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The experience and meaning of infertility for biologically childless infertile men Webb, Russell E. 1994

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THE EXPER]ENCE AND MEANING OF INFERTILITY FORBIOLOGICALLY C1TILDLESS INFERTILE MENbyRUSSELL E. WEBBBA., Trinity Western University, 1989A THESIS SUBMITTED iN PARTIAL FULFILMENT OFTHE REQUIREMENTS FOR THE DEGREE OFMASTER OF ARTSinTHE FACULTY OF GRADUATE STUDIESDepartment of Counselling PsychologyWe accept this thesis as conformingto the required standardUNIVERSITY OF BRITISH COLUMBIAApril 1994© Russell E. Webb 1994In presenting this thesis in partial fulfilment of the requirements for an advanceddegree at the University of British Columbia, I agree that the Library shall make itfreely available for reference and study. I further agree that permission for extensivecopying of ths thesis for scholarly purposes may be granted by the head of mydepartment or by his or her representatives. It is understood that copying orpublication of this thesis for financial gain shall not be allowed without my writtenpermission._________________________Department of___________________The University of British ColumbiaVancouver, CanadaDate______ _____DE-6 (2188)11AbstractA qualitative phenomenological paradigm was used to explore the experience ofmale factor infertility for childless men. Six men were recruited; three fromVancouver, B.C. and three from Regina, Saskatchewan. The men described theirexperience of infertility within an individual, in-depth, audiotaped interview. Eightcommon themes were extrapolated from an analysis of the data.The results indicated that the mens’ experience of male factor infertilityincluded all of the following: (1) intense grief and loss, (2) a sense of powerlessnessand loss of control, (3) feelings of inadequacy, (4) betrayal, (5) isolation, (6) a senseof threat or foreboding, (7) a need to overcome or survive, and (8) a need for positivereconstruction of the situation and of the self, whereby, the men found new andpositive meanings (or purposes) for an experience that originally seemed meaninglessand painful.111Table of ContentsAbstract iiTable of Contents iiiAcknowledgments vDedication viCHAPTER 1: Statement of the Problem 1CHAPTER 2: Review of the Literature 12Response to Infertility 12Infertility and Stress 12Infertility as Crisis & Loss 17Infertility and Coping 18Gender Differences in Response to Infertility 20Men’s Response to Male Factor Infertility 25CHAPTER 3: Methodology 31Design 31Bracketing 33Participants 34Procedure 36Data Analysis 39Limitations of the Study 42CHAPTER 4: Results 45Profiles of the Six Co-researchers 45Common ThemesGrief and LossA Sense of Powerlessness and Loss of Control.A Sense of InadequacyA Sense of BetrayalA Sense of IsolationA Sense of Threat or Foreboding.A Need to Overcome or Survive.A Need For Positive Reconstruction.CHAPTER 5: Discussion And ConclusionThe Essential Structure of the ExperienceComparison to the LiteratureImplications for Future ResearchImplications for CounsellingConclusionReferencesAppendix A: Advertisement for the study .Appendix B: Letter to UrologistsAppendix C: A Sample of Screening InterviewAppendix D: Consent Formiv525457616366707276818188100102109111119120121122123QuestionsAppendix E: Questions to Participants125Appendix F: Questions which may be used to guide the interviewsVAcknowledgmentsI would like to acknowledge and express my gratitude to my committeemembers Dr. Judith Daniluk, Dr. Larry Cochran, and Dr. Patrick Taylor for theirwork, encouragement and support for this endeavour. I thank them for their dedicationto academic excellence, which reflects in all they do and has been a model for me toemulate. I would especially like to thank my thesis supervisor, Judith Daniluk, for hergracious patience, insightful guidance, endless encouragement, empathic understanding,and keen sense of humour. Most of all, I thank her for her continued faith andconviction that this research topic is important and needs to be better understood.I would like express my deepest gratitude to my wife, Tina, without whom itwould not have been possible for me to reach this goal. I thank her for her strongfaith in me and for her encouragement and commitment to see this project complete.I would also like to thank my family who understand the strains and stresses ofa thesis and who always had faith that I could do it. Their support helped when thework was as difficult as “chewing sand”. Their humour was invaluable.Last, but by no means least, I express my heart-felt gratitude to the six men,Garret, Jeff, Sean, Bob, Dave, and Les, who shared their stories and lives with me.Their courage in coming forward, candid honesty, and willingness to share theirexperiences has been inspiring. Without their personal and generous contribution, thisresearch project would not have been possible.viDedicationThis work is lovingly dedicated to:My parents:Dr. (Bud) Marian Leslie & Rhoda Doreen Webbwho always told me that I could do anything I put my mind toand whose continued love and support encouraged meto “seek first” those things that endure,AN1To my beloved wife:Tina Marie Webbwho stood by me and encouraged me throughout this project,whose love means more to me than a thousand theses,and whose loving and gentle spirit continues to sustain me,ANDTo my son:Michael Zachary Emory Webbwho surprised us and changed our lives,whose absence kindled and inspired this workandwhose life fosters healing within my own.1CHAPTER 1Statement of the ProblemThroughout history fertility has been admired and celebrated. The importanceof the basic right of people to bear and raise children has been emphasized across mostcultures, around the world and throughout history (Mullens, 1990). In the past fertilitywas viewed as an unknown mystery or miracle that was not under human control.Different cultures attributed fertility to different gods such as Ishtar, Iris,Astarte, Aphrodite, Demeter, Maia, Ops, Freyja and many others (Mullens, 1990).These were the gods that were worshipped and appeased in order to gain some senseof control over fertility and child bearing. With fertility being an ascribed power of agod or goddess, the importance of fertility is evident.During Biblical times, women who could not bear children were ostracized anddishonoured. There was such a real pressure to have children in that day that to nothave children was considered intolerable. The ancient Jewish Talmud makes mentionof three forms of living death: to have poor health, to be poor, and to be barren (Theliving Talmud: The wisdom of the fathers, 1957).Religions (e.g. Christianity, Judaism) have placed great emphasis upon havingchildren. In Genesis, God’s command was to be fruitful and multiply. King Solomonstated (Psalm 127) that children are a reward and gift from God. Therefore, in achildless marriage, some people assume that God is not blessing the couple and mustbe punishing them for some wrong that was committed.The Roman Catholic church takes the position that a marriage entered with the2intent of being childless is not valid in the eyes of God (Pohlman, 1970). Manyreligious perceptions serve to reinforce the relationship between fertility orchildbearing and an individual’s sense of personal worth or value.The psychological community has also reinforced this connection betweenfertility and adult status in providing support for the belief that parenthood is animportant element of normal adult development. Erikson’s (1960) theory of humandevelopment includes as the seventh stage, an emphasis upon generativity. In histheory, Erikson states that all individuals have the desire to create, procreate, orgenerate. Failure to progress through this developmental stage leads to stagnation andthe inability to move to the last stage of maturity, ‘ego integrity’. One common formof generativity is having children.Even in more recent psychological literature, there continues to be a belief thatchildless couples are in some way maladjusted and emotionally disturbed (Abse, 1966;Akhtar, 1978; Denber, 1978; Eisner, 1963; Singh & Neki, 1982) which reflectscultural beliefs about the relationship between mental health and infertility. If theexperts of a culture think that childlessness and maladjustment are often linked, thisthen adds to the cultural pressure towards parenthood (Pohlman, 1969, 1970).Experts’ opinions also have the potential of continuing to reinforce the connectionbetween fertility status and personal worth. Today, with only 5% of the world’spopulation choosing to remain voluntarily childless (Veevers, 1980) it would appearthat such family values continue to be perpetuated.More than any other transition such as moving out of the parental home,3finishing school, getting a job, becoming self supporting, or even getting married;parenthood is thought to establish a person as a truly mature, and an acceptablemember of the adult community (Hoffman & Manis, 1979). Society’s perception ofmarried couples with children is more positive and affirming than for couples withoutchildren (Callan, 1985). Many people tend to view couples without children as beingselfish or immature in some way.Veevers (1980) states that Western society defines childlessness in almostexclusively negative terms. This perception may hurry couples into parenthood inorder to combat such perceptions (Pohiman, 1969, 1970). With such pervasive valuebeing placed upon the ability to reproduce and with the link being made betweenfertility and both worth and psychological normalacy, it is not surprising that theachievement of the parental role continues to be considered a major life goal for mostadult men and women. Fertility similarly continues to be assumed to be a basichuman right (Menning, 1977; Pohlman, 1969).Of those attempting to become biological parents however, one out of six,approximately 17% of the population, experience problems with infertility (Leader,Taylor, & Daniluk, 1984; Ulbrich, Tremagliocoyle & LLabre, 1990). Infertility iscommonly defined as the inability to conceive or bear a child after one year of regularsexual relations without the use of contraceptives (Grantmyre & Hanson, 1992). Adistinction is also made between primary and secondary infertility. While secondaryinfertility is the inability to conceive or bear children after having at least one child;primary infertility is the inability to conceive or bear children without any previous4children. Although approximately 50% to 60% of couples do eventually conceive anddeliver, still 40% to 50% remain infertile (Colins, Garner, Wilson, Wrixon & Casper,1984). Thus approximately 3.5 million couples in the United States are infertile(Ulbrich et al., 1990).Only 25 years ago, 40% to 50% of infertility had no known physiologicalexplanation (Burns, 1987). As a result, in such cases it was believed that emotional orpsychological factors were to blame (Abse, 1966; Akhtar, 1978; Bresnick & Taymor,1979; Denber, 1978; Eisner, 1963; Singh & Neki, 1982). However, with advances inmedical diagnostic technology, it is now understood that only 5% to 10% of infertilecouples have no known physiological explanation for their infertility (Burns, 1987).Of those infertile couples with known physiological problems, 7 times out of 10 theinfertility is either strictly male factor or strictly female factor (Benson, 1983).Although our culture generally perceives infertility as being a woman’s problem,research indicates that men are just as likely to experience infertility (Grantmyre &Hanson, 1992; McNeely, 1990). A breakdown of the physical causes of infertilityidentifies men as the origin of the problem in approximately one third of the cases,women in one third of the cases, the couple sharing the problem in 20% of the cases,and unexplained infertility being the diagnosis in the remaining 10% of cases(Grantmyre & Hanson, 1992).It has become well known that couples who experience infertility may gothrough a great deal of stress and strain, personally and interpersonally (Abbey,Andrews & Halman 1991; Berg & Wilson, 1990; 1991; Daniluk, 1988; Daniluk,5Leader & Taylor, 1987). Leading up to the diagnosis of infertility and afterwards, ithas been found that many men and women experience depression, helplessness, andmarital strain (Abbey, et al., 1991; Berg & Wilson, 1991). Infertile people oftenreport that there is no part of their lives that has been left untouched by theoverwhelming experience of infertility (Mahlstedt, 1985).Infertility has also been conceptualized as a crisis (Menning, 1980), based oncouples’ commonly reported emotional reactions of frustration, anger, sadness, guilt,depression, confusion, desperation, hurt, humiliation and isolation (Abbey, et al., 1991;Andrews & Arbor, 1991; Kendem, Mikulincer, Nathanson, & Bartoov, 1990; Bresnick& Taymor, 1979; Clapp, 1985; Daniluk, 1991; Daniluk, Leader & Taylor, 1987;Valentine, 1986; ).Individual responses to infertility have not only been described in terms of acrisis reaction, but also as a mourning process (Clapp, 1985; Leader, et a!., 1984;Mahlstedt, 1985; Shapiro, 1982). Many couples experience a great sense of grief overnot being able to have a child. This grieving process is similar to grieving other kindsof losses except that the loss may not be recognized (Clapp, 1985). Mahlstedt (1985)states that, “the fact that there is nothing tangible to represent the loss actuallyintensifies the pain and makes the loss more difficult to understand” (p. 336).The losses that are experienced with infertility are multifaceted. The infertilecouple may experience the loss of a love object, loss of power and control over theirlives, loss of someone of great value, loss of the experience of being pregnant andgiving birth, loss of positive and hopeful developments in their lives, and loss of a6dream or fantasy (Mahlstedt, 1985).For some people having children is viewed as a developmental milestone that isessential to becoming an adult. Not to have a child becomes developmentallyfrustrating and to lose the vision of this idealized adult self can be painful (Mahlstedt,1985; Veevers, 1980). Often infertile people experience a sense that they are damagedgoods (Abbey et al., 1991; Leader et al., 1984; Seibel & Taymor, 1982). Self imageand self esteem may decrease along with the person’s own sense of femininity ormasculinity (Leader et al., 1984; Menning, 1977).The impact of infertility can also permeate the marital relationship. Due to eachpartner dealing with their own loss, there can be a loss of closeness between partners,as neither may have the inner resources to support the other (Daniluk, 1991; Mahlstedt,1985; Menning, 1977). Infertile couples reportedly experience greater maritaldissatisfaction than fertile couples (Hirsch & Hirsch, 1989). Marital difficulties due tounfulfilled marital expectations are common in infertile marriages (Burns, 1987).Infertile couples may also experience a period of time when the sexual satisfactionwithin the relationship is significantly decreased (Daniluk, 1988; Hirsch & Hirsch,1989; Mahlstedt, 1985).A great deal of research has also examined differences between husbands’ andwives’ reactions, coping abilities, and resolution of their infertility. A number ofstudies suggest that male partners are less affected by infertility (Andrews & Arbor,1991; Berg & Wilson, 1990; Bresmck & Taymor, 1979). Some researchers report thatmen do not perceive infertility as being as stressful as women do, and express less7negative affect than women (Abbey et al., 1991). In a review of thirty controlledresearch publications, Wright, Allard, Lecours and Sabourin (1989) found that therewas convincing evidence that infertile female participants scored higher onpsychosocial distress scores than their male counterparts. However, Wright et al. alsofound that both infertile women and men scored higher on measures of psychosocialdistress than did fertile control groups.These results have frequently been interpreted as suggesting that infertility doesnot affect men as much as it does women. However, this may be an incorrectdeduction. It may be that men simply react and deal with infertility in a differentmanner than women do (Daniluk, 1991; Mahlstedt, 1985), resulting in differing scoreson tests measuring psychological distress. The measures commonly used may not tapinto the way in which the experience of infertility is expressed for men.Another possible reason for the reported sex differences in the reaction toinfertility (Andrews & Arbor, 1991; Bresnick & Taymor, 1979) could lie in the rolesthat men and women have taken in our society. Abby et al. (1991) state that theseapparent gender differences in response to infertility, “.. .reflect general genderdifferences in the ways in which men and women have been socialized to cope withnegative affect” (p. 298). Generally, women have been socialized to talk more openlyabout their problems, whereas men have been socialized not to show emotions.Consistent with this perspective, in semi-structured interviews with 12 infertile couples,Valentine (1986) found that the men expressed a sincere desire to be supportive andavailable to their wives. However, they reported that talking about infertility raised8their stress level rather than lowered it. Daniluk (1991) concurred with Valentine, insuggesting that many infertile men experience considerable distress at being unable toease their partner’s pain or help ‘fix’ the problem.There is a possibility that men may take on gender-specific roles in dealingwith infertility. This is exemplified in the words of one infertile man:.when I do feel like crying about not having a child, I don’t, because I’mafraid my crying would make her feel worse. And she believes that I am notupset. I’m playing a game, and we are both losing (Mahlstedt, 1985, p.343).Thus, the roles that spouses play in marriage and that men and women play in societymay result in an incorrect perception of men being less affected and/or more stoic intheir responses to infertility.Both Daniluk (1988) and Mahlstedt (1985) confirm that an individual’sresponse to infertility may be dependant upon which member of the couple isidentified as the physiological source of the infertility problem. Thus, the origin of theinfertility may be a significant factor in considering the differences in men’s andwomen’s responses to infertility. In many research studies (Abbey et al., 1991; Brand,1989; Bresnick & Taymor, 1979; Draye, Woods & Mitchell, 1988; Hirsch & Hirsch,1989; Greil, Porter, Thomas & Riscilli, 1989; Link & Darling, 1986) however, theorigin or source of infertility was not included as a variable in the analysis.Based on the belief that infertility is a more stressful and distressing experiencefor women, relatively little research has been conducted looking specifically at men(Kedem, Mikulincer, Nathanson, & Bartoov, 1990; Berg & Wilson, 1990; Berger,91980; Feuer, 1983; MacNab, 1986; Snarey, Kuehue, Son, Hauser & Vaillant, 1987) ormore specifically, men’s response to male factor infertility. It would be a mistake toassume that what the research literature states about women’s experience can beapplied to that of men; as men and women are socialized differently and thus theirexperiences and the meanings they attach to their infertility may be different. Also,most of the limited work on the psychological aspects of male infertility (Kedem et al.,1990; Berg & Wilson, 1990; Berger, 1980; Feuer, 1983; MacNab, 1986; Snarey et al.,1987) has been conducted using quantitative methods; no qualitative work hasinvestigated how infertile men meaningfully integrate their experience of infertility intotheir lives.Of the studies that have examined men’s reactions to infertility, researchershave found that infertile men have lower self-esteem, higher anxiety and display moresomatic symptoms than fertile men (Kedem et al., 1990). It is also common forinfertile men to experience a period of impotence after diagnosis (Berger, 1980).Infertile men and women also experience higher levels of tension, depressivesymptoms, worry, and interpersonal alienation (Berg & Wilson, 1990). After adiagnosis of infertility, it has been found that in the place of parenting, infertile mensubstituted either: (1) other people’s children, (2) other objects, or (3) themselves.Those who substituted other people’s children were most likely to achieve generativity,as defined by Erikson (Snarey et al., 1987). Hence, Snarey et al. (1987) found thathow these men dealt with infertility had developmental implications in later life.Feuer (1983) interviewed male-factor infertile couples, as well as, administered10the Spanier Dyadic Adjustment Scale, the Rosenberg Self-Esteem Scale, and the BeckDepression Inventory on all subjects. Feuer found that the scales for “quality ofmarital relationship”, “locus of control”, “self-esteem” and “social isolation” allindicated that infertility impacted negatively on these men. He also stated that:Significant differences were found between questionnaires and interviews andSubjects’ report of the impact of the infertility on their lives. The tendency ofSubjects to deny the impact of infertility on the questionnaires is stronglycontrasted by the results of the interviews, suggesting that the latter methodmay be a more accurate method for assessing this phenomenon (Feuer, 1983)Feuer confirmed the necessity of qualitative research for investigating infertility.Therefore, this study is an qualitative investigation into the meaning of theinfertility experience for primary infertile men who are experiencing male factorinfertility. Primary infertility is defined as the inability of bearing children withoutpreviously having had children. Male factor infertility is defined as the inability toconceive due to male physiological impairment.The research question being asked is: What is the experience of infertility aslived by infertile men? This research is unique in attempting to clarify how infertilemen make meaning out of their experience of infertility. Hence, this study issignificant in beginning to understanding the process of constructing meaning that mengo through in coming to terms with their male factor infertility.This study may help to bring clarity to the meaning of infertility for men andmay help clinicians begin to understand the significance and impact of infertility in the11lives of men. Thus, because this study will help in understanding the male experienceof infertility and how men come to terms with their infertility, it may be helpful toboth medical and psychological professionals who work with infertile men.Counselling professionals need to understand the significance and meaning ofinfertility for infertile men if they are to avoid the stereotypic assumption thatinfertility is a woman’s problem, and if they are to assist infertile men and couples intheir personal journeys toward meaningfully integrating their experience of infertilityinto their lives and relationships.12CHAPTER 2Review of the LiteratureThe research into the psychological aspects of infertility can be divided intothree areas of study. These three areas are important to investigate to set the groundwork for understanding the context of this study. The first area deals with researchconcerning the general psychological responses to infertility, showing the importanceof research into this experience. The second area will review those studies that madedistinctions in response to infertility according to gender. The third area of researchwill review those studies that specifically focused on the response of men to malefactor infertility.Response to InfertilityThe experience of infertility has a significant impact on people’s lives. Thefollowing research has been arbitrarily divided into 3 general areas - (1) infertility andstress, (2) infertility as crisis and loss, and (3) infertility and coping.Infertility and Stress. The stress that couples may endure during diagnosisand treatment for infertility is reported to be high. Mahlstedt, MacDuff and Bernstein(1987) in a questionnaire study of 94 in vitro fertilization participants found that 80%of infertile respondents described their infertility as stressful or extremely stressful. Ofthe respondents, 63% thought that their infertility experience was more stressful thandivorce when they had experienced both events.Thus, the impact of infertility upon people’s lives can not be underestimated.We know that divorce is rated as being one of life’s most stressful events (Booth &13Amato, 1991; Dreman, 1991; Kraus, 1979; Pledge, 1992). Hence, it is imperative thatwe understand the nature and impact that infertility has on the lives of those it touches.In a review of thirty publications of controlled research, Wright et al. (1989)investigated three hypotheses concerning the relationship between infertility andpsychosocial distress. Their first hypothesis, that psychosocial distress triggeredinfertility, received little support. Their second hypothesis stating that infertilitytriggered psychosocial distress, received more support although this hypothesis had notyet been adequately tested. Wright et al. found that in the studies reviewed, patientsdiagnosed and treated in infertility clinics showed significantly higher levels ofpsychosocial distress than their control counterparts. This was supported consistentlywith such reactions as loss of self-esteem, intense grief reaction, increased anxiety andsexual