The manuscript presents male infertility as both a clinical and theoretical challenge, urging nursing to reconceptualize care, vulnerability, and reproductive justice to serve diverse masculinities and reduce structural inequities. This article reframes male infertility as a relational, socially embedded phenomenon and a site of disciplinary transformation. Further studies are required to explore the emotional well-being of relationships during infertility treatment, especially for the more vulnerable patient groups, and verify the need to support not only the patient but also the couple confronting the issue together. Notably, studies with an isolated focus on men in ART treatment were excluded due to the uncertainty of whether such participants have received male-specific infertility treatment. To ensure that the included studies accurately reflect the perspectives of infertile men who have personally experienced male-specific treatment, strict selection criteria were adopted for this systematic review. There was a feeling of marginalization among men who have terminated ICSI following TESE.11 They felt that much of the clinical workup and treatment was not focused on male infertility and the cause of their azoospermia was not investigated, leaving unanswered questions that caused frustration. In the USA, a retrospective review was performed examining the sexual health, measured by the clinically validated Male Sexual Health Questionnaire (MSHQ), and testosterone levels of 34 patients who had undergone microsurgical varicocelectomy.14 Half of these patients had presented due to infertility and the other half due to sexual dysfunction. Two academic databases (Embase and Sociological Abstracts) were chosen as the most relevant medical and social science databases. Inspired by the ecological model,35 the authors distinguish three levels at which interventions are possible. First, certain groups are socially distinguished and labelled based on issues of social importance in a certain historical and social setting (e.g. those who can or cannot / do not have children). Building a Supportive Environment All search strings covered the topics of infertility, intervention, and various ways to refer to LMICs, according to World Bank definitions. This can include influential persons expressing themselves in public in a positive way about people who experience stigma or coming out themselves to open up the conversation and address negative stereotypes. Interventions at this level may also comprise educational interventions (e.g. changing curricula contents of medical schools) and mass media involvement to influence stigmatising public opinions at larger scales. Few interventions had been evaluated to assess their effectiveness and impact, although a positive exception was for intrapersonal level interventions involving counselling, group therapy and support programmes.Infertility or reduced fertility can result from testicular dysfunction, endocrinopathies, lifestyle factors (such as tobacco and obesity), congenital anatomical factors, gonadotoxic exposures and ageing, among others.Therefore, additional care should be taken throughout the clinical management of men with this condition, including routine screening of their psychological, relationship and sexual well-being, along with follow-up when treatment fails.Yet, they add, infertility stigma should also be addressed at community level to really change values and attitudes.39In the USA, a retrospective review was performed examining the sexual health, measured by the clinically validated Male Sexual Health Questionnaire (MSHQ), and testosterone levels of 34 patients who had undergone microsurgical varicocelectomy.14 Half of these patients had presented due to infertility and the other half due to sexual dysfunction.This can include influential persons expressing themselves in public in a positive way about people who experience stigma or coming out themselves to open up the conversation and address negative stereotypes.These four components of stigma are underpinned by a fifth, the power derived from existing social inequalities, such as those based on gender or class. Infertility or reduced fertility can result from testicular dysfunction, endocrinopathies, lifestyle factors (such as tobacco and obesity), congenital anatomical factors, gonadotoxic exposures and ageing, among others. You are using a browser version with limited support for CSS. I am committed to creating a supportive and confidential space for men to explore their emotions and experiences. In 2019, and again in 2021, online search engines (Google) and social media platforms including Facebook, YouTube,e Instagramf and the Android Play Store were also searched, to broaden the research strategy and optimise infertility-related findings. Articles were excluded if they were published before 1999 or if they did not target infertility interventions. For example, an educational intervention might encourage stigmatised people to become activists, advocating for changes in legislation or health provision. At the interpersonal level, interventions can, for example, encourage collective support among stigmatised groups or “meaningful, high-quality contact” (p.104).23 between stigmatised