Interfility and IVF

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What do men think and feel about their role in IVF treatment? After all, the woman is not the only patient; her male partner in conception is a crucial player in the treatment too.

As IVF nurses in the Reproductive Biology Unit at Mount Sinai Hospital in Toronto, we decided to survey male patients on the day of egg retrieval. We’d like to tell you a bit about some of their experiences, and share some of their comments about their role in infertility treatment.

We distributed questionnaires to the male partners after ovum retrieval. In all, 134 patients were questioned. Of these, we obtained 125 usable questionnaires.

The more you tell us, the more we can help

There are plenty of good reasons why we need to hear from male IVF patients. We seriously hope that our study will help to raise the standard of care, and initiate changes in practice.

First, we’d like to be able to identify those male patients who could benefit from a support group or one-on-one counselling. To do this, we need to know first about the coping and support mechanisms you already have: friends, co-workers, extended family members, religious counsellors.

There’s also a lot we need to learn about how men interpret their IVF experience: about the couple’s relationships, communication, participation in treatment, intimacy and outside friendships.

Second, we want to identify changes we might need to make in the environment where the male partner produces his sperm sample. What can be done to make him more comfortable and so ensure a secure and private environment for sperm collection?

Third, we received confirmation that the distance between procedure room and collection room in our institution wasn’t acceptable (they’re in 2 different buildings, one block apart).

Fourth, we wanted to identify other sources of stress: financial demands, waiting time and the overall stress of the IVF treatments.

Who Do You Confide In? 

For male patients, IVF treatment tends to be a strictly private affair – almost too private.

We discovered that only 13% of our male IVF patients discuss their situation with friends. At work, even with the need to get time off for appointments, 64% of the men we asked seldom, if ever, told their employers or workplace superiors that they were undergoing an IVF treatment.

Luckily, when it comes to talking about not being able to talk, our patients have plenty to say:

“It’s difficult for me to disclose information about my wife. It would have been more effective had there been a sperm problem.”

“The IVF program is considered a private matter and most friends’ and families’ perception is not favourable.”

“I’ve told half of my extended family and not the other half, for fear of too many questions. I feel that the uninformed half would speak freely of it and not respect privacy.”

“My wife has found it difficult allowing me to discuss our issues with friends or family. Being a rather private person and this not being a result, as it seems, of my own infertility (as my sperm levels have been good), my wife would prefer me not to mention our ‘problems’ to others. This has resulted in some difficulties between us.”

“People can be unintentionally insensitive in their questions and comments. It’s difficult for some people to understand that there can be unexplained infertility.”

You’re Not Always Alone!

If you’re feeling alone, the friend you need may be nearer than you think. We found that 19% of our male patients – nearly one in five – actually had found a male friend who was going through infertility treatment too. And 78% of these male patients felt comfortable confiding in their friend who understood their feelings and experiences first-hand.

This isn’t to say it’s easy. In fact, 6% of the men we talked to felt infertility interfered with their friendships – either alone, or as a couple. Especially among friends with children.

“My wife has issues with other pregnant women, which I don’t. She will avoid contact with friends who are pregnant, while I don’t.”

“This is very difficult, tearful and unfair. It is difficult being around friends with healthy children.”

“It is something we have been dealing with for a number of years. I think it has much more of an impact on my partner which does affect our relationships with couples who have children. In recent years we have been able to deal with this, but others can be reluctant to tell us when they are pregnant.”

Among the male patients we talked with nine out of ten (90%) say they communicate frequently about infertility, and share the experience with their partner.

“I loved being part of the whole experience. It helps my wife and I feel more connected. This is a very clinical process and it helps a lot to share as much as possible with my spouse.”

“We have a very open communication link between us and I try to be as helpful/supportive as I can and feel the burden is on both of us during her monitoring treatments etc. She should not have to do this alone.”

“Over the years we have been to support groups. When my wife has good support, we share that, and both benefit, and we are a support to each other.”

Two-thirds (66%) had disclosed their infertility problem to their families. And 85% of the families were supportive. There seems to be more reluctance, however, in seeking out a religious counsellor; 84% of our male patients had never sought clergy support. On the other hand, infertility treatment needn’t be taboo in the work place. As one patient said, “My staff at work are aware and very understanding and supportive.”

For half of all our male IVF patients, sample collection was a stressful experience. Most said that a peaceful environment was important. The actual physical amenities – having a chair or a bed, access to videos or magazines were less important, though our patients weren’t afraid to field other significant suggestions.                                                                           

“The amount required to produce should be better communicated. A big jar was given with measurements on the outside. I was thinking I should go for a second turn at bat to top up!”

“Sperm sample collection is the most stressful emotional issue for me.”

“Videos would be helpful. I would prefer no medical equipment in the room.”

Privacy and easy delivery were definitely concerns for our patients. How does Mount Sinai measure up? Proximity of the two key facilities scores a major negative: 93% of our respondents said they would prefer the sample collection room to be closer to the retrieval area. Nearly two-thirds, however (65%), accepted the room setting.

“In the sample room I did not feel confident that the door was locked. You can lock it but it still opens from the inside. This does cause stress. Going from building to building is annoying.”

“Sperm samples should be done in the same building as egg retrieval.”

“I did not like leaving the building. I didn’t feel like I was in that controlled safe environment of the IVF clinic. Having to wait outside the room wasn’t great. If you feel embarrassed it just increases the stress that you feel.”

How do the front-line staff members measure up at sample collection time? Is reception private and confidential? 72% of our male IVF patients said yes. The vast majority (95%) felt they were treated respectfully, and 97% said they felt comfortable with the RN’s collection instructions.

A large majority of male patients (79%) felt that the cost of IVF was a financial hardship – a significant or even extreme hardship for almost 40%. Even those for whom the cost is not a serious problem don’t think the system is entirely fair. Said one patient, “The treatments are, fortunately, not a financial burden. However it makes no sense to me that OHIP will cover some infertility cases and not others. If one is infertile because of ‘X’ and someone else because of ‘Y,’ are both not still infertile? It’s very frustrating.”

Here’s what our survey of Mount Sinai’s male IVF patients found:

·        The men generally did not allow infertility to interfere with their friendships with those who have children.

·        They rarely spoke to friends about their infertility. However, many disclosed to family, and received support.

·        Most don’t disclose to their employers.

·        Most men did not seek support from clergy.

·        Most wanted the sample collection room closer to retrieval area.

·        Our staff provided respect, comfort and privacy.

·        Although some of our IVF patients are funded by Ontario Health coverage, IVF still remains a financial hardship for them (drug costs) and for others who are not funded.

Of course there are some questions we wish we’d asked. For example, in the workplace, does infertility disclosure depend on the gender of your boss? Do men think there will be particular repercussions from co-workers or friends? And what makes them reluctant to discuss these problems with clergy? We’d also like to learn more about disclosure to friends and employers from the female partner’s perspective – as well as their feelings about friends with children. Which is why we look forward to an opportunity to continue this study.

We had the impression our male IVF patients were very pleased to participate in this questionnaire. One man said, at the end, “Thanks for asking and thanks for all your help.” We certainly can say, “Same to you!”

ABOUT THE AUTHORS: Both Linda Hunter and Theresa Skuza are registered nurses in the Reproductive Biology Unit at the Mount Sinai Hospital in Toronto. This survey was originally presented as a poster for the CFAS Annual Meeting in Jasper, Alberta, where it won the British Exchange Award. It was subsequently presented at the British Fertility Society conference in England.