The process of investigation for subferrile women is less performance oriented than that experienced by subfertile men. Infertility requires men to perform sexually, both for tests (semen analysis and postcoital testing) and in attempts to conceive (natural and assisted). This means that men are provided with opportunities for both immediate and future success or failure (i.e., test results or pregnancy). Carmeli and Birenbaum-Carmeli interviewed infertile men in Israel and Canada about their experiences of infertility treatment and suggested that men often felt marginalized because treatment tended to focus on women, even when there was a male-factor problem. Male partners were also sometimes excluded from attending procedures that their partner underwent, such as egg retrieval and insemination. They concluded that these experiences could undermine men’s position in conjugal decision-making with respect to infertility.
One study compared 18 men undergoing intracytoplasmic sperm injection and 22 men undergoing in vitro fertilization for one complete treatment cycle. The men completed a daily chart, which assessed emotional, physical, and social reactions to infertility treatment. They found that distress changed across the cycle, with the active stages of oocyte retrieval and embryo transfer and the pregnancy test day being most distressing. Another study comparing the distress of men in couples undergoing intracytoplasmic sperm injection versus those undergoing in vitro fertilization found that distress levels were similar in each group, apart from a marginal difference just prior to retrieval of sperm when men undergoing intracytoplasmic sperm injection were found to be slightly more distressed.
Daniluk performed psychological tests on 63 couples attending an infertility clinic over four sessions: immediately following initial consultation with the doctor, four weeks after initial consultation, one week after diagnosis, and six weeks after diagnosis. Psychological distress was highest for both men and women at the time of the initial medical interview. In another study, Takefman et al. assessed couples at the beginning and end of their investigation for fertility problems over a minimum period of three months; they reported that men whose psychological distress levels increased over the sessions had higher neuroti-cism scores and higher intercourse frequency than those whose levels remained unchanged.
A study on the immediate impact of medical consultation on anxiety, depression, self-blame, information appraisal, and perceptions of future fertility in subfertile men found that anxiety levels were high before the consultation, but afterwards, anxiety and self-blame had reduced while depression had increased. Even when a poor prognosis was given during the consultation, participants remained overly optimistic about their chances of achieving a pregnancy. Similarly, a study of 103 men attending a specialized fertility clinic looked at how they rated their partner’s chances of achieving a pregnancy. Before consultation, patients expected that their chance of pregnancy would be increased following the clinic visit. Post consultation, their perceptions of their chances of pregnancy were often inaccurate and were more influenced by their preconsultation expectations than the consultant’s view.
A subsequent study had 29 subfertile men complete questionnaires before and after consultation to assess expectations. Subfertile men rated increasing the chances of their partner conceiving as most important, with gaining information also receiving high ratings. Following the consultation, patients felt that they had gained understanding and their expectations of receiving help with decision-making had been fulfilled. They rated their satisfaction with the consultation as high and distress during the consultation as low despite the fact that many of their initial expectations had not been fulfilled.
In summary, the evidence seems to suggest that investigation and treatment of infertility is experienced as a process punctuated by events (e.g., clinic visits, giving semen samples, and receiving test results) and that these events may provide more or less stress. In addition to these particular events, it seems likely that the process has a cumulative effect, with stress increasing over time. Consultations appear to be perceived as a valuable experience even in the absence of a “cure”; however, understanding and recall of information may often be poor and influenced more by expectations than by the information actually given.