Health: Infertile doesn't mean impotent

Men who have a problem fathering children often feel that their manhood itself is under threat.

Women who are unable to conceive often suffer from depression; men may react in a more complex way to the discovery that they have a fertility problem.

Ken Gannon, a psychologist at St Barts and the Royal London Hospital in east London, has researched the emotional effects of infertility on men and women. He and his colleagues found high levels of psychological distress in both sexes, in line with previous research, but, more important, the type of distress differed between the sexes.

"We found that subfertile men were more likely to suffer from anxiety, whereas subfertile women were more likely to be depressed," he says. "The levels of anxiety in men are really very high. About 50 per cent of them have clear clinical symptoms."

This means, he says, that mainstream fertility counselling, which usually follows a bereavement model by acknowledging feelings of loss, may be less appropriate for men than for women.

"Men may feel less like grieving, and more threatened by their subfertility," he says. "There is a powerful feeling that their identity as men is under attack. They also know that society confuses potency, in the sense of the ability to have sex, with fertility."

This makes it hard for men even to acknowledge their distress to themselves. Dr Sammy Lee, a reproductive physiologist at London's Portman Clinic, says that men may react to this huge blow to their self-esteem by isolating themselves from other people and going into complete denial.

"Too many infertile men don't realise that their greatest asset is their partner, who can give them so much support if they'll only let her. Sometimes I get a call from a woman who seeks counselling on behalf of her man - he'll be in the background, chipping in, and I'm counselling him through her. Or he may even be watching the football on TV at the same time."

Nicky Wesson helps to run a support group for infertile couples. "It's daunting for men to come along to a group," she says. "They feel like outcasts - as if they can't talk to anyone. Even communication within the couple is difficult."

It is not surprising that things are the way they are, though, says Dr Lee. Infertility treatment tends to focus on the female, whether or not it is she who has the physical problem. "Men are absent in the clinic, except for the times when they're being treated, or producing a sample. We reduce them to the role of sperm providers.

"It's typical of the way men's feelings are sidelined throughout everything to do with pregnancy and birth," agrees Ken Gannon. "It's the same after a miscarriage. Most of the concerns are directed to the woman, whereas the man may need support, too."

Yet male fertility is a factor in at least half of the one in six couples who have problems. Male subfertility is increasing. Cases of disorders of the male reproductive tract have doubled in the last 30 to 50 years, and there has been an overall fall in sperm counts.

Various environmental reasons have been put forward as a possible cause, including chemical pollution, and, in the case of individuals, substance abuse. "Heavy cocaine use can be extremely damaging to the body's ability to produce sperm," says Dr Lee. And, more startlingly, he also speculates that there may be a physiological link between the way men feel about themselves in a changing world, and their hormones. "Men are in crisis," he says. "They see women in power, and in management positions above them, and they haven't learnt to cope with it yet. If we could investigate, I think we'd find an effect on their sperm production - these ladies bite your balls."

Some of the more dramatic advances in fertility treatment help men, especially men with a low sperm count. Intracytoplasmic sperm injection (ICSI), for example, injects a single sperm into the egg. There is now work being done on extracting a sample of sperm from the testes, and then treating it to zap up its fertility. However, as Marsali Macdonald, a counsellor from Nurture (Nottingham University Research and Treatment Unit in Reproduction), says, new breakthroughs can be a curse as well as a blessing. "It can mean it's difficult to know when to get off the treatment treadmill. It's like the lottery. If you try one more time, could this be the month you strike lucky?"

The cost of fertility treatment may also add to the stress. 75 per cent of couples pay for at least some of their treatment. The patchy availability of NHS services means that it is "treatment by postcode" for some . One man, delighted to be the father of triplets after successful treatment at Nurture, told the Derby Evening Telegraph that he reckoned their children had cost them, all told, pounds 50,000, including his wife's loss of earnings after having had to give up work to undergo treatment.

The Family Planning Association's new booklet, "Infertility Tests and Treatment", acknowledges the effect that infertility has on relationships, including sexual relations. Speaking for men as well as women, it says, "it can be very easy to despair, or to get so anxious about having a child, that nothing else seems to matter."

That was the case with Paul, 36, from London, a catering supplier. Paul has azoospermia - he produces no sperm. "When I got the diagnosis, after two sperm tests, I was really very angry," he says. "Then the anger turned to profound feelings of failure. My wife Rosie and I followed up every possible lead. I had hormone injections for months. Then I had a course of Chinese herbs. But nothing made any difference. I felt that my whole world was being ruled by my infertility. Life was becoming a treadmill of injections, tests, clinic appointments. I wasn't in control."

Paul found that counselling was useful in helping him and his wife decide it was time to stop. "We wanted to take back control, and return to what we had at the start of our marriage - our life as a couple. Now, we accept we won't ever have children, but while we can't say we're happy about it, it doesn't rule our lives any more. If people ask, `how many children do you have?' I just say, `none, I can't have any'. A few years ago, I might not have been able to say that without being emotional."

