A Longitudinal Investigation of the Emotional Experience of Men Using Medically Assisted Reproduction.

This study aimed to provide a more comprehensive understanding of men’s emotional experiences of infertility and MAR. To do so, we used the Joint Experience of Fertility Treatments Questionnaire, which emphasizes the relational context of infertility and captures a wide range of emotionally salient experiences – both positive and negative – beyond traditional psychopathology measures. In contrast to prior qualitative studies based on smaller samples, our study relied on a large group of participants, enhancing the generalizability of findings to North American men. We also employed a prospective design to examine changes in men’s experiences across a 12-month treatment period, an approach not previously used in this area. Overall, this exploratory study sought to describe men’s emotional experiences of infertility and MAR within the couple context and to examine how these experiences evolve over time, with the aim of informing clinical practice with this population.

This study was part of a larger prospective project examining predictors of adjustment among couples beginning fertility treatment. To participate, couples had to be within 6 months of their first visit to a fertility clinic in Canada or the United States. Participants needed to have access to the internet to complete the questionnaires, speak or read either French or English, and be of at least 18 years of age. Couples were excluded if one or both partners self-reported severe psychiatric disorders (e.g., psychosis, bipolar disorder) that were not well managed. For this study, only data from male partners collected during the first year (December 2019 to October 2021) were included. The initial sample comprised 277 men. We excluded three who did not report medical infertility (e.g., same-sex partners), three who separated from their partner before study completion, and 117 whose partner became pregnant or gave birth during the 12-month period, thereby ending treatment. The final sample included 154 men who were involved in fertility treatments over a 12-to-18-month period. Joint Experience of Fertility Treatments Questionnaire (JEFT-Q). The JEFT-Q assesses emotionally salient experiences commonly reported by couples facing infertility and undergoing MAR. It was developed based on empirical literature and clinical work with couples in fertility treatment by the second and last author. The original questionnaire included 22 items rated on a seven-point Likert scale (1 = strongly disagree to 7 = strongly agree), with higher scores reflecting stronger endorsement of each experience. In line with best-practice recommendations for exploratory factor analysis ( Sakaluk & Short, 2017 ), we used a common factor extraction method (ML), an oblique rotation (oblimin), and parallel analysis for factor retention, which yielded a three-factor solution explaining 46.96% of the variance. Six items were excluded due to low shared variance with the remaining items ( Tabachnick & Fidell, 2019 ), resulting in a final set of 16 items with factor loadings ranging from .314 to .829. The Kaiser–Meyer–Olkin index (.80) indicated adequate sampling adequacy, and Bartlett’s test of sphericity (χ 2 (153) = 1405.20, p < .001) supported the suitability of the data for factor analysis. We acknowledge that the sample size ( n = 154) was below the recommended minimum of 200–250 participants ( Sakaluk & Short, 2017 ), which may affect the stability of the factor solution. The first factor, labeled Positive experiences toward the partner , included four items reflecting appreciation and positive regard (e.g., admiration, gratitude, compassion) and demonstrated acceptable internal consistency (α = .76). The second factor, Concern for the partner , also comprised four items capturing feelings of worry, distress, and helplessness regarding the partner’s experience (e.g., feeling sorry for the partner, fearing relational consequences), with lower reliability (α = .65). The third factor, Resentment/alienation from the partner , included eight items reflecting dissatisfaction, emotional distance, and reduced engagement in the relationship (e.g., anger, disappointment, keeping distance), and showed good internal consistency (α = .81). Participants were recruited through brochures and advertisements distributed both online and in clinical settings. Online recruitment involved social media platforms (e.g., Facebook, Reddit, Kijiji, Twitter, Instagram), personal blogs, and websites of North American infertility-related associations. In fertility clinics, couples were approached either by a research assistant, who provided a brief study description and assessed eligibility, or by clinic staff who obtained consent for follow-up contact with the research team. A research assistant conducted a phone screening to determine eligibility and explain the study. Following verbal consent, both partners received an email containing the informed consent form, to provide written consent, and the baseline questionnaire to complete individually on a secure online platform within the same month. The baseline survey included sociodemographic variables, medical information related to fertility treatments, the JEFT-Q, and additional measures not examined in the present study. Except for demographic information, these measures were reassessed at 6 months (Time 2) and 12 months (Time 3). Each partner received up to $57 CAD for participation. The study was approved by the institutional research ethics board. Preliminary analyses were conducted using SPSS 27.0. Missing data were handled using multiple imputation (50 datasets) to enhance robustness and reduce bias associated with incomplete responses. A repeated-measures multivariate analysis of covariance (MANCOVA) was then performed to examine changes over time in the three emotional experience dimensions assessed by the JEFT-Q (i.e., positive experiences, concern for the partner, resentment/alienation from the partner). When significant time effects were observed, post hoc contrast analyses were conducted. Effect sizes were estimated using partial eta-squared (η 2 ). Three covariates were included: number of failed treatment cycles, use of medication for mood or anxiety disorders (yes/no), and current or past psychotherapy for infertility-related issues (yes/no), given their potential influence on psychological adjustment during fertility treatment ( Faramarzi al., 2013 ). In this sample, 10.4% of men reported taking medication for a mood or anxiety disorder, and 16.9% reported current or past psychotherapy for infertility-related concerns.

