(Male) infertility: what does it mean to men? New evidence from quantitative and qualitative studies

A Dyadic Study of Attachment, Coping, and Quality of Life in Couples Seeking Fertility Treatment

This study examined attachment insecurities, infertility-specific coping strategies, and quality of life (QoL) in 87 couples seeking fertility treatment. Partners completed self-report measures. Path analyses showed that women's and men's attachment anxiety were associated with their own lower QoL, whereas attachment avoidance was associated with their own and their partner's lower QoL. Adaptive coping in men and women were associated with women's higher QoL. Non-adaptive coping was associated with men and women's lower QoL. Coping strategies explained the associations between attachment and QoL. This highlights the importance of individual and dyadic factors for understanding QoL in couples seeking fertility treatment.

The quality of life of men experiencing infertility: a systematic review

BACKGROUND

Men experiencing infertility encounter numerous problems at the individual, family, and social levels as well as quality of life (QOL). This study was designed to investigate the QOL of men experiencing infertility through a systematic review.

MATERIALS AND METHODS

This systematic review was conducted without any time limitation (Retrieval date: July 1, 2023) in international databases such as Scopus, Web of Science, PubMed, and Google Scholar. The search was performed by two reviewers separately using keywords such as QOL, infertility, and men. Studies were selected based on inclusion and exclusion criteria. The quality of the articles were evaluated based on the Newcastle-Ottawa Scale. In the initial search, 308 studies were reviewed, and after removing duplicates and checking the title and abstract, the full text of 87 studies were evaluated.

RESULTS

Finally, 24 studies were included in the final review based on the research objectives. Based on the results, men's QOL scores in different studies varied from 55.15 ± 13.52 to 91.45 ± 13.66%. Of the total reviewed articles, the lowest and highest scores were related to mental health problems and physical dimensions, respectively.

CONCLUSION

The reported findings vary across various studies conducted in different countries. Analysis of the factors affecting these differences is necessary, and it is recommended to design a standard tool for assessing the quality of life of infertile men. Given the importance of the QOL in men experiencing infertility, it is crucial to consider it in the health system. Moreover, a plan should be designed, implemented and evaluated according to each country's contex to improve the quality of life of infertile men.

Lay understanding and experience of sexual intercourse among couples with infertility undergoing an assisted reproduction technology program: A qualitative study

Aim

To explore the perception and lay understanding of sexual intercourse and sexual life experiences among infertile couples before, during, and after undergoing an assisted reproduction technology (ART) program.

Method

The participants of this descriptive qualitative study were Indonesian couples with infertility who underwent an ART program. Semi-structured interviews were conducted between September and December 2022, and the participants' responses were recorded. Data were analyzed using a step-by-step analysis based on Braun's qualitative analysis. The study was reported based on the Consolidated Criteria for Reporting a Qualitative Research (COREQ) Checklist.

Results

Fifty participants were included, and five themes were developed before and two themes during or after the ART program. The couples' knowledge varied as they experienced sexual intercourse at different periods, such as before, during, and after the ART program. Many participants reported that ART affected their emotions and mood, leading to decreased desire to engage in sexual intercourse. However, some used sexual intercourse as a basis for creating optimism and confidence in having offspring. Furthermore, couples perceived that the purpose of sexual intercourse is not only to have offspring but also to improve communication, promote intimacy, and express affection. In contrast, some perceived the ART program as time consuming, preventing them from engaging in sexual activities. However, not all couples considered sexual activity solely as a means of procreation. They concluded that sexual behavior is not only determined by genetics.

Conclusion

Couples who underwent the ART program regardless of its effectiveness were aware that sexual interaction is not only for having children but also for preserving harmony and familial connection.

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.

The Impact of Using Donor Sperm After ICSI Failure in Severe Oligozoospermia on Male Mental Health and Erectile Function

Objective

To analyze the mental health and erectile function status of men using sperm donor during pregnancy after ICSI failure in severe oligoasthenospermia and to provide reference for clinical implementation of more targeted psychological intervention and nursing for this group.

Methods

A total of 410 sterile men who received assisted pregnancy treatment in our hospital from December 2020 to December 2022 and met the inclusion and exclusion criteria were collected as the study subjects. Among them, 68 patients with severe oligoasthenospermia who used donor assisted pregnancy after ICSI failure were used as the study group. Sixty-eight patients with severe oligoasthenospermia who continued to receive ICSI assisted pregnancy were matched by propensity score 1:1 as control group. General data questionnaire, self-rating Anxiety Scale (SAS), self-rating Depression Scale (SDS), Chinese version of perceived Stress Scale (CPSS) and International Erectile Function Index Rating Scale (IIEF-5) were used to conduct a cross-sectional investigation to compare the mental health and erectile function status of the two groups.

Results

There were statistical differences in age and occupational status between the two groups before PSM (P < 0.05), but there was no statistical significance in social demographic data between the two groups after matching (P > 0.05). The incidence of anxiety, depression, stress and erectile dysfunction (ED) in the study group was higher than that in the control group, and there were statistical differences between the two groups (P < 0.05).

Conclusion

The use of donor sperm to assist pregnancy has a great impact on the mental health and erectile function of infertile men. Medical personnel should pay attention to the mental health and erectile function of these men, and formulate targeted measures to help these patients actively cope with infertility, so as to improve the life and marriage quality of this group and improve their mental health status.

"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.

How fear of intimacy affects infertile men's neuropsychological functioning through mental toughness

OBJECTIVE

There is a significant need in Pakistan to investigate the psychological effects of infertility on the mental health of infertile men. The current study examined how fear of intimacy affects neuropsychological impairment and evaluated its relationship to other variables including quality of life and mental toughness.

METHOD

An analytical cross-sectional study was carried out on infertile male patients in various healthcare settings in Punjab, Pakistan. The participants were recruited using a non-probability (purposive) sampling strategy. The sample size was 120 infertile. SPSS 26 was used to analyze the data.

RESULTS

Fear of intimacy was found significant impact on neuropsychological impairment (r = 0.40; ***p < 0.001), as well as fear of intimacy, significantly associated with emotional problems (r = 0.48; **p < 0.01), learning problems (r = 0.33; **p < 0.01), sensory and motor problem (r = 0.55; **p < 0.01), concentration problem (r = 0.21; **p < 0.01), mental & physical in coordination (r = 0.37; **p < 0.01) and depression (r = 0.22; **p < 0.01). Fear of intimacy has negative impact on QoL (r = -0.25; *p > 0.05). Similarly, neuropsychological impairment was found to be negatively associated with QoL (r = -0.52; **p > 0.01). The relationship between fear of intimacy and neuropsychological impairment was found to be significantly mediated by QoL. Furthermore, the findings revealed that mental toughness significantly moderated the relationship between fear of intimacy and neuropsychological impairment.

