Male Infertility - Men Talking

Mary-Claire Mason

• Publisher: Routledge
• Year: 2003
• eBook ISBN:
  9781134907236
• Topic: Medicine
• Subtopic: History & Theory in Psychology

How do men react to diagnosis of male infertility and how, if at all, are all their lives affected by it? Male infertility is commonplace yet the male experience of it has been woefully neglected. Male Infertility - Men Talking explores these issues by gathering together men's stories and seeing what common strands, if any, exist between them. Mary-Claire Mason explores the past and present medical management of male infertility as this forms an essential backdrop to the men's stories but the main emphasis is on how men's lives are affected. In the first half of this book the discovery of sperm and the man's role in reproduction is considered together with a review of how the past affects the present medical management of male infertility and the problems that bedevil it. The male voice predominates in the second painful events and relationships with families and friends, their feeling of isolation, their medical experiences, the importance of biological fatherhood, and their hopes for the future.

Part I

1 Introduction

INFERTILITY IS A WOMAN’S CONCERN

Men are shadowy figures when it comes to matters of fertility. Little is still known about what they feel when confronted with the dilemmas raised by infertility generally. As Osherson says, ‘we know a good deal about the turmoil women experience when couples are infertile but much less about men’ (1986:97). The picture may change again when a question mark hangs over the man’s fertility, the subject of this book.

A veil of ignorance has cloaked this delicate topic keeping it hidden from view. Times may be changing but it is still women who dominate the infertility agenda. Children are seen as a woman’s business and events from conception onwards her concern. She is the one who suffers when such natural matters do not go according to plan, and the one to take charge of fertility problems when they arise, regardless of whether the cause of the problem lies with her, the man or both of them. Figures from a recently established British fertility telephone helpline illustrate this picture. Some 2, 582 women rang the phone line in its first year of operation compared to 326 men (Dickson, 1991), and little information is currently available about male infertility drawn from men themselves (Congress of the US, Office of Technology Assessment, 1988c).

Accounts of fertility in the past revolved round the woman. Bible stories emphasised infertility as a woman’s concern. The man’s reproductive potential was essentially unquestioned, impotence the only acknowledged cause of male infertility (Spark, 1988). In the Old Testament men could take on additional wives where the original ones were barren. Sterility was regarded as a divine punishment (Turner, 1984) and the ability to have children has historically been of great importance. Johnston comments ‘to earliest man the propagation of the race and its survival was a source of real anxiety; a woman who failed to conceive and carry a pregnancy to term was a source of concern and she regarded her plight as a disgrace’, but the man was not generally castigated. Basically his role in conception seems to have been misunderstood. The Ingarda tribe in Australia for example believed that the child was the product of something the mother had eaten (1963: 261).

More is known nowadays about male reproductive physiology and so about the problems of male fertility. Yet the assumption still lingers that it is the woman who is at fault (Stanway, 1986). Medical tests and treatments have largely been directed at her with the result that her experiences have been highlighted and the man’s passed over.

Women are expected to be upset about involuntary childlessness. Infertility is seen as a tragedy for them. At the start of a book on the infertility experience, Pfeffer and Woollett say:

In speaking predominantly to women we describe the experience from a woman’s point of view because, although in at least one-third of cases male factors are heavily implicated, infertility is mostly seen as a woman’s problem. Women are assumed to be more committed to wanting children and so infertility is seen as more of an issue for them. This is an assumption that we wish to question. But while this is how men’s and women’s motivation to have children is perceived, infertility is a greater life crisis for women than for men. This may make women more ready to talk about it. Also, it is women who by and large undergo the infertility investigations even when the problem lies with the man. So it is largely women for whom infertility becomes an issue and so we have concentrated on their experiences.

(1983: 3)

A look at books and articles on infertility confirms this view. First-person tales written by women are the rule. They talk about their sorrow and anguish and the problems that beset them. Such pieces by men are exceptional. An article by John Green about his infertility grabbed my attention because it was so unusual (1988). More usually, the woman relays the man’s experience, filtering it through her eyes. Back copies of Issue, the magazine produced by the British self-help group of that name (formerly National Association for the Childless), has letters from women writing in about their partners’ problems, wanting more information about tests and treatments for male infertility. Letters from men are rare.

Likewise Ann Ferris writing about her own experience of in-vitro fertilisation (IVF) explains that her partner’s sperm were found to be of dubious quality. The IVF attempt failed because none of the eggs collected from her was fertilised. Whilst mainly talking about herself, she talks about how her partner feels. ‘I hate him to see me upset because I know he feels guilty. He knows he can’t give me the one thing I desire more than anything – his child’ (1991:54).

