was not the primary source of information regarding their infertility. While most men (59%) viewed their infertility positively, a large majority were not very likely (73%) to talk about it. Most respondents indicated a lack of awareness or absence of male infertility support groups.

CONCLUSIONS

These are the first multi-national population data revealing men's feelings about their infertility, what motivates them to seek help and their awareness of resources for peer support and information. These findings also serve to highlight significant gaps that exist in the provision of male reproductive health care and in supportive resources for men suffering from infertility. We offer recommendations on how to address the problem(s).

Understanding the sex inequality in childlessness: an approach using Swedish register data

In most countries, men are more likely to be childless than women. Understanding how this inequality arises is important given the significance of parenthood for individuals' lives. The objective of this study was to explore how three prominent explanations for sex inequalities in childlessness relate to the Sex Gap in Childlessness (SGC) in Sweden. The three explanations examined were sex ratio imbalance (more men than women), mismeasurement of fatherhood (inequalities in registration) and partnership differences (inequality in multi-partner fertility). Administrative register data for cohorts born in 1945-1974 were used. The population was restricted to men and women who were born in Sweden or arrived prior to the age of 15, and all registered childbearing partnerships were examined. To explore the possible significance of the three explanations, counter-factual standardization was used. Of the three explanations examined, the population sex ratio had the largest positive impact on the SGC, while multi-partner fertility had a negative impact. The results show that inequalities in the sex ratio can explain about 20-34% of the SGC depending on cohort. Inequalities in registration of fathers explain about 9-24% of the SGC depending on cohort. Finally, results show that women are slightly more likely to have multiple partners, and that this behaviour has a substantial minimizing effect on the SGC (minimizing it by 6-65%). To the authors' knowledge this was the first paper to estimate the scope of the impacts of these three mechanisms on the SGC. Differences in multi-partner fertility have in many instances been used as an explanation for men's higher childlessness. This study shows that women have slightly more childbearing partners than men, and that this actually leads to a smaller SGC in the studied population.

Stigma, social appearance anxiety and coping in men and women living with skin conditions: A mixed methods analysis

Background

The psychological impact of living with a skin condition can have a profound impact on quality of life and could cause appearance-related social anxiety. Existing research suggests ambiguous findings in relation to whether the impact of living with a skin condition differs between males and females.

Objectives

The present study aimed to explore the association between stigma, coping styles and social appearance anxiety in men and women living with a skin condition in the United Kingdom.

Methods

231 participants (n = 199 females, n = 30 males, n = 2 non-binary) completed a cross-sectional online questionnaire, capturing quantitative data with the social appearance anxiety scale (SAAS), the shortened version of the coping inventory for stressful situations (CISS-21), and qualitative data from free-text comments and thematic content analysis. Respondents were also asked to provide additional free text comments in relation to the challenges faced and how these were managed.

Results

Content analysis revealed that males and females faced daily practical, social and emotional challenges and coped with them in several ways; with higher levels of social appearance anxiety associated with both higher perceived severity of skin condition and younger age. Males and females appeared equally as emotionally affected by living with a skin condition, with the only significant gender difference being females as significantly more likely to engage in avoidant coping behaviours than males.

Conclusions

Living with a skin condition presents daily practical, social, and psychological challenges for males and females that have the potential to impact on quality of life. Findings highlight the need for dermatological care to routinely address these issues, and psychosocial interventions must be made available to promote healthy coping with skin conditions.

Access to Care for Infertile Men: Referral Patterns of Fertility Clinics in the United States

OBJECTIVE

To evaluate fertility clinic management of male factor infertility, including website educational content as well as factors associated with referral for urologic evaluation and care.

MATERIALS AND METHODS

Using 2015-2018 Centers for Disease Control and Prevention Fertility Clinic Success Rates Reports, 480 operative fertility clinics in the United States were identified. Clinic websites were systematically reviewed for content regarding male infertility. Structured telephone interviews of clinic representatives were performed to determine clinic-specific practices for management of male factor infertility. Multivariable logistic regression models were used to predict how clinic characteristics (geographic region, practice size, practice setting, proximity to urologist, in-state andrology fellowship, state-mandated fertility coverage, annual in vitro fertilization cycles, and percentage of in vitro fertilization cycles for male factor infertility) were associated with patient referral to a urologist for male infertility care.