problems. Their third hypothesis was that there was a bidirectional relationshipbetween distress and infertility. They found that the research that supported theirsecond hypothesis could also support their third. None of the research they reviewedgave definitive results to support one hypothesis over another due to the lack ofrigorous methodology in many of the studies they reviewed. However, they didindicate that generally, females scored higher on psychosocial distress than males.In reporting on the 16 studies that compared psychosocial responses of males &females to infertility, Wright et al. did not mention the origin of the infertility as afactor under consideration (whether male factor, female factor, or combined factorinfertility) in the studies reviewed. The studies reviewed did not consider the origin ofa couple’s infertility as a factor in their analysis. This perhaps confounded the results14of such studies, because the origin of infertility was a vital factor to consider incomparing the response to infertility according to gender. This research highlightedthe need for new research that specifically looks at the men’s and women’s response toinfertility when the origin of the infertility is factored into the inquiry.However, in several studies, reviewed by Wright et al. that included socialdesirability scales, the researchers generally reported that men score high on suchscales, suggesting that men tend to downplay the psychosocial impact of infertility.This also was a factor to consider in gender comparative studies (Abbey et al., 1991;Bernstein, Potts & Mattox, 1985; Brand, 1989; Draye et al., 1988; Ulbrich et al., 1990)that suggested that women are more distressed by their infertility than men. This alsosuggests that future research may need to use a methodology that better taps into theexperience of infertility for men.McEwan, Costello and Taylor (1987) in a multi-regression quantitative studyinvestigated the psychological adjustment to infertility for 62 female and 45 maleattendants of an infertility clinic. Due to the low number of male factor infertilityparticipants they were not able to include this factor in their analysis; nevertheless,they did find that younger infertile women were more likely to be emotionallydistressed than older infertile women. One suggested explanation given was thatwomen who wait longer to have families, do not value having children as highly asyounger women do or they may have invested energies into other areas of life thathave given them a sense of gratification. This would suggest that the value a womangave to having children decreased with age - a suggestion not substantiated by their15research. McEwan et al. (1987) also suggested that it could be that women who hadspent most of their lives without children, may have had less difficulty adjusting tothis as a permanent situation. They also found that women who felt personallyresponsible for their infertility were more distressed than those who did not.Daniluk (1988), in a longitudinal repeated-measures study of 43 infertilecouples during the medical investigation for their infertility found that couplesexperienced significant levels of distress during the initial medical interview and at thetime of diagnosis. She also found that depression was a commonly reportedsymptomatic reaction to infertility. Sexual satisfaction mean scores for participantsstayed within the “sexually satisfied” range, although large standard deviationssuggested wide variability in the degree of sexual satisfaction levels amongparticipants. Daniluk noted that her results indicate that there was a higher degree ofsexual satisfaction among couples who receive a neutral diagnosis of unexplainedinfertility as compared to those men and women who had receive a negative diagnosisand prognosis for possible treatment.Similar results were also reported by Berg and Wilson (1991) in theirlongitudinal study of 104 couples undergoing medical investigation and treatment forinfertility. They found that couples experienced acute stress at the time of diagnosis,after which stress levels appeared to decrease in the second year. However, they alsofound that the stress became acute again as the treatment extended into the third year,suggesting a curvilinear relationship between the degree of stress experienced and theamount of time in medical investigation and treatment.16In another study by Berg and Wilson (1990), a standardized questionnaire wasgiven to 104 infertile couples currently involved in an infertility investigation. Theyfound that the stress of infertility was reflected in tension, depressive symptoms,worry, and interpersonal alienation. These occurred frequently for both the infertilemen and women in the study.The stresses and losses of infertility may also negatively effect the infertilecouple’s marriage. In an interview study of 157 couples, Andrews, Abbey, andHalman (1991) found that increased stress in these relationships due to infertility wasdirectly related to increased marital conflict, decreased sexual self-esteem, anddecreased satisfaction with own sexual performance. The stress associated with theparticipant’s infertility was also found to negatively affect (both directly and indirectly)their evaluations of life-as-a-whole, self-efficacy, marriage, intimacy and health.These studies (Andrews, et al., 1991; Berg & Wilson, 1990, 1991; Daniluk,1988; Mahlstedt et al.,1987; McEwan et al., 1987; Wright et al.,l989) all concludedthat infertility resulted in considerable psychological distress, particularly for women.Younger women were more greatly distressed than older women. Distress was alsomore significant upon women if they felt responsible for the infertility.This may also be the case for men experiencing male factor infertility, althoughthis research could not draw such conclusions. This research also indicates that theorigin of the infertility may contribute to a person’s sense of responsibility and distressregarding infertility.In these studies the distress experienced was significant for men and women at17the initial medical interview, as well as at the time of diagnosis. The stress ofinfertility was reflected in tension, depressive symptoms, worry, and interpersonalalienation. Although the stress brought on by an initial diagnosis decreased after thefirst year, there is some evidence to suggest that the stress increased after the thirdyear of treatment. The stress of infertility increased marital conflict for couples anddecreased sexual self-esteem and satisfaction.Infertility as Crisis & Loss. In an semi-structured interview study of 12couples experiencing infertility, Valentine (1986) found that the couples experiencedstrong emotional reactions to infertility such as sadness, depression, confusion,desperation, hurt, and humiliation. Behavioral reactions to infertility includeddisorganization, distraction, exhaustion, moodiness, and obsessive thoughts andbehaviours. These strong emotional and behavioral reactions were explained byValentine in terms of crisis theory, as a crisis reaction. Valentine also suggestedunderstanding infertility as a multiple loss and multiple stressor. The losses reportedby her participants were: loss of potential children; loss of genetic continuity; loss ofpregnancy, child bearing and breast feeding experiences; loss of a life goal; and loss ofthe control over one’s body. The sources of stress for infertile couples that Valentinefound were from: medical procedures; medical staff insensitivities; unhelpful andinsensitive comments from family and friends; society’s negative perception andstigmatization of childlessness; a strained sexual relationship; and adoption workerswho expected couples to demonstrate that they had emotionally resolved their feelingsabout their infertility prior to being approved for adoption. Thus, infertility had a18significant impact upon these participants who were reacting and responding to a crisis,a multiple loss and multiple stressors in their lives.Based on years of clinical experience in working with infertile people, bothMenning’s (1980) and Mahlstedt’s (1985) experiences concurred with the research ofValentine’s (1986) that at some point in the fertility investigation an infertile personexperiences a state of crisis. Both stated that common emotional reactions to infertilityinclude surprise or shock, denial, anger, isolation, guilt and grief. Mahlstedt (1985)states that the infertile couple may experience loss of a love object, loss of power andcontrol over their lives, loss of someone of great value, loss of positive and hopefuldevelopments in their lives, and loss of a dream or fantasy. The most commonproblem for infertile couples from Menning’s experience was a failure or inability togrieve. Menning stated four possible reasons for this: the loss may not be recognized,the loss may be seen as “socially unspeakable”, the loss may be uncertain, and theremay be an absence of a social support system.This research (Mahlstedt, 1985; Menning, 1980; Valentine, 1986) indicates thatcouples experience infertility as a significant loss in their lives. This loss evokesstrong emotional reactions due to their grief and lack of control over their situation.At some point couples may experience infertility as a crisis, as well as a significantstressor in their lives.Infertility and Coping. Individual responses to infertility may vary accordingto an individual’s ability to cope. Koropatnick, Daniluk and Pattison (1993) in across-sectional, multifactorial study investigated the adjustment to infertility of 4319infertile women and 28 men who attended an infertility treatment clinic. Koropatnicket al. found that high self-esteem, internal locus of control, higher socio-economicstatus and moderate age were all factors that relate to an individual’s abilities to copemore effectively with infertility. Although the entire sample exhibited moderately highlevels of distress in comparison to the normative groups; high levels of anxiety anddistress were correlated with low self-esteem, undifferentiated sex role identity andadvanced age. Koropatnick et al. also found that participants’ perceptions of theoutcome of their infertility appeared to contribute a great deal to their response toinfertility. Individuals who perceived their infertility as permanent rather thanuncertain or temporary, reported fewer interpersonal distress symptoms. The receipt ofa definitive diagnosis was reported as being predictive of better overall adjustment.Koropatnick et al. stated that,Individuals and couples who perceive their infertility as final may incorporatethis reality into their identity, an essential step in the process of successfuladaptation to such a transition (p.169).Both men and women embarking upon IVF and DI treatments experienced highlevels of anxiety while attending an infertility clinic, in a standardized interview andquestionnaire study of 59 women and 34 men, by Cook, Parsons, Mason andGolombok (1989). Cook et al. also found when these same men and women weredivided into high and low distress groups and compared with respect to their use ofdifferent coping strategies, that those who were anxious and/or depressed were morelikely to engage in avoidance coping strategies.20This research (Cook, 1989; Koropatnick et al., 1993) suggests that anindividual’s ability to cope depends upon their level of self-esteem, locus of control,socio-economic status, age and whether they perceived the infertility to be permanentor temporary. Those who experience more anxiety and depression are more likely toutilize avoidance coping strategies.Gender Differences in Response to InfertilityThe second area of research in infertility that needs to be understood for thispaper includes investigations of the differences in response to the experience ofinfertility based on gender.Draye et al., (1988) investigated the coping strategies of infertile men andwomen. In their questionnaire study of 39 women and 27 men who attended aninfertility clinic, they found that these men and women experienced infertilitydifferently in that the women had significantly more problems in the areas of self-esteem, personal life, health care systems and occupation in comparison to the men.Although both the men and the women used a similar number of problem-oriented andsocial support coping strategies, women employed significantly more avoidancewithdrawal coping strategies than did men. However, it is important to note that thisstudy has some methodological flaws. The researchers did not make the source of theinfertility (whether male-factor, female-factor, combined factor or unknown) a variablein their analysis. Thus, it is difficult to ascertain the reason for the differences inresponse between the men and women in this research.Abbey et al. (1991), in a survey of 275 couples (of which 185 were infertile),21reported that infertile wives, as compared to their husbands, perceived their infertilityproblem as being significantly more stressful than their husbands. The women in thestudy felt that they had experienced more disruption and stress in their personal, socialand sex lives than presumedly fertile women. They also felt more responsible for theirinfertility and in more control of the solutions for their infertility. Infertile wives alsoperceived having children as more important than did their husbands. Thesedifferences were not found among the 90 presumed fertile couples surveyed.However, it is important to keep in mind the kinds of infertility represented inthis study. Of the 185 infertile couples, only 10% were male factor, while 46% werefemale factor, 30% were combined factor and 14% were unexplained infertility. Thus,this representation is skewed and does not accurately represent male factor infertilemen. Thus, the conclusion that women find infertility more stressful than men maynot be a valid conclusion as in the sample female factor infertility was overrepresented and male factor infertility was under represented.Bernstein et al., (1985) found that the results of the 21-item, self-reportassessment questionnaire of 70 participants (39 women and 31 men) from an infertilityclinic indicated that 21% experienced mild distress, and 3% moderate distress. Meanscores for the men were within normal ranges, while means for women were moredistressed in the area of interpersonal relations, depression, and hostility. Women alsoscored significantly higher than their male counterparts on impairment of self-esteem.Bernstein et al. did not distinguish within their results the response’s of men who wereinfertile and men who’s spouses were infertile.22The intensity of the initial disappointment of infertility was significantly greaterfor women than for men as reported by Brand (1989), in a thirteen item semi-structured interview of 59 infertile couples. This suggested that the experience ofinfertility more greatly affected women than men. It may be that the effect ofinfertility on men was experienced differently or expressed differently. Men’s maritalroles may not allow for the same degree of emotional expression. There was also theproblem that although the semi-structured interview was constructed to measureacceptance of infertility, Brand gave no indication as to how this was measured.Important to note, this research too was skewed disproportionately. Of the 59participating couples, only 5 involved male factor infertility. With only 8.5% ofBrand’s sample representing male factor infertility, it is difficult to make comparisonsbetween men’s and women’s acceptance of or reaction to infertility.If research comparing men and women in their the response to infertility is tobe valid, researchers need to compare male factor infertile men with female factorinfertile women. They could also compare men who’s partners are infertile withwoman who’s partners are infertile. In this way researchers may determine if theexperience of an infertile man is the same as that of a man who’s partner is infertile.Brand (1989) also reported that women not only discussed their infertilityproblem more frequently than men, but the women in this study also found it easier totalk about the subject with people other than their spouse. Mahlstedt (1985) concurredwith Brand on this point and also stated that women may confuse a man’s silence as alack of concern when in reality it is not the case.23As stated previously Daniluk (1988), in a longitudinal repeated-measures studyof 43 infertile couples during the medical investigation for their infertility, found thatthe infertility investigation was most stressful at the time of the initial medicalinterview. Daniluk also found that the distress associated with infertility was greaterfor the individual identified as having an organic fertility problem. This suggests thatfor couples with male factor infertility, the man may well experience greater distress.A more recent study Ulbrich, Tremagliocoyle and Llabre (1990) investigatedthe adjustment to involuntary childlessness for 103 couples in treatment for infertility.Through mailed questionnaires Ulbrich et al. (1990) found that there was a significantdifference in men’s and women’s experiences of stress associated with the couple’sinfertility. They found that the wives experienced more stress than their husbands;however, it must be noted that although the source of the infertility was known, it wasnot factored into the analysis of the data. They also found that men who were thesource of a couple’s infertility reported less satisfaction with the expression ofaffection and sex in their marriages than that of other men in the study. Men alsoassociated acceptance of a childless lifestyle with greater marital adjustment and menadjusted better to an involuntary childless marriage if their partners were employed orhad high earnings.An interesting aspect of this study was the skewed participation in respondingto the questionnaires with respect to the source of the infertility. The participants wereobtained through Resolve, a support organization for infertile couples and throughinfertility specialists. Of the 103 responding couples there were more than 6 times as24many female-factor infertile couples represented than male-factor infertile couples.This representation was discrepant to commonly reported incidence of approximately35% of infertility problems being male factor in origin and 35% female factor inorigin (Grantmyre & Hanson, 1992). This skewed representation may suggest twopossibilities. Infertile men may be less likely to fill out and respond to mailedquestionnaires or possibly infertile men are less likely to attend an infertility supportgroup. In either case infertile men were under represented in this study.From these studies that compared men and women in their response toinfertility, the research appears to suggest that infertility affects women more thanmen. These women had significantly more problems in the areas of self-esteem,personal life, dealing with the health care system and their occupations in comparisonto the men. Women employed significantly more avoidance-withdrawal copingstrategies than did men. Women perceived their infertility problem as beingsignificantly more stressful than men and reported greater disappointment at the initialdiagnosis of infertility and greater distress in the area of interpersonal relations anddepression.However, it must be noted that most of the research had one of two problemsthat must be taken into consideration in interpreting the results: most researchers didnot make the source of the infertility (whether male-factor, female-factor, combinedfactor or unknown) a variable in their analysis and the number of infertile men weregreatly under represented in a number of studies. This under representation may haveskewed the results of the research. With the source of the infertility not taken into25account or male factor infertility under represented, it is difficult to ascertain thevalidity of their findings.It could be that women are over represented in the research because they tendto be more open in discussing their infertility than men (Brand, 1989). However,although women may share more openly than men, it should not be concluded thattheir greater voice is an indication of greater distress or pain.Men’s Response to Male Factor InfertilityThere are generally two kinds of diagnosis for male infertility - oligospermiaand a.zoospermia. Oligospermia is understood to be a deficient amount of spermatozoain the seminal fluid. This resultant subfertility can be significant enough to be thegrounds for a couple’s inability to have children. Azoospermia is the absence or nearcomplete absence of spermatozoa in the seminal fluid (Thomas, 1989).Berger (1980), in an interview study of 16 male factor infertile couples foundthat it was common (63%) for infertile men to experience a period of impotencelasting 1 to 3 months after diagnosis (Berger, 1980). Berger also found that 87% ofthe women interviewed had experienced rage toward their husband and when thesewomen were asked to share their dreams around the time of diagnosis, three differentthemes emerged from their dreams - concern for their husband, a wish to be rid ofhim, and guilt over this wish. Husbands whose wives were symptom free did notexperience impotence. Therefore, Berger (1980) suggested that impotence following adiagnosis of male factor infertility may be an interactional problem involving bothhusband and wife. If this inference is correct, it may imply that not only does the26diagnosis of infertility bring about a sense of emotional crisis and distress, but that theinteractive relationship between partners may also elicit emotional distress.One interesting longitudinal study (Snarey et al., 1987) with a sample of 343men studied over 40 years found that 52 men (15.2%) in the study experiencedinfertility in their first marriages and that the way they dealt with their infertility hadlasting personal implications. The researchers found that all of the 52 infertile menchose activities to substitute for parenting. Sixty three percent substituted nonhumanobjects to lavish their attention on (e.g. their houses), 25% took part in the activities ofother people’s children and 12% substituted themselves (e.g. body building). Thesemen were rated by the researchers as to their generativity (as defmed by Erikson).They reported that of the three substitutes, 75% of those who substituted otherpeople’s children, 25% of those who substituted nonhuman objects, and none of thosewho substituted themselves, achieved generativity. Hence, how these men dealt withinfertility had developmental implications in later life. Snarey et al. (1987) also foundthat the attribution of the infertility problem to only one spouse had a greater negativeimpact upon the couples’ marriages than when both spouses had a medical problem.In a thorough review of the literature the following studies were identified asresearch specifically investigating the experience of male factor infertility. Feuer(1983), in his study, used three self-report evaluation scales as well as personalinterviews to investigate, The Psychological Impact of Infertility on the Lives of Men.In order to provide baseline data on this phenomenon, Feuer (1983) investigated thedependant variables of “depression”, “quality of marital relationship”, self-esteem”,27“masculinity”, “locus of control” and “social isolation” through the following three selfevaluative scales: the Spanier Dyadic Adjustment Scale, The Rosenberg Self-EsteemScale and the Beck Depression Inventory. Each variable was tested under two separateconditions: (1) at the time of diagnosis, and (2) still trying/no longer trying toconceive. Feuer does report the period of time between the two testing intervals.Of the six hypotheses “depression” was supported under both conditions; theparticipants were significantly more depressed than norm groups. Four hypotheses(“quality of marital relationship”, “locus of control”, “self-esteem”, “social isolation”)were supported under one condition each. Information was not available as to thespecific nature of the four hypotheses, nor under which of the 2 conditions eachhypothesis were supported.Information regarding the purpose of the study, the way in which it was carriedout (methodology), the sample size, and the resulting relationships between thevariables investigated was also not available. Therefore it is difficult to establish thedegree of validity for Feuer’ s findings and or the relevant implications. That being thecase, Feuer did find that participants who were diagnosed as oligospermic consistentlyshowed the greatest impact in response to the infertility. Feuer stated that this may bedue to uncertainty associated with the diagnosis - a result confirmed by otherresearchers (Koropatmck et al. 1993). According to Feuer participants diagnosed asazoospermic indicated that infertility had significantly less of an impact on their livesthen those diagnosed as oligospermic. He stated that this effect may be due to thefinality of the diagnosis in contrast with that of oligospermia.28In MacNab’s (1986) questionnaire and interview study of 30 men in infertilemarriages, MacNab drew the following six conclusions based on his research:(1) The issues men have in dealing with infertility have been denied andsuppressed by our society, by clinicians, by wives and families, and by the menthemselves. (2) Infertility is a major life stress. (3) Two key variables influencehow men experience infertility: the duration of the infertility struggle and thecertainty of the medical diagnosis. (4) Infertility interrupts the life paths ofmen. (5) Infertility has a paradoxical impact on the adult development of men.