We first examined sample characteristics and potential differences between included and excluded participants. Participants included in the study did not significantly differ from excluded participants in age, socioeconomic status, and relationship duration. The only significant difference was in the duration of attempts to conceive ( t (260) = 2.261, p = .025), with men in the final sample having tried to conceive for longer on average. In the final sample, participants ranged in age from 19 to 56 years ( M = 34.12, SD = 5.22). Most were native English speakers (62.1%), followed by native French speakers (32.7%), and 5.2% reported another first language. The majority identified as White (88.3%), with smaller proportions identifying as Black (3.9%), Latino or Hispanic (1.3%), Asian (1.3%), Indigenous (1.9%), Middle Eastern (0.6%), or other ( n = 5). Nearly half had completed university (48.7%). Annual income was $49,999 CAD or less for 24% of participants, $50,000–$89,999 CAD for 54.5%, and $90,000 CAD or more for 21.4%. On average, men had been in their relationship for 8.34 years ( SD = 4.59), and 66.3% were married. Regarding medical background, 96.7% of men consulted fertility clinics in Canada and 2.4% in the United States. A quarter reported a male-factor infertility diagnosis (25.5%), 25.5% reported female-factor infertility, 9.2% reported an unknown or unexplained cause, and 9.8% reported mixed-factor infertility. Most men (77.2%) had experienced at least one unsuccessful treatment cycle with their partner in the 6 months prior to study entry. Over the 12-month study period, participants reported an average of 2.5 failed treatment cycles (up to 14). Before addressing the study objectives, we examined the distributional properties of the variables and patterns of missing data. All variables were normally distributed, except for resentment/alienation at Time 1, which showed a right-skewed distribution. Data were missing for 5 participants at baseline, 34 at Time 2, and 38 at Time 3, with missingness occurring at random (Little’s MCAR test: χ 2 (18) = 24.09, p = .152). The first objective of the study was to describe the subjective experiences of North American men undergoing fertility treatment with their partner. Correlations and descriptive statistics for the three JEFT-Q dimensions at T1, T2, and T3 are presented in Table 1 and Table 2 . Within 6 months of their initial clinic visit (T1), men reported higher levels of positive experiences toward their partner (e.g., admiration, gratitude, compassion) than concern or resentment-related experiences. Specifically, 79% of men endorsed positive experiences (i.e., mean score ≥ 5 on the 7-point scale). In contrast, only 21% reported similarly elevated levels of concern for their partner, suggesting that feelings such as fear, helplessness, or pity were not strongly endorsed at study entry. At T1, most men (94.6%) scored 4 or lower on the resentment/alienation dimension, indicating neutrality or disagreement with these experiences; only one participant had an average score of 5 on this dimension. Table 1. Bivariate Correlations Between Emotional Experiences Toward the Partner at Each Time Point Variable 1 2 3 4 5 6 7 8 1. Concern T1 - ​ ​ ​ ​ ​ ​ ​ 2. Concern T2 .445** - ​ ​ ​ ​ ​ ​ 3. Concern T3 .353** .295** - ​ ​ ​ ​ ​ 4. Resentment T1 .380** .207** .080 - ​ ​ ​ ​ 5. Resentment T2 .102 .612** -.017 .230** - ​ ​ ​ 6. Resentment T3 .170 .127 .452** .329** .194* - ​ ​ 7. Positive experiences T1 -.034 -.024 .034 -.407** -.164 -.099 - ​ 8. Positive experiences T2 -.047 .254** .127 -.324** .117 -.133 .465** - 9. Positive experiences T3 -.013 .038 .502** -.081 -.060 .460** .254** .441** Note. N = 155; data are expressed as combined coefficient correlations; T1 = Baseline survey; T2 = 6-months follow-up survey; T3 = 12-months follow-up survey. * p <.05. ** p < .01. Table 2. Descriptive Statistics for the Three Types of Emotional Experiences Toward a Partner Captured by the Joint Experience of Fertility Treatments Questionnaire Variable T1 T2 T3 Concern for partner 4.048 (0.108) 4.375 (0.132) 4.904 (0.128) Resentment & alienation 1.708 (0.867) 2.288 (1.766) 2.686 (1.039) Positive experiences 5.937 (0.918) 6.146 (1.020) 4.917 (0.872) Note. N = 155. Data are expressed as combined estimated marginal mean (standard deviation). Bivariate Correlations Between Emotional Experiences Toward the Partner at Each Time Point Note. N = 155; data are expressed as combined coefficient correlations; T1 = Baseline survey; T2 = 6-months follow-up survey; T3 = 12-months follow-up survey. * p <.05. ** p < .01. Descriptive Statistics for the Three Types of Emotional Experiences Toward a Partner Captured by the Joint Experience of Fertility Treatments