Infertile men face significant anxiety, study shows

By Dr. Priyom Bose, Ph.D.Reviewed by Benedette Cuffari, M.Sc.Jul 11 2024

In a recent study published in the journal BMC Public Health, researchers determined the incidence of anxiety symptoms in infertile men.

Study: Prevalence of anxiety symptoms in infertile men: a systematic review and meta-analysis. Image Credit: Numstocker / Shutterstock.com

The psychological effects of infertility

Infertility can be defined as the inability to conceive after one year of unprotected intercourse. As a leading reproductive problem throughout the world, about 17.5% of the global population is affected by infertility, with the prevalence of infertility varying in different regions.

The World Health Organization (WHO) considers infertility a significant public health issue, as it leads to negative physical, psychological, social, and financial stress. Couples experiencing infertility are more likely to experience anxiety, depression, fear, guilt, avoidance, and frustration.

Previous studies estimate that the male factor is the primary or effective factor in 50% of couples experiencing infertility. Infertile men often suffer isolation, self-blame, feelings of sexual inadequacy, and anxiety, with many associating their infertility with incomplete identity and masculinity.

The inability to have children induces many psychological problems, particularly in societies where fertility is highly valued and a prime goal of marriage. Infertility induces fear of divorce, rejection, remarriage, and other unwanted changes that trigger anxiety in men.

About the study

To date, no study has conducted a meta-analysis to understand the prevalence of anxiety in infertile men. This information could help clinicians design proper interventions to alleviate psychological stresses that may influence infertility treatment outcomes.

For the current systematic review, all relevant data were obtained from Cochrane Library, PubMed, Web of Sciences, PsyINFO, Scopus, and Google Scholar. A total of 6,376 articles were initially identified, following which duplicates were removed and eligibility criteria were applied.

This led to 27 and 24 articles included in the systematic review and meta-analysis, respectively, comprising 6,624 infertile men. The lowest and highest prevalence of male infertility was observed in Canada at 3.7% and Iran at 43%, respectively, thus confirming the global variability in the prevalence of male infertility.

The selected studies assessed anxiety symptoms in infertile men through several standard tools including the Mini International Neuropsychiatric Interview (MINI), Symptom Assessment-45 Questionnaire (SA-45), Primary Care Evaluation of Mental Disorders (PRIME-MD), Depression Anxiety and Stress Scale (DASS), Hospital Anxiety and Depression Scale (HADS), Self-Rating Anxiety Scale (SAS), Beck Anxiety Inventory (BAI), and Spielberger Trait Anxiety Inventory (STAI-T).

Study findings

A total of fourteen studies used the HADS questionnaire to evaluate symptoms of depression and anxiety in patients who visited the clinics of public hospitals as outpatients, which indicated a 19.8% prevalence of anxiety symptoms in infertile men.

The STAI-T questionnaire has been designed to assess state anxiety, which reflects the respondent's current temporary state, as well as trait anxiety, which is an individual's general tendency to experience anxiety. STAI-T questionnaire results estimated the pooled prevalence of anxiety symptoms in infertile men to be about 30.1%.

The BAI questionnaire was developed in 1988 and includes 21 questions related to anxiety symptoms. Several studies have validated this tool and indicated its reliability. BAI analysis estimated the pooled prevalence of anxiety symptoms in infertile men to be about 7.1%.

SAS estimated the pooled prevalence of anxiety symptoms to be 18.5% of infertile men. Moreover, the DASS questionnaire, which contains a total of 21 questions that are divided into depression, anxiety, and stress sections, estimated the pooled prevalence of anxiety symptoms to be 34.9% of infertile men.

Previous studies have reported that cultural, religious, and individual factors influence the desire to have children in both men and women. As compared to infertile women, infertile men receive less social support, with most infertile men reluctant to discuss infertility with their family, friends, and even counselors, which contributes to their enhanced anxiety levels. The socio-economic situation and availability of healthcare facilities also influence the prevalence of anxiety in infertile individuals.

Conclusions

The current study highlights anxiety as one of the most common symptoms experienced by infertile men that impacts their health, quality of life, and response to treatment.

The highest and lowest prevalence of anxiety in infertile men was 34.9% and 7.08%, respectively, using the DASS and BAI tools. These estimates were higher than the prevalence of anxiety in the normal population.

Infertile men are more likely to seek emotional support from infertility physicians than from mental health professionals, friends, or self-help groups. Therefore, it is crucial to integrate psychological counseling into the infertility treatment process, as reducing anxiety levels could also improve treatment outcomes.