CONCLUSION

Overall, infertile men in Pakistan had relatively high levels of fear of intimacy, which largely caused neuropsychological impairment. This study can help neuropsychological researchers, mental health professionals, as well as policymakers in improving clinical mental health practices for infertile patients.

Male infertility: what on earth is going on? Pilot international questionnaire study regarding clinical evaluation and fertility treatment for men

Infertility is a time-consuming and exhaustive process, which disproportionally affects women. Although concerns have been raised about deficiencies in clinical evaluation of infertile men, there is currently little published data documenting this. A SurveyMonkey questionnaire was therefore created to capture current clinical practice of fertility specialists working in IVF clinics. Responses were collected May - July 2021. 112 clinicians completed the pilot survey with respondents from Europe (n=49; 43.8%), Africa (n=39, 34.8%), North America (n=6; 5.4%), Asia (n=16; 14.3%), South America (n=1; 0.9%) and Australasia (n=1;0.9%). 41% fertility specialists (45/110) reported taking only a brief medical history and 24% reported that they never routinely examined infertile male patients. 54% fertility specialists also reported issues getting men to undertake diagnostic semen analysis. Treatment for male infertility spanned Assisted Reproductive Technology (ART), with themes of individualised medicine influencing treatment recommendations. 48.2% clinicians reported using empirical medical therapy (EMT) for unexplained male infertility. Notably, 3.6% respondents recommended testosterone treatment, despite likely negative impact on spermatogenesis. However, high levels of opportunistic general health advice were reported, including discussion of life exposures thought to be important for male reproductive health. This study adds novel evidence and highlights current deficiencies in clinical practice relating to male infertility. Evaluation of the infertile male using simple medical tools (detailed history taking and clinical examination) has the potential to identify treatable or reversible conditions and should be an immediate focus for education and improvement in Reproductive Medicine. Investment in research and development is much needed in the field of andrology, to develop effective non-ART treatment options for male infertility.

Paramedical counselling in infertility treatment: its effects on anxio-depressive symptom severity, perceived stress and self-esteem

Aims

The importance of contributing psychological factors and stress-control in female infertility is well documented, but research on their role in male infertility is scarce. The present study aimed to evaluate the effects of a novel paramedical counselling on anxio-depressive symptom severity, perceived stress and self-esteem in infertile men participating in an infertility treatment programme.

Methods

Patients were recruited from clinics of University of Szeged, Hungary between 2019 May and 2020 December, and were sorted into control (n = 51) and experimental (n = 57) groups, where patients in the experimental group received a 5-session paramedical counselling in extension to their medical treatment. The levels of anxio-depressive symptom severity, perceived stress and self-esteem were measured prior to and after receiving paramedical counselling. The control group scored lower in regards of the severity of depressive symptom, and showed an increase of self-esteem, while the experimental group resulted in a significant decrease of anxio-depressive scores with the elevation of the level of self-esteem.

Results

Our results indicate that joining an infertility treatment programme alone had a positive role in reducing depressive symptoms and in the increase of self-esteem among infertile men, but receiving additional paramedical counselling throughout the treatment programme resulted in the decrease of anxio-depressive symptoms, besides the elevation of the level of self-esteem, with a significantly higher decrease in the state anxiety compared to not receiving this additional paramedical counselling.

Conclusions

Thus, it would be advisable for infertility treatment programmes to incorporate screening for psychological vulnerability and implement additional paramedical counselling to alleviate these confounding symptoms detrimental to conceiving.

Does male fertility-related quality of life differ when undergoing evaluation by reproductive urologist versus reproductive endocrinologist?

The female infertility experience is well-described, but the male experience is less explored. We sought to understand if fertility motivations and quality of life differ for males undergoing fertility evaluation by a reproductive urologist (RU) versus a reproductive endocrinologist (RE). A cross-sectional study of 201 males undergoing fertility evaluation at an academic centre, by either a RU or RE, over a 2-year period, was performed. A survey was administered, with demographic, medical, and fertility motivations questions, and the validated Fertility Quality of Life (FertiQoL) questionnaire. Responses were compared by provider type using descriptive statistics, chi-square, and t-test. Most men (91.1%) pursued evaluation because of a mutual desire for children. RE evaluated males were older, earned higher incomes, and were more likely to pursue IVF versus those RU evaluated (p < 0.05). Men evaluated by RUs had lower FertiQoL scores, (p < 0.05), which correlated with having known male factor infertility (p < 0.05). Nearly all (96.2%) men evaluated by RUs indicated this was helpful for understanding their infertility. Our findings provide new insight into the male fertility evaluation experience. Despite the lower QoL seen by men seeing a RU, nearly all men reported that a RU evaluation was helpful for understanding their infertility experience.

Adolescent attachment to parents and peers in singletons and twins born with assisted and natural conception

STUDY QUESTION

Does adolescent attachment to parents and peers differ between singletons and twins born with ART or natural conception (NC)?

SUMMARY ANSWER

Adolescent attachment anxiety with the father was higher among NC singletons than among ART and NC twins, whereas attachment avoidance with the father was higher in ART singletons than in NC singletons and NC twins. No differences were found in attachment to the mother, best friend or romantic partner.

WHAT IS KNOWN ALREADY

Most studies have not found differences between ART and NC singletons in parent–adolescent relationships, but twin relationships may be more at risk. No previous study has examined all four groups in the same study, or specifically looked at attachment relationships.

STUDY DESIGN, SIZE, DURATION

This was an 18-year, prospective and controlled longitudinal study with families of 496 ART singletons, 101 ART twin pairs, 476 NC singletons and 22 NC twin pairs. Families were recruited during the second trimester of pregnancy; the ART group was recruited from five infertility clinics in Finland and the control group was recruited from a hospital outpatient clinic during a routine visit.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Mothers and fathers gave background information for this study during pregnancy, and during the child’s first year and early school age (7–8 years). For the ART group, infertility characteristics and prenatal medical information was also obtained from the patient registry of the infertility clinics. Children (originally 50% girls) filled in electronic questionnaires related to their attachment to mother, father, best friend and romantic partner (Experiences in Close Relationships—Relationship Structures) at 17–19 years of age.