Questionnaire Note. N = 155. Data are expressed as combined estimated marginal mean (standard deviation). To address the second objective, a repeated-measures MANCOVA was conducted to examine changes in men’s emotional experiences across three time points, controlling for number of treatment failures, use of medication for mood disorders, and psychotherapy. The multivariate test was significant, F (6, 75) = 26.34, p < .001, η 2 = .681. Follow-up univariate analyses showed a significant main effect of time for the Concern for the partner scale, F (2, 84) = 5.76, p = .004, η 2 = .067. Post hoc comparisons indicated no significant difference between T1 and T2 ( p = .430), but concern increased significantly from T2 ( M = 4.39, SD = 1.61) to T3 ( M = 4.91, SD = 1.25; p = .023), and from T1 ( M = 4.05, SD = .11) to T3 ( p < .001; see Figure 1 ). The univariate analysis for “resentment/alienation from partner” revealed a significant main effect of time, F (2, 84) =12.42 1 , p < .001, η 2 = 0.134, with a significant increase between T1 ( M = 1.71, SD = .87) and T2 ( M = 2.29, SD = 1.77, p < .001), no significant difference from T2 to T3 ( p = .55) and a significant difference between T1 and T2 ( p < .001). With regards to positive emotions, a significant main effect of time was also observed, F (2, 84) = 37.40 2 , p < .001, η 2 =.319. The endorsement of positive emotions did not change significantly between T1 ( M = 5.94, SD = 0.92) and T2 ( p = .58), but it decreased significantly from T2 ( M = 6.15, SD = 1.02) to T3 ( M = 4.92, SD = 0.87, p < .001) as well as between time 1 and time 3 ( p < .001). None of the three covariates were significantly associated with changes in the three emotional experience dimensions over time. Figure 1. Change in the three dimensions of the Joint Experience of Fertility Treatments Questionnaire across time Note. T1 is onset of study, T2 is after 6 months, and T3 is after 12 months Change in the three dimensions of the Joint Experience of Fertility Treatments Questionnaire across time Note. T1 is onset of study, T2 is after 6 months, and T3 is after 12 months

The present study examined North American men’s subjective emotional experiences toward their partner over one year of MAR using a longitudinal quantitative design. Overall, men reported consistently high levels of positive feelings, such as compassion, admiration, and gratitude. However, after 12 months of treatment, these experiences appeared to decline, alongside a significant increase in more challenging affective states, including concern, helplessness, frustration, and alienation. These findings enhance understanding of the complex emotional experiences of men undergoing MAR with their partner and align with patterns previously identified in smaller qualitative studies. Our analyses identified three types of emotional experiences among men undergoing MAR with their partner: (1) positive feelings reflecting appreciation toward the partner, (2) concern for the partner, and (3) resentment or alienation from the partner. Positive experiences, particularly evident at Time 2 (i.e., 6 to 12 months after the initial clinic visit), included feelings of admiration, gratitude, and compassion. Given that much of the treatment process involves women’s bodies, men’s strong sense of gratitude may reflect recognition of their partner’s physical and emotional investment. Witnessing demanding or painful procedures may foster compassion and admiration. Although endorsement of these positive feelings declined significantly by Time 3 (i.e., 12 to 18 months of treatment), most participants continued to report relatively high levels of positive regard toward their partner. Future research should examine whether positive affective experiences function as protective factors for partners’ psychological and relational adjustment during fertility treatment. This perspective aligns with findings suggesting that, for some couples, the MAR journey can strengthen the relationship. Sauvé et al. (2018) reported that couples who had recently completed treatment described greater mutual engagement, increased closeness and understanding, and improved communication and support. Similarly, Peterson et al. (2011) found that among 1,406 couples undergoing MAR over 5 years, nearly one third reported increased marital benefits despite unsuccessful outcomes, particularly when using positive coping strategies. Positive emotional experiences, such as those examined in the present study, may therefore contribute to more adaptive relational dynamics or perceived relationship gains. Future research could extend these findings by incorporating broader indicators of relationship well-being alongside measures of affective experiences toward the