Diagnosing "his" infertility : men's experiences and reflections on the diagnosis of azoospermia

Abstract

Background: A male cause is the main or a contributing factor in up to 50% of couples presenting with infertility. Azoospermia (lack of sperm in the semen) is present in approximately 15% of infertile men. Unlike psychosocial aspects of female infertility, male attitudes to their own infertility are poorly understood. Male infertility can potentially have a significant impact on psychological and social aspects of men’s lives, impacting negatively on self-image, relationships and causing psychological distress. Objective data in this area is lacking. Aim: The aim of this study was to assess the impact of the diagnosis of azoospermia on men’s psychological and social functioning. Method: This was a qualitative interview study, involving fifteen men with azoospermia attending a fertility clinic. All men were over twenty three years of age and suffering from primary infertility for more than a year. Participants gave their own account of how they perceived the experience of receiving the diagnosis, undergoing further investigations and having treatment. Data were collected between June 2013 and November 2013. The interviews were fully transcribed and analysed thematically using NVivo® software. Results: Major themes that emerged from the interviews included ‘reaction to the initial diagnosis’, ‘lack of cause and explanation’, ‘effect on interpersonal relationships’, ‘disclosure of the diagnosis’, ‘support seeking’ and ‘decisions regarding fertility treatment’. Key findings highlighted a feeling of shock and disbelief as a prominent part of men’s experience. Many men said that they never expected to be told of a ‘completely zero’ sperm count. Finding out was described as ‘heartbreaking’, ‘devastating’, ‘confusing’ and ‘sad’. The possibility of biological fatherhood was perceived as non-existent by some, with one commenting: ‘It felt as it was the end of the world’. One third of participants felt the diagnosis to be a threat to their masculinity, and to have a negative impact on their sense of self-confidence. Men found the lack of a precise aetiology frustrating and distressing. Most men were reluctant to share the diagnosis beyond close family members. The diagnosis brought partners closer together in most cases. Most men did not feel the need to seek external psychological support following the diagnosis and were satisfied with the support provided by clinic staff and their partners. A sperm retrieval operation was in most cases the only hope for establishing biological fatherhood. Decision- v making with regards to this and donor sperm treatment took into account multiple factors, including the risk of potential complications and side effects, their partner’s influence, and attitudes towards using donor sperm. Conclusion: Male infertility impacts substantially on men’s quality of life and healthcare professionals should be aware of this when investigating and treating patients with azoospermia. An improved understanding of men’s experiences is important for the provision of optimal clinical and psychosocial care. Better education and publicity about male factor infertility will reduce stigma and encourage men to seek help sooner. Men find the lack of specific aetiology frustrating and therefore further research is required into the aetiology of male infertility.