MAIN RESULTS AND THE ROLE OF CHANCE

Adolescent attachment anxiety to father was higher in NC singletons than in ART twins, P = 0.004 and marginally higher than in NC twins, P = 0.06. Adolescent attachment avoidance to father was higher in ART singletons than in NC singletons, P = 0.006 and marginally higher than in NC twins, P = 0.055.

LIMITATIONS, REASONS FOR CAUTION

The sample size was small especially in the NC twin group and there was drop-out over the 18-year time period, especially among boys and families with lower parental education level. The study only included native Finnish-speaking families. The results could differ in a more diverse population. ART singletons were younger and had fewer siblings than ART twins and NC children, and ART and NC twins had more newborn health risks than ART and NC singletons.

WIDER IMPLICATIONS OF THE FINDINGS

The study adds to a growing body of evidence that neither ART treatments nor being a twin places mother–child relationships or peer relationships at long-term risk. However, in our study, which was the first to examine both ART and twinhood simultaneously, we found that there may be more problems in father–adolescent relationships, but only in ART singletons and only related to attachment avoidance. Our findings suggest that men, as well as women, should receive enough support in pre- and peri-natal health care during and after infertility treatments.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by Academy of Finland (grant number 2501308988), the Juho Vainio Foundation and the Finnish Cultural Foundation. The authors report no conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

Assessment of Quality of Life in Men Treated for Infertility in Poland

The aim of this study was to assess the quality of life (QoL) of men treated for infertility in Poland. This cross-sectional study was conducted using the Abbreviated World Health Organization Quality of Life questionnaire (WHOQoL-BREF), Fertility Quality of Life tool (FertiQoL) and an author-constructed questionnaire. The study included 1200 men treated for infertility without the use of assisted reproductive technology (non-ART), intrauterine insemination (IUI) and in vitro fertilization (IVF). The control group consisted of 100 healthy men with confirmed fertility. The quality of life assessed by the WHOQoL-BREF questionnaire was significantly lower in study groups in the Environmental domain, compared to the control group (p = 0.009). Statistically significant differences were found in the case of FertiQoL subscales: Emotional, Mind-Body, Relational, and Treatment Environment, depending on applied treatment. Men whose partners were treated without the use of ART assessed their QoL significantly more negatively than those treated with IUI. Reproductive problems and type of their treatment influenced the quality of life of the affected men. Non-ART treatment, rural place of residence, and increased BMI were associated with lower QoL.

For patients with non-obstructive azoospermia, the outcome of testicular sperm extraction correlates with self-esteem, sexual health and the quality of the couple's relationship

BACKGROUND

A very small number of studies have indicated that azoospermia or negative testicular sperm extraction (TESE) outcomes are linked to depression or erectile dysfunction. However, the data are often weak, conflicting and gathered with non-validated questionnaires. Hence, we performed a cross-sectional study of 44 men with non-obstructive azoospermia. Levels of self-esteem and the quality of the couple's sex life and overall relationship were assessed with validated questionnaires before and after the TESE procedure as a function of the TESE outcome.

RESULTS

A positive TESE outcome (n = 24) was associated with a statistically significant increase in self-esteem (particularly with regard to family aspects), sexual health and couples' adjustment quality. In contrast, a negative TESE outcome (n = 20) was associated with statistically significant decreases in self-esteem, erectile function, intercourse satisfaction, orgasmic function, couples' adjustment quality and all aspects of the couple's relationship (consensus, cohesion, satisfaction and affection).

CONCLUSION

For men with non-obstructive azoospermia (NOA), negative TESE outcomes may have a negative impact on self-esteem and the quality of the couple's sex life and overall relationship. This should be borne in mind when counselling men with NOA and their partners to (ideally) help them to cope with and decrease the harmful impacts of azoospermia and negative TESE.

Psychological Resilience as the Mediating Factor Between Stigma and Social Avoidance and Distress of Infertility Patients in China: A Structural Equation Modeling Analysis

Background

Stigma, social avoidance and distress may seriously affect the quality of life of infertility patients. Psychological resilience has been proved to effectively combat psychological stress. This study aimed to explore the mediating role of psychological resilience between stigma and social avoidance and distress (SAD) in females with an unfulfilled wish for a child.

Methods

Stigma Scale, Social Avoidance and Distress Scale (SADS), and Psychological Resilience Scale were used to evaluate 266 females with infertility. Structural equation model was used to test the mediating effect of psychological resilience on the relationship between stigma and SAD.

Results

The SADS, stigma scores, and psychological resilience scores of 266 females with infertility were 13.36 ± 5.77, 77.84 ± 16.91, and 58.84 ± 12.24 points, respectively. The stigma scores were positively correlated with SADS, and negatively correlated with psychological resilience scores. The psychological resilience scores were negatively correlated with SADS. Psychological resilience played a partially mediating role between the stigma and SAD of infertility patients, and the mediating effect accounted for 25.5% of the total effect.

Conclusion

Psychological resilience had a partial mediating effect on the relationship between stigma and SAD, and could reduce the negative effect of stigma on the development of SADS. Therefore, positive psychological interventions improving psychological resilience might help to reduce stigma and improve SAD in infertility patients.

Chronic stress inhibits testosterone synthesis in Leydig cells through mitochondrial damage via Atp5a1

Stress is one of the leading causes of male infertility, but its exact function in testosterone synthesis has scarcely been reported. We found that adult male rats show a decrease in bodyweight, genital index and serum testosterone level after continual chronic stress for 21 days. Two-dimensional gel electrophoresis (2-DE) and MALDI-TOF-MS analysis identified 10 differentially expressed proteins in stressed rats compared with controls. A strong protein interaction network was found to be centred on Atp5a1 among these proteins. Atp5a1 expression significantly decreased in Leydig cells after chronic stress. Transfection of Atp5a1 siRNAs decreased StAR, CYP11A1, and 17β-HSD expression by damaging the structure of mitochondria in TM3 cells. This study confirmed that chronic stress plays an important role in testosterone synthesis by regulating Atp5a1 expression in Leydig cells.

In vivo and in vitro protective effects of the Wuzi Yanzong pill against experimental spermatogenesis disorder by promoting germ cell proliferation and suppressing apoptosis

ETHNOPHARMACOLOGICAL RELEVANCE

Wuzi Yanzong pill (WZYZP) is a classical traditional Chinese medicine (TCM) formula originated from the Tang dynasty. WZYZP has a long history of use for reinforcing kidney and alleviating male infertility in China.

