The Male Crisis in Understanding And Reacting to Infertility*

Twelve percent of American couples suffer from infertility-the inability to get pregnant after 12 months of trying. If you are part of a couple going through infertility, or you have a friend going through infertility, you probably know how much emotional pain is involved in the struggle to get pregnant. But most of the upset feelings you have heard talked about-the emotional feelings of worthlessness, the roller coaster of the medical tests and procedures, the effects of fertility drugs, probably have been discussed from the female perspective. Because motherhood is more salient to women's' role than fatherhood is to the male role, and because women talk about their feelings more than men do, most of what we know about people's reactions to infertility is from the female perspective. But what do men feel when they are undergoing this life crisis?

We actually know less than we should about men's feelings during and after an infertility experience. Male socialization against experiencing and expressing weakness means that men often cannot find the words to talk about losses. In addition, men who do feel upset about infertility are living lives in which they keep their upset feelings a secret.

The traditional male sex role requires that men be independent, strong, self reliant, competitive, achievement-oriented, powerful, adventurous, and emotionally restrained. When confronted with a loss, even with a great loss, men are not supposed to cry, exhibit weakness, or seek support. Research studies have found that among infertile couples, women appear to experience significantly more distress than men do, including higher levels of depression, anxiety and cognitive disturbance. Research also has found that men's initial reactions to infertility are more varied than women's and often lack the intensity of women's reactions. In a study by Freeman and al (1985) half the women viewed infertility as the worst experience in their lives, as compared to l5% of the men.

However, it is impossible to take these statistics at face value when we realize that men are socialized to conceal rather than reveal feelings. It is difficult to talk about grief when all sad reactions must be censured. And it is almost impossible for a man to allow himself to expose his vulnerability when the news of his poor sperm count comes from a powerful male physician, unless that physician communicates a very vigorous signal of acceptance along with the diagnosis.

In addition, men may be secretive about male infertility because they feel that others will link their infertility with impotence and lack of masculinity. Given men's lack of enthusiasm for discussing the subject, it is easy to see why research on men's reaction to male infertility has been stymied.

Researchers have studied the ways in which men and women respond to loss in general. Dr. Phyllis Silverman of Massachusetts General Hospital comments that men and women use "different metaphors" when speaking about loss. The male reaction to loss is "separation and disengagement". Unlike women, who usually talk about their problems and seek out relationships for support, men often resort to denial following a loss. Their goal is to pick themselves up, dust themselves off, and proceed down the road of life.

This hypothesis is supported by Dr. Tracy McNab's research (1984) on men and infertility. In his study of men in infertile couples (with infertility due to male, female, or combined factors), it took some men three years after learning of their infertility to begin experiencing feelings of depression and loss.

More recent research and a careful reexamination of the data has shown that infertility poses inherent threats for men, although they may be more subtle and may not show up for several years. Several studies show that the population at large and childless men in particular do associate fatherhood with adulthood and masculinity.

Certain men are very disturbed by their infertility. When researchers used quantitative methods to study couples undergoing infertility treatments, they found that when the infertility had been attributed to male factor infertility, men's responses to infertility closely approximated women's. Men felt stigmatized, emasculated, or disabled by their infertility, and call themselves "dud" and "loser". They experienced their diagnosis as a loss, both of their potency and of their ability to father. They felt role failure because of their inability to procreate. And lastly, they reported a loss of self-esteem.

Men are more vulnerable than women in terms of their isolation from others. Husbands don't ask their wives for support because they believe their role is to support their wives. Men are not likely to tell other men or women about their infertility because they fear others will link their infertility with impotence and lack of masculinity. Even in mixed gender groups run by the organization RESOLVE a self help organization for infertile people), men report that they would not reveal their own sense of being upset with the infertility unless other men in the group had already admitted being equally upset.

Psychologist and sex therapist Bernie Zilbergeld Ph.D. has written brilliantly about the masculine sexual stereotypes in American society. An example of such stereotype is, "A man's sexual tastes are easy to satisfy. He will take it any way he can get it, but what he really wants to do is stick it in and hump away until he has an orgasm, with as little tenderness, communication and relating as possible."

Contrary to stereotype, many men cannot function like sexual machines. They need to feel tenderness and connection to their wives, if not to get erections, then to feel sexual and emotional pleasure. If a man is not having trouble obtaining erections, that does not mean that he is undisturbed about the sexual demands being placed upon him by infertility treatment. Having sex when there is no desire is anything but pleasurable. Most married men are saddened and worried by mechanical sex with a wife who is upset about infertility, who isn't turned on, and who only wants to get it over with. They are isolated in their feelings and cannot get sympathy from other men, who often make fun of them for complaining about needing to have sex every other day. These husbands worry that their sexual relationship has been ruined and that they will never get it back.

In a fair number of marriages, infertility causes marital discord. Although men may not talk about it, the conjugal discord is depressing and threatening. When such fighting occurs, men find themselves upset by intrusive images of the marriage ending or of things never improving. Even when they're not yet upset about the infertility, husbands are frustrated and saddened by their wives' distress and the women's accompanying emotional unavailability to them. They are disquieted by their inability to comfort their wives effectively and they may feel helpless.

In the consultation room, as a psychologist, I often hear comments from men like this: "Actually, the worst part is my frustration over her frustration. I don't know how to comfort her and help her move through the upset quickly," or "I don't' think we fight about the infertility directly. The infertility has created a higher level of stress that is becoming the new normal level for us. Our fights are about everyday, relatively small things. However, because our stress level is consistently elevated, it doesn't take much to set either of us off. Lately, I've started to withdraw and sometimes even leave the scene, because I am so frustrated and angry that I don't know what to say or do."