RESULTS

We interviewed 477 fertility clinics and analyzed available websites (n = 474). The majority of websites (77%) discussed male infertility evaluation while 46% discussed treatment. Fifty clinics (11%) had an on-site urologist. Clinics with on-site urologists were more likely to be larger practices, academically affiliated, and discuss male infertility treatment on their website (all P ≤ .05). For clinics without an on-site urologist, practice size and presence of an in-state andrology fellowship program were the strongest predictors of urologic referral (P <.02).

CONCLUSION

Variability in patient-facing education and infertility practice setting and size influence access to urologic care for couples with male factor infertility.

The male infertility evaluation still matters in the era of high efficacy assisted reproductive technology

Today's reproductive endocrinology and infertility providers have many tools at their disposal when it comes to achieving pregnancy. In the setting of highly efficacious assisted reproductive technology, it is natural to assume that male factor infertility can be overcome by acquiring sperm and then bypassing the male evaluation. In this review, we go through guideline statements and a stepwise male factor infertility evaluation to propose that a thorough male evaluation remains important to optimize pregnancy and live birth. The foundation of this parallel evaluation is referral to a reproductive urologist for the optimization of the male partner, for advanced diagnostics and interventions, and for the detection of other underlying male pathology. We also discuss what future developments might have an impact on the workup of the infertile male.

Is perceived inability to procreate associated with life satisfaction? Evidence from a German panel study

Most studies of the psychosocial consequences of infertility have focused on those who seek medical treatment, leaving a research gap regarding the psychosocial consequences of perceived inability to procreate in the general population. Moreover, most studies are cross-sectional and the results are thus likely affected by omitted variable bias. Inspired by aspects of the Theory of Conjunctural Action, this study analysed 10 waves of data from the German Family Panel (pairfam) for women and men using fixed effects panel regression and including time-varying control variables suggested by theory and research. This study found that both women and men experienced lower life satisfaction in years when they perceived an inability to procreate. This association was not affected by the inclusion of relevant time-varying control variables. Furthermore, the association between perceived barriers to procreation and life satisfaction was found to differ depending on life circumstances and gender. Women with partners and men without partners had lower life satisfaction when they perceived an inability to procreate compared with when they did not. Women and men who intended to have a(nother) child had lower life satisfaction when they perceived an inability to procreate compared with when they did not. The association, however, was only significant for men. Somewhat surprisingly, women who perceived an inability to procreate also had lower life satisfaction when they were not intending to have a(nother) child. This study makes an important contribution to research on the psychosocial consequences of perceived infertility, and provides insights into why some people may pursue assisted reproductive technology for family creation.

'Just have some IVF!': A longitudinal ethnographic study of couples' experiences of seeking fertility treatment

We present findings from a longitudinal ethnographic study of infertile couples seeking treatment following initial GP referral to specialist fertility services. Repeated observations and interviews were undertaken with the same 14 heterosexual participants over an 18-month period. Heterosexual, non-donor couples comprise the majority of fertility clinic patients; however, research interest in this group has dwindled over time as IVF cycles have increased. In the United Kingdom, IVF is presented as a logical response to involuntary childlessness, and as an entirely predictable, and linear, course of action. The market is well-developed and often patients' first experience of privatised health care in the NHS. Our couples were challenged by this, and while they felt expected to move on to IVF, some wished to explore other options. While IVF is ubiquitous, the discomfort and challenge around fertility treatments remain; experiences are prolonged and characterised by recursive narratives and expressions of disequilibrium, which are rarely acknowledged and reflected in ongoing clinic-patient interactions. Our findings develop understanding of the process of 'mazing' (Image - The Journal of Nursing Scholarship, 1989, 21, 220), the pursuit of parenthood, by showing that the routine and normative status of IVF, at least in the current health care context, is at odds with the lived experiences of individuals.

