Male fertility: how nursing staff can support men

Male fertility and declining sperm quality is a growing concern.

According to the World  Health Organization, about 7% of men worldwide are affected by infertility with around half of fertility issues in heterosexual couples affecting the man.

Male factor fertility (declined sperm quality or issues with conceiving a child naturally) is just as common as female factor fertility according to the Human Fertilisation and Embryology Authority.

Men tend to feel forgotten when it comes to fertility

But nurse Anne Howard, fertility nursing specialist and deputy director of nursing for digital health company Peppy Health, says many men remain in the dark when it comes to talking about fertility, and the focus is often still on women.

“It’s important for all nursing staff to have a good understanding of male factor fertility influences and the various things that can impact it, especially as nursing staff may often be the first point of contact for patients when they have questions,” says Anne.

Anne has seen an increase in the number of people seeking fertility advice and services. “It seems to be an area of health that is growing massively,” she says.

Male infertility can be caused by low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. Illnesses, injuries, chronic health problems, lifestyle choices and other factors may contribute to male infertility.

New RCN guidance

To support nursing staff in this area, Anne, in her role as Deputy Chair of the RCN Fertility Nursing Forum, led the creation of new guidance specifically on male factor fertility.

“As a forum, we felt this guidance was necessary for all nursing staff as some may have limited knowledge or understanding of the issues relating to male fertility and the tests and treatments available,” says Anne.

The guidance is aimed at nursing staff in all settings, not just fertility services. “Fertility, especially for men, crosses into many other areas of nursing – urology, oncology and general practice,” says Anne. “This guidance aims to raise awareness of male physiology, mental and physical challenges for men and how nursing staff can support those trying to conceive.”

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For some men, the idea of reduced fertility can be a taboo or shameful thing, cultural differences can also play a role. Anne wants to create more awareness of male factor fertility to reduce this.

“When a couple struggle to conceive, people automatically think it’s an issue with the woman, but actually it can be 50/50, or sometimes unexplained,” she says.

Anecdotal evidence and research suggest men tend to feel forgotten when it comes to fertility.

“It’s important for men to feel included in discussions and next steps,” she adds.

Patient perspective

The new guidance includes explanations of factors affecting male fertility and begins by focussing on one man’s fertility journey.

“We wanted people to understand how it feels for a lot of men going through fertility issues,” says Anne. “It’s taken a lot of work to make sure we’re covering everything, but not blinding people with science.”

British racing car driver Toby Trice, gives an honest account of his 6-year struggle to conceive outlining the challenges, both physical and emotional.

The stigma surrounding male factor fertility weighed heavily

Toby explains how he felt isolated after he set out on his fertility journey. In the publication, he recalls: “I vividly remember sitting in a room with my partner and a gynaecologist and it was like I was a fly on the wall. With the results being spelt out to my partner about the good and bad. As if I wasn’t there, no care or consideration from the consultant about how my emotions were running so high.”

Anne says, despite the support of his wife, Toby struggled to find a sense of belonging in a world where conversations about fertility often revolved around women. “The stigma surrounding infertility weighed heavily, exacerbating feelings of isolation and despair,” says Anne.

Reducing stress

Recognising the delicate nature of conversations about fertility, this guidance advises on effective communication strategies for nursing staff.

“It equips them with the tools needed to engage in open, supportive, and empathetic discussions with individuals and couples navigating male factor fertility challenges,” says Anne.

At every stage, patients should be reassured that ongoing support is available, either individually or as a couple.

“Providing reassurance, support, and inclusion at every step of the way can help reduce the stigma and stress that’s sometimes associated with issues that arise when reproduction becomes medical rather than natural,” says Anne.

Top tips: supporting people with male factor fertility issues

1. Sensitivity. Men should be encouraged to escalate any concerns regarding their fertility, but this can be challenging. Establishing a good rapport is vital for honest and open conversation.
2. Neutrality. Avoiding language suggesting blame while ensuring men are involved in the treatment process can improve emotional wellbeing throughout their fertility experience.
3. Differences. Being aware of barriers due to differing social and ethnic background, neurodiversity and disabilities is important: not everyone communicates the same.
4. Support. Recognising men may be feeling emasculated, self-conscious and experiencing a wide range of emotions can be useful to remain supportive.
5. Signposting. Nursing staff should signpost men to the appropriate medical professionals and support groups if applicable. There are also several podcasts (The Male Fertility Podcast) and resources (Test Him) to support men.