AIM OF THE STUDY

The effect of WZYZP on male infertility and the mechanism underlying this effect was not clarified clearly. Therefore, this study aimed to investigate the protective effect of WZYZP in experimental spermatogenesis disorder via in vivo and in vitro studies, to promote the use of this formula for the treatment of spermatogenesis disorder.

MATERIAL AND METHODS

Male SD rats were exposed to tripterygium glycosides to induce experimental spermatogenesis disorder, and WZYZP was subsequently administrated at different dosages for treatment. Sperm counts, sperm motility, and serum hormone levels were detected. HE staining and TUNEL staining were performed to evaluate the pathological lesions and apoptosis of testes, respectively. Next, germ cells were isolated from spermatogenesis disorder-model rats and treated with WZYZP- containing serum at different concentrations. CCK-8 assay and flow cytometry assay were performed to detect cell proliferation and apoptosis. Immunofluorescence assay, qRT-PCR and Western blotting analyses were performed to detect the expression of Beclin 1, LC3 and TGF-β-PI3k/AKT-mTOR pathway - related factors, including TGF-β, PI3K, AKT, mTOR, 4 EBP-1 and p70S6K.

RESULTS

In vivo experiments showed that WZYZP protected against spermatogenesis disorder in model rats by improving sperm count and motility, as well as restoring serum hormone levels. HE and TUNEL staining demonstrated that the pathological injuries and cell apoptosis in testes of the model rats were alleviated by WZYZP treatment. Moreover, in vitro experiments of germ cells isolated from spermatogenesis disorder-model rats showed that WZYZP treatment increased the cell proliferation, inhibited cell apoptosis and autophagy. qRT-PCR and Western blotting assay results showed that this protective effect was associated with the regulation of the TGF-β/PI3K/AKT/mTOR signaling pathway. The expression levels of p-PI3K/PI3K, p-AKT/AKT, p-mTOR/mTOR, 4 EBP-1 and p70S6K were increased, while TGF-β was inhibited in the WZYZP treated groups.

CONCLUSION

The results showed that WZYZP could protect against experimental spermatogenesis disorder by increasing the germ cell proliferation and inhibiting their apoptosis. Our support the clinical use of this formula for the management of spermatogenesis disorder.

Male fertility as a marker for health

Male reproduction is a complex biological process, and male factor infertility is increasingly recognized as a biomarker for overall male health. Emerging data suggest associations between male reproduction and medical disease (genetic, infectious, chronic comorbid conditions), psychological disease, environmental exposures, dietary habits, medications and substances of abuse, and even socioeconomic factors. There is also evidence that a diagnosis of male fertility is associated with future disease risk including cancer, metabolic disease and mortality. As such, there is a growing view that the male fertility evaluation is an opportunity to improve a man's health beyond his immediate reproductive goals, and also highlights the necessity of a multidisciplinary approach.

Who can take advantage of medically assisted reproduction in Germany?

Compared with other European societies, access to medically assisted reproduction (MAR) in Germany is rather restrictive. Surprisingly little is known about the actual utilization of MAR in Germany and its social selectivity, primarily due to a lack of appropriate data. This article studies the use of MAR by drawing on 11 waves of the German Family Panel (pairfam), an annual survey that collects data on partnership and family dynamics in Germany. In estimating pooled logistic regression models that take into account whether or not MAR has been used, the following treatments were included: (i) in-vitro fertilization or micro-fertilization; (ii) intrauterine insemination; and (iii) any type of surgery performed to treat infertility. The highest odds of seeking medical help for infertility were found among married, childless couples who had a higher income, a strong desire to have children, a poor self-assessed health status, and who reported having problems conceiving a child prior to the year of the interview. Among these married couples, those with an above-average income were particularly likely to use MAR. These findings indicate that social selectivity in the uptake of MAR is based on economic resources and on the importance of marriage as the cultural ideal for a 'normal family'.

Marital Duration, and Fertility-Related Stress as Predictors of Quality of life: Gender Differences among Primary Infertile Couples

Context

Infertility is a global public health issue, and the current data suggest that the problem is growing. Various infertility-related issues are responsible for poorer mental health and well-being in couples with primary infertility.

Aim

The present study aimed to understand the gender differences of psychological factors related to infertility in couples with primary infertility. Furthermore, an attempt was also made to understand gender-specific associations that could interact with the fertility-related quality of life (FertiQoL).

Settings and Design

This cross-sectional hospital-based study included 100 married couples with the diagnosis of primary infertility, irrespective of the cause of infertility. The study was conducted at Infertility centers in the Eastern region of India.

Subject and Methods

One hundred men and women (n = 100 couples) with the diagnosis of primary infertility were recruited in the study. The fertility problem inventory and FertiQoL were used to measure the couples fertility-related stress and FertiQoL, respectively.

Statistical Analysis Used

Descriptive statistics, independent t-statistics, Pearson correlation, linear regression, and mediation analysis were conducted.

Results

A significantly higher social and sexual concern of infertility and "need for parenthood" were found in women. Men had a significantly better quality of life compared to women. Significant negative predictors of quality of life were noted for both men and women separately. Fertility stress was a significant mediating factor between marital duration and global FertiQoL in men. However, women showed a direct negative association between marital duration and FertiQoL.

Conclusions

The study provides important insights into the couple's experiences with various infertility problems that may potentially be addressed during psychotherapy or during infertility counseling.

Positioning the donor in a new landscape-mothers' and fathers' experiences as their adult children obtained information about the identity-release sperm donor

STUDY QUESTION

How do heterosexual parents experience identity-release donation when adult children have obtained information about their sperm donor?

SUMMARY ANSWER

Adult offspring's receipt of identifying information about the sperm donor challenged the fathers' role as a parent, which was reflected in how parents positioned the donor in relation to the family.

WHAT IS KNOWN ALREADY

An increasing number of countries provide access to treatment with identity-release or 'open-identity' donors. However, there is limited knowledge about how parents experience and manage the situation when adult offspring obtain identifying information about the donor and may even establish contact with him.

STUDY DESIGN, SIZE, DURATION

This qualitative interview study included 23 parents whose offspring had obtained information about their sperm donor. Interviews were conducted from October 2018 to January 2019.

