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Reviewed research
Authors M Crawshaw
Review Date March 2015
Citation Reproductive BioMedicine Online 2013; 27: 261-270
Background
The biopsychosocial model has become increasingly popular in the fields of (in)fertility and cancer in recent years. The model aims to take into account the interaction of biological, psychological and social factors in assessments and interventions. While the increased use of this model has led to the incorporation of psychological understanding in matters that were previously considered as biological only, few papers have focused on associated sociological aspects (i.e. understanding why health differences based on social identities arise and endure), particularly when it comes to cancer and fertility in men.
Aim
To extend understanding of male infertility by considering gender-specific social influences on cancer-related fertility experiences over time.
Methods
This paper was part of a larger study comparing the fertility and cancer experiences of White and South Asian men in the United Kingdom (UK). Men aged 18-40 years who had been diagnosed with cancer (including in childhood) but were outside of active treatment and who had been informed their fertility was or may be affected were invited to participate in the study. Semi-structured interviews were conducted; these were analysed thematically with a theory driven approach to identify and examine social constructs that appeared to influence men’s fertility experiences.
Results
Twenty-eight men participated in the study, including 13 who identified as White and 15 as South Asian (9 Pakistani, 5 Indian, and 1 Bangladeshi) in origin. The mean age at interview was 30.7 years and six had been diagnosed before 18 years of age (range 8-38 years). Cancer types included testicular cancer (n=15), Hodgkins lymphoma (n=8), non-Hodgkins lymphoma (n=2), and the rest single types. Seventeen men were in a ‘permanent’ relationship and ten had children.
Managing stigma Many perceived there to be considerable stigma attached to the discussion of potential or diagnosed infertility due to cancer, particularly with their male friends. Some men of South Asian origin reported increased stigma when visiting family outside of the UK only. Many men found religion to be a protective factor as it allowed them to re-frame infertility as a ‘test’ of their faith.
Sexuality and virility Some men reported decreased social confidence due to fear of having sexual partners or social networks perceive them to be “less of a man” due to the removal of a testicle and/or compromised fertility. To compensate, some men became more sexually active as a way of ‘proving’ they were still a man and/or engaged in coping behaviours such as excessive drinking. One man noted that such behaviour “ruined” many relationships and delayed his life goals of marriage and children.
Ambiguity in fertile status Some reported not wanting to know their fertility status (through the use of semen analysis) as they preferred to have uncertainty but also hope that they are fertile rather than have certainty and no hope. Although some men with partners involved them from the beginning others did at a later stage or they never told their partner they could be infertile. Of note, few men reported being offered semen analysis testing.
Men’s relationships to sperm The majority of men (n=21) had banked sperm, with many seeing it as a good ‘back up’ plan to fulfilling the biological fatherhood role. Others, however, felt it challenged their masculine self, were worried doing so might transmit cancer to their children, or felt they had lost control of their sperm and were anxious about its safety and use. Several men had named partners on consent forms to use their sperm and two had not informed these women of this action.
The meaning of fatherhood Some men felt that potential or diagnosed infertility meant they were less entitled to marriage as they perceived it to be a union that people enter into to have children. Adoption was deemed to be more acceptable than donor insemination (DI) by the majority of men as this ‘social solution’ could employ a range of favourable religious, cultural and gendered explanations that tied into a ‘rescue’ narrative. South Asian men were more likely to favour informal adoption among their family to ensure a blood tie while White men were more likely to favour ‘stranger’ adoption. DI prompted negative attitudes among some men, in part due to the idea of another man biologically fathering a child with their partner.
Conclusion
The findings of this study suggest the impact of cancer-related infertility is affected not only by the capacity of an individual’s psychological resources and bodily function but also the expectations formulated by the social influences and context encountered. Health organisations and clinicians need to pay careful attention to the use of language and concepts that reframe rather than reinforce masculine stereotypes. Men may benefit from routine inquiries about the potential social impact of (diagnosed or potential) infertility to model the acceptability of such discussions. It is also important not to engage in cultural stereotyping and assume that men of certain ethnicity or religion will feel a particular way about infertility and the health care options available (e.g. sperm banking).
Points to Note
- Few studies on fertility and cancer have considered the related ‘social dimensions’ despite the increase in biopsychosocial approaches within this area.
- This paper examined the social influences affecting fertility related experiences of 28 South Asian and White men who had been diagnosed with cancer.
- The impact of cancer-related infertility is affected not only be men’s individual psychological resources and bodily function but also their expectations formulated by the social influences (e.g., perceptions of masculinity, cultural assumptions about the value of fatherhood) and context (e.g. use of routine inquiries about effect of potential or diagnosed infertility on men’s lives) encountered.
- Men may benefit from health professionals using language that reframes rather than reinforces masculine stereotypes.
- Routine inquires about the potential social impact of diagnosed or potential infertility may model acceptability of such conversations with men.
- Participants were recruited by health professionals involved in their care and the sexuality of participants is not reported. Future research that employs a wider range of recruitment strategies (so as those targeted at men who no longer seek medical care) and the inclusion of men with varied sexual identities may produce richer insights into men’s experiences of infertility and cancer.
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