“Who needs an app? Fertility patients’ use of a novel mobile health app”

Objective

The number of couples experiencing infertility treatment has increased, as has the number of women and men experiencing infertility treatment-related stress and anxiety. Therefore, there is a need to provide information and support to both men and women facing fertility concerns. To achieve this goal, we designed a mhealth app, Infotility, that provided men and women with tailored medical, psychosocial, lifestyle, and legal information.

Methods

This study specifically examined how fertility factors (e.g. time in infertility treatment, parity), socio-demographic characteristics (e.g. gender, education, immigrant status), and mental health characteristics (e.g. stress, depression, anxiety, fertility-related quality of life) were related to male and female fertility patients’ patterns of use of the Infotility app.

Results

Overall, the lifestyle section of the app was the most highly used section by both men and women. In addition, women without children and highly educated women were more likely to use Infotility. No demographic, mental health or fertility characteristics were significantly associated with app use for men.

Conclusion

This study shows the feasibility of a mhealth app to address the psychosocial and informational needs of fertility patients.

An mHealth App to Support Fertility Patients Navigating the World of Infertility (Infotility): Development and Usability Study

Background

The experience of infertility and its treatment engenders considerable stress and is often described as an emotional rollercoaster. A mobile health (mHealth) app may be a novel solution to address the psychoeducational and psychosocial support needs of fertility patients because of its potential to reduce stress and increase patient empowerment. There are a few fertility-related apps that provide information and support to both men and women undergoing fertility treatment; however, none have documented their development and evaluation process.

Objective

This study aims to describe the development and evaluation process of a bilingual mHealth app, Infotility, designed to meet the psychoeducational and psychosocial support needs of men and women undergoing fertility treatment.

Methods

To develop the Infotility app, we adhered to the Medical Research Council guidelines for the development and evaluation of complex interventions. First, we conducted literature reviews and needs assessment surveys of fertility patients and health care providers who informed the content and design of the app. Second, we tested the intervention with a small group of end users who provided feedback on the design and appropriateness of the app’s content. Third, we evaluated the uptake and usability of the app using a pre-post study design. Finally, we updated the app’s content based on participants’ feedback and searched for partners to disseminate the app to the broader public.

Results

This study is the first to describe the development and evaluation process of an mHealth app for men and women undergoing fertility treatment. The app met its goal in providing fertility patients with a clinician-approved, portable resource for reliable information about medical and psychosocial aspects of infertility and its treatments and a confidential peer support forum monitored by trained peer supporters. Participants rated the engagement, functionality, information, and esthetics of the app positively, with an overall app quality mean score of 3.75 (SD 0.53) and a star rating of 3.43 (SD 0.75), with a total possible score and star rating of 5.00.

Conclusions

By documenting the systematic development and evaluation of the mHealth app for men and women undergoing fertility treatment, this paper can facilitate the replication of the study intervention and the development of similar mHealth apps.

The crafting of hope: Contextualising add-ons in the treatment trajectories of IVF patients

The proliferation and popularity of additional treatments in IVF, also known as add-ons, has generated widespread discussion and controversy in the UK, where concerns have addressed the lack of evidence to support the efficacy and safety of these treatments, their cost, and their connection to a wider context of privatisation of fertility treatment. Drawing on 42 interviews with IVF patients, this article explores the role of hope in the appeal of add-ons from the patient perspective. The analysis is presented in two parts: firstly, we investigate the role of hope in patients' decision-making on treatment, contextualising add-ons in the broader trajectory of their IVF experience; secondly, we examine how patients navigate the offer of add-ons, focusing on the role of hope in how they rationalise their decisions on whether to include them in their fertility treatment. Our analysis shows how patients craft their hope to navigate the increasing number of available options in their quest to find the treatment(s) that will "work" for them. We suggest that the imperative for patients to explore all options is intensified with the emergence of add-ons, which produces a novel context and version of a "hope technology".