PARTICIPANTS/MATERIALS, SETTING, METHODS

A purposive sample of parents (15 mothers and 8 fathers) was recruited via adult offspring, who had requested identifying donor information at five Swedish University hospitals. All participating parents were part of a heterosexual couple who had conceived with sperm from an identity-release donor. Individual semi-structured interviews were conducted face-to face or via telephone, and transcribed audio recordings were analyzed using reflexive thematic analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

The parents expressed diverse experiences related to their parenthood and the presence of the donor after offspring had obtained information about him; these were described in two themes. The theme 'Navigating (in)visible markers of parenthood' describes parenthood as embedded with dichotomous meanings of nature and nurture that parents navigated in relation to social approval. The theme 'Positioning the donor in a new landscape' describes how parents managed the presence of the donor by positioning him at a distance or acknowledging him as a person or even as part of the family, while some struggled to position him, giving rise to ambivalent feelings. The absence of genetic connectedness challenged the father's role as parent, which was reflected in parents' positioning of the donor.

LIMITATIONS, REASONS FOR CAUTION

The study was performed within the context of the Swedish legislation on identity-release donation and is based on experiences of heterosexual couples who had used sperm donation and had informed their offspring about their donor conception. This, together with the fact that parents' accounts were predominantly represented by mothers, must be taken into consideration regarding transferability to other populations.

WIDER IMPLICATIONS OF THE FINDINGS

Negotiations of social and genetic parenthood are still present among parents many years after treatment and may resurface when adult offspring obtain the donor's identity. Access of the adult offspring to identifying information about the donor may have unexpected consequences for family relations, including expanding the family to include the donor. Challenges related to male infertility and family dynamics indicate that parents should have access to counseling and support to manage family life with varying genetic linkage within and outside the family unit.

STUDY FUNDING/COMPETING INTEREST(S)

Financial support was from The Swedish Research Council (Grant 2013-2712). There are no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

The Etiology of Infertility Affects Fertility Quality of Life of Males Undergoing Fertility Workup and Treatment

This panel study explored the effects of male, female, mixed, or idiopathic factor of infertility on the fertility quality of life (FertiQoL) in involuntarily childless males undergoing fertility workup for the first time. A convenience sample of 255 married males (age range = 22–51 years, mean = 30.24 years), 254 (99.6%) of whom suffered from primary infertility were assessed (1) at the baseline, before their initial fertility evaluation (T1); (2) before their second andrological appointment, 2–3 months after diagnostic disclosure (T2); and (3) before subsequent treatment-related/ follow-up appointments (T3, T4). The timing of psychological assessment was strictly related to andrological appointments and routine medical procedures. Respondents completed Emotional, Mind–Body, Relational, and Social subscales of the Polish version of FertiQoL and a baseline demographic survey. The research demonstrated that the FertiQoL scores across the Emotional, Mind–Body, and Relational subscales markedly decreased after the diagnostic disclosure, particularly in the subgroups with male and concurrent male and female factor. Social subscale scores in all subgroups remained stable after the diagnostic disclosure (at T2) but significantly decreased in the follow-up (at T3 and T4). Significant differences in FertiQoL scores associated with respondents’ infertility factor could be demonstrated at each time point. The study identifies the FertiQoL in unintentionally childless males is significantly affected by their factor of infertility and evolves across the pathway of treatment-related/follow-up appointments.

Simplified sperm testing devices: a possible tool to overcome lack of accessibility and inconsistency in male factor infertility diagnosis. An opportunity for low- and middle- income countries

Background

Manual semen assessment (MSA) is a key component in a male’s fertility assessment. Clinicians rely on it to make diagnostic and treatment decisions. When performed manually, this routine laboratory test is prone to variability due to human intervention which can lead to misdiagnosis and consequently over- or under- treatment. For standardisation, continuous training, quality control (QC) programs and pricy Computer-Assisted Sperm Analysis (CASA) systems have been proposed, yet, without resolving intra- and inter-laboratory variability. In response, promising simplified sperm testing devices, able to provide cost-effective point-of-care male infertility diagnosis are prospected as a plausible solution to resolve variability and increase access to sperm testing.

Materials and methods

A throughout literature research for semen testing, sperm analysis, smart-phone assisted semen analysis, ‘at-home’ semen testing, male infertility, infertility in developing countries, infertility in low- and middle-income countries (LMIC) and quantitative sperm analysis was performed. A total of 14 articles, specific to ‘at-home’ simplified sperm assessment, were included to treat the core subject.

Results

Continuous training and consistent QC, are sine qua none conditions to achieve accurate and comparable MSA. Compliance does not rule-out variability, nevertheless. Emerging simplified sperm assessment devices are an actual alternative to resolve the lack of standardisation and accessibility to sperm analysis. YO ® , SEEM ® , and ExSeed ® are commercially available, user-friendly smartphone-based devices which can accurately measure volume, sperm concentration (millions/ml) and total motile sperm count. More broadly, by cost-effectiveness, availability, accuracy and convenient application, these devices could effectively select patients for first-line artificial reproduction treatments such as intrauterine insemination.

Conclusions

Accuracy and cost-effectiveness make smart-phone based sperm testing devices a practical and realistic solution to overcome variability in MSA. Importantly, these tools represent an actual opportunity to standardise and improve male subfertility diagnosis and treatment, especially in LMIC. However, before clinical application is possible, guidelines, further testing with special attention on accuracy in washed sperm, availability, cost-benefit and reliability are required.

Sterility, an Overlooked Health Condition

Clinically, infertility is defined as the inability to conceive after a certain period. In contrast, sterility is defined as the inability to produce a biological child; however, this is not a practical definition that can be applied in a clinical setting to a patient’s diagnosis. Unlike infertility, sterility is rarely discussed in biomedical and clinical literature and is often used synonymously with infertility. Infertility affects about 10% of couples globally, but the prevalence of sterility remains unknown. We divide sterility into three subtypes natural, clinical, and hardship. To estimate sterility prevalence, we analyzed primary literature and meta-analysis papers on the rates of live births and pregnancies throughout several treatments of infertile couples (e.g., untreated patients, in vitro fertilization-treated, and patients administered other treatments). This analysis indicates that all treatments fail in delivering a biological child to most couples, suggesting that most infertile couples may fail to conceive. More comprehensive primary studies are needed to provide a precise estimate of sterility. Furthermore, research is needed to study the causes of sterility, as well as develop methods for diagnosis and treatment that are financially affordable and emotionally tolerable. Altogether, sterility is an under-discussed condition that is more common than expected, as many infertile couples are unable to conceive and are, in effect, sterile.