But these are indirect observations of the man’s experience. What do men themselves feel and think about their infertility? They have been reluctant to bare their souls in a way that women have not. The pioneering, excellent book written by Diane and Peter Houghton describes how the National Association for the Childless came to be set up in Britain. The Houghtons were unable to have their own children and towards the end of the book, Diane rather than Peter writes about her infertility experience. She explains along the way that her husband had fertility problems, yet his voice is absent from her moving story (1987). The impression is reinforced that infertility is a woman’s rather than a man’s business.

Men seem to have been left on the sidelines. A complex mix of social, cultural, medical and historical factors must surely account for this neglect. Reading articles and books on infertility written during the 1980s, several points emerge about male infertility. One dominates. From a medical perspective, the topic is a baffling puzzle waiting to be solved. One piece for example, talked of the lack of effective medical treatments for male infertility despite it being commonplace. There were no male specialists so men had to queue at female clinics for help, but men were also seen as partly to blame for this state of affairs as they mistakenly linked infertility to a lack of virility. Male infertility was seen as a major stigma and medical advances would only come about once the subject was brought out into the open (Hodgkinson, 1983). Another article also said men were haunted by the myth that fertility and virility were the same thing (Prentice, 1984). Philipp (who founded the British Fertility Society) blamed the lack of interest on men and doctors. The former were too proud to seek medical assistance for problems or were unaware they had any, and too few doctors took an exclusive interest in the subject (1984).

Speculation about why so little is known about the medical treatment of male infertility leads to another related area. Little is known about how men’s lives are touched by infertility other than comments passed about the stigma attached to male infertility. There is a glaring gap in those studies that have considered the emotional and psychological aspects of infertility usually at the treatment stage. Women have largely been the centre of attention in these studies and men have been disregarded (Pantesco, 1986). More specifically a study on the psychology of male infertility reviewed various research pieces but found that only a minority concentrated on male patients. The author’s explanation for this oddity was that men rarely showed clinical symptoms of infertility, and that the ‘traditional view of confounding reproductive and sexual potency in men may have attributed to the hesitation in investigating the male patient for psychological factors’ (Bents, 1985: 332).

CHANGING TIMES

Infertility has become a more talked about subject in the last decade and seems set to continue that way in the 1990s. Men are coming under closer scrutiny. One author though writing about women’s particular problems acknowledges the male position – ‘many men will also be extremely distressed by infertility and the associated treatments’ (Doyal, 1987: 178). Infertility articles have considered the male experience, at least at the medical level, and talk of sperm counts and treatments is not uncommon in the media. A mix of factors seems to have encouraged this.

New treatments always provoke media interest. The birth of the world’s first IVF baby in 1978 stimulated much discussion about how women could be helped to have children. IVF is now being used to help couples where the man has sperm problems, provoking discussion about male infertility. More recently other developments for men have attracted media attention.

Campaigning self-help groups have been established. Resolve was founded in 1973 in America and the British group, the National Association for the Childless, began in 1976. Infertile people emerged into the open according to one journalist, demanding better treatments and so gaining a higher profile. Previously they might have suffered in silence and adopted children, but changes in abortion law and improved contraception closed that route (Laurance, 1982). Inevitably such groups have wanted more effective treatments not only for women but for men and have raised awareness of the man’s position.

Male health in general has been neglected and is a subject for shame argues Lyndon (1990), but it is getting more attention. Male-health clinics for example, have been established and men are being encouraged to check themselves for signs of prostate and testicular cancer. Discussion of male infertility may be part of this trend towards greater male enlightenment.

On the social side, fatherhood has become desirable (Landesman, 1991) and is something all boys can aspire to. Perhaps this has encouraged debate about what men can do if they find their road to fatherhood blocked. Male infertility was also thought suitable enough to include in a British television serial (McAllister, 1991).

A reflection of all these changes is that men are starting to talk about their experiences. Resolve has published a Collection on the Male Perspective. Contributors (some have fertility problems, others not) set down their feelings about infertility and talk about what it feels like from the man’s standpoint. Articles are appearing where men who have fertility problems are prepared to be identified and talk about their side of the story (Mason, 1990 and Barber, 1992).

Clearly the tide is turning. The purpose of this book is to explore and air men’s experiences about their own infertility. It is important to say that I am highlighting a particular group. Men experience infertility even where their own fertility is not compromised. A man, for example, may be fertile yet unable to have children because his partner is infertile, but I am looking at those whose fertility is in jeopardy. Inevitably there are shared experiences between these two groups though I believe that men’s experience of infertility may be significantly coloured by the fact of male infertility.