(6) Couples adopt gender-specific roles in dealing with infertility (p.T74).MacNab’s finding may be significant to better understand the experience ofinfertility for men; however, basic information about this study was unavailable. Itwas uncertain whether the men in this study were the source of the infertility for eachcouple. The origin of the infertility, whether male factor, female factor or combinedfactor, was not reported. The specific methodology, questionnaire, and type ofanalysis were also not made available. Therefore it is difficult to establish the degreeof validity for MacNab’s findings.Finally, in a recent study by Kedem et al. (1990), 107 men who suspected theymay be infertile were compared with 30 men who had no such suspicion.Questionnaires (shortened version of the Attribution Style Questionnaire, theRosenberg Self-esteem Test, and the Hopkins Symptom Checklist) revealed that thesuspected infertile men scored significantly lower self-esteem than their matchedcontrol group. The suspected infertile men also scored higher on anxiety and showed29more somatic symptoms than the control group. In addition, Kedem et al. also foundthat infertile men were less hopeful when their infertility was primary than when itwas secondary.Kedem et al. (1990) also found that men who attributed their infertilityproblems to more global causes and appraised their infertility as more stressful tendedto also report more somatic symptoms of depression, although their scores fordepression were not significantly different from their matched control group. Globalattribution was measured by the men’s response to the following question: “To whatextent does your problem of infertility affect other areas in your life?” (p.75). Thegreater the extent to which a participant felt that infertility affected other areas of hislife, the greater the measure of global attribution. Therefore, infertile men who feltthat infertility had affected other areas of their lives were also more likely to alsoexperience somatic symptoms of depression. Because this part of their research wascorrelational in design, causality between these variables could not be determined.Hence, Kedem et al. conceded that it was also possible that the symptoms ofdepression may have altered the degree of global attribution and perceived subjectivestress of the suspected infertile men.Although, when Kedem et al. (1990) compared men who suspected they wereinfertile with men who had no such suspicion, no significant differences were found asto feelings of sexual inadequacy, depression, obsessive-compulsion and interpersonalsensitivity. When considering these findings, it is important to note the small controlgroup (N=30) in comparison to the sample of 107 suspected infertile men. The small30control group may be responsible for the lack of statistical power to ascertain relevantdifferences between the two groups.From the studies discussed above it would appear that infertile men mayexperience greater depression, lower self-esteem, higher anxiety, more somaticsymptoms and less satisfaction with the expression of affection and sex in theirrelationships than that of fertile men. It would appear that there may be a greaterpsychological impact for men with oligospermia than for men with azoospermia,possibly due to the uncertainty associated with this diagnosis. Infertile men may alsobe less hopeful when their infertility is primary than in the case of secondaryinfertility. This may be due to the fact having at least one child gives hope that othersare possible. It could also be that secondary infertile men have already achievedparenthood and thus the losses incurred with infertility are fewer.It is apparent from the literature that there is little research on the maleexperience of infertility, especially when the origin of the infertility is exclusively malefactor. Yet given the documented gender differences in response to the experience ofinfertility, it would appear to be inappropriate to extrapolate to men, the fmdings ofstudies of the response to infertility based primarily on female samples. Little isknown about how men make sense of their experience of infertility or how theymeaningfully construct and integrate their experience into their self and life structures.As such, in this study the focus of investigation will be upon the meaning that menattribute to their experience of male factor infertility.31CHAPTER 3MethodologyDesignThe study was conducted in an attempt to begin to understand how menmeaningfully construct their experience of infertility. Thus, this study’s methodologyneeded to reflect the nature of the inquiry.The underlying research question was: What is the experience of infertilityas lived by infertile men? The goal was to bring a greater understanding to thenature of this experience for men, and also to develop propositions for furtherinvestigation.The topic of this investigation is quite sensitive in nature, and thus it wasvitally important that the methodology used be responsive to the feelings, needs andexperiences of the participants. In the past a large number of researchers studying theexperience of infertility investigated the phenomenon using quantitative methods(Abbey et al., 1991; Andrews & Arbor, 1991; Bartoov et al.,1990; Brand, 1982; Berg& Wilson, 1990, 1991; Bresnick & Taymor, 1979; Callan, 1987; Cook et al.,1989;Daniluk, 1988; Daniluk et al., 1987; Draye et al., 1988; Feuer, 1983; Hirsch & Hirsch,1989; Koropatnick, et al., 1993; Link & Darling, 1986; McEwan et al., 1987; Snareyet al., 1987; Ulbrich, et al., 1990; Wright, et al., 1989). In this study it was assumedthat men who have endured the very invasive, impersonal, and possibly demeaningmedical procedures associated with the investigation into their infertility, might beopposed to any further personal investigation which they perceived as invasive and32impersonal. Quantitative testing procedures were believed to potentially replicate theimpersonal and invasive nature of their medical experience. Menning (1980) quotes awoman’s experience with infertility to help understand this aspect of the infertileperson’s experience:There is no inner recess of me left unexplored, unprobed, unmolested. Itoccurs to me when I have sex that what used to be beautiful and very private isnow degraded and terribly public. I bring my charts to the doctor like a childbringing home a report card. Tell me, did I do well? did I ovulate? Did Ihave sex at all the right times as you instructed me? (p. 315)Thus, it was considered important in approaching this area of investigation to use aone-to-one, empathically personal approach rather than employing standardized testingprocedures that could be perceived as invasive and unempathic. A qualitativeinterview method of inquiry was considered more suited to examining the personalconstruction of meaning for infertile men.The nature of the infertility experience is a very complex one, which toucheson many aspects of a person’s life. To grasp the most comprehensive picture of themeaning of infertility for infertile men a holistic approach was needed. To access themeaning of the infertility experience, it was necessary to allow each participant toconstruct their own reality about their experience. Colaizzi (1978) states that thephenomenological approach is non intrusive, in that it does not intrude upon or coercethe phenomenon, but rather, lets the phenomenon speak for itself. Thephenomenological approach neither denies experience or distorts it through33transforming it into some sort of operational definition (Colaizzi). It is a method that.remains with human experience as it is experienced, one which tries to sustaincontact with experience as it is given” (pg.53). Therefore to access more accuratelyhow men meaningfully construct their experience of infertility, a phenomenologicalapproach was chosen for this study.The phenomenological paradigm is useful for research which aims at revealingthe lived experience of a phenomenon as well as for understanding experiences aboutwhich little is known or for which many misconceptions may exist (Giorgi, 1985).The meaning attached to the experience of a phenomenon is disclosed through anindividual’s subjective experience, thoughts and feelings. Such an approach wasbelieved to be well suited for investigating the experience and meaning of infertilityfor involuntarily infertile men.BracketingThis topic area became of interest to me for a number of reasons. First, I cameto realize the impact of infertility when I experienced it personally. I learned that Iwas infertile and could not have biological children. As a result, I became interestedin researching the literature as to the nature of this experience.Secondly, I came to realize that a great majority of the literature on infertilityaddressed the female aspects of the experience and that most of this same literaturesuggested that the experience of infertility did not impact men the way that it didwomen. This did not fit my own personal experience.Thirdly, the research that I read described the reactions that men and women34had to being diagnosed as infertile and how this had impacted their lives. However, Icould not find research on how men created meaning and made sense of theirexperience of infertility. Therefore, I undertook to investigate men with male factorinfertility to understand how these men made sense out of their infertile experience.My assumptions were that the experience of infertility changes a man’s mostbasic sense of identity. I thought that I would fmd that infertile men go through aconfusing period characterized by a deep sense of loss, out of which they mustconstruct some new meaning of their sexual identity, and make some sense of why thishas happened to them. I also assumed that these men would describe a process oftransition to an infertile identity. Finally, I suspected that the impact of infertilityupon these men would be comparable to that reported in the literature on women, butwould be experienced, dealt with, and displayed somewhat differently. Althoughmen’s and women’s experience with infertility would be similar in intensity, the waymen deal or cope with the issue and the meaning it has for them personally would besomewhat different than for women. I suspected that the men I interviewed wouldrelate a great sense of isolation, as they would more likely attempt to try and deal withinfertility alone; not having the kind of social supports that women have.ParticipantsParticipants selected for inclusion in a phenomenological study must haveexperienced the phenomenon of interest and be adequately articulate to illuminate thenature of the phenomenon (Colaizzi, 1978; Giorgi, 1985; Osborne, 1990). Theparticipants for this study were men who had been diagnosed as having male factor35infertility, who had not had biological children in the past. This study was focusedupon primary infertility rather than secondary infertility. It was believed thatsecondary infertility was uniquely different from primary infertility and that theexperience might be different for secondary infertile couples. Thus, for this study onlyprimary infertile participants were chosen.Participants were required to be at least one year past their initial diagnosis.This was to ensure that they had had sufficient experience with the phenomenon inquestion to be able to reflect on their attempts to integrate and make sense of theirexperience of infertility. As well, it was required that all participants felt that theirfertility and/or having biological children was important to them; that the experience ofinfertility mattered to them. Although there is a small population of couples whochoose childlessness (Veeres, 1980), it is important that they were not represented inthis research, as it was believed that their experience and meaning of infertility wouldbe qualitatively different.Men from couples where both partners had been identified as having aninfertility problem were excluded from participating in this study. Research hasindicated that the experience of infertility may differ if it has been a shared etiology ordiagnosis (Daniluk, 1988; Mahlstedt, 1985; Ulbrich et al.,l990). The focus of thisstudy was upon men’s experience of male factor infertility.Participants were also required to report that they had a sense or feeling thatthey “had come to some sort of positive resolution of their experience of infertility”,prior to their inclusion in the study. This was vital to ensure that they had indeed36undergone a process of meaning construction around their infertility.Phenomenological studies are not designed with the intention of statisticalgeneralizability, but rather require as many participants as it may take to illuminate thephenomenon (Colaizzi, 1978; Osborne, 1990). For this reason, six individualsparticipated in this study. This number was considered sufficient to expose thediversity and commonality in the men’s experiences, while also ensuring the themeswhich were derived from the protocols did not occur by chance.ProcedureParticipants were recruited through contacts with professional organizationswhich specialized in infertility. Advertisements (see Appendix A) were sent out to thenewsletters of The Vancouver Infertility Peer Support Group and the Adoptive ParentsAssociation. These notices were also placed on bulletin boards at the University ofBritish Columbia. Urologists and infertility specialists were asked to informparticipants who met the inclusion criteria of the study (see Appendix B).After some time had passed and an insufficient number of participantsresponded to the recruitment notices, a friend of the researcher’s in Regina, who knewof this research, contacted the researcher to say that he had talked to three infertilemen in Regina who were all interested in participating in the research. All three menmet the research criteria and were included in the study.Each man interested in the study was requested to contact the investigator byphone. At that time, the potential participants received additional information aboutthe study (ie., background information about the investigator, the Counselling37Psychology Program, the goals of research) and had the opportunity to ask anyquestions they had about participating. It was stressed that the interviews were notmeant to take the place of counselling or therapy.During the phone conversation the investigator asked potential participantsquestions to ascertain if each fit the research criteria (See Appendix C), and evaluatedthe potential participant’s comfort with and ability to articulate their experience ofmale factor infertility. The first six participants who met the selection criteria outlinedpreviously, were accepted as participants in this study. Mutually agreed upon timesand locations were arranged with each man for the first in-depth, tape recordedinterview.The interviews took place in comfortable and private settings which weresuitable for both the investigator and the participants (the participant’s place ofresidence, and/or a counselling room available to the investigator). The initial goal atthe onset of the first interview was to establish a trusting rapport (Colaizzi, 1978).The parameters of the participant’s involvement were reviewed at the outset of theinterview and each man was asked to read and sign two copies of an ethical consentform (see Appendix D). An opportunity was given to each participant to ask anyquestions he had regarding the study, prior to the start of the interview.The first interviews were minimally structured in order not to impose meaningor structure to each co-researcher’s preconceived ideas and feelings about thephenomenon (Giorgi, 1985; Van Manen, 1990). To begin the interview an orientingstatement was presented to help focus the participant upon the phenomenon in a38general way (See appendix E). A further list of questions was available to assist in thedeeper exploration of the specific topics and issues, if they were first raised by theparticipants (See Appendix F).Active empathic listening (Colaizzi, 1978; Gordon, cited in Osborne, 1990),which is essential for this kind of research, was used by the investigator throughout theinterviews. Questions were open ended to avoid directing or leading the participant(Osborne, 1990). Probes also were used to elicit greater explanation or clarification.Silence was used to allow each participant to express fully all of his thoughts (VanManen, 1990). The researcher tracked topics which needed further elaboration.Process notes were also used by the researcher to assist in capturing as much of eachparticipants’ experience as possible.Each interview was tape-recorded and lasted for approximately two to threehours, till the participant felt that he had had sufficient opportunity to tell his storyfully. Participants were asked if they would like to suggest a pseudonym for theirstories to ensure confidentiality of their experience in any oral or written accounts ofthe material. Only one participant asked for a particular first name. All participantswere encouraged to phone the investigator after the interviews should new thoughtsarise pertaining to the study, although none did. Participants who had additionaldescriptions of an elaborate nature were requested to write out this additional materialto reduce the need for more interview time and more transcriptions (Osborne, 1990).None of the participants did so.Following each interview the recorded tapes were transcribed. The transcripts39were analyzed for thematic content, where upon a copy of the common themes, theirpersonal profile and their interview was mailed or hand delivered to them. Eachparticipant was instructed to read through their profile for accuracy of content. Aswell, each was asked to read common themes that were extrapolated from the data.The researcher then phoned the participants to conduct validation interviews to validatethe accuracy of their individual profiles and their thoughts and feelings regarding thecommon themes. One man could not be located to complete his validation interview.These interviews took place with each participant to ensure that the themes derivedfrom each of their protocols were an accurate reflection of their experiences.Participants were given the opportunity to recommend any changes, additions ordeletions to the thematic descriptions, to be certain that their experiences were fullyand accurately depicted by the researcher.A few small changes were made to the individual profiles and themes by theparticipants in the validation interviews. These changes were made to enhance theaccuracy of what was written. For example, one participant pointed out where thisresearcher had stated that all of the couples used birth control. This was not the casefor that particular couple, so the appropriate changes were made. Other changes weremade to the accuracy of the individual profiles that were written about each of themen. Upon reading the common themes, the men were satisfied that the themesincorporated the main elements of their experience with infertility.Data AnalysisA thematic analysis procedure devised by Colaizzi (1978) was used. The40following procedural steps were under taken. All of the participant’s descriptions, orwhat Colaizzi (1978) calls protocols, were read from beginning to end to get an overallfeel for the material. Then each protocol was read individually extracting significantphrases or sentences that directly related to the phenomenon under investigation. Theinvestigator then engaged in “creative insight” to formulate meanings from thesignificant phrases. This process required that “...the researcher go beyond what [was]given in the original data and at the same time, stay within it” (p.59). The data had tobe allowed to “speak for itself’. It was important that conceptual theories not beallowed to mould the data to fit with any particular theory. This procedure wasrepeated for each protocol.The process of extrapolating themes from the protocols involved readingthrough all of the protocols a number of times. The researcher also read through themwhile listening to the taped recordings of the interviews; to ensure accuracy and to geta clearer understanding of the transcript through the tone of voice used by theparticipants in their interviews. This greatly aided the researcher in catching thenuances of communication that were not reflected in the original typed transcripts.Initially, in extracting possible themes from the protocols for this research, manythemes or variations of themes were found. The researcher evaluated how the themeswere connected to each other. For example, anger was a part of the experience of allof the men; however, as a theme it was connected to ‘grief and loss’, ‘powerlessnessand loss of control’ and ‘betrayal’. Anger was elicited within the context of all threeof these themes and thus is connected to these three themes. All of the themes were41evaluated in regard to how they interconnected with each other.To extrapolate the eight major themes from the protocols involved a cyclicalprocess of the following: (1) reviewing the protocols; (2) distancing from the protocolsand reflecting on all of the themes and the way they were connected to each other; (3)formulating a possible hierarchy for the themes - finding those themes that aresubordinate to more central themes; (4) engaging in dialectic with other people as tothe prospective hierarchy of themes and receiving feedback as to other possible themesor theme hierarchies; and then (5) going back to the data within the protocols andrepeating the processing cycle. Eventually, certain themes emerged as stronger ormore central to the experience of infertility.Of the original 35 possible themes, some were not common to all, while othersseemed to be a part of or incorporated into more central themes. As an example, mostof the men experienced depression which was experienced in a number of differentcontexts. Although it could be a theme, the depression appeared to always be in thecontext of ‘loss and grief’ , ‘sense of powerlessness and loss of control’ or‘inadequacy’ - three more central themes. Hence, depression was then discussed as apart of those themes. Although, this “exhausting of themes” may not be completelypossible, results can serve in the identification of relevant research variables and indirecting clinical practice.Once a list of formulated meanings had been drawn from the protocols, theinvestigator organized them into “clusters of themes” (Colaizzi, 1978 p.59). Theseclusters of themes were then referred back to the original protocols in order to validate42them. Colaizzi (1978) stated that this is accomplished by asking whether there is anymaterial in the original protocols that is not accounted for in some way in the clusterof themes. When there was material unaccounted for or when there were themeswhich were not substantiated or found within the original material then the precedingprocedural steps were redone and re-examined. This was to ensure that the identifiedthemes were based solely upon the data. The results of this analysis were “...integratedinto an exhaustive description of the investigated topic” (Colaizzi, 1978, p.61) that wasformulated in such a way as to identify the fundamental structure of the phenomenonof men’s attempts to make sense of male factor infertility and to integrate thisexperience into their lives.Limitations of the StudyThe focus of this study was limited to an exploration of the experience ofinfertility for men within the confines of a two to three hour interview with eachparticipant and a follow up validation interview. A more complete investigation couldbe accomplished through additional interviews over a longer period of time; however,limitations of time and resources did not made this practical or possible.This research focused specifically upon male factor infertility and made noattempt to examine men’s experience of female factor infertility or combined factorinfertility. This study also did not include investigating women’s experience ofpartner’s who are infertile, although many of the partners of the participants in thisstudy expressed directly to the researcher or their husbands reported that they wouldhave liked to participate. This study was limited to the experience of infertility solely43from the perspective of the men who were themselves infertile. In-depth interviewswere the primary source of data collection.This research is based upon self-report and therefore relies upon what theparticipants remembered and on their level of insight and self-awareness. Factualaccuracy of the self-reports is not of fundamental importance to the phenomenologicalresearcher, since meaning making arises out of the salience of the experience from theperspective of the participant (Van Manen, 1990). What the participant chooses topresent in content and affect comprised the meaning of the experience to him.Although factual accuracy within the stories of these men is not crucial; theirfidelity to their own experience is. In the case where one individual may distort thetrue nature of his experience, whether knowingly or unknowingly, this distortion is aptto fall by