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Author Topic: The modern male: more than just sperm  (Read 8339 times)
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Historically, the man’s role in assisted reproduction treatment (ART) has, in some regards, been credited as being little more than a source for DNA. From initiation into the treatment clinic to culmination in IVF, the man’s role has been supremely subordinate to that of the woman’s. The reason(s) are largely practical. The woman receives the majority of medical and supportive (compassionate) attention from nurses and physicians during examinations, repeat ultrasound scans and blood work, inseminations, egg retrieval and embryo transfer. The man is directed to show up at an appointed time and to sequester himself in a room, special or not, to masturbate and produce a semen sample for subsequent use. For the man, this ‘performance on demand’ scenario can cause significant anxiety and a questioning of ones ‘maleness’.

As treatments have advanced so has there been an enhanced role for the male in the ART process. The advent of intracytoplasmic sperm injection (ICSI) has brought a greater spotlight on the significance of the man’s contribution to the IVF process. In the past, donor sperm, adoption or childlessness would have been the only choices when a man was diagnosed as azoospermic. Today, surgical intervention allows for sperm to be harvested (akin to oocyte harvesting) from the epididymis and testicular tissue and, with ICSI, used for conception attempts. Available evidence suggests that the man’s sense of self-worth and esteem in the ART process has been fortified as a consequence of this advance. More recently, the wider application of preimplantation genetic diagnosis has afforded the ability to deselect embryos that contain paternally inherited lesions, thereby removing any stigma or grief associated with potentially fathering an affected child or any associated threat to self-esteem by ‘resorting’ to donor sperm.

Several of the papers that make up the special symposium collection in this issue of Reproductive Biomedicine Online involve psychosocial aspects related to the male partner and his emerging role and identity in ART. They delve into aspects of how men feel about their role and how that role is evolving in an emotional context, as an individual as well as in partnership. The limited amount of recent supporting literature cited in these papers collectively reveal that much still remains unanswered or obscure and, as such, there is a necessary urgency for more research into these and other areas regarding the evolving role of the male in ART.

The focus of the remaining papers is on more unique but equally important topics. Adult and childhood cancers are increasing and as such there is a desperate need for fertility preservation. Pre-chemo/radio therapeutic strategies include not only freezing of sperm and of adult and prepubertal testicular tissue, but also supportive counselling for the affected male. It is becoming increasingly apparent that there is grief associated with the potential loss of fertility and a concordant feeling of diminished virility. Clinics must be prepared to redesign their delivery of service to include pre- and post-therapy counselling as a necessary way to mitigate such negative self-perceptions.

Gay couples are becoming increasingly aware of and utilizing ART for family building. In lesbian couples, family building can be as (relatively) easy as a turkey baster and donated sperm. In contrast, a gay male couple requires the enlistment of an egg donor and perhaps a separate gestational surrogate. This requirement sets the stage for unique family structures that are novel to the present day. The male-male relationship can be seen by some as lacking in the necessary ‘ingredients’ normally associated with female involvement in child rearing. As gay male couples increasingly utilize ART, the dual male role in child rearing, the impact on and role of the extended family in support of the couple, and, lastly, societal adaptation to new family structures will be clarified. Psychosocial and therapeutic strategies can be better formulated to support all stakeholders.

In conclusion, the role and contribution of the male towards family building using ART in both heterosexual and same sex relationships is evolving rapidly. As highlighted in this special collection of papers, a man’s self-identity and esteem in this regard has already begun an associated evolution. To keep pace with this evolution there is a need for more research to understand the psychosocial aspects of this metamorphosis. Further, mental health resources must simultaneously adapt and be made available so that support can be provided to all parties involved.

As a post-script to this brief introductory editorial, the authors of the papers requested mention be made of the outstanding contributions and recommendations made by the referees. In addition, acknowledgement and gratitude is extended to the Editors and staff of the journal for their support in this unique and important collection.

The papers were first delivered at a symposium on Men, Infertility and Assisted Reproductive Technologies held at De Montfort University, Leicester, UK in April 2012. The authors of the collected pieces would like to thank all the contributors to that event for their contribution to discussion of the papers.

PII: S1472-6483(13)00377-5


© 2013 Reproductive Healthcare Ltd. Published by Elsevier Inc All rights reserved.

« PreviousNext »Reproductive BioMedicine Online
Volume 27, Issue 3 , Pages 223-224, September 2013.
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