Issue: 01922 722888; Child, the National Infertility Support Network: 01424 732361. Nurture: 0115 9709490. For the Family Planning Association booklet, which has a useful list of contacts plus treatment information, send pounds 1.50 to FPA Publications dept, PO Box 1078, East Oxford DO, Oxford OX4 5JE. `Alternative Fertility Treatments' by Nicky Wesson (Vermilion, pounds 8.99), `Counselling in Male Infertility' by Dr Sammy Lee (Blackwell Science, 1996)

Arts and Entertainment
Caroline Flack became the tenth winner of Strictly Come Dancing
tvReview: 'Absolutely phenomenal' Xtra Factor presenter wins Strictly Come Dancing final
Arts and Entertainment
J Jefferson Farjeon at home in 1953
booksBooksellers say readers are turning away from modern thrillers and back to golden age of crime writing
Arts and Entertainment
Nick Hewer is to leave The Apprentice after 10 years

TV review Nick Hewer, the man whose eyebrows speak a thousand words, is set to leave The Apprentice

Arts and Entertainment
Female fans want more explicit male sex in Game of Thrones, George R R Martin says

film George RR Martin owns a cinema in Santa Fe

Arts and Entertainment
Clued up: John Lynch and Gillian Anderson in ‘The Fall’

TV review

PROMOTED VIDEO
Arts and Entertainment
Rhys says: 'I'm not playing it for laughs, but I have learnt that if you fall over on stage, people can enjoy that as much as an amazing guitar solo'
musicGruff Rhys on his rock odyssey, and the trouble with independence
Arts and Entertainment
Krysia and Daniel (Hand out press photograph provided by Sally Richardson)
How do today's composers answer the challenge of the classical giant?
Have you tried new the Independent Digital Edition apps?
Arts and Entertainment

ebooksNow available in paperback
Arts and Entertainment

ebooks
News
Shenaz Treasurywala
film
News
tv
Arts and Entertainment
Jason Watkins as Christopher Jefferies
tv
Arts and Entertainment
Star Wars Director JJ Abrams: key character's names have been revealed
film
Arts and Entertainment
Pharrell Williams won two BBC Music Awards for Best Song and International Artist
music
Arts and Entertainment
Mark, Katie and Sanjay in The Apprentice boardroom
TV
Arts and Entertainment

Film The critics but sneer but these unfashionable festive films are our favourites

Arts and Entertainment
Frances O'Connor and James Nesbitt in 'The Missing'

TV We're so close to knowing what happened to Oliver Hughes, but a last-minute bluff crushes expectations

Arts and Entertainment
Joey Essex will be hitting the slopes for series two of The Jump

TV

Who is taking the plunge?
Arts and Entertainment
Katy Perry as an Ancient Egyptian princess in her latest music video for 'Dark Horse'

music
Arts and Entertainment
Dame Judi Dench, as M in Skyfall

film
Arts and Entertainment
Morrissey, 1988

TV
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    Surrounded by high-rise flats is a little house filled with Lebanon’s history - clocks, rifles, frogmen’s uniforms and colonial helmets

    Clocks, rifles, swords, frogmen’s uniforms

    Surrounded by high-rise flats is a little house filled with Lebanon’s history
    Return to Gaza: Four months on, the wounds left by Israel's bombardment have not yet healed

    Four months after the bombardment, Gaza’s wounds are yet to heal

    Kim Sengupta is reunited with a man whose plight mirrors the suffering of the Palestinian people
    Gastric surgery: Is it really the answer to the UK's obesity epidemic?

    Is gastric surgery really the answer to the UK's obesity epidemic?

    Critics argue that it’s crazy to operate on healthy people just to stop them eating
    Homeless Veterans appeal: Christmas charity auction Part 2 - now LIVE

    Homeless Veterans appeal: Christmas charity auction

    Bid on original art, or trips of a lifetime to Africa or the 'Corrie' set, and help Homeless Veterans
    Pantomime rings the changes to welcome autistic theatre-goers

    Autism-friendly theatre

    Pantomime leads the pack in quest to welcome all
    The week Hollywood got scared and had to grow up a bit

    The week Hollywood got scared and had to grow up a bit

    Sony suffered a chorus of disapproval after it withdrew 'The Interview', but it's not too late for it to take a stand, says Joan Smith
    From Widow Twankey to Mother Goose, how do the men who play panto dames get themselves ready for the performance of a lifetime?

    Panto dames: before and after

    From Widow Twankey to Mother Goose, how do the men who play panto dames get themselves ready for the performance of a lifetime?
    Thirties murder mystery novel is surprise runaway Christmas hit

    Thirties murder mystery novel is surprise runaway Christmas hit

    Booksellers say readers are turning away from dark modern thrillers and back to the golden age of crime writing
    Anne-Marie Huby: 'Charities deserve the best,' says founder of JustGiving

    Anne-Marie Huby: 'Charities deserve the best'

    Ten million of us have used the JustGiving website to donate to good causes. Its co-founder says that being dynamic is as important as being kind
    The botanist who hunts for giant trees at Kew Gardens

    The man who hunts giants

    A Kew Gardens botanist has found 25 new large tree species - and he's sure there are more out there
    The 12 ways of Christmas: Spare a thought for those who will be working to keep others safe during the festive season

    The 12 ways of Christmas

    We speak to a dozen people who will be working to keep others safe, happy and healthy over the holidays
    Birdwatching men have a lot in common with their feathered friends, new study shows

    The male exhibits strange behaviour

    A new study shows that birdwatching men have a lot in common with their feathered friends...
    Diaries of Evelyn Waugh, Virginia Woolf and Noël Coward reveal how they coped with the December blues

    Famous diaries: Christmas week in history

    Noël Coward parties into the night, Alan Clark bemoans the cost of servants, Evelyn Waugh ponders his drinking…
    From noble to narky, the fall of the open letter

    From noble to narky, the fall of the open letter

    The great tradition of St Paul and Zola reached its nadir with a hungry worker's rant to Russell Brand, says DJ Taylor
    A Christmas ghost story by Alison Moore: A prodigal daughter has a breakthrough

    A Christmas ghost story by Alison Moore

    The story was published earlier this month in 'Poor Souls' Light: Seven Curious Tales'