the wayside when searching for themes that are common to all. Suchindividual distortions do not become major themes because of the unlikelihood of thesame distortion being common to all of the participants’ stories.The study, intent upon understanding how infertile men meaningfully constructtheir experience of infertility, necessarily required that some of the participant’saccounts would be retrospective in nature. Most people desire consistency betweentheir current life and what they remember of past experiences. Thus retrospectiveaccounts may be subject to distortion, whether intentional or unintentional. However,the focus of this research was upon the individual meaning-making process inexperiencing this phenomenon; a process that is not contingent upon accurate recall.The men’s reports in the study may also have been influenced by their desire to44be socially desirable or viewed in a positive way. Factors such as denial, self-deception, shame, humiliation and guilt may have influenced the participant’s self-reports. In phenomenological methodology it is recognized that the content of eachman’s story and how he processes his experiences are embedded in the context of thesituation and thus are shaped by cultural influences (Colaizzi, 1978; Van Manen,1990).Other limitations of this research are common to phenomenological researchersin general which pertain to the lack of generalizability of the results to otherpopulations or settings (Borg & Gall, 1989; Giorgi, 1985; Osborne, 1990). With onlysix participants, the results of this study cannot be generalized to all men who haveexperienced male factor infertility. Generalizability is not acquired through one study,but rather, through the on-going process of other infertile men telling their stories andresearches checking, disputing, refining and challenging the themes to more accuratelydepict the nature of the phenomenon (Colaizzi, 1978). The results of this study canhowever, be compared to theory and can also influence the direction or focus of futureresearch.It was also important to realize that the process of exhausting of the possiblethemes can in reality never be totally accomplished, just as no human being can beexhaustively investigated (Colaizzi, 1978). Therefore, the phenomenologicalinvestigator was continually faced with the acknowledgement that his study can neverbe “complete or fmal” (p. 70).45CHAPTER 4ResultsIn this chapter descriptions of the six men who participated in the study arepresented. Following their biographical descriptions, the eight common themesextracted from the men’s protocols are presented. Each presented theme includes adiscussion of the nature and meaning of the theme itself, and how the theme was livedout in the lives of these men. Specific quotes from the various participants areprovided to help illustrate and support each theme. The results of this chapter may notbe generalizable to larger populations until further research can substantiate them andcontinue the process of refining our understanding of the nature of the experience ofinfertility for men.The following profiles represent descriptions of the 6 men who participated inthe research, although all names have been changed to ensure confidentiality andrespect privacy.Profiles of the Six Co-researchersGarret. Garret, at 32 years of age, works in the construction business. At thetime of the interview, Garret had known about his infertility for 4 years. He had beenmarried to his wife, Heather, a training consultant for a major corporation, for 10 yearsand both always wanted to have children. They had started 6 years ago to try to havechildren. After a year of trying, they approached their doctor to investigate the matter.They continued to try and conceive through the use of a basal thermometer andcharting. A year later, their doctor began an exploratory investigation on Heather.46Later, Garret had a series of sperm tests done and the results indicated a low spermcount. However, the doctor was uncertain regarding Garret’s condition as he had beensick within 3 months of each test, which the doctor stated could be the cause of thelow counts. Eventually, Heather was referred to a gynaecologist, who was able toonly find 2 small ovarian cysts. No other problems were found in the testing onHeather.Garret was then referred to a urologist who thought he had found a varicocele;however, after being tested, none were found. Soon after, Garret and Heather enteredinto an in vitro fertilization program at a local hospital. The doctors were able toretrieve 10 or 11 eggs, however, in attempting fertilization, only one egg wasfertilized. The implant was unsuccessful. It was then that the 1W doctor told themthey were probably not good candidates for 1W and so they did not proceed with anymore IVF treatments. Garret found out from the doctor that the probable cause for theinfertility was his very low sperm count and possibly a missing enzyme. The doctorstated that he could investigate the exact cause of the infertility, but Garret andHeather decided not to proceed. Garret and Heather also tried artificial inseminationunsuccessfully and have now began the process of adoption.jçff. Jeff is a 34 year old accountant of a Jewish heritage and faith. Wheninterviewed, he and his wife, Rachel had been married for 6 years. They had alwaysplanned to have children and began to try to conceive after 2 years of marriage. After7 months of attempting to conceive, Rachel asked Jeff if he would mind being checkedout for any fertility problems. Jeff went for a sperm test, simultaneous to Rachel47being tested for fertility impairments.. He then found out that he had a low spermcount; however, “not so low that it should be a problem”, according to the doctors.Jeff then went through minor surgery and the doctors found that the sperm were notmaturing enough, and would die before conception. After recognizing the problemJeff and Rachel decided to have children through artificial insemination by a donor.Approximately 3 months after the diagnosis of infertility, Jeff and Rachel went forartificial insemination. After only one cycle of insemination, Rachel became pregnantand delivered a baby girl. After two years, they decided to try artificial inseminationby a donor again in order to have a second child. Again Rachel was pregnant after thefirst attempt. On each occasion, just following the insemination, Jeff and Rachel hadsexual relations. Jeff still wonders if the two girls that were the result of D.I. (DonorInsemination) may really be his own biological offspring.At the time of the interview, most of their friends were unaware of theirpresent situation, and they were wondering about how to tell their children of theirconception or if they should not tell them at all.Sean. At the time of the interview, Sean was a 28 year old Elementary Schoolteacher, who had been married for 5 years to his wife, Melody, a 26 year old Englishinstructor. Both Sean and his wife are practicing Catholics. Sean had known of hisinfertility for 5 years. As a child, Sean had a condition in which his testicles had notdescended. At 12 years of age, Sean received drug therapy to try and help the testiclesdescend; however, it was successful for only one testicle. Sean then underwentcorrective surgery in order to lower the second testicle.48Before Sean and Melody were married, Melody had a medical check up andtold her doctor of Sean’s situation. He advised that Sean get a sperm test to ensurethat his fertility was not in jeopardy. So, just six weeks before getting married, Seanwent for a sperm test, only to find out that he had a very low sperm count;approximately 2 percent of what would be considered normal.Despite this news, Sean and Melody married with the conviction that somehow,they would have children. Both Sean and Melody had come from large families andboth wanted a large family of their own. The only medical intervention available tothem was donor insemination, which they did not attempt. Five years later, a fewmonths previous to the interview, Sean and Melody adopted a baby boy and areconsidering another adoption attempt.Bob. Bob, at the time of the interview, was a 35 year old seminary student,working towards a Masters of Divinity degree. He had been married to his wifeCathy, a data processing clerk, for 15 years and had known about his infertility for 13years.A year after Bob and Cathy were married, they decided that it was time to starta family. They both had always desired to have a family of their own and assumedthat they could do so. After 6 months of trying to conceive, Cathy went to her doctor.Because it was easier to test male fertility than female, Bob went for a sperm test. Hewas calm and felt sure that there was no chance that he could be infertile. Two testsconfirmed a diagnosis of a.zoospermia; no sperm in the seminal fluid. The reason orexact cause of the infertility was never pursued. Bob never had a biopsy done to fmd49out the exact cause, because he didn’t want to find out the reason. For Bob, at thattime, to find out the exact reason would then “make it final”.Six months after the diagnosis, Bob had an affair. He felt strongly that it wasin some way tied to his experience of infertility. The affair lasted 3 months.Although Bob could have pursued a medical investigation into why he might beinfertile, he chose not to do so and donor insemination did not appeal to him. Sevenyears later, Bob finally accepted his infertility and he and his wife started the processof adoption. They now have three children through adoption, 2 girls and a boy.Dave. When interviewed, Dave was a 34 year old business analyst and hadbeen married to his wife Lori, an accountant, for 14 years. He had known about hisinfertility for 8 years. In 1985, Dave and Lori decided that it was time to have thefamily they had always wanted. After a year of unsuccessfully trying to conceive,they consulted with their physician about the situation. Dave went for some testingand was shocked to find out that he was infertile. He had 5% to 10% the number ofsperm that would be considered normal. His doctor then referred him to a urologistwho performed a biopsy, but nothing corrective could be done.After a short time, Lori then brought up the option of adoption; but, at thetime, Dave wasn’t in favour of it. A few months later Dave found himself speaking toa friend, who was also infertile, about all the reasons why his friend should adopt. Itthen dawned on Dave that all Dave had been saying to his friend applied just as wellto himself. So, Dave and Lori started the process of adoption. Donor inseminationwas considered but not chosen because both Dave and Lori felt uncomfortable with50this option.In the first attempt at adoption, the birthmother changed her mind and theadoption fell through. Their second attempt also fell through as the parents of thebirthmother convinced her to keep the child. And while waiting for that child, anotherwas offered to them. They declined, as they felt sure that they were going to beadopting already.Their third attempt also failed. They had the child since birth for 5 days,however the birth mother changed her mind and this third attempt faltered. Finally, ona fourth attempt, Dave and Lori adopted a baby boy. A few years later, they adopteda little girl.Then, in 1992, Dave and Lori thought that Lori might have been pregnant.This was a great surprise and joy; however, to their dismay it was not to be. In thefall of 1992, they made the decision that Dave would have a vasectomy. This closedthe chapter for Dave and Lori on the possibility of having any biological children andon raising any more false hopes.L. When interviewed, Les was a 39 year old pastor of a church and hadbeen married to his wife Janet for 17 years. He had known about his infertility for 14years at the time of the interview.Les and Janet were married in 1976. They had always planned to have a largefamily of six or more, as both had come from large families and had valued thisexperience. They waited a couple of years before trying to have children.By 1979, Les and Janet suspected that something might be wrong, so they went51to their doctor and Janet underwent a number of tests checking for fertilityimpairments. As none were found, Les then had a sperm test done. The resultsindicated no sperm in the seminal fluid. A second test only verified the first. Thefollowing year, Les had three operations to try and correct the problem. The biopsyconfirmed that he was producing sperm. The doctors sought to determine why thesperm were not getting to where they should be. It was then that the doctors foundout that Les had had two hernia operations in the lower groin area as a child. The twooperations that followed confirmed that the two doctors who had operated on his twohernias, on separate occasions, had in fact cut the vas deferens tube on both sides.The damage was too severe on one side to even try and reconstruct the tube.Reconstructive surgery on the other vas deferens tube was attempted but did notimprove his fertility.Les was intensely frustrated and angry about the fact that two doctors, three orfour years apart, had each made the same mistake. He then attempted to sue thedoctors for their errors, only to find out that this type of suite had to be processedwithin a year of the event happening. However, Less was unaware at the age of tenthat he was infertile. So, the malpractice suite was abandoned and the hope for havingbiological children was crushed.As Les and Janet did not consider donor insemination to be an option for them,so they decided to build their family through adoption. They began the process ofadopting in the spring of 1980 and brought home a four day old baby girl, two yearslater. They went on to adopt a second baby girl in 1983, when she was 11 days old.52Then in 1985 they adopted two boys who were birth brothers; one at age 5 and theother age 3. Then eight years later in 1993, Les and Janet brought home a 6 year oldboy to adopt. He is Les and Janet’s fifth adoption, making for a family of seven. Lesand Janet and their children are open and considering the possibility of adopting morechildren into their family.Common ThemesIn studying the six protocols, there were two marked distinctions in two of theinterviews when compared to the rest which need to be elaborated on. The firstdistinction was within the interview with Jeff. It was qualitatively different. Thisinterview had within it a number of inconsistencies, suggesting that perhaps theparticipant was not yet fully aware of or connected to his experience. He appeared tostill be denying the reality of his infertility when he stated that he still had hope thathis two children conceived through donor insemination might very well be his ownbiological children because he had intercourse with his wife after each insemination.His belief that his children might be biologically tied to him suggests an inability toreconcile his own infertility. This possible denial also appeared to shaped how heviewed his experience of infertility and the meaning that he made this experience inhis life.The common themes found in the other protocols can be found within thisparticular protocol; however, they were more difficult to extrapolate and appeared torequire more inferential judgements during the analysis. Thus, in the examples of thethemes provided in the following discussion, few statements made by Jeff are cited, as53he did not express the themes as fluently as the other participants.The second marked difference was within the last protocol with Les. Hisexperience was unique in that his infertility was due to human error. It was as a resultof the mistakes of two doctors that Les become infertile. This changed his experienceof infertility in some ways. All of the other participants saw themselves to blame tovarying degrees, for why they could not provide children for their spouses. The causefor their infertility was perceived as internal to themselves, while Les attributed theblame for his infertility to the two doctors who had erred during surgery. Hence, hisown self image or self concept was not altered to the degree that the othersexperienced. Each of the common themes presented were found within the story ofLes’ experience of infertility. His unique situation appeared to provoke Les toexperience a greater intensity of anger, which was more focused and experienced for agreater length of time. This impacted his experience of loss and grief, in that heuniquely felt robbed and cheated. It also impacted his experience of infertility in thatwhile the other participants experienced a need to positively reconstruct their ownidentities (a part of the last theme presented), this theme was difficult to extrapolatefrom his interview. His own self image or self concept was not altered to the degreethat the others experienced, perhaps because he perceived the cause of his infertility asexternal to himself.After an analysis of all of the protocols, a total of eight themes emerged ascommon to them all. The themes are presented in an order that approximates howthey might be found within any one protocol. They are as follows: grief and loss, a54sense of powerlessness and loss of control, a sense of inadequacy, a sense of betrayal,an experience of isolation, a sense of threat or foreboding, a need to overcome orsurvive, and a need for positive reconstruction of the situation and of self.Grief and Loss. For each of the participants, an important part of theirexperience of infertility was a profound sense of loss and grief. Implicit to grief isloss of some kind. There was naturally the loss of fertility, but infertility seemed toincorporate a multifaceted loss, and some of these other losses touched a deeper chordfor these men than just the loss of fertility.The following were mentioned by the participants as different aspects of theloss of fertility that they had to face. The quotes reflect the specific words theparticipants used to describe their losses. They felt a sense of loss of a biologicalchild they would never have or know. They would “never be able to father [their] ownchild”. Some expressed that “it’s a death”, the loss of a “dream child”, the loss of afuture with that child - of what their life would have been like with them. The menalso experienced a loss of manhood where they might feel “less than a man” or “lessthan complete”, or a sense that something had died within them. They expressed thatthey had lost the ability to pass on physical and intellectual characteristics to theirchildren; “I couldn’t pass myself on biologically”. Other losses mentioned were thefollowing: a loss of being able to be “biologically linked” or connected to anychildren they might have through other means (adoption, donor insemination), a “lossof control” of an important aspect of their lives, a loss of an identifying symbol of “acouple’s love for each other”, a loss of some of the meaning that is a part of55intercourse, a loss of the “blood line” and “of carrying on the family name”, and a lossof the hopes and dreams for the future that they as a couple had formed in their desireto have children together.The reactions to the loss in the lives of these men varied in length andintensity, although all experienced grief or a sense of mourning over the losses theyhad incurred. They used words like the following that depict aspects of grief: “shock”,“disbelief’, “denial”, “devastated”, “emotional pain”, “anger”, “anger at God”, a senseof “injustice”, “frustration”, feeling “numb”, and “depressed”. The feelings of grief andloss experienced by these men are reflected in the words of Bob as he talked of theintensity of his grief:At the same time, I was going through anger and deep gut wrenching grief attimes. There would be times when I would just cry, you know, because I feltso desperate to have kids.Being unable to have a biological child was of major significance within thelives of the men. In reflecting on the intensity of this experience, Sean compared hisgrief of infertility to that of his adopted Grandfather dying:It was more grief then I had with. .with the loss of my adopted grandfather. Itwas just. .grief - physical, emotional grief, that I had lost - I had lost this gift,this ability - fertility - the idea that I would never see, never have a child, abiological child that would have some of my characteristics.A little later in the interview, he expressed his feelings around this loss emphasisingthe pain associated with the grief of infertility:56It has been a painful journey, and pain.., and like I say there will be things thatwill bring back memories of those painful moments, very painful times, longperiods of time of pain.A number of the men stated that they realized that their infertility is notsomething that will go away, but rather is a part of their experience that will have tobe dealt with for many years to come and possibly all of their lives.Not only was infertility a long lasting loss to live with, but it came as such ashock for most of these men. All of the men had held the assumption that they couldhave children at any time. There was a sense that they were entitled to have children.Most of their friends were having children at the same time they were trying toconceive. They never imagined that having children would be a difficult task. Mosthad taken precautions to prevent pregnancy, previous to trying to have children. Thuswhen they found out about their infertility, they felt “shocked” because this was notsupposed to happen to them. They also felt “cheated” because they felt this wassomething they had a right to experience and feared they would not. Some suggestedthat this assumption was ingrained in them as boys; that to be a man was to havechildren. Bob stated it very clearly when he said, “I had felt that to be a man, youhad to have children.” Dave learned it from his culture growing up. He stated,I’m sure that if I examine the roots of that (feeling incomplete as a man), it’sthe culture I grew up in.... sex was a big thing and I can remember one of myfriends, his girl friend becoming pregnant and rather that being quite upsetabout it, he was quite delighted cause to him that proved he was a man.57Thus, when they realized they would never have their own biological children, theyexperienced significant shock and a profound sense of loss.Even in the beginning stages of the investigation of infertility, most of the menassumed that if there was a problem, it would be with their wives - not themselves.Bob emphasised that he felt strongly at the time that the infertility problem had to behis wife’s, when he exclaimed,Obviously it wasn’t my problem, it had to be her’s.., infertility is not a maleproblem. It’s a female problem. The woman can’t have the baby. Not theman, it’s the woman... .The woman is the one who needs to be tested, not theman.There seemed to be a sense that these men believed that fertility (and thus alsoinfertility) was a woman’s issue, and therefore shouldn’t touch them.The sense of loss that accompanied their experience of infertility was notsomething that the participants dealt with easily or in a short time. For these men, thissense of loss and grief seemed to return again and again. Different things wouldtrigger the return of the grief, such as seeing other parents with their children,comments from family or friends, or Father’s Day. These events would often triggerfeelings of pain, sorrow, sadness, guilt, anger and depression. With time, these grieffeelings would ease. And for most, it seemed that fatherhood through adoption hadalso lessened the sense of loss and grief.A Sense of Powerlessness and Loss of Control. A sense of loss of control isdefined separate from loss in general, since the men appeared to describe this as a58distinct experience. Up until the time of a diagnosis of infertility, all but one of themen assumed that they were not only fertile, but that they needed to be responsible fortheir fertility and thus placed controls upon it. When the controls (contraceptivedevices) were volitionally lifted, they assumed that pregnancy would result. Thistechnological control over preventing pregnancy gave these men a false sense of powerand control over achieving pregnancy. When pregnancy did not occur the menbecame anxious about what the problem might be. Their sense of entitlement or beliefin their inherent right to have children exacerbated the experience of feeling out ofcontrol and powerless, an experience that resulted in frustration for the participants.When these men were diagnosed as infertile, they reported experiencing a senseof being out of control; an experience that left them initially somewhat immobilized.Sean articulated well this sense of loss of control,.when you are fertile, you have control. That is why you have got allthe.. .that is why you have people trying to prevent conception, and you try andput some control in it by putting a rubber on or taking whatever means ormethods of family planning. You are trying to be in control of this ability youhave. You are trying to master something. So, when you are infertile, you nolonger have this gift. You don’t have this control, this reproductive control.The sense of loss of control that was experienced by the men incorporated farmore than just the loss of control over the ability to impregnate their partners. It alsoincorporated: loss of control in the medical investigation of the infertility and in thetime