In America, approximately 7.3 million women of reproductive age have sought reproductive services (1), sometimes with less than cooperative spouses. Women and men approach infertility differently and this can cause tension in the relationship. As women, trying to consider the reasons behind men's reluctance to undergo fertility treatment may contribute to harmony that restores the unified effort of trying to conceive.
So, why might a man deny why help is necessary in the first place? Women are often more open to medical testing of any kind, and may not see a problem with getting checked out, particularly if it is a test covered by insurance. Men don't necessarily think of it that way.
First of all, there is the barrier of actually making the appointment and giving the semen specimen to the lab. Men often don't want to have to collect a semen specimen at the clinic, which can be embarrassing. Using the collection room, which is usually a bathroom with some adult magazines, can make men very uncomfortable, especially when the walls are not sound proof and they can hear people walking or talking nearby. Having to "perform on command" can be daunting for some men, increasing their stress level. It helps to ask if the clinic allows men to collect their specimen at home. This can give a man the freedom to produce the specimen in the comfort of his own surroundings. His wife may offer to take the specimen cup into the lab for him, to avoid the awkwardness of facing the lab staff.
The next barrier is the fear of the results. Many men identify their masculinity with their sexual performance and the quality of their sperm. Even the possibility of getting a negative diagnosis in the form of a poor semen analysis result can stop a man in his tracks.
How can a woman broach the subject without creating a fight or argument? It is good to approach this topic with sensitivity. A woman should consider his perspective: the embarrassment, the fear of negative results, and the potential attack on his identity as a man. These can be very real issues, and cause a man to drag his feet. Studies have shown that it can take a man several months to go in for a semen analysis after it has been ordered.
The idea of getting a semen analysis done can be discussed from a financial stand point. The test is usually one of the least expensive fertility tests available and may be covered by insurance. Also, the results can give the couple peace of mind; they will know what they are facing.
There is the very real possibility, however, that the problem may lie with the man. Unfortunately in this situation women have to sometimes be cautious and not share the concern that he may have a problem with his semen bluntly. A gentle, non accusing approach is appropriate here. This is not the time for pointing fingers, it is important not to assign blame; 20-40% of the time the diagnosis is shared. (2) For example, he could have a low sperm count and she might not be ovulating. As a couple, they are in it together no matter where the problem originates.
To fully address the deeper relational issues, using the services of a counselor, particularly a fertility counselor, may be of help. Of course, men who have unspoken objections about participating in fertility treatments may be unwilling to see a fertility counselor. For men who are not very open about the process, seeing a counselor may be seen as putting themselves into another kind of vulnerable situation, similar to having the testing done. If a woman able to convince her partner to go to some counseling, the fertility counselor can take the lead so that it is not seen as an attack coming from her. Also, being open minded in the process is vital; the counselor is not there to take either side, but to help both process their emotions so that they can make good decisions. The counselor can point out the spectrum of issues involved in infertility. Of all diagnosis, about fifty percent of the time it is related to the male. There is also a good chance that the problem is both male and female related. Seeing a counselor both individually and as a couple can certainly be beneficial.
How can a woman help a man to feel like a real partner in the fertility process? Men can definitely feel left out, with "the couple" becoming the woman and her doctor. Suddenly, the doctor becomes the person who is going to get her pregnant; a further challenge to his masculinity and role in the relationship. Being sensitive to this and offering to include him as much as possible can help. Considering using an at home based Conception Kit is a good way to start. (3) Using the Conception Kit can allow the man to get involved with the cycle planning, if he wants. The best part is that the couple gets to have sex, not just having to collect the sperm in some bathroom. Using the kit, the semen is collected in a non-spermicidal, non-latex condom, and then transferred to a silicone cervical cap, which is worn by the woman. The Conception Kit can also be used prior to getting a semen analysis, which will remove some of the hesitation on the man's part. This may allow a reluctant couple to get started sooner!
It is possible that the man may not want to be more involved in the process. Women tend to really dig in and learn all that they can, tracking their cycles religiously and watching for all the fertility signs. Men take a more laid back, simplistic approach. Realizing these differences can be a strength, the man and the woman can balance each other out. It is important to not insist that he reacts the same way that she does to the challenges of trying to conceive. Let him be himself, and appreciate him for who he is, and don't push him too hard.
Footnotes
1. National Survey of Family Growth, National Center for Health Statistics, United States Department of Health and Human Services http://www.cdc.gov/nchs/fastats/fertile.htm
2. http://www.asrm.com
3. http://www.conceptionkit.com
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