Behind the wall of silence lies a mental health catastrophe. A wealth of scientific studies and surveys have confirmed that men who are struggling with infertility are experiencing deep emotional trauma, shame and pain.

Estimates suggest 5-15% of men may suffer from infertility, with many tormented by feelings of anxiety, guilt and loneliness. This ordeal is exacerbated by the social stigma which equates male fertility with masculinity, making infertile men feel somehow diminished. But many men also suppress their emotions out of a desire to appear stoical in support of their partners.

A survey conducted by Infertility Network UK found that 52% of men would not discuss their fertility even with their own partner. As a result, many women experience devastating feelings of isolation and loneliness. In the quest to make new lives, existing lives are being broken.

Dr Esmée Hanna, an associate professor in the School of Allied Health Sciences at De Montfort University, Leicester, is an expert in the sociology of male infertility. Her research found that 93% of men says infertility has had a negative impact on their wellbeing and self-esteem.

In one survey-based study, Dr Hanna found that infertility is often viewed by men as “a failure of masculinity, as stigmatising and silencing, and as an isolating and traumatic experience.” By driving men into stoical silence, this trend only “burdens women and marginalises men.” Her research has also revealed the devastating wider impact on a man’s life, from impaired job performance to financial stress and loss of identity.

In an exclusive Unfiltered inteview, Dr Hanna discusses the silent shame of male infertility – and reveals how men can find the help and support they need.

Also in our Male Infertility special investigation

• Sperm counts in freefall: is the male infertility crisis an existential threat to humanity?
• “Are men facing a terminal decline in testosterone?”
• 10 ways men can boost their fertility
  

How does male infertility affect a man’s emotional health?
Certainly in the online settings that we’ve looked at, men are sharing some really in-depth and traumatic feelings. It is obviously very distressing for these men. But it is a whole range of feelings. Some of that is the obvious stuff of being sad and crying.

But also anger and resentment towards other people that get pregnant without trying, or for people who they perceive will make bad parents, and the galling nature of that. Also, the clinical encounters they have with doctors and professionals can make them feel less important. A lot of literature has historically focused on the crying and trauma, which is obviously part of it. But there is all the other stuff: the relationship stuff, the family stuff, the friends. What you planned for your life becomes completely thrown up in the air.

How are traditional views of masculinity shaping the emotions of infertile men?
The bigger issue that’s problematic for men and women is the way in which gender roles and ideals are shaped by society. That fertility-virility linkage is this ongoing issue. There is no link, but there’s this (perceived) conflation that if you’re infertile, it means you can’t have sex, which isn’t true.

But I think that feeds into those social norms, that this is somehow problematic, and that the idealised man is able to not only secure a female partner, but to have sexual prowess, to produce children, to provide, and to not show their emotions or to have mastery over them. They’re all contrasted to women as being ‘hysterical’ or ‘weak’. All of which isn’t true. But that idea is really pervasive.

Masculinity is hugely influential in relation to all of this, in the idea that ‘boys don’t cry’ and men need to be stoical, particularly for their women folk. The ‘sturdy oak’ or the ‘rock’ are the classic metaphors we see time and again around the infertility narrative. And that doesn’t predispose men to showing their emotional side.

Why do many men struggle to talk about infertility even to their own partners?
People feel they have to fall into a set role. And we often hear that men feel they’ve got to be the practical one and make decisions. That often falls into those gendered dynamics. That stoicism, I think, is just a presentation of some of that emotional backroom stuff. When you know that your partner is devastated by the situation, it’s very difficult to say: I’m really devastated! Here are all my feelings! Help me with them!

We know that as people are in long-term relationships, their friendship group grows potentially smaller. So where do those emotions go? Does stoicism become a front for some of that stuff? Because men don’t want to put a burden onto their female partners.

How can infertility affect a man’s relationships with his family, friends and work colleagues?
Most grown-up adults don’t want to bring up their sex lives at work, or with their friends, especially as people move beyond their teens and 20s when who you are having sex with becomes less of a discussion point. But we also found in our research that men say that friends and family are a really poor source of comfort. That is really hard.

There is also that disappointment of not making your parents into grandparents. Your siblings aren’t going to become aunts and uncles. It impacts families in those ways. Particularly if they have other family members who have children and they feel left out. And there is still that massive social pressure. When people get married, the next question is: when are you having babies?