it took to get appointments with specialists; loss of control of all aspects of their59lives during medical interventions as life was generally put on hold (eg: postponingvacations, changing plans all around IVF treatment); loss of control of their sex life asit became a regimented schedule to achieve pregnancy. They also experienced loss ofcontrol with their family in terms of how family members might react to, or how theymight accept, the decisions that the couple made regarding their infertility and futureparenting options. They lacked of control in the donor insemination program ofensuring that the doctor would not make any drastic mistakes that the couple wouldthen have to live with. They also experienced loss of control over their emotions inthe grieving process; loss of control over the process of getting children throughadoption; and loss of control in determining and assuring their contribution to theattributes and characteristics of children born through D.I. or children they adopted.The sense of powerlessness or lack of control resulted in some of the menfeeling forced to try anything that might help the situation. They felt a desperationthat obliged them to try out any advice that would supposedly solve their problem.This included sometimes listening to well-intentioned friends or family members whoprovided “helpful suggestions”. These solutions often implied that the infertile couplecould get power and control over fertility if only they really knew what to do or trieda secret trick. Garret related how he felt obligated to try these suggestions in order toappease his friends:But the other thing too, is that if somebody gives you a piece of advice likethat, you almost feel compelled to try it out or compelled to do it because nexttime when they say, “Well, did you listen? Did you take my advice?” or the60next time somebody else says it, you can say, “Well, we tried that already”.You know... .1 still have pictures of Heather just about standing on her headwith her hips straight up in the air.... This is on the advice of a urologist!?These experiences took the control of fertility out of the men’s hands completely andserved to increase their sense of frustration at their own lack of ability to change thesituation. Infertility was something that these men felt powerless to change.However, at some point all of the participants began a process of assertingcontrol in their lives, where they actively began to exert some control (eg. choicesregarding the pursuit certain medical treatments or options). These men began toassume control over the areas where they had lost control. This gave them a new senseof empowerment and strength. For example, Garret and his wife began to set limitson the extent of their medical treatment program. He explained,You take control. You take control back and that’s the biggest thing, rightthere. It’s like one morning you just wake up and it’s like, to hell with this.And, you know, we kind of talked in business terms, but, you know, it wasbasically like cutting your losses. This is it! Cut your losses. Let’s get on withit.Garret and his wife began to set different ending dates where they would no longercontinue the treatment process. Dave and his wife eventually took control throughmaking the decision that Dave would have a vasectomy. They took control throughchoosing to close the book on even the slightest possibility of having any biologicalchildren. Les took control by proceeding with a law suite against the doctors61responsible for his infertility. Thus, each participant found ways to take back someaspect of the control that they had lost, a necessary component in the process ofcoming to terms with their infertility and getting on with their lives.A Sense of Inadequacy. A part of each of the participant’s experience of hisinfertility was this deep sense of personal inadequacy which was woven into eachman’s sense of his masculine identity. Each participant expressed their experience ofinadequacy with words like “failure”, “useless”, “a dud”, “less than average”,“inadequate”, “not a full man”, “not a real man”, “less of a man”, “unmanly”, “feel likegarbage”, “defective”, “not a whole person”, “a loser”, “sexually inadequate”,“questioned my manhood”, or questioned “was I married only for my fertility”. All ofthese words describe the mens’ profound sense of personal inadequacy as a result oftheir infertility.Bob experienced infertility as taking away his very sense of masculinity. Likethe others, he grew up with the definition that to be a man meant you had to havechildren; as indicated in the following passage:A man should be able to have children, should be able to give his wifechildren. So, because I couldn’t I wasn’t a real man. That’s what I mean,simple, straight forward. That was my view at that point, of what a real manwas. And so that’s why I felt an attack on my maleness... .1 guess that it allcomes down to one word - inadequate. It’s not that I wasn’t male. I’m stillmale. Maybe it has something to do with masculinity, but then does that meanI’m more feminine? No. It just means I’m not masculine. You know, but I’m62still male.Bob struggled with feelings of inadequacy and within a few months of his diagnosis ofinfertility, had a 3 month affair. After some thought, Bob discerned that his affair wasa reflection of his feelings of inadequacy. He stated that the affair was an attempt“ build up [his] maleness.HTo better express the extent or depth of his feelings of inadequacy to his wife,Sean recalled writing to her about the effect that infertility had had on him in thisarea:With a lump in my throat I wrote that I felt unmanly, inadequate, andpowerless when I compared myself to other men who have children. I told herthat I often tried to compensate for my feeling of inferiority by looking andacting like a super jock... .1 also explained that I felt inadequate sometimeswhen my performance as a sexual partner was not perfect. And, that I imaginemy infertility might have something to do with this.In this quote, Sean disclosed that part of the experience of inadequacy involvedcomparing himself to other men. This was also the case in a number of the othermen’s experiences.Sean also disclosed that he tried to compensate for his feelings of inadequacythrough acting like a super jock. Some of the other men interviewed also tried tocompensate through a variety of avenues. Both Bob and Dave attempted tocompensate for these feelings through devoting more time and energy into beingsuccessful and competent at work. Although all of the participants expressed feelings63of inadequacy, with the passage of time and with working through their issues, thesefeelings eventually subsided. Dave related how he worked through his feelings ofinadequacy through a process of convincing himself of what he still had as a may be just a whole journey of convincing myself intellectually, that this isthe case....Convincing myself that it isn’t necessary for me to be fertile in orderfor me to be a complete person. I’m still a husband and a father. I performjust as well at work. I am just as capable in all other areas of my life.A Sense of Betrayal. The experience of infertility also incorporated a sense ofbetrayal. In living with infertility, these men felt betrayed by their families, friendsand medical professionals. Some of the men reported that extended family did notaccept the reality of the impact of their infertility; they felt others sometimes belittledthe impact that infertility had on their lives. Sometimes the men felt family memberswould deepen the wound of infertility, in assuming to know what the men might beexperiencing or by trying to give advice. Others reported feeling betrayed and rejectedby family members who avoided talking about the issue altogether; interpreting theirsilence as meaning they did not really care or they felt disgrace about their infertilityand thereby reinforcing the men’s sense of shame about their infertility. For theparticipants, these experiences elicited feelings of frustration, anger, a sense ofisolation, and betrayal. Garret illustrated how he felt betrayed by his family in thefollowing way:• . .my family [has] always been great for, I guess the one liners, you know - theone line solutions. You know, “take a holiday”, “relax”, you know, “everything64will work out”, you know? Dad kinda pats you on the back, “Let me show youhow to do it” and that sort of stuff... that’s the way my family treated thiswhole thing and I don’t think, even when my parents, I’ve never really had aserious discussion. I don’t think that they’ve, even to this day, graspedcompletely what we’ve been through.. .it’s not that they wouldn’t understand, Idon’t think they want to understand.Garret interpreted his family’s reaction to his infertility as a lack of caring orunderstanding. Although not explicitly, like the other men in the study, he felt thatwhen he turned to his family for support he was denied and rejected, resulting in asense of betrayal by those he loved and counted on..Some of the men also felt betrayed by the medical system or specific medicalprofessionals. Garret felt betrayed by the medical system for running them through atreadmill of treatments with no apparent caring or end in sight. Les felt betrayedspecifically by the two doctors who made him infertile and who never tookresponsibility for their mistakes. Both Les and Dave felt betrayed by otherprofessionals (eg. social workers) who they expected to have some understanding, butwho they experienced as only betraying their trust though insensitive comments,questions or advice. Most (Garret, Jeff, Sean, Dave and Les) felt betrayed by somefamily members exerting pressure on them to have children, and for their perceivedinsensitivity and their lack of understanding. Some felt betrayed by friends for thesame reasons. Les had hoped that his friends at church might have tried to be helpfulbut he felt they ignored the issue:65None of them reached out to us. This is before the days of quote, end quote,support groups. And nobody knew what to do with us. And so it was justignored. It was basically swept under the carpet at church. Nobody talkedabout it. Not everybody knew, but the one’s who did know - nobody talkedabout it. Nobody dealt with it. And nobody worked anything through with us.All of the men had hoped that they could count on others for support, and were leftfeeling abandoned and betrayed by the people they were counting on the most. Thisexperience of betrayal appeared to increase the men’s sense of isolation, in that theyfelt alone in the struggles to survive with this issue.Some of the men felt betrayed by God, questioning why God had done this tothem. Some of the men felt betrayed by God for the injustice of making them infertilewhen others who abuse their children were not infertile. Bob reflected this commonsentiment when he said:You still don’t want to see people enjoying their kids. You don’t want to seeother people abusing their kids - that’s even worse. God, why did you givethem a child when I want one and I could take better care of them than thatguy.Sean also felt betrayed by God and explained,• .we were both angry at God. We were so angry for different reasons, angryat God for screwing up our plan and thinking, “He (God) really blew it.It was not uncommon for these men to feel betrayed even by their spouse.Some felt their spouse had unjustly blamed them for not giving them children, even66though infertility was never something within their control. One man blamed his wifefor his infertility due to the fact that she had considered the idea of adoption yearsearlier. This was betrayal, because he felt her positive view of adoption hadinfluenced God to make him infertile. Both Bob and Dave felt a sense of betrayal inthat this shouldn’t be a man’s problem. They felt betrayed by society for teachingthem to believe that children and fertility are a woman’s sole domain.For most of the men, these feelings of betrayal subsided over time, although forsome the sense of betrayal still continued. Twelve years after fmding out about hiscondition, Les still felt a great deal of betrayal and anger at the doctors who wereresponsible for his infertility. Bob continued to feel betrayed by people who implythat his family (of three adopted children) was somehow not a real family. The senseof betrayal appeared to lessen for most of these men when they became parents, eitherthrough adoption or donor insemination. Albeit, each man appeared to exhibitdifferent levels of experiencing betrayal at the time of the interview. For some, theirsense of betrayal seemed to be an experience of the past, while others continued toreport this experience.These men all experienced a deep sense of betrayal from a variety of sources:family, friends, spouse, God, medical professionals, social workers, and society ingeneral. Their feelings of betrayal reinforced feelings of isolation, the sense that theywere alone and no one truly understood what they were experiencing.A Sense of Isolation. A very strong theme that ran through all the stories ofthe participants was a deep sense of isolation. When they heard about their own67infertility, the men felt that they had been diagnosed with something few people everhad to bear. Sean expressed this experience of feeling alone or unique:Like we thought nobody was going to have the same problem that wehave.... There was a time in our relationship we thought nobody had this issue,that we were some special couple that had never - the only couple in the wholeworld that has had to deal with such a terrible, dramatic thing, as infertility.Because the experience was very personal and touched feelings of inadequacy,these men also felt inhibited to share their experience and were reluctant to risk thepossibly of not being understood. When they did disclose their secret, if theyperceived that the listener ignored the issue or devalued the importance of it, theyagain felt betrayed. This betrayal of trust would elicit fear of future hurt and thuseach man was inclined to distance himself from others as a means of self protection,thereby increasing his sense of isolation.These men felt the pain of isolation from their families and friends. Many evenfelt isolated from accessing professional help, support groups or other resources. Mostreported experiencing difficulty finding the help that they needed. And even if suchhelp and support were available, some of the men would not have been willing to risksharing their secret. Garret, as a case in point, talked about how at one point in timehe was not willing to go to a local infertility support group, as he did not want to beseen as a “loser”. However, later he sought counselling and reported difficultly infinding any specific counselling resources to help him deal with his infertility.The feelings of isolation were not solely the result of the men’s perception or68reactions to the behaviours of others. The isolation was also a part of the men’sattempts to avoid any more pain; they withdrew to escape from the pain they wereexperiencing. For example, Garret reflected upon how he distanced himself fromothers and stated,Yeah. It’s true because, you know, there’s many times when you just go for awalk and I just didn’t want - hell, I didn’t want to take the dog. I just wantedto get away - just to be apart, just not to have to deal with anything. Kind ofan escape.Later Garret admitted, “We isolated ourselves from a lot of people.” Thus, for themen in the study the experience of isolation was a two way process; isolation inresponse to the behaviour of others and self-imposed isolation through withdrawal.Each of the men also felt for some period of time, a sense of isolation evenfrom their wives. At times each found it difficult to talk to their wives about theirexperiences. For some this was because they felt they were personally at fault, whilefor others their wives became a symbolic reminder of the reality of their owninfertility. In any case, each participant felt isolated for some period of time fromtheir wife. According to the men this isolation was perpetuated both by them as wellas by their spouse. Sean illustrated how the isolation invaded his relationship with hiswife:If Melody was sobbing at night in one side of the bed, I would just turn overand not be.. .not be any sort of source of ... couldn’t really listen to her - reallylisten to what she was communicating and the feelings, the emptiness. There69were times there where I felt Melody was going to leave me. And there weretimes I felt resigned; resigned to the fact that she was going to get up and go.There were times where she would threaten me with leaving me or going homeand at times I felt or I judged that Melody was going to go. So, the feelings ofbeing alone, sometimes feeling hurt, but expressing it. My reaction to itwas being very silent, withdrawing, not wanting to talk about it.This deep sense of isolation from their partners was particularly painful for the men asthey tried to come to terms with the reality of their infertility.However, this emotional isolation did not last forever. After some period oftime (sometimes years), the isolation between husband and wife was overcome. Thesecouples began to see infertility as a shared experience. Many stated that they becamecloser as a couple through their experience. For example, Sean shared how theexperience of infertility eventually made him feel closer to his partner,.1 could never have imagined that an area that had kept us so distant fromeach other, infertility, and in such pain, could make us feel so close.Dave also reported that he felt closer to his spouse in working through this issue withher,.the pain that we have gone through, both in dealing with that (infertility) andwith going through adoption, I think has brought us closer together; helped usto understand how each other works.The deep sense of isolation ended as many found support through others whowere also dealing with infertility. Dave regretted that he didn’t fmd someone he could70talk to about his infertility. He reflects,if I had known enough to think about it and spend time talking to somebodyabout it, I would have gotten through that time more quickly. It wouldn’t havetaken years to finally put it to rest.A Sense of Threat or Foreboding. Within these men’s stories of theirexperience of infertility was a sense of foreboding or threat. Upon the diagnosis ofinfertility, these men not only had to deal with the losses that it brought, but alsosensed a threat to their futures. They were unsure as to what kind of impact infertilitymight have upon the rest of their lives; something that elicited anxiety and fear. Atsome level, each man recognized that infertility threatened the very essence of all thatthey had held as secure; their future family, their marriage, and their personal identity.Not knowing for sure what the full impact of infertility might be, they felt helplessagainst this sense of an impeding doom. Questions that were raised by the experienceincluded: How much would infertility destroy their futures? Would it destroy theirmarriages? Would it permanently wound how they felt about themselves?For each of these men the fears that followed a diagnosis of infertility varied intype and intensity; however, they all induced anxiety, uncertainty, and apprehension.Their fears included such things as the following: the fear of rejection by spouse, thefear that their spouse would leave or divorce them, the fear that the marriage will endbecause of the degree of stress and pain that infertility brought on, the fear that theirspouse would turn to another man and have an affair, the fear that infertility wouldsomehow be used against them in the future by their spouse or others, the fear that71others might fmd out (fear of exposure) and the fear of what others might think ofthem, the fear of facing all of the feelings brought on by infertility, the fear of sharingtheir true feelings with their spouse and others because of possible rejection orhumiliation, the fear that their families might not accept the decisions that theysubsequently make, the fear of medical slip ups or mistakes (eg. in donorinsemination), the fear that their children through donor insemination might not bondwith them, the fear that donor inseminated children may later reject them, and the fearthat their adopted children may one day reject or abandon them.By far the most prevalent fears surrounded their marriages was that theirmarriage might be destroyed by infertility. Garret related how he feared that his wifemight never get pregnant and how he felt guilty over it. He suggested that she havean affair to solve the problem,even after the in vitro, there was still a bit of a, you know, it was almost likea hangover effect and I can’t believe some of the things I said actually that.. .1mean, I was to the point where I was almost encouraging Heather to have anaffair and don’t tell me about it.. .again you’re riding this guilt thing.Sean described how he felt about telling his wife-to-be about his recent diagnosis ofinfertility,I remember having to tell Melody this; feeling panicked, feeling fearful, feelingworried. Now this is a couple of weeks before marriage; feeling kind of scaredbecause maybe Melody would consider it might be wise to hold back off themarriage.72Later, Sean talked about how he thought that Melody would leave him. He fearedrevealing his feelings to his wife and feared how she might feel towards him..1 think Melody was dealing with it (infertility) alone. I was dealing with itdetachedly - going through all the, you know, fear, sometimes thinking that thismarriage was going to be at an end... (later in the interview).. .1 did not want toseriously examine my feelings because I did not want to face the feelings ofpain, sorrow, disappointment and inadequacy. ..I did not want to hear Melody’sfeelings of pain and anger about my infertility.Thus, for Sean, his fear made him seek for the safety of distance in his relationshipwith his wife. This distance further isolated himself from his wife. He felt that themarriage was doomed to destruction and lived with the feeling that he could donothing to stop it.These fears about how infertility would affect their relationships with theirspouses, families and others were experienced by the men as real and serious threats.For the men in the study, the experience of infertility threatened their basic sense ofsecurity in their relationships with their spouses and in their perceptions of what theirfutures would hold.A Need to Overcome or Survive. Although infertility brought with it anumber of fears or threats for these men to cope with, it is important to note that eachalso felt a strong need to overcome these perceived threats that they felt had beenplaced before them. All of the men talked about different ways in which they coped.Implicit to the very essence of coping is the fact that their is a perceived threat and73that the coping is a strategy to survive the threat or ordeal. This coping was necessaryfor the men in order to eventually overcome the threatening aspects of their experienceof infertility. Their use of coping strategies was important to their process of dealingwith the impact of infertility in their lives.Some of the coping strategies used by the men included the following: denial,suppression, intellectualization, escaping, withdrawal, avoidance, self comfortingthrough eating, the use of humour, blaming, fmding emotional support, taking backcontrol in their lives, talking with others who were also infertile, sharing theirexperiences with their spouses, reading books, and coping through focusing solely onpotential solutions to the problem. Some coping strategies were more helpful thanothers. All of these coping strategies were employed in an attempt to cope, to survive,and to eventually overcome the experience of infertility.All of the participants felt a strong need to respond to the impact of infertilityin their lives, and their responses were constructed in the best way each knew how, forthe purpose of surviving the impact of infertility in their lives and marriages. Itseemed that some of the men took on the role of “the strong one” in their relationshipwith their partner. They endeavoured to be strong for their spouse, to ensure that theirpartner and their marriage would survive the experience of infertility. Sean sharedhow infertility brought a great deal of emotional pain for his wife and how he tried tocomfort her, but that the emotions were too much for him at the time.Melody [would be] in tears, angry, feeling alone. A lot of these things I justcouldn’t handle as a man. I couldn’t handle all these things that I was seeing -74all this emotion, all this hurt. I would tell Melody not to even think about it orto “hang in there”, “let’s give ourselves time”...”we can’t give up.”Like many of the other men, Sean tried be strong for his wife endeavouring tosurvive this experience of infertility. It was his role to try and comfort his wife, evenif the feelings that she was expressing made it difficult for him to cope. Sean alsoshared how he initially tried to cope with infertility in his marriage through avoidanceor withdrawal:it was really scary, rough. I mean, I would express no emotions to Melody.I would try not to discuss the matter. I would say, “Let’s give ourselvestime”... .And I think in the first while in dealing with infertility, I