Meeting multiple same-donor offspring: psychosocial challenges

Debates regarding donor-conceived people's rights to genetic information have caused some jurisdictions to abolish donor anonymity. Moreover, voluntary services have been established whose primary focus is providing possibilities to find information about the donor. A less discussed consequence is that donor-conceived people also find information about donor half-siblings: people conceived through the same donor. In the recent climate of openness and online DNA tests, there is an increased chance of finding multiple donor half-siblings. This study explored how donor-conceived people experience meeting multiple same-donor offspring in a group setting. Second, the study investigated donor-conceived people's need for support when meeting multiple donor half-siblings. A qualitative approach was used. Nineteen donor-conceived offspring who participated in donor half-sibling network meetings were interviewed. Using a grounded theory approach three themes were identified regarding group aspects: (i) defining group membership; (ii) regulating closeness and distance; and (iii) managing group dynamics. Professional support needs in relation to these themes were also analysed. While establishing relationships between donor half-siblings are viewed as generally more beneficial than connecting with a donor, this study showed that these new relationships also come with their challenges, and counselling may need to be refined towards a more specific same donor-offspring relationships' framework.

Point-of-care semen analysis of patients with infertility via smartphone and colorimetric paper-based diagnostic device

Male infertility affects millions of males worldwide and is rising in prevalence due to social and environmental conditions. However, men often feel too embarrassed to receive a semen analysis in the hospital due to social stigmas. To overcome this problem, we developed a 3-(4,5-Dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide test strip to distinguish semen samples with low total motile sperm concentration from those with normal motile sperm concentration. This is a point-of-care colorimetric semen analytical method with a one-step, inexpensive, equipment-free evaluation process, and adequate accuracy validated in a 42-sample clinical trial. In this study, results were evaluated visually and with a smartphone application. Using visual observation methods, the area under the curve (AUC) was 0.71 (95% of confidence interval = 0.55-0.86; p = 0.021), sensitivity was 41%, specificity was 95%, positive predictive value was 90%, negative predictive value (NPV) was 59.4%, and accuracy was 67%. Using a smartphone recording and analytical system, AUC was 0.766 (95% of confidence interval = 0.612-0.92; p = 0.003), sensitivity was 96%, specificity was 65%, PPV was 75%, NPV was 92.9%, and accuracy was 80.9%. This work demonstrated a screening tool that could elevate semen analysis to the level of routine healthcare and provide for private, in-home self-assessment.

Alexithymia, infertility-related stress and quality of life in women undergoing an assisted reproductive treatment

The investigation of the association between alexithymia and quality of life in infertility is a relatively neglected area of research. The aim of this study was to evaluate the association between alexithymia and infertility-related quality of life in women during Assisted Reproductive Treatment. Data were collected in a clinic in Rome, 93 infertile women completed the 20-item Toronto Alexithymia Scale (TAS-20), the Fertility Quality of Life (FertiQoL) questionnaire and a socio-demographic questionnaire. TAS-20 total and two factors-Difficulty in Identifying Feelings (DIF) and Difficulty in Describing Feelings (DDF)-showed significant negative correlations with the overall questionnaire and with both Core and Treatment modules of FertiQoL. The regression model explained the 43% variance in FertiQol overall scores (R² = 0.43; adjusted R² = .38); a significant effect was reported for the number of previous attempts (beta = 0.20; p < .04), TAS-20 DIF (beta = -0.47; p < .001) and TAS-20 Externally Orientated Thinking (EOT) (beta = 0.20; p < .04); after applying Benjamini-Hochberg correction procedure only TAS-20 DIF maintained its significance. Alexithymia is associated with a worsened quality of life in infertile women; specifically, low difficulties in identifying feelings were associated to higher quality of life. Further investigations are needed also to develop specific therapeutic interventions aimed to promote emotional abilities in infertile people.

A qualitative study of factors influencing male participation in fertility research

BACKGROUND

Although fertility is a couple-based outcome, fertility studies typically include far fewer males than females. We know little about which factors facilitate or inhibit male participation in fertility research. In this study we aimed to explore factors that influence male participation in fertility research among North American couples trying to conceive.

METHODS

We conducted a qualitative research study of male participation in Pregnancy Study Online (PRESTO), a prospective preconception cohort of couples actively trying to conceive in Canada and the United States. Between January-August 2019, we carried out 14 online one-on-one in-depth interviews and one online focus group of males and females with varying levels of participation. The in-depth interviews included females who enrolled in PRESTO but declined to invite their male partners to participate (n = 4), males who enrolled in PRESTO (n = 6), and males who declined to participate in PRESTO (n = 4). The focus group included 10 males who enrolled in PRESTO. We analyzed the transcriptions using inductive content analysis.

