In the three years that Thomas Smialek and his wife Sara have been trying to have a baby, they’ve endured two miscarriages and multiple failed infertility treatments. But this latest round of in-vitro fertilization, or IVF, has been especially challenging.
Not only are they shelling out thousands of dollars in insurance co-pays and taking time off work to drive three hours round trip from their home in Marion, Illinois to their fertility clinic appointments in St. Louis, but Smialek, 33, can’t shake the feeling of being left out.
While his wife and their doctor seem to talk over him during their conversations about treatment approaches and next steps, “I’m on the sidelines,” he said.
And he’s at a loss how to support his wife when her hormone medications make her feel on edge.
“She feels as if I don’t understand what she’s going through,” says Smialek about her polycystic ovary syndrome diagnosis. “I’m trying to be careful not to upset her, but I don’t know a good way to comfort her.”
Fertility is one of the few medical fields that has long focused on the experience and needs of women. After all, women bear the physical and emotional brunt of hormone treatments, surgical procedures and, of course, the preconception smoothies.
Yet there’s a growing awareness that men suffer from the emotional ups and downs of infertility treatments, too ― and that includes the increased number of gay men looking to fertility science to build families.
Men also grieve pregnancy loss and failed IVF attempts, deal with financial stress from the high cost of treatment and wrestle with feelings of failure and disappointment, especially if they’re the infertile ones.
“It’s easy for men to be forgotten or minimized in the process,” says Sharon Covington, director of psychological support services at Shady Grove Fertility in Washington D.C. “They have to insist on having a voice in doctor meetings so doctors realize they are 50 percent of the equation.”
By nature, men are bystanders in fertility medicine: Their role in getting their female partners pregnant has been moved from the bedroom to the lab. But they’re excluded in other ways, say psychologists, such as learning about lab results only after a nurse tells their female partner first and not being consulted on treatment plans – despite the fact that their sperm is most likely involved.
“One couple I worked with came in after multiple miscarriages. The husband felt he was being dragged along by the doctor and his wife. No one listened to him. He wasn’t even given the opportunity to say how he felt about doing another cycle,” says Covington.
The Emotional Burden Men Carry
It’s not just doctors who are ignoring men. Researchers haven’t given them much attention, either. There are few studies focusing on how men hold up emotionally during treatment, but the existing research suggests men struggle: One 2015 study that was published in the journal Fertility and Sterility found that while 39 percent of women suffered from major depression during an 18-month period of infertility treatment, so did at least 15 percent of their male partners.
That isn’t a huge surprise ― it’s well-known among doctors that infertility is rough on relationships. One 2014 Danish study concluded that infertile couples were three times more likely to divorce following failed IVF attempts, for example.
Men who were diagnosed with infertility – they make up half of cases – fared even worse psychologically. A recent study of 274 infertile men undergoing treatment found that 32 were diagnosed with depression and that more than 60 percent met the clinical criteria for anxiety. Only 11 percent had received counseling, and less than a quarter were told about the existence of mental health services at their fertility clinics.
“Their emotional concerns weren’t even acknowledged,” says lead author Lauri Pasch, a psychiatrist from the University of California at San Francisco.
One British researcher who interviewed 15 men about their infertility wrote they experienced it as a “mentally, physically and socially demanding condition.”
They spoke of being shocked when they learned of their diagnoses, feeling shame and embarrassment and thinking of themselves as “less of a man” because they couldn’t impregnate their partner.
“What I found is that men aren’t likely to talk about it. There’s still a lot of taboo and stigma around male factor infertility, and they’re isolated,” says lead author Shafali Talisa Arya of the University of Surrey. “No one mentions men in the cultural conversation, and they’re often knocked out of the equation at the clinic. One man told me: ‘I have the problem, and the doctor was talking to my wife about my private parts.’”
Doctors are being encouraged to engage men
There are signs the fertility field is taking men more seriously. For example, the American Society for Reproductive Medicine recently sponsored several seminars on pregnancy loss and male infertility that encouraged doctors to consider men’s emotional experiences.
“It’s slow progress. The bulk of presentations are about the female,” said William Petok, Ph.D., a Baltimore psychologist who works with infertile men.
In a paper about the lack of counseling for the “forgotten male partner” in 2015, he called on doctors to share educational resources with men that are tailored to their needs.
“Of course, men don’t have the same feeling about this because they’re not women,” he added. “They have the feelings men would have.”
He’d also like to see male celebrities increase public awareness by coming forward with their infertility struggles.
Over the last few years, Covington tried to start several support groups just for men, but she couldn’t find enough participants to keep them going. She’s had better success with co-ed groups.
“Men say they will come to support their partners, but once they’re in the room, they often welcome the opportunity to talk to other men about what it’s like,” says Covington, who urges men to check out co-ed support groups offered by the nonprofit RESOLVE. She’s also observed more men initiating couples’ counseling. “That’s where they open up. What touches me is that they have a tremendous sense of sadness, powerlessness and helplessness, and they don’t know what to do next,” she says.
Smialek says he copes with the emotional rollercoaster of infertility by keeping a positive outlook and telling his wife to “have faith in God’s plan.”
“I think he feels like he has to be strong for me,” says his wife Sara, 32. “Men are fixers by nature. So when infertility happens they don’t know what to do since they can’t fix us.”
But he admits he’s been privately devastated, such as the time he had to tell his 10-year-old son he wasn’t going to be a big brother soon. “That really hurt,” he says.
He describes the two times he learned about the miscarriages at their six-week ultrasound appointments.
“It was heartbreaking thinking you’re pregnant and expecting a heartbeat,” he says. “So I try to keep my expectations low with every new treatment. You don’t want to get too excited to prevent your world from crashing down again.”