think Melodywas dealing with it alone. I was dealing with it detachedly, and going throughall the fear, sometimes thinking that the marriage was going to be at an end,and not willing to communicate, not even having the ability. I think a lot of itwas not having the ability or the honesty to know what I was feeling.Like the other men in the study, Sean was eventually able to share his feelings withhis wife, but only after he had stopped trying to cope through avoidance. Sean, thendeveloped another coping strategy which involved risking sharing his feelings abouthis infertility with his partner as a means of enhancing mutual understanding andsupport.Garret also spoke of a need escape from the situation in order to survivepersonally, but also for his marriage to survive. In speaking about his wife, he statedto her, “You buried yourself in your work.” And then shorter after, Garret reflected75upon how he would cope through trying to “escape”, as he called it. Like many of themen, Garret withdrew or escaped from his partner and the situation as a way coping;as a way for he and his marriage to endure.Jeff’s way of coping was to avoid looking at the impact of the problem,because he couldn’t change the fact he was infertile and to focus on finding a solution.He explained,.bottom line is that, if it’s very important for us, for you to have children,then the answer would be, you will! You will have children if you wantchildren. There are many ways that you can overcome this problem. Andrather than sitting and sulking and wondering.. .take me as an example, andmove on from the pain. Brush off the pain and you know, experience the pain,deal with it! Don’t dwell on it. And do something to overcome it because it’sthe only way you are going to have children.Jeff relied on more action-oriented coping.Each of the men felt a need to overcome and survive the impact of theirinfertility. Infertility was threatening enough for these men to recognize that they hadto respond; even if the response chosen was to deny the reality or impact of infertilityfor a time. This too was a way of coping, a way of surviving. Bob explained thatdenial was part of his way of coping with what he called a “crisis” for a number ofyears:This isn’t happening to me. I don’t need anymore tests. We don’t need toworry about this. Something else will come up... .My wife and I went through76a crisis period. For me it was basically denial. Denial for 7 years, to beexact.... (Later in the interview).. .Denial is a pretty powerful way of dealingwith things. And as long as you’re denying, you don’t have a problem.This way of surviving was utilized by most of the men to some extent, although theduration of this kind of coping varied greatly.All of the men also coped with their situation through gleaning positivemeanings from it. This was another way of coping, surviving and overcoming thenegative aspects of their experience of infertility.A Need For Positive Reconstruction of The Situation and of the Self.Apparent within the stories of these infertile men was a desire or momentum towardstaking this negative situation and gleaning positive meanings out of it. For each of themen in the study there seemed to be a need to find new and positive meanings (orpurposes) to what originally seemed meaningless and painful. Within the protocols,there emerged two main areas of positive reconstruction; one focused on the situationitself, and the other focused on the men’s sense of self or identity.There were many ways in which each of these men positively constructed theirsituation. While each man realized that their infertility took something away fromthem, they each came to realize that infertility also gave different things to them thatthey valued.Each of the men needed to, and came to believe that some good had or wouldcome out of the whole experience. In expressing some of the “good” that they felt hadcome from their experience of infertility, the men used stated that infertility had given77them “more compassion”; “the ability to empathize with others who are experiencingloss”; more caring; “not so judgemental”. They also stated that “it’s broadened mythinking in a lot of areas” and felt that their experience had made them “more sensitiveto other people’s needs”, problems or issues. Some felt that their pain had made themmore aware and sensitive to the pain of other’s. In some cases this was tied to a beliefin a loving God who does not allow for purposeless pain; thus God had some purposefor this experience in their lives. Although a belief in God may have helped some tofind or believe that good would come out of the experience, faith was not a necessarycomponent in the meaning making of all the men.Some of the men felt that their infertility helped them to reprioritize their lifegoals and change their values. Garret’s goal was to be a millionaire by the time hewas thirty. But after his experience of infertility that goal and focus was no longer ofinterest to him. The experience of infertility changed the goals and value systems ofseveral men. Some mentioned that infertility allowed them to dialogue in a moremeaningful way with their family and friends. It also resulted in a number of the mengaining an ability to listen to and talk to others about their concerns and pain,particularly around infertility. Some of the men said that their infertility experienceenabled them to better understand themselves, their childhoods and their relationships.The experience of adoption was also viewed positively by the majority of thesemen. Les told how adoption had not only been “good” for him but also has brought“good” into the lives of his adopted children.a comment that my kids made to me - this is pretty close to a quote, it may78even be a quote - that, “If you could have had kids of your own, you wouldnever have adopted us.” And that also helped me to work it through. Thatagain can relate back to the good that has come out of all of this - is that wehave taken some kids, some of them wouldn’t have had much of a chance otherwise. Because some of our kids were adopted as older, what do you call them,special needs kids.... So, that’s been part of the good that’s come out of it aswell.Five of the six men also referred to their marital relationship as beingstrengthened through the whole experience. When the men moved past feelingpersonally isolated from their wives, they began to risk sharing their inner feelings andexperiences. As they shared their fears and their pain, this sharing tended to bring thecouples closer together. Sean explained this common experience when he said:Until I took this risk in dialogue (communicating with his wife) I could neverhave imagined that an area that had kept us so distant from each other -infertility - and in such pain, could make us feel so close... (later in theinterview).. .Infertility has tested us. It has taken us to the edge of despair andhas brought us to new understandings and depths; new tightness together as acouple.New closeness in their relationships was seen by the men as a very positive outcomeof the whole infertility experience. Some of the men even suggested that because theirrelationship had endured infertility, it gave them hope and strength that theirrelationships could face and endure any other problems that might come in the future.79Not only did the men feel a need to positively reconstruct and make sense outof their infertility, but they also had a need to positively reconstruct their sense of self.With the loss of fertility, these men felt that they had lost part of themselves. Manywent through a process whereby they reevaluated and redefined their worth asindividuals. Dave explained his process of self reevaluation:I was convincing myself that it isn’t necessary for me to be fertile in order forme to be a complete person. I’m still a husband and a father. I perform justas well at work. I’m just as capable in all other areas of my life.Most of the men felt a need to redefine their sense of masculinity. This need ofpositively reconstructing their sense of self appeared to be closely tied to their feelingsof inadequacy as men. Bob shared how he felt that his “. . .maleness had beenattacked...” and felt that if he had had a better self image and sense of what it meant tobe a man that the impact of infertility would have been less. He stated,If I’d had a good self-image, a good image of myself, a good hold on what itmeant to be masculine, what it meant to be male, I think it (infertility) wouldhave affected me a lot less; a lot less. Because maleness doesn’t come fromhaving kids. It doesn’t come from having the ability to give a woman a baby.It’s something else.Like the other men in the study, Bob had to rework his personal definition ofmasculinity. He sensed a need to positively reconstruct this aspect of his identity. Herecognized that a significant portion of his definition of masculinity consisted of theability to impregnate. Thus, his loss of fertility compelled him to build a new80definition and understanding of masculinity and a new self definition.Although these men may have reconstructed more positive self images and cansee positive aspects of this difficult life experience, they in no way implied that theynow think of their infertility only as a positive experience. A number of the menstated that they had come to the realization that infertility would be with them for therest of their lives. Although they may have come to terms with their losses and evenidentified some gains, they recognized that in some sense they may never be able toclose the book on the impact infertility has had on their lives. Bob expressed it wellwhen he said,I think that the biggest thing that we’ve had to work through as a couple andme as a person, is just learning to live with it. Because it changes everything.Being infertile changes everything.81CHAPTER 5Discussion And ConclusionThe purpose of this study was to explore and document the nature of childlessmen’s subjective experience of male factor infertility. The research was conductedusing a phenomenological paradigm (Colaizzi, 1978) to inform the researcher of thesemen’s attempts to make meaning out of their experience of infertility. The primaryresearch question being asked was: What is the experience of infertility as lived byinfertile men? The researcher sought to illuminate the meaning of the experience ofinfertility for men through an analysis of six participants’ narratives.This chapter includes a synopsis of the essential structure of the experience ofmale factor infertility, as well as a comparison of the findings with the researchliterature. The chapter concludes with a focus upon the implications for futureresearch, practical implications for counselling, and a brief conclusion.The Essential Structure of the Experience of Male Factor Infertility for MenThe following synthesized description of these six mens’ experience ofinfertility has within it a process or journey through which these men travelled. Theseresults may not be generalizable to larger populations until further research cansubstantiate or refine the themes presented in this study. Although the themesdescribed may sometimes appear to be discrete, discontinuous or possibly sequential, itis important to recognize that the phenomenological perspective attempts to representan integrated or holistic understanding of the experience (Colaizzi, 1978; Giorgi,1985). The themes were not experienced as isolated parts of their experience, but82rather, were intertwined throughout the stories of these men’s experience of infertility.Prior to finding out about their diagnosis of infertility, all of the men in thisstudy desired a family. They assumed that they would be able to have children andfelt that they were entitled to this right and tradition. Many felt pressure from society,friends, family and sometimes even their partners to have children. It was never aquestion of “if’ for these men but rather a question of “when”.Each of the participants assumed that they were not only fertile, but that theyneeded to be responsible for their fertility and thus placed controls upon it. When thecontrols (contraceptive devices) were volitionally lifted, they assumed that pregnancywould result. This technological control over preventing pregnancy gave these men afalse sense of power and control over achieving pregnancy.At some point, each couple decided that it was time to start a family. As timewent by, most of these men did not consider that there might be a problem. Instead,they comforted their spouses through reassuring them that these things take time andnot to worry about it. Eventually, usually after a year or so of trying to conceive,each couple went to their doctor to investigate the situation. The men of this studyexperienced anxiety seeing the doctor, not knowing what he or she would say or do.The family doctor either sent them to a specialist or else began some kind ofexploratory testing of both the men and their partners.Each man was asked to supply a semen sample for testing their sperm countand mobility. The men in this study had mixed feelings about doing such a test andfelt humiliated and awkward in handing in their sample to a lab technician. Often there83was a sense of shame handing in such a sample due to the stigma of masturbation andthe men’s recognition that all the clinical staff were fully aware of how such sampleswere retrieved. Usually 2 or 3 samples were required and sometimes more if resultswere inconclusive or if the effectiveness of a treatment was being evaluated.All of the men in the study assumed that if there was an infertility problem, itwould most likely be their wives. Thus, when they received the news that they wereinfertile, their was a great sense of shock and disbelief. Some of the men stated thatthey went into denial over the reality of their diagnosis. The length and intensity ofthe denial varied greatly for these men. But at some point, they eventuallyexperienced the full impact of their loss.These men experienced a profound sense of grief and loss over the biologicalchild they would never have or know. They compared it to that of a very closefriend’s death. They felt devastated, angry, frustrated, a sense of injustice, as well as,feeling “numb”, and depressed. Infertility was a difficult loss to grieve for these mendue to the fact that it was an unseen loss, not recognized by others. Their experienceof loss and grief seemed to return again and again. Different events or situationswould trigger the return of the grief, such as seeing other parents with their children,comments from family or friends, and Father’s Day. These events would triggerfeelings of pain, sorrow, sadness, guilt, anger and depression.When the men of this study were diagnosed as infertile they also experienced asense of powerlessness and being out of control; an experience that left them initiallysomewhat immobilized. The sense of powerlessness resulted in some of the men84feeling intense desperation to try anything that might help the situation. They feltobliged to try out any advice that would supposedly solve the problem. Thesesolutions offered by well-meaning friends and family often implied that the couplereally could get power and control over their fertility if only they knew what to do orif they tried the right trick.While the participants had to deal with their loss and grief, and feelingpowerless to change their situations, they also examined themselves as men. Theyrealized that a part of their own definition of what it meant to be a man involved theability of having children. They did not meet this requirement and experienced apersonal sense of inadequacy and shame. These men felt like they had let their wivesdown in not fulfilling their marital duty.The men of the study experienced a crisis that called their masculine identitiesinto question. Who they had thought they were had changed or no longer existed.They could no longer have their own children. They could not give the children theirspouses so desperately wanted; a symbol of their own male maturity and virility.Thus, they felt they were no longer adequate as marriage partners because they couldnot fulfil their essential part in providing children; an expectation they and theirpartners had for marriage. Many of the men in the study tried to compensate for theirfeelings of inadequacy. One reported acting like a “super jock”, while otherscompensated by devoting more time and energy into becoming successful andcompetent at work. One man had an affair 3 months after his diagnosis of infertilityand realized that this, too, was a way of trying to validate his masculinity.85Their deep sense of inadequacy and the personal nature of their experienceinhibited these men from talking to others about their experience. They were reluctantto risk the possibly of not being understood. They felt that to be open might bringshame or humiliation. When they did disclose their secret, if they perceived that thelistener ignored the issue or devalued the importance of it, these men felt betrayed.This betrayal of trust elicited fear of future betrayal and thus they were more inclinedto distance themselves from others as a means of self protection. This defensivestrategy only worked to increase their profound sense of isolation.Their sense of betrayal and isolation seemed to work in conjunction with eachother. The greater the experiences of betrayal, the deeper the sense of isolation. Themore isolated these men felt from the people they thought they could count on, thegreater the sense of betrayal.The men of this study felt betrayed by their families and friends for theirinsensitivity and belittlement of the impact of infertility upon their lives. They feltbetrayed and rejected by family or friends who avoided talking about the issuealtogether; interpreting their silence as meaning they did not really care or they feltdisgrace about their infertility and thereby reinforced the men’s sense of shame abouttheir infertility. They felt betrayed by God; questioning why God had done this tothem, when others who abuse children are infertile. These men felt betrayed evenby their spouse for not being understood or for being blamed for not being able toproduce children.Their sense of betrayal elicited a sense of isolation in their relationships with86their spouses. At times the men of this study found it difficult to talk to their wivesabout their experiences with infertility. They felt personally at fault and their wivesbecame a symbolic reminders of the reality of their own infertility. These men wouldalso isolate themselves from their wives’ experiences of pain surrounding infertilitybecause this would elicit pain for them as well as feelings of powerlessness in notbeing able to do anything to change the situation.As these men looked to the future, they experienced anxiety and fear as to whatthe full impact of infertility might bring upon them; it was a sense of foreboding orthreat to their futures. At some level, each man recognized that infertility threatenedthe very essence of all that they had held as secure - their future family, theirmarriage, and their personal identity. Not knowing for sure what the full impact ofinfertility might be, these men felt helpless against their sense of impeding doom.They feared being exposed, shamed, humiliated, devalued, and rejected; but the mostprevalent and intense fear was a fear that their marriage would not survive the stress,strain and pain of infertility.All of the men of the study felt a strong need to respond to the impact ofinfertility in their lives. They endeavoured to cope through a variety of means inorder to survive their ordeal. Some of the men took on the role of the strong one intheir relationship with their partner. They endeavoured to be strong for their spouse,to attempt to ensure that their partner and their marriage would survive the experienceof infertility.As time pasted, these men eventually began a process of recovery. At some87point, they realized they really did not loose all control in their lives as previouslythought. The men of this study realized that they did have a measure of control intheir lives and began to assert their control over areas in their lives where they couldassert control. They could not change the reality of their infertility, but they did havethe power to decide the extent of the medical investigation, what options to proceedwith and the power to choose adoption, donor insemination, or to remain childless.This new awareness of the choices that they did have revitalized their sense of powerand control in their lives.These mens’ process of recovery also included taking risks to share theirexperience with their partners and with other people. This started the process ofbreaking down the walls of isolation they had experienced so significantly earlier.They started to see they were not alone in their experience with infertility, but that itwas a shared experience of betrayal, pain, loss, and grief with their spouses. Many ofthe men in the study stated that their marriage relationships become emotionally closerand more meaningful. They also risked sharing their experience with others; usuallyon a one-to-one basis and some were able to find other men who had had similarexperiences.A major part of the process of recovery for these men was a desire towardstaking this negative situation and pulling positive meanings out of it. These menfound new and positive meanings (or purposes) for an experience that originallyseemed meaningless and painful. They felt that their experience of infertility hadgiven them more compassion, empathy, and sensitivity to other people’s needs,88problems and issues. They felt that they had grown to be more open and lessjudgemental. They felt that their experience of infertility had helped to reprioritizetheir life goals and values, and that it had deepened their communication andconnectedness with family and friends. Most of all, the majority of the men in thisstudy felt that it had been the catalyst for building a stronger and closer relationshipwith their spouses.Not only did the men of this study feel a need to positively reconstruct andmake sense out of their infertility, but they also had a need to positively reconstructtheir sense of self. With the loss of fertility, these men felt that they had lost part ofthemselves. Many went through a process whereby they reevaluated and redefinedtheir worth as individuals. Most of the men felt a need to redefine their sense ofmasculinity. As they did so, they recognized that they were still men and could feelmore positive and secure about their sense of masculinity.Five out of six of the men eventually adopted, while one went through donorinsemination to achieve parenthood. With time and the experience of fathering, theintensity of the experiences of infertility diminished. It must be pointed out, however,that all the men felt that their infertility is an issue they will have to deal with for therest of their lives.Comparison to the LiteratureIn this study the researcher investigated the experience of male factor infertilityfor men. The empirical research on the psychological aspects of infertility is fraughtwith methodological problems. In particular, some researchers have neglected to89incorporate the etiology of infertility as a significant variable in their researchinvestigating the experience of infertility for men or in comparative studies of men’sand women’s response to infertility (Bernstein et al., 1985; Draye et al., 1988;MacNab, 1986). Other research is problematic due to the skewed under-representationof male factor infertile participants within these studies (Abbey et al., 1991; Brand,1989; Ulbrich et a!., 1990). Therefore generalizations and conclusions as to the natureof the experience of male factor infertility for men has been difficult to ascertain fromthis research.In the present study, a qualitative methodology was employed to investigate thephenomenon of male infertility. Most results of the previous studies reviewed in thispaper are based on quantitative analysis of specific variables. However, a comparisonof the findings of this study to existing research will be attempted.The literature as a whole appears to agree that infertility is an important eventin people’s lives that produces significant distress, although, there appears to be anassumption that this phenomenon does not meaningfully impact men to the samedegree or intensity as it does women (Abbey et a!., 1991; Bernstein et al., 1985;Brand, 1989; Draye et al., 1988; Ulbrich et al., 1990). The findings in this studyfindings are contrary to this perception, and indicate that men who experience malefactor infertility perceive it as a significant loss in response to which they feel grief,depression, powerlessness, inadequacy, betrayal, isolation, fear, and a sense of threat.The experience of infertility for the participant’s of this study was both meaningfullysignificant and intense.90These findings concur with Daniluk (1988) who found that the distressassociated with infertility was greater for the individual identified as having an organicfertility problem. This suggests that for couples with male factor infertility, the manmay indeed experience greater distress. In this study, it can not be inferred thatinfertile men experience more distress than their partners as it was not a comparativestudy and the partners of these men