RESULTS

Male and female participants perceived that fertility is a women's health issue and is a difficult topic for men to discuss. Men expressed fears of infertility tied to masculinity. However, men were motivated to participate in fertility research to support their partners, provide data that could help others, and to learn more about their own reproductive health.

CONCLUSIONS

Male participation in fertility studies will improve our understanding of male factors contributing to fertility and reproductive health issues. Results indicate a need for more education and health communication on male fertility to normalize male participation in fertility and reproductive health research. Men are much less likely than women to participate in research on fertility and pregnancy. However, it is important for men to participate in fertility research so that we gain a better understanding of male factors that impact fertility and pregnancy outcomes. In this qualitative study, we interviewed men and women from Canada and the United States who were trying to become pregnant to understand why men choose to participate in fertility research, why men choose not to participate in fertility research, and why women choose not to invite their male partners to participate in fertility research. We found that both men and women believe fertility is a woman's health issue. Men find it difficult to talk about pregnancy and fertility and have fears of infertility tied to masculinity. However, men are motivated to participate in fertility research to support their partners, to help others, and to learn more about their own reproductive health.

Success of assisted reproductive technology treatment and couple relationship: A pilot study on the role of romantic attachment

Infertility is a deeply distressing experience, which can threaten important personal and martial goals, frequently affecting the psychophysical health. A supportive relationship and a secure romantic attachment appear to reduce infertility stress, as well as play a relevant role in the success of assisted reproductive technology treatments. The principal aim of the study is to investigate the predictive effect of romantic attachment, couple characteristics, quality of life and age on assisted reproductive technology outcome. A total of 88 infertile women, enrolled in an assisted reproductive technology Centre of Rome, completed the Experience in Close Relationship-Revised, the Couple Relationship Inventory, the Fertility Quality of Life and a socio-demographic questionnaire. The participants completed the questionnaires at the beginning of the medical treatment. Data analyses showed significant associations among Experience in Close Relationship-Revised dimensions, Couple Relationship Inventory and Fertility Quality of Life Scales. Assisted reproductive technology outcome was negatively correlated to Experience in Close Relationship-Revised Avoidance and positively related to Couple Relationship Inventory Dependence. A multi-variable logistic regression revealed that Experience in Close Relationship-Revised Avoidance decreased the probability of pregnancy. The present findings partially confirmed the study hypotheses since several associations among couple characteristics, attachment anxiety and avoidance dimensions, infertility-related quality of life in infertile women were found. Furthermore, according to a definition of Avoidance, assisted reproductive technology positive outcome appears to be associated to lower levels of fear of dependence and interpersonal intimacy, and to a low need both for self-reliance and for reluctance to self-disclose within the romantic relationship. Further investigations are needed both to confirm this preliminary finding and for promoting focused therapeutic interventions for couples facing assisted reproductive technology.

Men and me(n)

There is an absence of literature on the dynamics of men interviewing men generally and particularly, on sensitive subjects. Childless men are, compared to women, absent from geographical, gerontological, psychological, reproductive and sociological research. These disciplines have mainly focussed on motherhood, women and family formation. Over the past 15 years, research literature on both involuntary childlessness and ageing has highlighted the paucity of material on men’s experience. Consequently, the fertility intentions, history and experience of men have been overlooked. Infertility research has shown that failure to fulfil the status of parenthood may lead to a complex form of bereavement and is a significant challenge to identity. In this piece, I draw on my experience of conducting an auto/biographical doctoral study on the life experiences of 14 involuntarily childless older men. I briefly explore the literature surrounding research interviews with men participants. I highlight the gender dynamics encountered in both interview and wider academic settings. I identify how danger, harm and risk are present in academic environments such as conferences. I use my experience to illustrate how physical, emotional and ethical dangers affect one’s sense of self. I argue that ethical standards should be applied to all research locations.