Predictors of infertility-related concerns in a Canadian survey of men and women seeking fertility treatment

OBJECTIVE

To examine if and how factors associated with infertility-related concerns and opportunity to discuss concerns differ between male and female fertility patients.

METHODS

A cross-sectional survey of 313 female and 254 male patients recruited from Canadian fertility clinics. An online survey asked about sociodemographic characteristics, psychological distress, the severity of psychosocial concerns on a scale of 0 (not concerned) to 5 (very concerned) related to fertility treatment, and their opportunity and desire to discuss concerns with healthcare providers (HCPs).

RESULTS

For women, higher stress, educational attainment and being childless were associated with higher concern (F(6, 287) = 14.73, p < .001). For men, higher stress, being religious and longer treatment duration were associated with higher concern (F(8, 222) = 9.87, p < .001). No significant difference existed between men's and women's average concern scores (t(558) = -1.62, p = .11) or opportunity to discuss concerns (t(149) = 0.28, p = .78).

CONCLUSION

Our results indicate an unmet need and desire for support among subgroups of patients who were concerned about psychosocial issues related to infertility, but did not have the opportunity to discuss these issues with HCPs.

PRACTICE IMPLICATIONS

There is a need to tailor resources to address the concerns of male and female fertility patients from diverse sociodemographic backgrounds and with different fertility histories.

The role of gender and self-esteem as moderators of the relationship between stigma and psychological distress among infertile couples

To determine if perceived stigma is positively associated with psychological distress, and examine if self-esteem has a moderating effect on the relationship between stigma and psychological distress among infertile Chinese couples. 369 infertile couples completed questionnaires including socio-demographic and clinical characteristics, stigma, self-esteem, and psychological distress. Stigma had a significant, positive association with psychological distress (r = 0.461, P < 0.01). Self-esteem moderated the association between stigma and psychological distress differently for men compared to women. Stigma had a positive, moderate association with psychological distress in men with high self-esteem compared to men with low self-esteem (t = 3.232, P < 0.01). However, there was no significant difference in the relationship between stigma and psychological distress between women with high and low self-esteem, tests of the simple slopes showed that non-significant difference of slopes between the two groups (t = -0.017, P = 0.987). The results indicate that self-esteem buffers the net effect of stigma on psychological distress in men but not women. Future research should focus on interventions that use self-esteem as a way to decrease the negative association of stigma with psychological distress, especially among men who are infertile and have low self-esteem.

Latest-Late Fertility? Decline and Resurgence of Late Parenthood Across the Low-Fertility Countries

After decades of fertility postponement, we investigate recent changes in late parenthood across low-fertility countries in the light of observations from the past. We use long series of age-specific fertility rates from the Human Fertility Database (1950-2016) for women, and new data covering the period 1990-2016 for men. In 1950, the contribution of births at age 40 and over to female fertility rates ranged from 2.5 to 9 percent, but then fell sharply until the 1980s. From the 1990s, however, the prevalence of late first births increased rapidly, especially so in countries where it was initially lowest. This has produced a late fertility rebound in the last two decades, occurring much faster for women than for men. Comparisons between recent and past extremely late (age 48+) fertility levels confirm that people are now challenging the natural fertility barriers, particularly for a first child.

Effect of infertility causes related to gender differences on Women's distress levels among patients utilizing a Turkish university hospital

Purpose

This study aimed to examine the effect of causes of infertility related to gender differences on the distress level of women who were treated for infertility.

Design/methodology/approach

This is a cross-sectional, descriptive study. The sample consisted of 314 women who were treated for infertility between September 2016 and June 2017. Data were collected as “Sociodemographic Characteristics Form” and “Infertility Distress Scale.”

Findings

A statistically significant difference was found between the mean distress scores of the women for whom the reason for infertility was related to a female factor, and of the women for whom this reason was related to a male factor.

Research limitations/implications

The situation should be determined with quantitative studies, and the reason for the differences should be determined with qualitative studies.

Practical implications

Infertility nurses should develop a care plan that ensures that couples understand their feelings, and which enhances their mutual respect and partnership.

Social implications

The study highlights the importance of cultural awareness in the care of infertile couples.

Originality/value

The authors highlight some important aspects about the gender difference on women's distress level.

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.

A comparison of sociodemographic and psychological characteristics among intended parents, surrogates, and partners involved in Australian altruistic surrogacy arrangements

OBJECTIVE

To characterize the sociodemographic and psychological profiles of participant groups involved in altruistic surrogacy in Australia.

DESIGN

Cross-sectional study.

SETTING

Single psychological practice in Sydney, Australia.

PATIENT(S)

Six hundred and two individuals involved in 160 altruistic surrogacy arrangements: 143 intended mothers, 175 intended fathers (including 17 same-sex intended father couples), 160 surrogates, and 124 surrogate partners.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Responses to a presurrogacy sociodemographic assessment counseling protocol and the Personality Assessment Inventory (PAI).

RESULT(S)

The surrogates were primarily sisters, sisters-in-law, mothers (48.6%), or other extended family or friends (46.3%) of the intended parents. Most participants resided in residential postcode areas within the highest socioeconomic status quintile; however, intended mothers were more likely than surrogates to live in the most advantaged residential areas, to be younger and be more educated, and to be employed in professional occupations. Most participant psychological profiles were normal. A statistically significantly elevated PAI Somatic Complaints-Health Concerns subscale for intended mothers was observed compared with other participant groups. The higher PAI Warmth scale scores of intended mothers and surrogates were statistically significantly different from their respective partners, although not different from each other.

CONCLUSION(S)

Sociodemographic and some psychological differences between participant groups were observed that warrant exploration in pretreatment surrogacy counseling. Importantly, the higher scores on the PAI Warmth scale exhibited by intended mothers and surrogates in the context of close family and friendship relationships are likely to serve as protective mechanisms for the altruistic surrogacy outcome.

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.

Gender differences in factors associated with depression in infertility patients

AIMS

To clarify gender differences in the demographic variables and infertility problems associated with depression among men and women undergoing infertility treatment.

DESIGN

A cross-sectional study.

METHODS

We surveyed 380 women and 360 men undergoing infertility treatment at the reproductive medicine center of a hospital in China's Ningxia Province from March - September 2016.

RESULTS

For women, ethnicity, the number of clinic visits, social concern, and sexual concern were factors linked with depression symptoms. For men, treatment cost pressure and social concern were significantly associated with depression symptoms.