were not interviewed. It can only be stated thatthe men of this study experienced significant pain in response to their infertility. Pastresearch which has neglected to incorporate the etiology of infertility as a significantvariable or which has a skewed under-representation of male factor infertileparticipants, may have erroneously discounted or minimized the experience ofinfertility for men.Grief and Loss. The men in this study experienced a profound sense of lossand grief. The reactions to the loss in the lives of these men varied in length andintensity, although all experienced grief or a sense of mourning over the losses theyhad incurred. They experienced feelings of “shock”, “disbelief”, “denial”,“devastation”, “emotional pain”, “anger”, “anger at God”, “injustice”, “frustration”,“numbness”, and “depression”. These emotional reactions to infertility are consistentwith the reports of many researchers who have investigated the experience of infertility(Berg and Wilson, 1990; 1991; Daniluk, 1988; Feuer, 1983; Mahlstedt, 1985;Menning, 1980;Valentine, 1986; Wright et al., 1989). Based on the results of hisstudy, Valentine (1986) concurs that couples experience strong emotional reactions toinfertility such as sadness, depression, confusion, desperation, hurt, and humiliation.91Valentine also suggests that it is important to understand infertility as a multiple lossand multiple stressor.The men in this study articulated a number of losses that they felt as a result ofinfertility. The felt a sense of loss of a biological child they would never have orknow. Some expressed it as a death, the loss of a “dream child”, the loss of a futurewith that child - of what their life would have been like with them. The men alsoexperienced a loss of manhood where they might feel “less than a man” or “less thancomplete”, or a sense that something had died within them. They expressed that theyhad lost the ability to pass on physical and intellectual characteristics to their children.Other losses mentioned were the following: a loss of being able to be biologicallylinked or connected to any children they might have through other means (adoption,donor insemination), a loss of control of an important aspect of their lives, a loss of anidentifying symbol of a couple’s love for each other, a loss of some of the meaningthat is a part of intercourse, a loss of the “blood line” and of carrying on the familyname, and a loss of the hopes and dreams for the future that they as a couple hadformed in their desire to have children together. These losses have also beenrecognized and recorded by Mahlstedt (1985), Menning (1980), and Valentine (1986).They concur that these losses are significant for anyone experiencing infertility.A Sense of Powerlessness and Loss of Control. The participants within thisstudy also experienced a sense of powerlessness and feelings of being out of control.This loss of control extended far beyond the loss of control over the ability toimpregnate their partner. They felt powerless throughout the medical investigation,92and powerless to change or fix the situation. They felt a loss of control of their sexlife as it became a regimented schedule to achieve pregnancy, and they experienced aloss of control in determining and assuring their contribution to the attributes andcharacteristics of children born through D.I. or children they adopted.Although the empirical research has not specifically investigated powerlessnessand loss of control, both Menning (1980) and Mahlstedt (1985) state that the infertilecouple may experience loss of power and control over their lives. Daniluk (1991)suggests that many infertile men experience considerable distress at being unable toease their partner’s pain or help ‘fix’ the problem.Other research appears to implicitly support this fmding specifically in the areaof sexual performance. The findings of research by Andrews et al. (1991) aresupportive in reinforcing the relationship between increased stress due to infertility anddecreased sexual self-esteem and satisfaction with their sexual performance. Valentine(1986) concurs that infertility places a strain upon the sexual relationship of a couple.However, although Berger (1980) reports that it is common (63%) for infertile men toexperience a period of impotence lasting 1 to 3 months after diagnosis, this was notreported in the experience of the men of this study. It could be that impotence wasnot experienced by the participants of this study, or it may be that they did experiencea period of impotence, but chose not to speak of it. If this were so, it could be fortwo reasons: (1) it was either too personal to share within a tape recorded interview or(2) it was not as significant as that which was shared. The men of this studyexpressed how part of their experience of infertility included a deep sense of93inadequacy. This deep sense of inadequacy may have been the primary experiencethat the men of this study wanted to communicate, rather than the secondaryexperience of impotence as a result of an infertility diagnosis.These studies appear to suggest that infertile men may experience a sense ofpowerlessness or loss of control due to their experience of infertility. Althoughempirical research has not specifically investigated the experience of powerlessness orloss of control as a result of infertility, research does not dispute this fmding.Anecdotal accounts (Menning, 1980; Mahlstedt, 1985) of the experience of infertilityconcur with the results of this study.A Sense of Inadequacy. A part of each of the mens’ experience of infertilitywas a deep sense of personal inadequacy which was woven into each man’s sense ofmasculine identity. They expressed their experience of inadequacy with words like“failure”, “useless”, “a dud”, “less than average”, “inadequate”, “not a full man”, “not areal man”, “less of a man”, “unmanly”, “defective”, “not a whole person”, “a loser”,“sexually inadequate”, “questioned my manhood”. All of these words describe themens’ profound sense of personal inadequacy as a result of their infertility.These findings are consistent with research which indicates that infertile peopleoften experience a sense that they are damaged goods (Abbey et al., 1991; Leader Ctal., 1984; Seibel & Taymor, 1982). Self image and self esteem may decrease alongwith the person’s own sense of femininity or masculinity (Leader et al., 1984;Menning, 1977).If it can be assumed that feelings of inadequacy may effect sexual performance,94these findings are then consistent with most of the research. Ulbrich et al., (1990)indicate that men who are the source of a couple’s infertility reported less satisfactionwith the expression of affection and sex in their marriages than other men in theirstudy from infertile marriages. The findings of Andrews et al., (1991) also suggestthat increased stress due to infertility is directly related to decreased sexual self-esteem,and decreased satisfaction with sexual performance.Despite the congruence of the this study with some of the findings of theresearch noted above, it must be pointed out that the findings of this study werecontrary to a recent study by Kedem et al. (1990). In their comparison of men whosuspected they may be infertile with men who had no such suspicion, no significantdifferences were found as to feelings of sexual inadequacy. It may be inferred by theirresearch that infertility does not elicit feelings of inadequacy for men. Although thispresent study did not compare infertile men with fertile men, this researcher found thatthe infertile men of this study experienced a deep sense of inadequacy.There are three possible conclusions that could be drawn from this discrepancy:(1) the two studies are not measuring or reporting the same aspect of the experience ofinfertility for men, (2) Kedem et al. ‘s study accurately depicts that infertile men do notexperience a sense of inadequacy and this present study is not representative of mostinfertile men or (3) that Kedem et al. ‘s study does not accurately depict the experienceof inadequacy for infertile men.All three are valid possible explanations for the discrepancy of the fmdings.However, when considering Kedem et al. ‘s findings, it is important to note their small95control group (N30). When the control group is this small in comparison to the largesample of 107 suspected infertile men, it may be responsible for the lack of statisticalpower to distinguish relevant differences between the two groups. Thus, Kedem et al.(1990) did not find that suspected infertile men had significantly greater feelings ofsexual inadequacy do to the small control group that the suspected infertile men werebeing compared with in the study. This would give credence to the third possiblereason for the discrepancy between Kedem et al. and this present study; that Kedem etal. ‘s study does not accurately depict the experience of inadequacy for infertile men.It is also possible that the two studies are not measuring or reporting the sameessence of the experience of infertility for men. Kedem et al. (1990) measured sexualinadequacy in concrete behavioral terms. Four questions were asked to determine anindividual’s sexual inadequacy score. They were asked if they had experienced anyproblems with the following: (1) achieving erection or maintaining it during sexualintercourse, (2) premature ejaculation, (3) difficulty in ejaculating during sexualintercourse, and (4) lack of interest in, or pleasure from, sexual intercourse. Althoughthe infertile men of this present study may have experienced some of these sexualproblems, the essence of the theme of inadequacy is much broader in definition orscope than that of Kedem et al.’s definition of inadequacy. The infertile men of thisstudy reported feelings of inadequacy that related to their role as men and husbands.A few of the men did express feelings of sexual inadequacy; however, these feelingswere only a part of their overall feelings of inadequacy. Therefore the study byKedem et al. (1990) and this present study may be tapping into different elements of96the experience of infertility for men.A Sense of Betrayal / A Sense of Isolation. In this study infertile menreported experiencing a deep sense betrayal as a part of their experience of infertility.Their sense of betrayal appeared to work in conjunction with their experience ofisolation. The men felt isolated and betrayed by friends, family, medical professionals,society, their spouse, and God. They used isolation as a means of self-protection toavoid more pain. These findings coincide with anecdotal descriptions (Menning, 1980;Mahlstedt, 1985) of the effects of infertility as well as findings from some of theresearch (Andrews, et al., 1991; Berg & Wilson, 1990; Brand, 1989; Daniluk, 1991;Feuer, 1983 Valentine, 1986) examining the effects of infertility in general. Berg andWilson (1990) report that the stress of infertility is reflected in interpersonal alienation.Due to each partner dealing with their own loss, there can be a loss of closenessbetween partners, as neither may have the inner resources to support the other(Daniluk, 1991; Mahlstedt, 1985; Menning, 1977). The participants of this study alsofound that there was less closeness in their marriage relationships due to theirperceived sense of blame from their spouse for the infertility or their own withdrawingfrom their spouse, as their spouse became a symbolic reminder of own infertility.Andrews et al., (1991) relates that the increased stress due to infertility is directlyrelated to increased marital conflict. Although the men in this study did not all relatethat there was increased marital conflict as a result of infertility, most did allude tosome marital conflict as a part of their experience of infertility. Marital conflict maybe experienced as a sense of betrayal from their spouse. It can also be experienced as97a sense of isolation from one’s spouse. Both of these experiences (betrayal andisolation) were experienced by most of the men in regard to their marital partners.Therefore, this research generally concurs with Andrews et al. (1991).Valentine (1986) reported in her study that the sources of stress for infertilecouples were from: medical procedures; medical staff insensitivities; unhelpful andinsensitive comments from family and friends; society’s negative perception andstigmatization of childlessness; strained sexual relationship; and adoption workers whoexpect them to demonstrate that they have emotionally resolved their feelings ofinfertility. These are also factors mentioned by the men in this study. Valentine statesthat these things were sources of stress. Within this study, these experiences elicitedfeelings of isolation and betrayal. Some of the men reported that extended family didnot accept the reality of the impact of their infertility; they felt others sometimesbelittled the impact that infertility had on their lives. Some of the men felt betrayed byprofessionals (eg. social workers) who they expected to have some understanding, butwho they experienced as only betraying their trust though insensitive comments,questions or advice.A Sense of Threat I A Need to Overcome and Survive. In this studyinfertile men were unsure as to what the full extent of the impact infertility might haveon their lives, resulting in a great deal of anxiety and fear. At some level, theyrecognized that infertility threatened the very essence of all that they had held assecure; their future family, their marriage, and their personal identity. To overcomeand survive they employed a variety of coping strategies in order for them to cope98with the issues related to their infertility.These findings are consistent with many researchers (Abbey, et al., 1991;Andrews & Arbor, 1991; Kendem, et al., 1990; Bresnick & Taymor, 1979; Clapp,1985; Daniluk, 1991; Daniluk, et al., 1987; Mahlstedt et al., 1987; Menning, 1980;Valentine, 1986 ) who report emotional reactions of frustration, anger, sadness, guilt,depression, confusion, desperation, hurt, humiliation and isolation in response to thecrisis of infertility. Crisis involves a sense of threat and by it’s very nature requirespeople to cope, survive and overcome that which elicited the crisis. This sense ofcrisis or threat coincides with the experience of the men in this study who felt thattheir marriages and their futures were threatened by infertility. The men employed avariety of coping strategies in order to survive this perceived threat.Cook et al. (1989) report that when infertile couples are divided into high andlow distress groups and compared with respect to their use of different copingstrategies, those who are anxious and/or depressed are more likely to engagespecifically in avoidance coping strategies. Avoidance is reported to be one of theways in which the men in this study coped with infertility. However, the men in thisstudy used a number of different ways to cope: denial, suppression, intellectualization,escaping, withdrawal, self comforting through eating, using humour, blaming, findingemotional support, taking back control in their lives, talking with others who were alsoinfertile, sharing their feelings and experiences with their spouse, reading books, andcoping through focusing solely on potential solutions to the problem.99A Need for Positive Reconstruction of The Situation and The Self. Theresults of this study indicate that infertile men have a desire to take the negativesituation of infertility and glean positive meanings out of it. They need to find newand positive meanings (or purposes) in making sense of and integrating an experiencethat originally seemed meaningless and painful. There is no support in the existingliterature on infertility for this theme. This finding is neither substantiated norunsubstantiated by the research on infertility to date. This may be due to two factors.The first is that most of the research on the psychological aspects of infertility hasbeen quantitative and specific in nature and therefore would not find such a outcome.This research is exploratory in nature and therefore does not seek to verify a specificset of hypotheses. Rather, the phenomenological research paradigm seeks to let thedata speak for itself (Colaizzi, 1978; Giorgi, 1985; Osborne, 1990). The second factoris that a number of the research studies (Abbey et al., 1991; Bernstein et al., 1985;Brand, 1989; Draye et al., 1988; Ulbrich et al., 1990) on the psychological aspects ofinfertility have implied that infertility does not impact men to the same degree aswomen; therefore, researchers have not focused upon the meaning infertile menattribute to their experience of infertility.It could be that the process of positive reconstruction is one way of coping withinfertility. To reframe one’s understanding and perspective to an event may changehow one feels about the event. An ascribed positive meaning and purpose to anegative event may elicit positive feelings about such an event and stop endless ‘why’questions. Ascribing positive meanings may also give a sense of meaning and purpose100to negative events in one’s life. If a negative event has a positive purpose or meaning,then a person may be better able to accept the reality of the negative event.Conclusions. The empirical research on the psychological aspects of infertilityis fraught with methodological problems. Researchers have neglected to incorporatethe etiology of infertility as a variable in their research and many studies have askewed under-representation of male factor infertile participants. Thereforegeneralizations and conclusions from this research as to the nature of the experience ofmale factor infertility for men are difficult.Although there is an assumption that infertility does not meaningfully impactmen to the same degree or intensity as women (Abbey et al., 1991; Bernstein et al.,1985; Brand, 1989; Draye et al., 1988; Ulbrich et al., 1990), this study’s findings arecontrary to this perception. The experience of infertility for the participant’s within thisstudy was both meaningfully significant and intense.The specific themes of grief and loss, powerlessness, inadequacy, betrayal, andisolation all appear to be generally supported by the research on the experience ofinfertility in general. These findings specifically contribute to our understanding of theexperience of male factor infertility for men.Implications for Future ResearchThe focus of this research has been upon the experience of male factorinfertility for men. There is a lack of research which incorporates the etiology of acouple’s infertility as a significant factor in analysis. Thus, more research is neededwhere this factor is taken into account. With the etiology of a couple’s infertility101factored into the analysis, a clearer understanding may emerge of the experience ofinfertility for both men and women. Future research needs to investigate the nature ofthe female partner’s experience of male factor infertility, as well as, the male partner’sexperience of female factor infertility. Future research is also needed in understandingthe essence of the experience of unexplained infertility for both men and women.Since all of the men of this study were white, middle class, and in their mid tolate 30’s, research into the experience of infertility from different cultures, socioeconomic levels, and age groups might provide additional information concerningmens’ experience of infertility. For example, the men in this study report that theyexperienced a deep sense of inadequacy and felt betrayed by society for teaching themthat fertility is woman’s domain and issue. An investigation of men’s experience ofinfertility from other cultures and religious orientations where attitudes regardingfertility may be different from our culture, would offer a comparison to the findings ofthis study. As well, a comparison of the experience of infertility for men in their 50sor 60s would also provide a comparison to the findings of this study.The men in this study used a variety of coping styles in dealing with theirexperience of infertility. Some of the men reported that they were in denial for anumber of years before they came to the point of accepting the reality of theirdiagnosis. Others appeared to not utilize denial to the same extent. A studyinvestigating the nature of different coping strategies for infertile men would help toinform how men may be able to cope with infertility better and how professionalscould be helpful to men in coming to terms and accepting their infertility.102According to the results of this study, the marital relationship for some infertilemen may come close to dissolving. Research investigating men or women’sexperience of infertility where the relationship survived with relationships that did notsurvive would give valuable information for practitioners who are working withinfertile couples; to discover more constructive ways of resolving problems for infertilecouples whose relationship might be in distress as a result of the impact of infertility.Finally, due to the lack of phenomenological research on the experience ofinfertility for men and the small size of the sample of this study, there are limitationsas to the generalizability of these findings. Replication of this study with a largersample size may contribute to a greater and more continually refined understanding ofthe meaning of this phenomenon.Implications for CounsellingOf the six men who took part in this study, one went to formal counselling,and three went to their pastor or priest for counselling regarding their infertility. Allof the men risked telling others about their problem, however, most did not feel heardor understood and thus felt betrayed. Some of the men felt betrayed by professionalswho invalidated their feelings and experiences. The men felt that these professionalsshould have known better, and should have been more understanding and moresensitive to the pain that they were experiencing. Thus, it is vital to explore whatimplications this research may have upon counselling.In trying to understanding the nature of the experience of infertility and itsimplications for counselling, an important question to address is the following: how is103male infertility unique as an experience of loss? Or what is specific to the experienceof infertility for men as opposed to other losses?There appears to be three significant aspects to the experience of infertility formen that are unique. First, infertility for these men in general was an unseen,unrecognized loss. Their infertility was not recognized as a loss by society in general.The multiple losses associated with infertility were not seen and were not concrete innature. Thus, counselling could be beneficial in helping a person understand the fullnature of their losses and may help in the process of grieving the losses of infertility.Secondly, infertility is unique as a loss for men in that there appeared to be alack of lay support for the men in this study. A number of the men stated that theresearch interviews provided the first opportunity to talk about their entire experienceof infertility with another person other than their spouse. After the interviews werecomplete, a number of the men commented that they had found the experience ofbeing able to talk about their experience of infertility with an objective and caringperson to be validating and gave them a new perspective to their experience. Thus,counsellors need to recognize that men may not have the social support for dealingwith infertility and that when men do tell their story of infertility to a counsellor, it isquite possible that the counsellor may be the first person with whom they have beenable to tell their story.Thirdly, infertility was unique as a loss for these men in that it touched theirvery identity. Most losses are external to self, while infertility was experienced as aninternal loss. This loss was unique in that it changed these mens’ concepts of104themselves. This loss affected their masculine identities. The losses of infertilityincluded a deep sense of personal inadequacy which was woven into each man’s senseof his masculine identity. The men experienced a loss of manhood where they felt“less than a man” or “less than complete”, or a sense that something had died withinthem. As such, counsellors need to recognize that this loss involves a man’smasculine identity, and that part of the process of recovery may involve redefiningtheir identities as men.The men in this study experienced a deep sense of loss and grief. Due to thefact that the losses of infertility are unseen, not recognized by society, and there maybe an absence of social support to deal with this experience (Mahlstedt, 1985;Menning; 1980), counselling focusing on grief work may be crucial. The men came torecognize their losses, but many stated that if they had had someone who could havehelped them work through their feelings of loss, then their process of recovery wouldnot have taken so long. The losses of infertility need to be explored, recognized andvalidated. Anger was a common reaction of these men that may be seen as a part oftheir grief work. However, due to the invisible nature of infertility and the lack ofvalidation of the losses incurred, such anger may be prolonged and increase theisolation experienced by the infertile men. Therefore, counsellors need to facilitateappropriate expression of men’s anger by validating their feelings of