Putting Out the Welcome Mat (Spring 2010)

PUTTING OUT THE WELCOME MAT
The importance of increasing male participation in fertility care

by Teresa Barry Longley, RN, MSN

We are made wise not by the recollection of our past, but by the responsibility for our future. --George Bernard Shaw

It’s a popular stereotype that men hate going to the doctor. Social scientists like Don Sabo (1) and Will Courtenay (2,3) have found in their research that men are less willing to seek help during illnesses, never mind when they’re well. But research has also shown that men die sooner than women regardless of the age, have a higher risk of infectious diseases, heart disease, cancers, more severe chronic illnesses, and more serious psychiatric illnesses(3) As well, men have an increased willingness to believe in the safety of activities that could undermine their health and/or injure them (binge drinking, speeding, extreme sports, drug use) (3)..

This attitude affects the people on the other side of the desk as well. Studies looking at how men interact with their physicians have shown that men may receive less face-to-face time with their doctors, may receive shorter explanations about their health and fewer instructions and health education from their primary care provider. Unfortunately, men do not have the same social supports as women and therefore experience social isolation especially under circumstances like illness, health worries, fertility issues, and emotional losses such as miscarriages or male infertility. This isolation only adds to their reluctance.

We also have to recognize the impact of cultural traditions and religious traditions on how men view themselves. There can be restrictions to or limitations on what men are comfortable with or even aware of in regard to their roles within their families and social networks. This can impact on their views of manhood, health, and healthcare.

Are we looking for blame? No. What social and health scientists’ are looking for is understanding that can lead all of us to better health and better healthcare. If we can understand men’s love of riskier activities and their unwillingness to seek health “help”, then we can find ways to reach them, teach them, and help them improve their lives.

So why am I talking about this today? Well, there is always a ripple in any pond when a stone is thrown in, and in the fertility pond, what men do or don’t do can have a profound effect on a couple’s success with fertility. But because fertility care is so female-focused in the investigations and treatments, the care of men, both fertile and infertile, can get lost in the efforts and desperation of getting pregnant. We realize that every patient who comes into a fertility clinic wants to be pregnant long before they step through the door. That urgency puts our focus on the process of pregnancy but may leave men thinking that it’s not about them. Add to that, the reluctance of some men to even come to clinic and we end up with missed chances to give care to them and educate them on their health. We are all responsible for this.

As providers of healthcare, we have to start seeing the men as patients not partners-to-patients; we have to see them as persons in need of care, advice, information, treatment, and compassion. I believe that if we treat men as patients, we will also see them and help them see themselves as fathers- to-be, not just “sperm donors” or “walking wallets” as some fellows have described themselves. Viewing themselves as fathers-to-be can change the value they place on their health, their activities, and even in the future, the value of the relationship they will have with their children.

So what can we do? Well, most fertility centres have on their websites or in their clinic, information specifically for men. This information can be part of the welcome package or it can be given upon request or suggestion. Research has shown that many men like to look at health information privately and so having sperm improving information or information on types of male infertility and such is often best located in a men’s only area on the clinic website. Asking men during an appointment if they have concerns or if they have health issues can start a relationship with the provider that can prove to the fellow that he is important and not invisible. Asking if he is coming again to the next clinic visit invites the fellow to see that his participation is wanted and needed. This may start an interest and an opening to discussing health issues.

We have seen in some men with infertility that the life style choices they have made has an effect on their fertility. Often when I am speaking with a man about smoking, drinking, street drug use, or occupational toxins, he will say “but other guys with the same stuff can get their wives pregnant’. That’s true as we don’t always know who is affected and who isn’t. But we have seen that by discussing the importance of male health for fertility success, male patients can improve their health not just for fertility but for their lifespan.

Now what do we do about the guys??? How do we get them in clinic? How do we get their attention? Many clinics insist that both partners be present for the first meeting. This is a good chance for the couple to get to know the clinic personnel. It is also a good opportunity to discuss past health issues or present concerns. Often we have seen surprise on guys’ faces as they realize that we are interested in them, too! That realization can change their interest in what we are doing and what they can contribute. Wives have a role as well. Many times I have heard a female partner talk about ‘how easy the guys have it’ and that ‘what they do is fun’. Well, there is nothing fun about trying to do a semen collection in a busy and noisy clinic. I have often said to women that if we told them that they had to do an orgasm prior to a procedure and that the orgasm would be evaluated, I doubt that we would have many patients!

I guess it comes down to offering respect and interest to a group of people who are not familiar or comfortable in a clinic setting, this group of people who often feel isolated or less than they should be due to the infertility that they are experiencing is often socially confused with impotency and diminished manhood. This embarrassment can lead to distancing within the couple’s relationship, workplace difficulties, and social stress. Fertility clinics are there to help both the woman and the man with this nightmare that they are in. We have the information, we have the concern, and we’re there to help. The door is open and ours hands are extended – come on in.

References
Courtenay, W. H. (2000). Endangering health: a social constructionist examination of men’s health beliefs and behaviours. Psychology of Men and Masculinity, 1, 4-15.

Courtenay, W. H. (2003). Key determinants of the health and well-being of men and boys. International Journal of Men's Health, 2(1), 1-30.

Sabo, D. (2004). The study of masculinities and men's health. In M. S. Kimmel, J. Hearn, & R. W. Connell (Eds.), Handbook of Studies on Men and Masculinities (326-352). Thousand Oaks: Sage Publications.

Teresa Barry Longley RN MSN is a clinical nurse specialist at HEART Fertility Centre in Hamilton, Ontario. She has been practicing in reproductive care for fourteen years and has a special interest in male fertility and sexuality as well as pregnancy care of the infertile. She is a Reiki practitioner and lives in the small community of Ancaster with her patient husband, fantastic daughter, and one lovely dog..