A qualitative study of factors influencing male participation in fertility research

(2020) 17:186 Harlow et al. Reprod Health https://doi.org/10.1186/s12978-020-01046-y Open Access RESEARCH A qualitative study of factors influencing male participation in fertility research Alyssa F. Harlow1* , Amy Zheng1, John Nordberg1, Elizabeth E. Hatch1, Sam Ransbotham2 and Lauren A. Wise1 Abstract Background: Although fertility is a couple-based outcome, fertility studies typically include far fewer males than females. We know little about which factors facilitate or inhibit male participation in fertility research. In this study we aimed to explore factors that influence male participation in fertility research among North American couples trying to conceive. Methods: We conducted a qualitative research study of male participation in Pregnancy Study Online (PRESTO), a prospective preconception cohort of couples actively trying to conceive in Canada and the United States. Between January–August 2019, we carried out 14 online one-on-one in-depth interviews and one online focus group of males and females with varying levels of participation. The in-depth interviews included females who enrolled in PRESTO but declined to invite their male partners to participate (n = 4), males who enrolled in PRESTO (n = 6), and males who declined to participate in PRESTO (n = 4). The focus group included 10 males who enrolled in PRESTO. We analyzed the transcriptions using inductive content analysis. Results: Male and female participants perceived that fertility is a women’s health issue and is a difficult topic for men to discuss. Men expressed fears of infertility tied to masculinity. However, men were motivated to participate in fertility research to support their partners, provide data that could help others, and to learn more about their own reproductive health. Conclusions: Male participation in fertility studies will improve our understanding of male factors contributing to fertility and reproductive health issues. Results indicate a need for more education and health communication on male fertility to normalize male participation in fertility and reproductive health research. Plain English Summary: Men are much less likely than women to participate in research on fertility and pregnancy. However, it is important for men to participate in fertility research so that we gain a better understanding of male factors that impact fertility and pregnancy outcomes. In this qualitative study, we interviewed men and women from Canada and the United States who were trying to become pregnant to understand why men choose to participate in fertility research, why men choose not to participate in fertility research, and why women choose not to invite their male partners to participate in fertility research. We found that both men and women believe fertility is a woman’s health issue. Men find it difficult to talk about pregnancy and fertility and have fears of infertility tied to masculinity. However, men are motivated to participate in fertility research to support their partners, to help others, and to learn more about their own reproductive health. *Correspondence: 1 Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02188, USA Full list of author information is available at the end of the article © The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Harlow et al. Reprod Health (2020) 17:186 Page 2 of 14 Keywords: Male fertility, Qualitative research, Male participation, Reproductive health, Research participation, Preconception cohort Background Although fertility is a couple-based outcome and male factors account for 50% of infertility cases [1], most fertility studies enroll females only and focus only on female determinants. Over the past decade, the National Institutes of Health and other funding bodies have placed greater emphasis on advancing scientific knowledge on male factors that influence fertility [2]. While advanced male age [3, 4], smoking [5–7], obesity [8–10], and other lifestyle factors [11–13] may affect fertility, other male factors are unknown. The lack of knowledge on male factors is partially due to a lack of available data, and the limitations of using female proxies for male exposures [14]. Few males participate in preconception and reproductive studies, and we know little about which factors facilitate or inhibit male participation in fertility research. Understanding these factors can inform targeted recruitment efforts and potentially improve male participation rates in fertility studies. One barrier to male engagement in reproductive health research is that men may feel disconnected from fertility because women get pregnant, not men [15]. Cultural and gender norms surrounding pregnancy also contribute to men and women perceiving that pregnancy is a woman’s domain and that men are not expected to be engaged in the preconception process [15–18]. These cultural norms may also cause investigators not to invite men to participate in studies on reproductive health [19]. Clinical treatment of infertility (e.g., assisted reproduction) tends to focus on female bodies, which in turn contributes to an environment where men feel they are not equal partners in the reproductive process [19–21]. Most research on male engagement in fertility or pregnancy processes includes either couples experiencing infertility, or men from the general population who are not actively trying to conceive with a partner. Few studies examine male participation in fertility research among couples actively trying to conceive. This study intends to understand the factors contributing to male participation in Pregnancy Study Online (PRESTO), a large preconception cohort study of North American pregnancy planners. Using qualitative research methods, we interviewed men and women from PRESTO to identify factors contributing to participation (or lack thereof ) by men in fertility research. Methods Study design We conducted a qu (...truncated)