injustice, betrayal,powerlessness and grief.The men all experienced feelings of being out of control and felt powerless inthe process of their infertility investigation, as well as powerless to change the105situation. Thus a counsellor needs to be aware that counselling infertile men mayrequire ensuring that the client feels that he has some control in the counsellingprocess; that it is his process and he has control of the speed and duration of thatprocess. This may help to personally empower the infertile men and enhance his senseof personal efficacy.The men in this study came to a point where they relinquished control of thatwhich was out their control and they began to assert control over those aspects of theirexperience where they could assert control. The men described this assertion ofcontrol as being a positive and helpful process for feeling more control in their lives.A counsellor may be very helpful by encouraging infertile men to recognized andaccept where they do not have control and by encouraging them to recognize aspectsof their experience where they do have control. They may not have control overinfertility, but they do have control over other life options and decisions (Menning,1992; Valentine, 1986). Some of these options include: the extent of the medicalinvestigation (Daniluk, 1991), decisions about possible treatments and the extent ofthose treatments, the choices of donor insemination, adoption, or remaining childless.Counsellors also need to be aware of infertile men’s issues surrounding theirsense of masculinity. Counsellors need to recognize that infertility raises feelings ofpersonal inadequacy that may be difficult for men to express. It may be valuable forcounsellors to explore with male clients how society, friends, and their family of originhave defined masculinity and how they themselves define it. The men in this studywent through a process of redefining their sense of masculinity. A counsellor could106help engage a client in the process of constructing a sense of masculinity whichincorporates the reality of their infertility. A counsellor can point out all the areas ofmasculinity that infertility has not affected, thus reaffirming the man’s sense ofmasculine identity. Although he may be infertile, he can still experience fatheringthrough other people’s children, through adoption or donor insemination. He is stillvirile and can express his masculinity through sexual intimacy with his partner. Hecan still be as competent, effective, useful and worthwhile at work. Such anexploration may be helpful in his process of evaluating his sense of masculinity and inhis process of coming to terms with or accepting his infertility.Counsellors need to be aware of infertile men’s experiences of betrayal andisolation. The infertile men may need to have his feelings and experience of infertilityboth validated and normalized. It is important for him to know that he is not alone inhis experience and that his feelings are not unique. This process of normalization andvalidation can help to break down feelings of isolation. As well, the counsellor canwork with the client to strategize about different approaches in communicating hisfeelings about infertility to his family, friends and spouse. These strategies mightinclude talking one to one with the people of concern, writing a letter, or givingliterature outlining the struggles and issues of infertility to better inform family orfriends. The purpose of any such strategy is to help the client to not feel so isolatedby the experience of infertility. Supplying clients with literature on the experience ofinfertility as well as information on local infertility support groups can help tonormalize his experience as well as helping to decrease feelings of alienation and107isolation.In the process of telling their stories to the researcher, a number of the menreported that it was the first time they had shared their entire story and indicated thattheir involvement in this project helped to clarify the meaning of their experiences.Through engaging in a review of their life experiences as they relate to infertility, abroader understanding was accomplished which promoted a sense personal growth.Counsellors can perform a similar role in providing a respectful, validating and safeplace for men to tell their story of infertility and explore their personal meanings oftheir experiences. Personal growth, increased personal awareness and change can befacilitated by a counsellor who demonstrates nonjudgemental positive regard, andempathic understanding of the client’s experience (Rogers, 1961).Once rapport has been built with a client, counsellors can facilitate clients intheir process of positively reconstructing their situation by allowing clients to glean thepositive meanings from their experience of infertility. Caution must be taken bycounsellors however, to not invalidate or discount clients’ painful experiences by beingoverly zealous in their search for positive meanings. This process of positivereconstruction was generally expressed by the men in the study in the last part of eachinterview. Thus, only after the researcher had been informed and understood the fullramifications of the experience of infertility for these men, did they disclose positivemeanings from their experience. It may be contraindicated to engage a client in thisprocess too early in the counselling process.Because infertility is an issue for the couple, marital counselling may be an108appropriate approach. If a couple comes for counselling regarding infertility, it isimportant for a counsellor to investigate the nature of the infertility and it’s etiology.Counsellors must not assume that infertility is more of an issue for women than men,even though women may be more verbal and open about their experience of infertilitythan men (Brand, 1989; Mahlstedt, 1985). Also, it might be important to tell couplesthat infertility may be experienced differently for each of them. As the men in thisstudy indicated, many felt isolated and alienated from their partners. Thus a focus ofmarital counselling needs to be upon opening or increasing a couple’s communicationregarding their feelings and issues around their infertility. If a couple can feel thattheir infertility is a shared experience, then their personal sense of isolation maydiminish.Marital counselling for infertile couples needs to address the issue of guilt andresponsibility. The men in the study felt personally responsible for the fact that theirwives could not have children. If wives blame their husbands for their infertility, assome men perceived their partners to do in this study, men’s feelings of alienation,isolation and betrayal may increase. Thus, responsibility for infertility needs to beremoved from either partner and feelings of anger or injustice validated without blameattributed to one spouse.Lastly, counsellors engaged in marital counselling for male factor infertilecouples may need to evaluate the roles that the members of the couple play in regardto coping with infertility. There seemed to be a tendency for the men in this study totry and be the strong one in their relationships. They saw themselves as trying to help109their wives through the whole experience of infertility. This appeared to inhibit theirown expression of feelings regarding infertility and to increase their sense of isolationwithin their marriages. Thus, a counsellor could investigate how the couples take careof each other; how men can be available to their spouses; and how men can expresstheir feelings and experiences surrounding infertility to their spouses. Greaterflexibility in roles may help a couple communicate and cope better with infertility.ConclusionThroughout history fertility has been admired and celebrated. The importanceof the basic right of people to bear and raise children has been emphasized across mostcultures, around the world and throughout history (Mullens, 1990). Of thoseattempting to become biological parents however, one out of six, approximately 17%of the population, experience problems with infertility (Leader, et al., 1984; Ulbrich etal., 1990). Although approximately 50% to 60% of couples do eventually conceiveand deliver, still 40% to 50% remain infertile (Colins et al., 1984). Little is knownabout the phenomenon of men’s experience of infertility. This study provided anaccount of the lived experience of male factor infertile men and their personalmeanings of their experience of infertility.The men in the present study described their experience with insight, pain,courage and humour. The results indicate that these men experienced all of thefollowing: a profound sense of loss and grief, a sense of powerlessness and loss ofcontrol, a personal sense of inadequacy, a deep sense of betrayal and isolation, a senseof threat or foreboding, a need to overcome and survive, and a need to positively110reconstruct their situation and their sense of self.Research and counselling implications were discussed with a particularemphasis on the need for validation and normalization of the experiences of infertilemen. Counsellors, in facilitating an exploration of the personal meaning of infertilityfor men can be helpful in the process of assisting men in dealing and coming to termswith their infertility.111ReferencesAbbey, A., Andrews, F.M., & Halman, L.J. (1991). Gender’s role in response toinfertility. Psychology of Women Ouarterly, 15, 295-316.Abse, W. (1966). Psychiatric aspects of human male infertility. Fertility and Sterility,fl, 133-137.Akhtar, L. (1978). Obsessional neurosis, marriage, sex, and fertility: Sometranscultural comparisons. International Journal of Social Psychiatry, 24,64-166.Ancirews, F.M. & Arbor, A. (1991). Psychosocial factors and infertility: Howdifferent are fertility - problem couples from other couples? Journal of theSociety of Obstetricians and Gynaecologists of Canada, j.Q, 100-105.Benson, R.C. (1983). Handbook of obstetrics and gynecology. Los Alto, CA: LangeMedical Publishers.Berg, J.B., & Wilson, J.F. (1991). Psychological functioning across stages ofinfertility. Journal of Behavioral Medicine, .1.4, 11-26.Berg, J.B., & Wilson, J.F. (1990). Psychiatric morbidity in the infertility population: Areconceptualization. Fertility and Sterility, , 654-661.Berger, M.D. (1980). Impotence following the discovery of azoospermia. Fertility andSterility, 4, 154-156.Bernstein, 3., Potts, N. & Mattox, J.H. (1985). Assessment of psychologicaldysfunction associated with infertility. Journal of Obstetric Gvnecologic andNeonatal Nursing, (suppl.), 63-66.112Booth, A. & Amato, P. (1991). Divorce and psychological stress. Journal of Health &Social Behavior, , 3 96-407.Borg, W.R., & Gall, M.D. (1989). Educational research: An introduction (5th ed.).New York: Longman.Bresnick, E., & Bums, L.H. (1987). Infertility as boundary ambiguity: One theoreticalperspective. Family Process, , 359-372.Bresnick, E., & Taymor, M.L. (1979). The role of counseling in infertility. Fertilityand Sterility, 32(2), 154-156.Callan, V.J. (1985). Perceptions of parents, the voluntarily and involuntarily childless:A multidimensional scaling analysis. Journal of Marriage and Family, U,1045-1050.Callan, V.J., & Hennessey, J.F. (1989). Strategies for coping with infertility. IhBritish Joumal of Medical Psychology, , 343-3 54.Clapp, D. (1985). Emotional responses to infertility: Nursing interventions. Journal ofObstetric Gynecologic and Neonatal Nursing, (suppl), 32-35.Colaizzi, P.F. (1978). Psychological research as the phenomenologist views it. In R.Valle & M. King (Eds.) Existential- phenomenological alternatives forpsychology. (pg. 48-71). New York: Oxford University Press.Collins, J.A., Garner, J.B., Wilson, E.H., Wrixon, W., & Casper, R.F. (1984). Aproportional hazard’s analysis of the clinical characteristics of infertile couples.American Joumal of Obstetrics and Gynecology, J.4, 527-532.113Daniluk, J.C. (1991). Strategies for Counselling Infertile Couples. Journal ofCounseling and Development, , 317-320.Daniluk, J.C. (1988). Infertility: Intrapersonal and interpersonal impact. Fertility andSterility, 42, 982-990.Daniluk, J.C., Leader, A. & Taylor, P.J. (1987). Psychological and relationshipchanges of couples undergoing an infertility investigation: Some implicationsfor counsellors. British Journal of Guidance and Counselling, .j, 29-3 6.DeCherney, A.H. (1986). Reproductive failure. New York: Churchill Livingston.Denber, H.C. (1978). Psychiatric aspects of infertility. The Journal of ReproductiveMedicine, 20, 23-29.Draye, M.A., Woods, N.F. & Mitchell, E. (1988) Coping with infertility in couples:Gender Differences. Health Care for Women International, 2, 163-175.Dreman, S. (1991). Coping with the trauma of divorce. Journal of Traumatic Stress,4, 113-121.Eisner, B.G. (1963). Some psychological differences between fertile and infertilewomen. Journal of Clinical Psychology, 1.2, 391-394.Erikson, E.H. (1960). Childhood and society. W.W. Norton: New York.Feuer, G.S. (1983). The psychological impact of infertility on the lives of men.(Doctoral Dissertation, University of Pennsylvania, 1983). DissertationAbstracts International, 44, 706A-707A.Giorgi, A. (1985). Phenomenology and psychological research. Pittsburgh, PA:Duquesne University Press.114Grantmyre, J.E., & Hanson, P. (1992). Investigating the male role in reproductivefailures. Canadian Journal of Diagnosis, 2, 45-60.Greil, A.L., Porter, K.L., Thomas A.L., Riscilli, C. (1989). Why me?: Theodicies ofInfertile Women and Men. Sociology of Health and Illness, II, 2 13-229.Hirsch, A.M., & Hirsch, S.M. (1989). The effect of infertility on marriage andself-concept. Journal of Obstetric Gynecologic and Neonatal Nursing,!, 13-20.Hoffman, L.W. & Manis, J.D. (1979). The value of children in the United States: Anew approach to the study of fertility. Journal of Marriage and The Family, ,583-596.Kendem, P., Mikulincer, M., Nathanson, Y., & Bartoov, B. (1990). Psychologicalaspects of male infertility. British Journal of Medical Psychology, 63, 73-80.Koropatnick, S., Daniluk, J & Pattison, H. (1993). Infertility: A non-event transition.Fertility & Sterility, , 163-171.Kraus, 5. (1979). The crisis of divorce: Growth promoting or pathogenic? Journal ofDivorce, ., 107-119.Leader, A., Taylor, P.J., & Daniluk, J. (1984). Infertility: Clinical and psychologicalaspects. Psychiatric Annals, 14, 461-467.Link, P.W. & Darling, C.A. (1986). Couples undergoing treatment for infertility:Dimensions of life satisfaction. Journal of Sex and Marital Therapy, j., 46-59.MacNab, R.T. (1986). Infertility and men: A study of change and adaptive choices inthe lives of involuntarily childless men. (Doctoral Dissertation, The FieldingInstitute, 1984). Dissertation Abstracts International, 4.2, 774A.115Mahlstedt, PP. (1985). The psychological component of infertility. Fertility andSterility, 4.., 33 5-346.Mahlstedt, P.P., MacDuff, S., & Berstein, J. (1987). Emotional factors and the in vitrofertilization and embryo transfer process. Journal of In Vitro Fertilization andEmbryo Transfer, 4, 232-236.McNeely, T.B. (1990). Semen analysis. British Columbia Medical Journal, Z(1 1),487-490.Menning, B.E. (1980). The emotional needs of the infertile couple. Fertility andSterility, 34, 313-319.Menning, B.E. (1977). Infertility: A guide for the childless couple. Englewooci Cliffs:Prentice Hall.Mullens, A. (1990). Missed conceptions: Overcoming infertility. Toronto:McGraw-Hill Ryerson.Osborne, J. W. (1990). Some basic existential-phenomenological researchmethodology for counsellors. Canadian Journal of Counselling, 24, 79-91.Pledge, D. (1992) Marital separation/divorce: A review of individual responses to amajor life stressor. Journal of Divorce & Remarriage, 1.1, 151-181.Pohlman, E. (1969). The psychology of birth planning. Cambridge, Massachussetts:Schenkman.Rogers, C. R. (1961). On becoming a person. Boston: Houghton Mifflin.Seibel, M.M., & Taymor, M.L. (1982). Emotional aspects of infertility. Fertility andSterility, fl, 137-145.116Shapiro, C.H. (1982). The impact of infertility on the marital relationship. The Journalof Contemporary Social Work, 9, 387-393.Singh, J.R., & Neki, J.S. (1982). Psychogenic factors in some genetic and non-geneticforms of infertility. International Journal of Gynaecology and Obstetrics, (2),119-123.Snarey, J.,Kuehue, V.S., Son, L., Hauser, S., & Vaillant, G. (1987). The role ofparenting in men’s psychosocial development: A longitudinal study of earlyadulthood infertility and midlife generativity. Developmental Psychology, ,593-603.Taymor, M.L. (1979). The role of counseling in infertility. Fertility and Sterility, 32,154-156.The living Talmud: The wisdom of the fathers. (1957). (J. Goldin, Trans.) New York:New American Library of World Literature.Thomas, C.L. (Ed.). (1989). Taber’s Cyclopedic Medical Dictionary (16th ed.).Philadelphia: F .A. Davis Company.Ulbrich, P.M., Tremagliocoyle, A., & Llabre, M.M. (1990). Involuntary childlessnessand marital adjustment: His and hers. Journal of Sex and Marital Therapy, j,147- 158.Valentine, D .P. (1986). Psychological impact of infertility: Identifying issues andneeds. Social Working Health Care, U, 61-69.Van Manen, M. (1990). Researching lived experience: Human science for an actionsensitive pedagogy. London, Ontario: Althouse Press.117Veevers, J.E. (1980). Childless by choice. Scarborough, Ontario: Butterworth.Wright, J., Allard, M., Lecours, A. & Sabourin, S. (1989). Psychosocial Distress andInfertility: A review of controlled research. International Journal of Fertility,34(2), 126-142.118APPENDICES119APPENDIX A - Advertisement for the studyA Study Exploring The Experience OfChildless Infertile MenI am a Graduate student in Counselling Psychology at the University of BritishColumbia interested in doing supervised research on the experience of male infertility.Many couples today (1 out of 5) are unable to have children. Although the origin ofthe infertility is divided equally between men and women, research has focused for themost part upon the woman’s experience. In an effort to understand the maleexperience of infertility and to aid professionals who work in the area of infertility aunique research study is taking place.You can participate• . if you are a man without any previous biological children and have been diagnosedover 2 years ago with a male factor infertility problem.Participating in this study..• . . involves discussing with a male researcher your experience as a childless infertileman and the meaning making process involved in coming to terms with yourinfertility. The study is completely confidential and would require approximately twohours of your time on each of two separate occasions. The results of the study wouldbe shared with you upon completion. If you or someone you know would like toparticipate in this study or would like further information regarding this research,please call me at the following number.Contact: Russell Webb M.A.(Candidate) - XXX-XXXXorJudith Daniluk Ph.D. (Supervisor) - XXX-XXXX120APPENDIX BLetter to Urologists1234 Nosuch StreetVancouver, B.C.V1C 2N3Dear_______________________I am a graduate student in Counselling Psychology at the University of BritishColumbia. I am presently doing research in the area of male infertility under thesupervision of Judith Daniluk Ph.D. I am interested in studying the meaning ofinfertility for men who are members of a couple experiencing male factor infertility.The purpose of the research is to understand how infertile men make sense or meaningout of their experience of infertility. This will be helpful in understanding the maleexperience of infertility and will be helpful to both medical and mental healthprofessionals.The research would entail 2 confidential interviews with the participant. If youfeel that you may know anyone who may be appropriate, please give this informationto that individual. If he is interested in more information please encourage him tophone me at XXX-XXXX or Judith Daniluk (Research Supervisor) at XXX-XXXX.He is under no obligation to participate by calling.Thank you for your consideration,Russell E. Webb121APPENDIX CA Sample of Screening Interview Ouestions:1. What is your age?2. Have you had an children?3. Have you been diagnosed as infertile? Is your partner/spouse also infertile?4. How long have you know that you were infertile? Has it been over 2 years since theinitial diagnosis?5. How significant or important is the ability to have your own biological children to you?6. Do you feel that you have come to some sort of positive resolution with yourexperience of infertility? If so, what tells you that this is the case?7. Have you every had the experience of discussing something this personal with someoneother than your partner? If so, how did you feel about the experience? Did you fmd itrelatively easy or difficult to express your thoughts and feelings - to find the words tosay what you meant?8. If you are looking for counselling to help you deal with your infertility, you realize thatthis research project is not designed to do that? If you are looking for counselling Ican refer you if you would like.122APPENDIX DConsent FormA Masters Thesis research study on theExperience and Meaning of Infertility for Childless MenThe investigator, Russ Webb, will meet with you on two separate occasions for up to atotal of four hours, for the purpose of hearing and recording your thoughts, feelings andexperience of infertility and the process you went through in making sense of this experience.These initial meetings will be audio-taped and then transcribed. All identifyinginformation will be deleted from the study and your name will be changed in the transcript tounsure absolute confidentiality. Upon completion of the transcription you will be contactedand asked to read the transcript. Upon reflection of what you read, you will be asked if itaccurately depicts your perceptions of your experience. All audio tapes of the interviews willbe completely erased upon completion of the transcripts. If any aspect of the procedureoutlined remains unclear, please feel free to contact me at XXX-XXXX, or call my researchsupervisor, Dr. Judith Daniluk in the Dept. of Counselling Psychology at UBC at XXXXXXX. If at anytime you wish to withdraw from the study for any reason, your right to doso will be respected. If the interviews raise personal concerns that you would like counsellingfor, a counselling referral will be made available to you at your request.I,_____________________________________, agree to participate in the study describedunder the conditions outlined and acknowledge receipt of a copy of this consent form.Pseudonym requested (optional):Date:________Signature:Investigator:Russell Webb, Department of Counselling Psychology,Faculty of Education, U.B.C., Phone: XXX-XXXX123APPENDIX EOuestions to ParticipantsOrienting Statement:The inability to have children has been scorned throughout history, whilefertility has been admired and celebrated. Our culture tends to label infertility as beinga woman’s problem; but, a breakdown of the causes of infertility identifies men as theorigin of the problem in 40% of the cases, with women as the origin of infertility in40% of the cases and the couple sharing the problem in the remaining 20% of thecases (Menning, 1977). However, the majority of research until now has focused onthe woman’s experience of infertility and on how infertility has impacted the maritalrelationship. There is little research on the experience of infertility for men andnothing that investigates how men make sense or meaning out of their experience ofinfertility.I am interested in the your experience and meaning of infertility as you lived itand attempt to make sense out of it. The experience of infertility is unique to everyindividual; however, it may be helpful to think of your experience and describe it tome as if it were a story with a beginning, a middle and an end.Possible Follow-up Probes:(To be used only if the topic is brought up by the participant and framed in thefollowing manner: “You mentioned_____________,would you tell me more aboutthis?”)1. How did it happen that...?1242. How did you feel about yourself before/at the time of/after you found out aboutyour diagnosis?3. How do you feel about yourself now?4. What was the process that you went through in not only understanding yourcircumstance but in deriving meaning out of your experience?5. Did infertility change your identity in any way? And if so, how?6. Did infertility change your out look on life? And if so, how?7. How did your diagnosis of infertility affect your partner and your relationship withher? How did she feel about it? How did you feel about your partner’s responseto your infertility?8. How have you/has your relationship with your partner changed since the diagnosisof your infertility?125APPENDIX FQuestions which may be used to guide the interviews:1. When you were growing up what were your expectations for yourself regarding afamily? How differently have things turned out then what you pictured?2. How did you learn about your infertility and what did you experience when youfound out about your diagnosis?3. How did you come to terms with being infertile?4. How did the experience of infertility relate to who you saw yourself?5. What have been the biggest challenge regarding making sense of and/or living withyour infertility? Why?


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