partner. Although men generally reported high levels of positive feelings toward their partner throughout the study, these experiences declined significantly with prolonged exposure to treatment. At the same time, concern for the partner’s well-being showed a modest but significant increase. After 12 to 18 months of treatment, participants were more likely to report feelings of helplessness, pity, guilt related to the couple’s difficulty conceiving, and fears about the relationship’s future if treatments were unsuccessful. While concern does not preclude positive interactions, repeated medical procedures and cycles of hope and disappointment can take a considerable emotional toll on couples ( Luk & Loke, 2015 Maroufizadeh et al., 2015 ; Pasch et al., 2016 ). Early in the treatment process, men may feel hopeful and express greater admiration and compassion toward their partner. Over time, however, prolonged uncertainty and setbacks may contribute to increased helplessness and relational concern ( Patel et al., 2019 ; Petok and Peterson, 2022 ). Consistent with these findings, research has shown that men participating in online discussion boards frequently seek guidance on how to support their partner ( Malik & Coulson, 2008 ; Richard et al., 2017 ). Some men also described “doing everything possible” to compensate for feelings of guilt associated with the couple’s fertility challenges ( Schick et al., 2016 ), a pattern also reflected in our sample. Notably, and in contrast with some prior studies ( Sauvé et al., 2018 ; Schick et al., 2016 ), participants in the present study reported concerns about the potential impact of unsuccessful treatment on their relationship. Together, qualitative research and the current findings highlight the range of aversive emotional experiences men may face during treatment, underscoring the limitations of relying solely on traditional measures of psychological symptomatology. A third affective dimension examined in this study was resentment and alienation from the partner , encompassing feelings such as anger, frustration, or disappointment, attributing blame for conception difficulties, emotional distancing, and reluctance to self-disclose for fear of judgment. These experiences were the least endorsed at baseline. However, after one year of treatment, men were significantly less likely to disagree with such statements, potentially suggesting the emergence of greater ambivalence over time. Similar emotional responses, such as frustration, isolation, and feeling misunderstood, have been reported in online communities, where some men describe infertility as a “lonely battle” and recount increasing emotional strain that contributes to irritability or reduced patience toward their partner. A common pattern also involves suppressing personal distress in an effort to remain supportive ( Patel et al., 2019 ). One possible explanation for the relatively low endorsement of conflictual affective experiences is the emotional caregiving role that men often assume in the context of MAR ( Herrera et al., 2013 ; Hudson & Culley, 2013 ; Patel et al., 2019 ). This role involves adopting a stoic stance and prioritizing the provision of emotional support to one’s partner. Men may perceive it as their responsibility to avoid adding to their partner’s emotional burden by withholding their own distress ( Herrera et al., 2013 ). Consequently, they may emphasize sympathy and concern while suppressing more hostile or conflictual feelings. Qualitative findings support this interpretation: for example, Schick et al. (2016) reported that men often viewed supporting their partner as their primary role, internalizing expectations to remain “strong,” which may entail emotional suppression. Such dynamics may help explain the limited reporting of conflictual experiences in the present study. It is also possible that men are less inclined to disclose negative feelings, particularly when their partner bears much of the treatment burden, or that the sample included individuals who adapted relatively well during treatment. Future research should aim to better distinguish patterns of adjustment over time. This study is among the few to adopt a relational perspective when examining men’s nuanced emotional experiences toward their partner during MAR, while also capturing changes in these experiences over a 12-month period. Previous research has often relied on cross-sectional or retrospective designs, or included men at varying stages of treatment. Although qualitative studies have provided valuable insights into men’s experiences of infertility and MAR, their smaller samples have limited generalizability. By using a newly developed questionnaire and a relatively large sample of North