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

Exploring men's struggles with infertility: A qualitative content analysis

AIM

To investigate the experiences of men struggling with infertility.

DESIGN

This is a qualitative study, and the report follows the COREQ checklist.

METHODS

A team of nurse researchers conducted this research in Iran to examine the experiences of 11 men with primary infertility. The participants were selected through targeted sampling and underwent in-depth semi-structured interviews. The data collected was analysed using the conventional content analysis method outlined by Krippendorff. To ensure the study's accuracy, it followed the criteria proposed by Lincoln and Guba.

RESULTS

The central theme, "the threat to masculinity," was identified upon analysis. It comprises six categories: psychological pressure of confronting reality, frustration, discomfort with others, holding out against ridicule, tolerating unwanted opinions and advice and concealment of infertility and therapy.

CONCLUSION

This study brings attention to the challenge to masculinity that men with primary infertility face as their central struggle. It highlights the importance of culturally sensitive care from healthcare professionals, emotional support, counselling services and public awareness to reduce the stigma surrounding male infertility. It can be valuable to evaluate and enhance infertility care in various settings.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

To provide the best possible care for infertile men, it would be beneficial for nurses to pay more attention to sociocultural factors. Fertility care should be respectful of patients' beliefs and backgrounds.

IMPACT

WHAT PROBLEM DID THE STUDY ADDRESS?: Infertility care has been the subject of recent research, focusing on the impact of sociocultural factors. Male-factor infertility is often overlooked in clinical care literature. There is a correlation between cultural background and men's acceptance of reproductive healthcare. WHAT WERE THE MAIN FINDINGS?: Male infertility is often avoided in discussions due to its perceived threat to masculinity. Multiple factors, including societal norms, cultural expectations and personal experiences, influence the nature of men's struggles with infertility. Providing emotional support and counselling services is crucial so that men can openly discuss their fertility challenges and seek treatment without feeling ashamed or judged. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Raising public awareness and providing education about male infertility is crucial. Nurses must exhibit cultural sensitivity while caring for men experiencing infertility. Policymakers need to implement strategies to reduce the stigma surrounding male infertility.

REPORTING METHOD

The study is reported using the Consolidated Criteria for Reporting Qualitative Research (COREQ).

PATIENT OR PUBLIC CONTRIBUTION

No public or patient involvement.

Male Factor Infertility: What Every OB/GYN Should Know

Male factor infertility plays a role in approximately 30% of infertility cases. Various causes of male factor infertility exist including congenital, acquired, idiopathic, or environmental factors. Identifying the underlying etiology of male factor infertility is a key step toward providing appropriate counseling, effective treatment options, and improving outcomes for couples with infertility. Although the recent advances and developments in assisted reproductive technology have undoubtedly improved fertility outcomes, clinicians must understand the scope of reproductive urologists in the evaluation and treatment of male infertility to provide comprehensive counseling, appropriate referral, comprehensive evaluation, and correct surgical sperm retrieval techniques when needed.

Evolution of the World Health Organization semen analysis manual: where are we?

The WHO (World Health Organization) manuals provide state-of-the-art guidance on how a semen analysis should be carried out. The much anticipated sixth edition of the WHO semen analysis manual has been released 10 years after its previous version and includes essential updates, such as new reference standards for semen volume and microscopic sperm characteristics of recent fathers. A well-conducted semen analysis remains an essential foundation of the infertility evaluation process and affects patient referral, diagnosis and treatment. However, a male infertility work-up primarily based on routine semen analysis does not provide men with an optimal fertility pathway; the primary reasons for routine semen analysis inadequacy in this context include its low predictive value for natural and assisted conception success, its inability to detect sperm DNA and epigenetic deficiencies that might negatively affect embryo development, implantation and offspring well-being, and the substantial overlap between semen parameters of fertile and subfertile individuals. Ideally, a full andrological assessment should be carried out by reproductive urologists in all men dealing with couple infertility and should include a detailed history analysis, physical examination, semen analysis, endocrine assessment and other tests as needed. Only through a complete male infertility work-up will relevant underlying medical and infertility conditions be revealed and potentially treated or alleviated. The ultimate goals of a comprehensive andrological assessment are to positively influence overall male health, pregnancy prospects and offspring well-being.