The Risk of Psychiatric Morbidity and Course of Distress in Males Undergoing Infertility Evaluation Is Affected by Their Factor of Infertility

This panel study aimed to explore the effects of male, female, mixed or idiopathic factor of infertility on the course of clinical distress and possible psychiatric morbidity in involuntarily childless males undergoing fertility evaluation for the first time. A sample of 255 males completed the General Health Questionnaire-28 (GHQ-28) (a) at the baseline, before their initial fertility evaluation (T₁); (b) before their second andrological appointment 2-3 months after diagnostic disclosure (T₂); and (c) before subsequent treatment-related/follow-up appointments (T₃, T₄) to be screened for clinically significant distress and risk for psychiatric morbidity. Then they were dichotomized as non-cases and cases. The timing of psychological testing was strictly related to andrological appointments and medical procedures. The research demonstrated that the baseline prevalence of clinical distress and psychiatric morbidity in all the subgroups was similar to reference values, but then significantly surged after the diagnostic disclosure, particularly in male and mixed factor respondents. However, the percentage of clinically distressed mixed or idiopathic factor of infertility respondents remained stable after diagnostic disclosure and during the entire follow-up. The prevalence of clinically significant distress and risk for psychiatric morbidity in the male factor of infertility, female factor of infertility, and mixed factor subgroups decreased during the follow-up but remained higher than at the baseline. The study identifies that the course of distress and risk of psychiatric morbidity of males is significantly affected by their factor of infertility and changes across the pathway of treatment-related/follow-up appointments.

The social construction of male infertility: a qualitative questionnaire study of men with a male factor infertility diagnosis

Although recent research has highlighted the distressing impact of infertility for men, fertility issues are still routinely seen as a 'women's issue' - even when male factor infertility is highlighted. This article reports findings from a qualitative questionnaire study focusing on a sample of men with a male factor infertility diagnosis; an under-researched and marginalised group in the context of reproductive medicine. Our analysis suggests that male factor infertility is viewed by men as a failure of masculinity, as stigmatising and silencing, and as an isolating and traumatic experience. It is also clear that these themes are shaped by wider societal discourses which present men as (unproblematically) fertile, uninvested in parenthood and stoic in their approach to emotional distress. Such norms also ensure that reproduction continues to be presented as a 'women's issue' which burdens women and marginalises men. In understanding male factor infertility experiences, the damaging nature of the social construction of male fertility is then more clearly illuminated.

Elective egg freezing and male support: a qualitative study of men's roles in women's fertility preservation

How do men participate in women's fertility preservation decisions and procedures? This binational, qualitative study assessed whether men play supportive roles either before, during or after women's elective egg freezing (EEF) cycles. From June 2014 to August 2016, 150 women (114 in the USA and 36 in Israel) who had completed at least one cycle of EEF were interviewed by two medical anthropologists, one in each country. The majority (85%) of women in the study identified the lack of a male partner as their main reason for pursuing EEF. However, nearly two-thirds (63%) of women relied on some form of male support during their EEF decision making processes and procedures. Five categories of men, in order of support, included: (i) fathers (or other male father figures), (ii) male partners (past or present), (iii) male friends, (iv) brothers and (v) male judges (some of whom supported EEF in divorce settlements). More than a dozen different forms of assistance were offered by men in four major categories: (i) instrumental, (ii) financial, (iii) physical and (iv) psychological. Although one-third (37%) of women went through EEF alone or with only female support, this study reveals the 'hidden' roles men play in supporting the reproductive aspirations of women.

Searching the Internet for Infertility Information: A Survey of Patient Needs and Preferences

Background

Given the complexity of infertility diagnoses and treatments and the convenience of the internet for finding health-related information, people undergoing infertility treatments often use Web-based resources to obtain infertility information and support. However, little is known about the types of information and support resources infertility patients search for on the internet and whether these resources meet their needs.

Objective

The aims of this study were to (1) examine what individual factors, namely, demographic characteristics and distress, are associated with searching the internet for different types of infertility-related information and support resources and (2) determine whether Web-based resources meet the needs of patients.

Methods

Men and women seeking infertility care responded to a survey assessing use of Web-based resources for accessing infertility-related information and support. The survey further assessed satisfaction with Web-based resources as well as perceived stress and depressive symptomatology.