American couples, the present study offers a more generalizable and systematic examination of men’s relational emotional experiences during fertility treatment. Several limitations should be considered when interpreting these findings. First, only men who remained in their relationship and continued treatment throughout the study period were retained in the final sample. As a result, the experiences of men who separated or discontinued treatment—who may have reported lower positive experiences and greater relational distress—were not captured. Second, the study relied on a newly developed measure. Although preliminary factor analyses supported its structure, the internal consistency of the concern for the partner subscale was modest, highlighting the need for further validation of the JEFT-Q. In addition, the sample was relatively homogeneous, consisting primarily of White and well-educated participants, which may limit the generalizability of findings to more diverse sociocultural or socioeconomic groups. Finally, although self-report questionnaires offer practical advantages, they may not fully capture men’s emotional experiences, particularly in a context where norms of masculinity and stigma surrounding infertility can influence emotional disclosure. The findings of this study support the notion that men going through fertility treatments can experience nuanced and various emotional states throughout the medical process. It would thus be important to closely investigate the experience of male partners whose treatment journey extends past 12 months to better understand what could account for a shift in their emotional experience, and optimally, offer guidance to the couples facing these challenges. In an effort to achieve this, future research could monitor these men using a weekly diary to record the unfolding of subjective experiences as couples struggle with unsuccessful treatment cycles or repetitive intrusive medical procedures with their partner. This could potentially provide meaningful material on the different perspectives resulting from the two roles needed (i.e., woman at the center of the medical procedures and the assisting partner) in this arduous and often lengthy journey to parenthood. Ultimately, investigating men’s experiences of involuntary childlessness and assisted reproductive treatments can significantly influence the way health care professionals (e.g., doctors, nurses, psychologists) provide support to them. As Petok (2015) mentions in his literature review on counseling men with infertility, even though there are resources currently available, many men will not use the offered help. The author suggests that these interventions might not be best suited to their needs given that they are predominantly based on studies regarding psychological distress and effective therapeutic methods among female patients. Yet there is empirical evidence supporting that men often report they are not properly informed on the medical vernacular surrounding fertility treatments by the clinical staff or they feel excluded from the process ( Arya & Dibb, 2016 ; Van Empel et al., 2010 ). As a result, men express feeling disengaged in the medical process, feeling isolated, and misunderstood ( Patel et al., 2019 ; Richard et al., 2017 ). Findings such as these underly the need of coming to really understand the male perspective on infertility and MAR. In turn, future counselling approaches could potentially benefit from including psychoeducation to both members of the couple on the various types of emotional experiences that can arise when undergoing fertility treatments. This seems particularly relevant given men’s tendency to supress their affective responses as a way to assist their female partner while female partners express a desire to hear more about their male partner’s experiences ( Herrera, 2013 ; Petok and Peterson, 2022 ). In the end, interventions best tailored for both men and women are of crucial importance given the interplay between each partner’s emotional adjustments ( Martins et al., 2014 ). The present study has made an important contribution to the current infertility literature as it has used a newly developed questionnaire investigating diverse emotional experiences in the context of a relationship across a large sample of North American men and over an extended period of 12 months. As the findings have highlighted, men can report important fluctuations in both positive and negative experiences when going through fertility treatments with their significant other. Indeed, the male experience of MAR can be very nuanced and future research efforts should be carried out to better capture the many facets of this journey for both members of the relationship.