In western cultures, infertility – defined by not conceiving after 12 months of unprotected intercourse – is often seen as the responsibility of the female partner, and much of the blame tends to be placed on women (Wischmann, 2013). However, male factor infertility contributes in ⅓ of cases and is the sole factor in an additional ⅓ of infertility cases (How Common Is Male Infertility, and What Are Its Causes?, n.d.).
It is important to understand the causes and risk factors of male factor infertility to fully grasp how common the problem is and why it occurs. The mental health consequences of male factor infertility must also be understood to provide comprehensive support to families struggling to conceive. The causes of male infertility generally fall into three categories: disruption of testicular or ejaculatory function, hormonal disorders, or genetic disorders (Infertility | Reproductive Health | CDC, 2021). Typically a semen analysis is performed to determine if and how any of these factors affect a man’s infertility (Infertility | Reproductive Health | CDC, 2021).
In a semen analysis, the concentration, motility, and morphology of the sperm are analyzed by a specialist (Infertility | Reproductive Health | CDC, 2021). Out of the many possible causes, two of them are the most common. The first is varicocele, a condition in which the veins in the testicles are enlarged, which causes the testes to overheat, which then affects the number and shape of the sperm (Infertility | Reproductive Health | CDC, 2021). Varicocele is by far the most common condition in men with infertility, as it is present in about 40% of male factor infertility cases (How Common Is Male Infertility, and What Are Its Causes?, n.d.). The second is a complete lack of sperm, which is present in between 10-15% of male infertility cases and can be caused by many different factors (How Common Is Male Infertility, and What Are Its Causes?, n.d.).
While many uncontrollable factors can cause male factor infertility, there are many other factors that put men at greater risk for infertility. Those factors include being overweight or obese, one’s age, smoking, excessive alcohol use, marijuana use, and exposure to testosterone, radiation, frequent high temperatures, certain medications, or environmental toxins (Infertility | Reproductive Health | CDC, 2021).
Environmental toxins may also have more of an effect on male infertility than previously understood. In the past 50 years, sperm counts in men have declined by 50% (Fertility Crisis Leaves Little Time for Solutions, 2021). Dubbed the fertility crisis, other aspects of fertility like miscarriages, testosterone levels, and premature egg depletion are all changing at similar rates, too (Fertility Crisis Leaves Little Time for Solutions, 2021). The current data point to the median sperm count being close to zero in 2045 (Fertility Crisis Leaves Little Time for Solutions, 2021). These alarming changes are occurring far too quickly to be attributed to genetics, pointing to another cause – namely environmental pollution linked to endocrine-disrupting compounds (EDCs) that are found in everyday plastic products (Fertility Crisis Leaves Little Time for Solutions, 2021). Reducing exposure to single-use plastics can help reduce your exposure to EDCs (Fertility Crisis Leaves Little Time for Solutions, 2021).
A person’s mental health status can be greatly affected by their ability – or inability – to conceive. The effects of infertility on mental health are well-documented in women. It has been shown that up to 40% of infertile women meet the criteria for either anxiety or depression (Cousineau & Domar, 2007). Despite this, there is very little research on how infertility affects men’s mental health, possibly due to the assumption that men suffer less psychologically than their female partners (Wischmann, 2013).
However, emerging research documents how “the impact of male infertility exceeds what has so far been represented in quantitative questionnaire scores and confirms the need to acknowledge men’s emotions and emotional needs” (Wischmann, 2013). While it was previously assumed that infertility takes a greater psychological toll on women due to the way that infertile women tend to communicate their emotional distress and grief, men suffer just as heavily. Yet, due to the socialization of men and the idea that men need to hide their emotions to support their partner, infertile men have suffered in silence for years (Wischmann, 2013). This can be at least partially attributed to how stigmatized male infertility is in society. In addition, male factor infertility is much more heavily associated with sexual disorders, such as low sperm count or low motility, than female factor infertility, causing people to often conflate male factor infertility with impotence (Wischmann, 2013).
One study found that infertile men have high psychological symptoms such as depression, anxiety, and hostility (Abdullah et al., 2019). While minor data collected has been collected, the findings have been very clear; infertile men suffer the same mental health repercussions as infertile women but lack the same resources and information infertile women receive.
The perception of masculinity in western cultures is an extremely significant part of understanding the stigmatization of male factor infertility. A Danish study found that 28% of men undergoing fertility treatment “believed that their reduced sperm quality affected their perception of masculinity” (Mikkelsen et al., 2013). Despite roughly 30% of participants reporting this altered perception of masculinity, very few of those men expressed a desire to be referred to psychological counseling (Mikkelsen et al., 2013). This is a clear indication of the need to discuss the psychological consequences of male factor infertility openly from the beginning of fertility treatments and make mental health resources clearly included.
Even infertility doctors themselves are not free from the false notion that infertility is a women’s issue. As Mikkelsen et al. (2013) shared, 63% of respondents stated that their fertility doctors and
other health professionals primarily communicated with their female partners, despite both partners undergoing fertility treatment. Additionally, 72% of the men participating in the study said they lacked basic information about the psychological consequences of male factor infertility (Mikkelsen et al., 2013).
One proposed avenue to help address these serious mental health consequences of men struggling with infertility is to make the infertility education space more inclusive of men. Using more dialogue, as “the data suggest that infertile men require a greater degree of openness and detail about their condition and its related psychological consequences” (Mikkelsen et al., 2013), can also help produce a change.
There is also a need to prioritize including BIPOC men in fertility conversations. A study showed that in comparison to white men, black men have lower adjusted sperm concentrations and are at greater risk for low sperm motility and low sperm counts (McCray et al., 2020). Hispanic men were shown to have higher adjusted sperm concentrations than non-Hispanic men, as well as a decreased risk of low sperm motility and counts (McCray et al., 2020). Given these trends, it is crucial that there is an increased effort to focus on BIPOC men in male infertility education.
This presents a huge opportunity for fertility health professionals to make strides to fix this problem. Over a third of men felt that health professionals did not take the time to address issues specific to their fertility journey. More than two-thirds found that health professionals did not provide an opportunity to discuss the specific experience of male infertility (Mikkelsen et al., 2013). These findings support previous evidence that there is a clear need for more extensive dialogue with health professionals regarding male infertility, which is something the study suggests can be started with nurses. However, all fertility health professionals should make a meaningful effort to create a deeper conversation about male infertility and its psychological consequences (Mikkelsen et al., 2013).
Another way that health professionals can help with this is to suggest counseling and support groups for their male fertility patients, as current data shows that neither male infertility patients nor their health professionals “raised the issue of psychological stress with any frequency” (Mikkelsen et al., 2013). In general, men from the developed West are less likely to seek out and utilize medical services and have higher morbidity and mortality rates than their female counterparts (Gannon et al., 2004). Given that, it is not surprising that male infertility patients do not tend to actively seek counseling specific to infertility or information on the psychological impacts of infertility. Male factor infertility is not discussed enough in society as a whole. Having those conversations with their patients, health professionals can start that conversation and help break the stigma surrounding male infertility and its severe psychological consequences.
Given the current trends in male factor infertility, it is necessary for all men – whether they intend on having biological children now or in 30 years – to think about their fertility. While many men might not want to have that uncomfortable or difficult conversation about fertility, talking about male fertility and infertility will only benefit men. The more frequent these conversations become, the more knowledge will be shared, and the less of a stigma male factor infertility will carry, which could also help reduce the risk of psychological effects.
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