With studies showing a decline in male sperm count amongst western societies, and with male factor issues contributing to almost half of all infertility cases, male infertility is certainly something that we should be talking about.

Dreaming of Baby speaks to Justin Lioi, LCSW, a men’s mental health expert. Mr. Lioi shares strategies and tips for coming to terms with challenges related to male infertility in the journey to parenthood.

Daniela: Good morning Justin and welcome to Dreaming of Baby. It’s a pleasure to be speaking with you today on a very important yet not sufficiently talked about subject: infertility and men’s mental health. Before we start our discussion, it would be great if you could kindly introduce yourself to our readers.

Justin Lioi, LCSW: Sure, my name is Justin Lioi, and I’m a men’s mental health psychotherapist. I work with men who are struggling with anger, challenges with emotional expression, and have a focus on men who are new fathers or working toward becoming dads.

Justin Lioi, LCSW: I’m an LCSW, a Licensed Clinical Social Worker, and have been working with dads and families in a clinical capacity for almost 10 years.

Justin Lioi, LCSW: Before that, I taught early childhood music (Music Together to those who are familiar) for nine years while trying to make a living as an actor. That program got me interested in working with families, particularly dads, as they were not always the ones in class.

Justin Lioi, LCSW: From there it went from working with children to wanting to spend more time with the parents who were the ones who spent the most time with the kids anyway! Along the way I began meeting men who were struggling to have children and there was very little space for them to talk about this.

Justin Lioi, LCSW: Most put their concern and attention on their female partner and all she was going through and were reluctant to “share the burden” of how they were managing with infertility. The ways they expressed (or didn’t express) this were often misconstrued by their partners and led to conflict instead of being able to find comfort with each other–even to suffer together as a means of comfort.  My practice began seeing more and more men struggling with infertility as well as perinatal loss.

The Impact of Infertility on Relationships

Daniela: Based on this wide-ranging experience, what impact does infertility have on relationships?

Justin Lioi, LCSW: Conflict, unfortunately, where there is an opportunity for greater closeness. I’m speaking in general here, but the more either partner connects with their gendered expectations, the more isolated both feel.

Justin Lioi, LCSW: A stereotypical man feels his job is to take care of his wife/girlfriend and the idea that he is unable to do this brings on a lot of shame. He also can’t take away her suffering. And often she feels this is “her” job and she’s failing at is as well.

Justin Lioi, LCSW: The couple doesn’t come together – plus, they often don’t want to share their challenges with friends (who may all be happily procreating). This means that they don’t have each other and they don’t have their regular support system either.

Daniela: That’s very interesting – and sad. In this regard, what tips would you share to help men express themselves more with their partners as well as to overcome these gendered expectations?

Justin Lioi, LCSW: We want to get rid of the feeling of “fault”, but there are many layers to that. Many men and women intellectually “know” they didn’t do something “wrong” but they will work very hard to make this a reality – “We waited too long… if I (or you!) were ready to have a child five years ago we wouldn’t be dealing with this.”

Justin Lioi, LCSW: So first off, it’s also getting those thoughts and feelings into the open. Even being able to voice to each other, “I blame myself for this, or I’m angry that you made us wait,” puts the feelings in the couple’s dynamic and not the unspoken realm that can just be death to relationships.

Justin Lioi, LCSW: Having a space outside each other is helpful too: a good friend or family member to be able to say all the things you’re not quite ready to say to the other – just so you’re not holding it in.

Justin Lioi, LCSW: I’m a big fan of bringing out the word “compassion” because I’ve always loved that it means “to suffer with”. There’s strength in being able to do this with each other and finding self-compassion as well as compassion for your partner is incredibly healing and helpful.

Justin Lioi, LCSW: This also includes finding doctors who are going to be straight with you as well – and doctors you are both comfortable with.

Justin Lioi, LCSW: Realize that so much of this can be bound up with your expectations. How did you imagine this process would go. Be able to let go of some of those ideals. Maybe even give yourself a chance to grieve that it’s not all going to be a simple conception and 9-month process like we were all told when we first learned about this!

Justin Lioi, LCSW: If this begins to bring up other conflict, if you start to not “fight fair”, be open to getting support from a couple’s counselor. If and when you do have a child you’re going to be faced with more and more challenges together. This can be the space where you learn how to move through problems that pre-existed your current struggles.

Justin Lioi, LCSW: The challenge with men is that it’s highly probably they are going to feel shame if we directly say, “You need to do x,y, & z because your sperm isn’t working” and the other, equally unhelpful, side is to “take care” of the male ego, hence the many euphemisms (“the engine’s not working right”). Each individual man is going to need somewhere in between to activate themselves into getting help and support.

Dealing with an Infertility Diagnosis

Daniela: Receiving such a diagnosis can be quite challenging. How can men deal with any sense of insecurity or self-doubt caused by finding out that they will have issues conceiving?

Justin Lioi, LCSW: Know that it’s not an evaluation of your sense of being a man. You haven’t failed a “man test” in some way. The more we can connect it to having high cholesterol or blood sugar the more we can move it toward a medical issue and not a place for self-judgment. But, the best thing you can do with this information is to talk about it. Express how shitty it makes you feel, express how scared and upset you are. Talk about the shame that it brings up. Holding that in, keeping that seed inside, can only eat away at you and your sense of self.

Daniela: If, for instance, a couple is finding it difficult to conceive and the male partner is hesitant about getting tested, do you have any tips for overcoming this fear and the man also working towards finding the cause of a couple’s infertility?

Justin Lioi, LCSW: I’d want to understand that fear a bit more and have a sense of what that fear is of. Is it what we’ve been talking about–fear of not living up to what their sense of what a Man is (or should be). Is it bound up with the fear of being one who’s preventing the pregnancy and is their fear of backlash from that? Is he afraid that his partner won’t stay with him? They’re going to need to talk out these fears together, and this may be the only way he goes to the doctor. He may need some reassurance in the power and strength of the relationship.

Justin Lioi, LCSW: Seeking out the more and more online men’s support forums is great too. He’s going to want to know he’s not alone.

Male Infertility and Mental Health

Daniela: If I understand well then, support and communication are key in this journey. Without both, and as a general question, what impact does male infertility and all the emotions associated with it, have on mental health?

Justin Lioi, LCSW: It can lead to depressive feelings, feelings of inadequacy. It often leads to erectile dysfunction as well which can further complicate things.

Daniela: As a final question, and based on your experience, how prevalent is the stigma associated with male infertility? On an individual basis working one-to-one with a patient, how is stigma best tackled?

Justin Lioi, LCSW: By both generalizing it and individualizing it. We look at how prevalent it is: you’re not alone. You’re not alone in going through this and you’re not alone in feeling this way about it – it’s just that no one talks about it! Then we need to look at what this means for you personally. What are your “gender norms and expectations”. We need to explore how you usually manage stress and disappointment. What kind of relationship do you have and do you seek refuge in each other.

Daniela: This is very helpful. Again, the importance of communication and sharing concerns strikes through. What would be your final piece of advice for someone going through this journey?

Justin Lioi, LCSW: Don’t avoid the painful feelings that will come up. If you try to, they’ll just find worse avenues to get to you. And have a sense of humor because this process can be too stressful and so much is out of your control otherwise.

Daniela: Thank you for that Justin, what you’ve shared with us today will be helpful for readers experiencing this journey. Thank you for your time!

Justin Lioi, LCSW: Glad to do it. Thanks so much for having me.

Learn more about male mental health and the services offered by Justin Lioi, LCSW at Park Slope Therapist.