In a men's group I led, much time was spent discussing upset feeling about giving one's wife physical pain while administering injections. In addition many men felt guilty that the infertility was causing much more physical discomfort and pain for their wives, in terms of procedures and medications, than it was for them, despite the fact that the infertility was the couples' problem.

As Dr. Tracy MacNab discovered, after three years of undergoing infertility diagnosis, work up and treatment, even men who denied feeling upset felt the full brunt of the emotional assault. Most experienced feelings of depression and loss. At that point, they made the deep connection between masculinity and fatherhood.

Men with close relationships to their fathers tend to be as devastated as their wives by infertility, but they hide their deep feelings, because "baby hunger" is not a feeling "real men" have. Men who had very close relationships with their father tend to imagine, since early childhood, growing up and "being a father, like my father." Like most women, at the first hint of infertility these men feel tremendous anxiety and grief at the possibility of not having a child. They experience envy when looking at pregnant women, are obsessed with the infertility, and, like women, feel out of control of their lives. They cannot ignore their sorrow and go to their jobs. They are devastated. But they keep their emotions secret. They sense that other men would not respect them for caring so much about having a baby. They perceive themselves to be totally separate from other men in the world.

Infertility causes many men to have disturbing changes in their body imagery and sexual imagery, even when the medical problem lies in their wife! They have intrusive negative imagery about being judged during intercourse, they dread being teased by other men about being sexual "duds" and they have fears that somehow part of the medical problem is hidden within their body, too. Every man who are not infertile can become fearful that they aren't really hairy enough, or muscular enough, or potent enough. Thanks to the built in pressure to win the competition, secretly, all men fear that they just aren't adequately masculine.

Men with male-factor infertility, and men with other pre-existing wounds to their sexual self- image feel the most difficult feelings. They are overcome with feelings of defectiveness. In my consulting room, I have seen many examples of the fact that men who are infertile or subfertile can be plagued with pictures of sexual vulnerability left unresolved from long ago.

For example, after getting back the poor results of his sperm count, one of my patients, who was able to produce vivid images, had a flashback to the sounds, smells, textures and sights of his high school locker room. He could feel the steamy heat and hear the sounds of the snapping towels and the teasing words about his genitals. The images remained too painful to share with either his wife or his friends.

Infertile men are plagued with spontaneous negative visual imagery: "I'm making Martian sperm" or " I see my sperm, trapped helplessly by the gunk (sperm antibodies). The feelings of being defective are devastating, yet too personal and disturbing for most men to acknowledge or discuss with their partners, friends, or medical professionals.

People who have something wrong with their body frequently intuitively feel guilty, as if the defect is punishment for wrongdoing. Infertile men can fear that their medical problem was caused by masturbation, adolescent sexual experimentation, promiscuity, illicit drug use, or punishment from God for some other misdemeanor. These negative thoughts need to be challenged. Infertility has existed from Biblical times and is mostly caused by bad luck.

Men are extremely secretive about how their sexuality is affected by their infertility experience, in large because they are secretive about their sexuality in general. Even though the introduction of Viagra has helped somewhat to bring erectile dysfunction problems out of the closet and into the public realm for discussion, the issues some men face during infertility still are not publically discussed.

Some men who are going through infertility have always had lower sexual desire than their wives. In a situation where what sex therapists call a sexual desire discrepancy has already existed between partners, there is a tendency for the higher-drive partner to always feel unsatisfied and rejected, and for the lower drive partner to feel guilty. When you throw infertility into the mix, with prescribed times to have intercourse, men with lower desire than their partners feel a tremendous amount of pressure and blame about their distaste for "performing" on a rote schedule. But they feel trapped and isolated in their feelings. If they reveal to friends that they are feeling upset because they have to have sex "too often," they may be laughed at or told that their friends "only wish that they had that problem," or, "ok, let me take over with your wife, I'll happily do it!"

Other men will feel used or stressed out sexually by the demands of infertility treatment. These include men with preexisting problems with premature or retarded ejaculation, men who do not feel comfortable with masturbation, and men who actually do not enjoy sex much under any circumstances.

One of my patients commented, " I hate to perform at certain times of the month, like an animal, at my wife's request. Sometimes it's five to seven times a month. I feel loving two or three times a month, but I feel used the rest of the time. The rest of the month, we may have sex, but I'm very turned off, to the point where I don't want to do it."

(*Parts of this article have been reprinted from Men, Women and Infertility (1993) and from articles previously written for Serono Symposia and Harvard Community Health Plans, Boston.)

HELP RESOURCES:

RESOLVE, a nationwide organization www.RESOLVE.org

Books:

Cooper, Susan and Glazer, Ellen. Beyond Infertility. New York: Lexington books, l994

Vercollone, C, Moss, and Moss. Helping the Stork: The Choices and Challenges of Donor Insemination. New York: Macmillan, 1997.

Johnson, Pat. Taking Charge of Infertility: Indianapolis, In.: Perspectives Press, 1994.

Zilbergeld, Bernie. The New Male Sexuality: The Truth About Men, Sex and Pleasure. New York: Bantam: l992.

Zoldbrod, Aline. Getting Around the Boulder in the Road: Using Imagery to Cope with Fertility Problems. (Center for Reproductive Problems, Lexington, Ma.) : l990.

Zoldbrod, A. Men, Women and Infertility: Intervention and Treatment Strategies. New York: Lexington Books, l993.