The spur for the book was my own personal experience, but the idea for it came from Pfeffer and Woollett’s work exploring the infertility experience from the female perspective. Whilst recognising that men have strong feelings about their own fertility, Pfeffer and Woollett say they did not attempt to ‘tap directly or systematically men’s reactions to infertility’. They think they got an indirect sense of the male experience by talking informally to women and men (1983:3). My purpose was to go directly to men with fertility problems to find out what they had to say in the belief that men need to share their experiences with others. If their voices are heard, men are less likely to be ignored.

LAYOUT

The rest of this part of the book looks in more detail at medical issues. Everybody I spoke to had been through some sort of medical experience. Though it is only one aspect of their stories, it was for most a vital one. I have therefore devoted space to sketching out what I think is the background to the present medical treatment of male infertility, then looking at current medical management. This overview should inform and make more sense of what men had to say.

Part two, the main section of the book, is given over to mapping out what men went through. I start by explaining how I contacted people, who they were and the purpose of our discussions. Medical experiences are then described followed by reactions to the diagnosis. The importance of fatherhood and ways to it come next with subsequent chapters on coping, support and resolution of infertility. The closing sections chart men’s ideas about whether their experiences are different from women’s and explores thoughts about the future.

THE AUDIENCE

Finally this book is written for those people whose lives have directly or indirectly been touched by male infertility, for those who work in the area and people interested in the subject. Though the stories come mainly from men living in Britain, I believe their experiences are not peculiar to this country and will be of interest to others elsewhere.

2 Setting the scene

This chapter explores the background to the medical management of male infertility, a subject that has attracted gloomy comment in the past. Stanway for example, says that for the most part it is ‘still pretty much in the Dark Ages’ (1986: 97).

More optimism is voiced when it comes to the treatment of female infertility. Far more research has been done into egg production in women in the quest for a contraceptive. The links between research into contraception and infertility emerged in Vaughan’s book on the pill (1972), with the result that more became understood about how the hormones involved in egg production work. This led to the female contraceptive pill and to the use of fertility drugs for ovulatory problems in the 1960s. According to gynaecologist Dr Robert Winston,

in 1961 Dr Greenblatt and his colleagues working in the United States produced an epoch-making study of the value of clomiphene for women who fail to ovulate. Since then this drug has been responsible for more pregnancies in infertile patients than probably any other treatment in the world.

(1989: 136)

Then the world’s first IVF baby was born in 1978. The technology which produced Louise Brown was developed to overcome blocked fallopian tubes in women and was hailed as a great step forward for women with tubal blockages.

Male reproduction in contrast has been far less researched and the result is a lack of effective treatment options for many men, and the absence of a male contraceptive pill. Before looking at what is now on offer, it makes sense to look at the past to see what light it can shed on the present treatment of male infertility.

THE PAST

There is an awareness nowadays that men as well as women can have fertility problems, though this has not always been the case. Pregnancy and childbirth have long been considered women’s business and they are the ones who have been blamed when all has not gone according to plan. Women rather than men have been held responsible in the past for the failure to conceive and miscarriages.

Mosse and Heaton point out ‘until relatively recently it was popularly assumed that all men were more or less fertile, that fertility problems were a woman’s affair and that every man produced enough sperm in every ejaculation to populate the whole of North America’ (1990: 9).

When male infertility has been considered, it is in the context of sexual impotency. It seems to have long been held that if the man is able to have sexual intercourse, then he is fertile, and children are seen as a sign of a man’s virility. Once he has done his duty, the rest is up to the woman.

For example, in pre-industrial England, the woman was assumed to be barren if she had sex with a man but failed to become pregnant (McLaren, 1984). MacFarlane remarks that

in many societies each extra child adds to its parents’ social prestige: infertility is a terrible curse, and a large and growing family a blessing. The virility of the man is shown through his many children and he gains esteem through each successive birth.

(1986: 59)

The view that it is only women who are responsible for infertility has held fast into the twentieth century. Hall reviewed letters written by men and women to Marie Stopes (the birth control pioneer) for advice in the 1920s and 1930s. Correspondents reported that doctors continued to regard sterility as the woman’s fault (1991).

In part this assumption may be based on the idea that the male reproductive system is more simple and straightforward than the female one and therefore less likely to go wrong. This idea is analysed and found wanting by Pfeffer...

Table of contents

• Front Cover
• Male infertility – men talking
• Title Page
• Copyright
• Contents
• Foreword
• Preface
• Acknowledgements
• Part I
• Part II
• Appendix: self-help groups
• References
• Name index
• Subject index