Although reproduction is a biological imperative in humans, it occurs within an intensely social context. In order to better understand how infertility affects the individual, it is necessary to consider both the value attached to conceiving and bearing children and the meanings ascribed to motherhood and fatherhood. It is also important to recognize the way in which sex roles and gender are viewed within a particular society in order to understand the impact on the individual of alterations in gender-normative life events.
Importance of Reproduction
Individual views and attitudes about fertility are inevitably influenced by prevailing societal and cultural standpoints. Fertility and parenthood are highly valued in almost all societies. Anthropologists have documented the extremes to which infertile women across cultures are willing to go to have children. These range from poor urban women bathing with miscarried fetuses and stillborn infants to Western women repeatedly undergoing risky medical procedures with unknown long-term effects; however, comparable information on the lengths to which men will go to father a child is lacking. In a small-scale study based in the United Kingdom, Dalton and Lilford examined the trade-off values in infertility. They found that individuals (presumably women although the authors did not specify gender) drawn from the general population (N=32) and from an infertile population (N=16) in England would be willing to shorten their life span by 12 years in order to become pregnant once. In addition, the infertile population would accept a 35% risk of death to have one child. In another study of 108 infertile couples, over 20% of the women and 7% of the men said that they were willing to give up everything to have children, with 30% of women and 28% of men willing to give up a great deal to have a child.
Infertility, Impotence, and Masculinity
There is a perception that “being a man” is synonymous with fathering a child. Work by Mason asserted that manliness is traditionally viewed as relating more to the ability to make a woman pregnant as opposed to undertaking the role of father. Another study interviewing infertile men suggested that fertility is central to men’s gender identity. There is an apparent underlying societal assumption that infertility is a threat to male sexuality or at least to masculinity. Whatever its origin, this confounding of impotence and infertility has consequences for infertile men. Fathering a child is seen as proof of masculinity and it follows therefore that not fathering one is seen as a failure to achieve this level of manhood. Nachtigall et al. found that approximately two-thirds of infertile men were preoccupied with the loss of their “physical potency.” On the other hand, few men raised this concern when infertility had an identified female cause.
Not all studies, however, have found an association between masculinity and infertility. Edelmann et al., asked 205 couples with male-factor subfertility if they agreed with the following statement: “a man can never be sure about his masculinity until he is a father.” Although they found few couples agreeing with the statement, it was suggested that this atypical finding was because their sample was drawn from a self-help organization and may not have been typical of infertile couples. Men who did agree with the statement, however, reported greater distress than those who did not, suggesting that, for some men at least, infertility may compromise masculine identity.
Goffman used the term “stigma” to describe the way in which a person’s identity can become compromised or “spoiled.” Nachtigall et al. specifically addressed the issue of stigma in infertile men. They found that two-thirds of the infertile men in their sample felt stigmatized and identified infertility as relating to their perceived loss of masculinity. Miall interviewed 71 men and 79 women with no fertility problems about their views of infertile men and women. Male infertility was associated with higher levels of stigma than female infertility; half the sample felt that society views male and female infertility differently. Miall identified three themes that emerged from the interviews: infertile men were more likely to be ridiculed than infertile women; infertile women were more likely to be offered sympathy than their male counterparts; and the inability to have children was more likely to be attributed to the woman. When the cause of infertility was attributed to the man, it was seen as the result of sexual dysfunction. The majority of men (83%) and half the women in the sample felt that infertile men would experience more difficulty with their self-perception than infertile women. Almost all who responded linked infertile men’s difficulties to their “tarnished” male ego or to worries about male sexual prowess. At an individual level, it seems that for men, the experience of infertility may relate not only to the fact of not having a child but also to the effect this has on individual self-perceptions.
Social theorists have developed the concept of hegemonic masculinity to describe the idealized form of masculinity at a given place and time. Beliefs and behaviors associated with contemporary Western hegemonic masculinity are the denial of weakness or vulnerability, emotional and physical control, the appearance of being strong and robust, dismissal of any need for help, a ceaseless interest in sex, the display of aggressive behavior, and physical dominance. Given this prevailing generalized set of powerful cultural values and expectations, and the particular issues encountered in confronting male-fertility problems, we might expect that men presenting with subfertility or infertility will experience psychological distress and that this may well differ from that being experienced by their partners. How they cope with this may have implications for their response to investigation and treatment.
The prevailing concepts of masculinity may have hindered research into male-factor subfertility and infertility, particularly in the psychological dimension. For example, Bents suggested that male infertility has not been researched because the confusion between potency and fertility led to it being a taboo subject. The perception that infertility is less significant for men than for women may also have contributed to the lack of research in this area.
Motherhood and Fatherhood
It is a fundamental view of society that motherhood is the ultimate expression of being a woman and that a woman cannot achieve her full potential without becoming a mother. Motherhood is idealized and highly valued but such strong constructions do not apply to fatherhood. While motherhood is central to the ways in which women are defined both by themselves and by others, fatherhood remains simply one aspect of many in men’s lives and yet another way in which they define themselves. In a study exploring attitudes to parenthood, Humphrey found that men, especially childless men, were likely to associate fatherhood with masculinity, while women associated motherhood with contentment. Men were less likely to associate fatherhood with contentment. The study of roles and meanings of fatherhood is relatively new. Although it is argued that children benefit from the presence of a father, scant research is available on the importance to men of raising children. At least in Western societies, it seems that the primary role of men in reproduction is viewed as enabling women to become mothers.
Newton et al. investigated the motives for parenthood in couples undergoing in vitro fertilization (IVF). They found that the primary reason given by the majority of men was a desire for marital completion while in women the emphasis was on the need to fulfill gender requirements. They suggested that men are less likely to see infertility as a threat to self-worth than as a threat to their marital relationship. Van Balen and Trimbos-Kemper found both men and women cite happiness as their primary motive for having a child, with well-being and fatherhood being second and third motives for men, respectively.