How can infertility issues affect a man’s work life?
We know a bit about it in relation to women, in terms of time off for (fertility) appointments and the challenge of navigating work in relation to those things. And we know that the modern workplace is a variable feast. But for men that are self-employed, time off is money you’re not earning. And industries where people are self-employed – construction and freelance trades – are predominantly still 95% men. So they’re more likely to be implicated.

But there are also the challenges of having to tell work. If you don’t want to tell people why you are going to a hospital appointment, people use their leave. But the grief, the distress and the trauma also affect people’s concentration and their ability to progress.

What is the financial impact of fertility treatments like IVF?
The majority of people having fertility treatment have it through private clinics. It’s very expensive. And they might be happy to spend the money, but that is partly determined on outcome. People want to try everything they can, and the ‘hope’ aspect keeps people going back for more. It can come to tens of thousands of pounds. So that is wiping out people’s savings.

Other people said the opposite: after they realised they weren’t going to have children, they became much more free and easy with their cash and holidayed. But it also affects those ‘life’ things, like people saving for a family, or to move to a bigger house to have a family, or their own future and retirement and care. Lots of people think their children are going to care for them. And if they don’t have them, then they need a different resource for that.

What are the hidden dangers if a man’s trauma is neglected?
Some of the men that we’ve worked with said that they do feel like they’re less of a man. So they become obsessed with other things, like work, to overcompensate. Some have talked about becoming obsessed with sex and using sex workers to overcompensate. Those things don’t generally make people feel better in the long term. And some of that is self-destructive rather than emotionally expressive.

Can traditional concepts of masculinity be harnessed as a positive force to help men?
Bigger social narratives focus on masculinities as being this toxic problematic element. Don’t get me wrong: there are lots of things that we all need to change about gender inequity, for all of us, men and women. But actually sometimes those things, for example, camaraderie with other men, can be really beneficial for men, and actually framing things in ways that men understand or that feels more comfortable to them. That might be ways that they want to share with other men – or not necessarily exclusively with other women.

Sometimes people want to talk to someone who’s been in their shoes. And that might be somebody else who’s got a male factor (infertility) diagnosis. It might be someone who is making decisions about whether to use donor sperm, who might want to talk to men who have been through that, and further down the line from that, how have they managed their relationships to their children and their wider family? So we have to be really careful that we’re not losing some of the bits (of masculinity) that we could utilise in terms of health promotion that are positive for men, whilst also challenging those other things.

Men are super-invested in having children and they’re devastated that they can’t. But they feel that they’ve got to buy into these social norms, and the need to perform these other ‘roles’. In our latest book – (In)Fertile Male Bodies – we talk about masculinity as being ‘liquid’ – that you can be all of those things simultaneously. So you can be desperately wanting to have this child and be emotionally expressive. But simultaneously you can be at the gym and being stoic about it. You can be doing all those things within yourself, but in different contexts.

Where can men find spaces to talk?
I think this is where these communities where men can be together and share experiences are good. Online is really good because it’s anonymous. You can be weeping at your laptop, but no one knows that. Those things help to break down some of that stuff.

Accessing men where they are is usually the best way. There is now lots of promotion of mental health literacy and services in football and rugby. The challenge is that not all men like sport. So it is about using the positives without it being stereotypical.
But partly because of the lack of visibility and the stigma around infertility, men are never asked what they want. That is part of the challenge: understanding more of what they would like. And how do we support men and women to support each other? This affects single men, gay men. There is a myriad of communities within men. But raising awareness is helpful. It is still a shock to men when they realise that other men feel like that too.

Challenging all of this takes a longer cultural shift. How can workplaces support men? What about other spaces like gyms – not just the GP surgery? How do we buddy men up to support each other in useful ways? Can fertility clinics do walk-and-talk meet-ups? This is about carving out spaces in ways which are useful to men.

Where can you get help?

• The Human Fertilisation and Embryology Authority (HFEA) outlines support services available. This includes the HIM Fertility campaign, which encourages men to talk, and the Men’s Fertility Support Group on Facebook.
• The Men’s Health Forum has an online chat community where men can discuss problems.
• The NHS offers a mental health helpline, and your GP can arrange for a referral to therapy and counselling services.
• The British Infertility Counselling Association (BICA) can help you find a counsellor, with the help of a handy postcode search tool and a choice of online and telephone services.