CONCLUSION

Psychological counseling and intervention programs should be integrated into in-vitro fertilization treatments and interventions should be targeted based on gender differences.

IMPACT

The provision of treatment-related sexual knowledge by nurses is indispensable for infertile participants. Mental health policies should be developed to facilitate the implementation of psychological services. Psychological counseling and intervention programs should be integrated into in vitro fertilization treatment to help men and women with infertility cope with psychological distress.

Managing absence and presence of child-parent resemblance: a challenge for heterosexual couples following sperm donation

This qualitative interview study sought to gather and better understand heterosexual parents' experiences of managing resemblance and non-resemblance between child and parent in an identity-release donor programme. The study is part of the prospective longitudinal Swedish Study on Gamete Donation (SSGD), including all fertility clinics performing gamete donation in Sweden. A sample of participants in the SSGD, consisting of 30 heterosexual parents with children aged 7-8 years following identity-release sperm donation, participated in individual semi-structured interviews. This study concerns a secondary analysis of the interview data. The results show how donor-conceiving parents experience the presence and absence of child-parent resemblance, and how they navigate between the importance of genetic connectedness and of 'doing parenthood' through social interactions. The analysis resulted in three categories: 'resemblance through nature or nurture', 'non-resemblance brings the donor to the front' and 'feelings about and coping with resemblance talk'. The first two categories deal with the intrapersonal aspects of physical and non-physical resemblance, while the last category includes aspects of resemblance in relation to persons outside the core family. The presence or absence of parent-child resemblance regarding both physical and non-physical characteristics appears to constitute a considerable challenge for heterosexual couples with school-aged children following sperm donation.

Men on the margins? Reflections on recruiting and engaging men in reproduction research

While social science research into reproduction is a vibrant and growing field of scholarly activity, the majority of research is conducted with women and focuses on women’s lives. Reproduction research which does focus on men tends to overlook aspects such as pre-conception desires for parenthood and planning. Scholars have argued for a greater inclusion of men in reproduction research, yet there is a paucity of methodological literature addressing how best to do so. This article reports methodological reflections from a qualitative study into men’s perceptions and intentions regarding the ‘right time’ to have children. It does this in reference to Critical Studies of Men and Masculinities – which foregrounds men as gendered beings and comprises the study of the gendered nature of men’s lives – as both a theoretical position influencing study conception and design and as an explanatory framework for enhancing understanding of the research encounter. The first part of the article describes the Critical Studies of Men and Masculinities–informed study conceptualisation and design, specifically the decisions to include unpartnered men in the sample and to address the absence of men in reproduction research in recruitment materials. It then goes on to discuss the most effective recruitment strategy employed, recruiting through informal gatekeepers, and to consider the consequences of this. The second part of the article presents data from the male participants pertaining to their stated motivations for participating, which relate to interest, helpfulness, and in response to perceived marginalisation, as well as their reflections on the interview encounter as enabling them to construct a narrative. It aims to extend knowledge and understanding regarding engaging men in reproduction research and to illustrate the utility of Critical Studies of Men and Masculinities for doing so, and in doing so to advance both reproduction research and discussions of Critical Studies of Men and Masculinities and methodology more broadly.

Can men be trusted in population-based surveys to report couples' medical care for infertility?

BACKGROUND

Men are usually excluded from surveys on reproductive health as some works have cast doubts on their ability to accurately report information on reproduction. Recent papers challenged this viewpoint, arguing that the quality of men's reports depends strongly on use of an appropriate study design. We aimed to explore the relevance of evaluating couples' use of medical care for infertility based on men's interviews in a population-based survey.

METHODS

The study was based on the last French sexual and reproductive health study (Fecond) conducted by phone interviews among a population-based sample of 2863 men and 4629 women aged 20-49 years.

RESULTS

Among respondents who had ever tried to have a child, the use of infertility medical care by couples (i.e. by the respondents and/or their partners) within the previous 15 years was 16% (95%CI 14 to 18%) based on men's reports and 17% (95%CI 15 to 18%) based on women's reports (p = 0.43). Men's and women's reports were remarkably concordant on most items (infertility duration, treatment). The main discrepancy concerned male medical checkup, which was reported much more often by male respondents than female respondents (86% vs. 57%, p < 0.001 for sperm analysis, 56% vs. 27%, p < 0.001 for male genital examination).

CONCLUSIONS

It is time to trust men to report couples' infertility medical care in reproductive surveys, as they provide information remarkably concordant with that provided by women. Conversely, women may poorly report the infertility checkups of their male partner.

Fertility patients demonstrate an unmet need for the provision of psychological information: A cross sectional study

OBJECTIVES

To examine the provision of information by health care providers (HCPs) to fertility patients about accessing psychological resources.

METHODS

This study utilized data from a cross-sectional survey of 659 male and female patients seeking fertility treatment at clinics in Toronto and Montreal. Regression analyses were used to assess if sociodemographic and treatment variables were associated with the receipt of information, the desire for information, the helpfulness of the information, and the likelihood that participants had sought counselling.

RESULTS

The majority of respondents (79.8%) said that their HCP had not given them information about accessing psychological resources. Of the patients who did not receive this information, most (60%) said that they wanted it. Regression analysis revealed that immigrants, women, and patients with higher perceived stress scores were significantly more likely to desire this information. Furthermore, having received this information was associated with increased odds of counselling seeking (odds ratio = 3.31, p = 0.013).

CONCLUSION

Fertility patients demonstrated an unmet need for information about accessing psychological resources, and HCPs may play an integral role in bridging this information gap.

PRACTICE IMPLICATIONS

To improve the patient-centeredness of fertility care, HCPs should be proactive in informing all patients about how to access psychological resources.

Perceptions of risk of infertility among male survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

BACKGROUND

The objective of the current study was to characterize and identify factors associated with perceptions of risk of infertility among adult male survivors of childhood cancer.

METHODS

A total of 1233 adult male survivors from the Childhood Cancer Survivor Study who were without a history of disease recurrence or subsequent malignancy reported their perceptions of their risk of infertility compared with men never diagnosed with cancer. Survivors were a median age of 37.8 years (range, 22.0-58.7 years) and were 28.4 years from their diagnosis (range, 21.4-39.2 years). Multivariable logistic regression evaluated factors associated with perceptions of risk.