Results

A total of 567 participants, including 254 men and 313 women, completed the survey. Most participants (490/558, 87.8%) had searched the internet for infertility information and support. Searchers were more likely to be women (P<.001), highly educated (P=.04), long-term patients (P=.03), and more distressed (P=.04). Causes of infertility, treatment options, and scientific literature about infertility were the three most frequently searched topics, whereas ways to discuss treatment with family and friends as well as surrogacy and ways to find peer support were the three least searched topics. Of those who searched the internet, 70.9% (346/488) indicated that their needs were met by Web-based information, whereas 29.1% (142/488) said that their needs were not met. Having unmet needs was related to greater levels of perceived stress (P=.005) and depressive symptomatology (P=.03).

Conclusions

This study provides evidence for the important role of the internet in accessing infertility information and support and for the ability of Web-based resources to meet patients’ needs. However, although distressed patients reported particularly high rates of searching, their needs were not always met, suggesting that they may benefit from alternative sources of information and support or guidance from health care providers when searching the internet.

Preferred problem solving and decision-making role in fertility treatment among women following an unsuccessful in vitro fertilization cycle

Background

While the literature on healthcare decision-making has long focused on doctor-patient interaction, fertility treatment is an exception, characterized by a triangular interplay between the doctor, the woman and her partner. This study examined treatment decision-making preferences of women undergoing in vitro fertilization (IVF) treatment, following an unsuccessful IVF cycle, especially their preferred level of doctor and spousal involvement.

Methods

A cross-sectional survey was conducted with 246 Chinese women undergoing IVF recruited from an assisted reproduction clinic of a university-affiliated hospital in Hong Kong. Data collection was conducted between January 2014 and August 2015.

Results

Most participants preferred sharing the decision-making tasks with their doctors (92%). In the doctor-patient relationship, passive roles were associated with higher marital satisfaction, presence of religious affiliation and secondary infertility, while autonomous roles were related to female-factor infertility. Fifty-two percent of participants anticipated sharing decision-making, while 46% preferred handing over the decision to their husbands. Preference for a passive rather than a shared role in the spousal relationship was related to a higher husband’s age, greater marital satisfaction and higher anxiety.

Conclusions

In brief, women tended to prefer sharing decision-making tasks with their doctor as well as actively engaging their partner in making decisions about fertility treatment. This study adds to our understanding of women’s role preference and level of involvement in infertility treatment decision-making by providing quantitative evidence from women’s experience. It highlights the importance of healthcare professionals in facilitating shared decision-making among couples.

Transition to parenthood after successful non-donor in vitro fertilisation: The effects of infertility and in vitro fertilisation on previously infertile couples' experiences of early parenthood

Recent social science research in the field of parenting following assisted conception has focused on the experiences of donor-assisted conception and surrogacy. This article draws from a study which explored the experiences of the transition to early parenthood in 16 heterosexual non-donor couples and includes a specific consideration of the experiences of men as they navigate this journey. We argue that these couples' transition to early parenthood can be as complex and provisional as in other newer forms of family making as they struggle with an emerging identity as a parent after successful non-donor in vitro fertilisation following their experiences of infertility. Their family making is contingent upon their ability to work at integrating their experiences of infertility and in vitro fertilisation into their emerging identity as a parent. This struggle is prominent when they contemplate a further pregnancy. Considering a sibling causes them further uncertainty and anxiety because it reminds them of their infertile identify and the possibility of further in vitro fertilisation. We report novel findings about the experiences of this transition to parenthood: how couples' identity as parents is shaped by the losses and grief of infertility and the anxiety of in vitro fertilisation. We argue that their struggle with an emerging parenthood identity challenges the normative, naturalised view of non-donor heterosexual in vitro fertilisation parenthood. Our work contributes to the work on identity in parenthood after in vitro fertilisation in an ongoing effort to understand how assisted technologies shape infertile parents' lives. This article reports a small study with a relatively homogeneous sample recruited from one fertility clinic. Nevertheless as an exploratory study of an under researched topic, we discuss useful insights and ideas for further research with larger and more diverse samples.