RESULTS

Overall, 35.9% of the survivors (443 of 1233 survivors) reported perceptions of their risk of infertility that were discordant with their actual risk based on previous cancer treatment exposures. Discordant perceptions were equally common among men exposed to gonadotoxic therapies (36.3%; 311 of 857 men) and those with no history of gonadotoxic exposure (35.1%; 132 of 376 men). Survivors who fathered children (odds ratio [OR], 4.14; 95% confidence interval [95% CI], 2.74-6.24), had no survivor-focused health care (OR, 3.07; 95% CI, 1.57-5.99), were nonwhite (OR, 2.28; 95% CI, 1.10-4.75), and were of lower income were more likely to report no increased risk of infertility after gonadotoxic treatment. Perceptions of increased risk of infertility among men with no history of gonadotoxic treatment were predicted by never having fathered a child (OR, 1.88; 95% CI, 1.17-3.03), recent participation in survivor-focused health care (OR, 2.11; 95% CI, 1.01-4.42), and higher educational achievement.

CONCLUSIONS

Many male survivors of childhood cancer are unaware of how their cancer treatments could impact their reproductive health, underscoring the need for all patients to receive education regarding their risk of infertility throughout the continuum of cancer care. Cancer 2018;124:2447-55. © 2018 American Cancer Society.

Toxic money or paid altruism: the meaning of payments for identity-release gamete donors

Public discourses commonly frame gamete, organ and other forms of bodily donation as altruistic 'gifts'. However, despite on-going debates about the ethics of payments to donors, few studies have examined the views of donors themselves regarding the meaning of payments and their compatibility (or not) with understandings of these practices as gifts. This article addresses this issue, analysing 24 in-depth interviews with UK identity-release gamete donors. It was crucial to all participants that their donation be viewed as fundamentally other-oriented, motivated by the desire to help others. However, whilst egg donors often accommodated payment within this narrative, male participants explained that any money would taint the gift they had given. I argue that sperm donors faced particular challenges to incorporating payment within a gift narrative for two key reasons: first, sperm donors relied on a discourse of 'pure altruism', including absolute opposition between gifts and market exchange, in order to present their donation as other-oriented. In contrast, egg donors were also able to mobilise a discourse of relational giving to present their donations as a personal gift. Second, according to a continued stereotype of sperm donors as financially motivated students, their payments have already been culturally earmarked as side-line earnings.

Factor structure and psychometric properties of the Fertility Problem Inventory-Short Form

The study analyses factor structure and psychometric properties of the Italian version of the Fertility Problem Inventory–Short Form. A sample of 206 infertile couples completed the Italian version of Fertility Problem Inventory (46 items) with demographics, State Anxiety Scale of State-Trait Anxiety Inventory (Form Y), Edinburgh Depression Scale and Dyadic Adjustment Scale, used to assess convergent and discriminant validity. Confirmatory factor analysis was unsatisfactory (comparative fit index = 0.87; Tucker-Lewis Index = 0.83; root mean square error of approximation = 0.17), and Cronbach’s α (0.95) revealed a redundancy of items. Exploratory factor analysis was carried out deleting cross-loading items, and Mokken scale analysis was applied to verify the items homogeneity within the reduced subscales of the questionnaire. The Fertility Problem Inventory–Short Form consists of 27 items, tapping four meaningful and reliable factors. Convergent and discriminant validity were confirmed. Findings indicated that the Fertility Problem Inventory–Short Form is a valid and reliable measure to assess infertility-related stress dimensions.

Role of Mental Health Practitioner in Infertility Clinics: A Review on Past, Present and Future Directions

A large body of literature has emerged over the past four decades which highlights the need to address emotional needs in infertility and integrates psychological services within routine fertility care. Evidenced-based guidelines in most countries propagate that the mental health expert (MHP) plays a vital role as a team member in reducing the impact of infertility on the lives of patients, across all stages of treatment. In accordance with these global developments, inclusion of psychosocial care in fertility treatments is an upcoming trend in our nation. This review article brings forth the traditional role of MHP in infertility, compares patient-centered care with counseling, and elaborates on the guidelines on determinants of patient needs and suitability for structured psychological interventions. It also highlights the evidence-based studies on the application of psychotherapy in infertility.

To be or not to be [fertile], that is the question

Background

According to our literature analysis, there are no data focused on spermatozoa emotional representations in childless men and data on the emotional repercussions of a diagnosis of infertility on men are still scarce. Thus, in this work, we investigated what the presence or absence of spermatozoa in the semen symbolize for men.

Material and methods

To answer this question, 441 childless heterosexual men participated in an anonymous, prospective, Internet-based survey.

Results

In response to the question “What would having a high or normal sperm count symbolize for you?” the most frequent answer was “ability to father a child”. Men living with a partner were significantly more likely than single men to answer “ability to father a child” (p < 0.05) and less likely to answer “virility” and/or “ability to have an erection/ejaculation” (p = 0.001). In response to the question “If you found out that you had a low sperm count or no spermatozoa at all, how would you feel?”, most of the men stated that they would be disappointed. Men living with a partner were more likely to state that they would feel ashamed (p < 0.05) or guilty with regard to their partner (p < 0.0001).

Conclusions

These preliminary results should help us to improve (i) the way that male infertility is announced (it is easier to find the right words if one understands the possible importance of having a high sperm count) and (ii) the psychological, marital and sexual counselling provided to men with a diagnosis of infertility.

Exploring Infertility from the Cultural Context of Latino College Students: Results from a Preliminary Focus Group

Despite a racial/ethnic disparity, little research has examined minority group perceptions of infertility. After developing a 15-question English-language focus group guide, 13 Latino college students (ages 19-22) at a Midwestern university were recruited to participate in a focus group to discuss their perceptions of infertility in the context of their family and culture. The focus group was audio recorded, professionally transcribed, and analyzed according to the constructed Grounded Theory approach. Three major themes were identified: 1) infertility is not considered when looking towards the future; 2) infertility is not discussed due to shame; and 3) infertility does not require a medical resolution. College students have the opportunity to make lifestyle modifications that can optimize fertility, but intention to change behavior is contingent on accurate fertility knowledge, which is often influenced by cultural norms. Our results suggest that these Latino students do not consider infertility a risk in their future lives nor is infertility something they consider should be explicitly discussed. Importantly, they do not perceive the need for medical interventions when addressing infertility, which carries implications for treatment seeking. When creating educational interventions for infertility, it is important to take into account the cultural lens through which infertility is understood.