and non-stigmatised persons to combat prejudices and increase understanding. In one of the intervention studies in Iran, the decrease in stigma was lowest at the family level. Therefore, the implementation of interventions should be followed with evaluation studies using suitable research designs.63 First, in only a few cases was the effectiveness of the interventions assessed, and in some of these cases with only small sample sizes and no long-term follow-up studies. Interventions addressing the structural level were mostly undertaken by patient support groups and activist individuals facing fertility problems themselves. Interventions at the intrapersonal and interpersonal levels for people facing fertility problems consisted of counselling and education, mainly provided by practitioners (psychologists, counsellors and medical staff), patient organisations and activist individuals. During the program, Merck Foundation showcased their animation film “More Than a Mother”, adapted from their storybook, to emphasize strong family values of love and respect from a young age which will reflect on eliminating the stigma of infertility and the resulted domestic violence in the future. Infertility can be preventive by adopting various measures like switching to a healthy lifestyle, quitting smoking, reducing stress and anxiety, and ending the practice of Female Genital Mutilation (FGM). The summit has been our effort towards raising awareness about infertility. The authors would like to thank Maria Siermann and Ronja Jansz for doing the literature and web-searches, and the members of the Share-Net CoP on Infertility in the Netherlands and the anonymous reviewers for their comments on earlier versions of this article. Interventions tackling infertility-related stigma need to be implemented across intrapersonal, interpersonal and structural levels. Supporting women and men to cope with and mitigate stigmatisation Another study approach was taken by Stevenson et al.10 and Johansson et al.,11 who conducted thematic analyses of challenges reported in semi-structured interviews of a total of 19 men who had received male infertility treatment. Studies conducted in settings other than treatment for male infertility were excluded; this included those concerning men in the context of ART procedures without specification of male-specific treatment involvement. The focus population was men with an MFI diagnosis who were undergoing or have undertaken surgical or medical male infertility treatment. To our knowledge, this scoping review is the first inventory of interventions addressing infertility-related stigmatisation in LMICs. It should be noted that none of the interpersonal interventions explicitly focussed on providing contact between stigmatised and non-stigmatised persons to combat prejudices and increase understanding. Core messages are that both women and men can face fertility problems, that they should both be involved in tackling the problem, and that women should be respected when they cannot become mothers. A small-scale project in Indonesia showed that fertility patients did not prioritise running a formal organisation, as they had already invested much of their time in fertility treatment.45 Study results showed that group counselling was effective in decreasing stress levels one month after the intervention in all measured domains (social, sexual and relationship concerns; rejection of childless lifestyle; need for parenthood and gender role attitude).38 This intervention gives opportunities for interaction with both peers and experts through social networks, online and offline seminars with reproductive health specialists in clinics, and text messages to participants’ mobile phones.h No evaluations were found regarding its effectiveness. Studies highlight promising ways to engage men and women with accurate information about infertility through family planning telephone hotlines.41 In India42 and Congo43, the large majority of calls to family planning hotlines were coming from men, and one of the topics often asked about was infertility. These sessions included information about physical, psychological and sexual aspects of infertility, sharing experiences, learning relaxation techniques, and improving communication with their husbands and others. Yet, they add, infertility stigma should also be addressed at community level to really change values and attitudes.39 Google and social media Although not the primary focus of this review, some studies also include childlessness due to other reasons (e.g., losing their child during or immediately after the pregnancy).The authors would like to thank Maria Siermann and Ronja Jansz for doing the literature and web-searches, and the members of the Share-Net CoP on Infertility in the Netherlands and the anonymous reviewers for their comments on earlier versions of this article.Additionally, this paper aimed to explore the implications of these studies on clinical practice as well as directions for future research.Few people know that Lockheed was the largest employer in the Valley until the rise of the .com bubble.No interpersonal interventions were found to stimulate contact between stigmatised and non-stigmatised persons to combat prejudices or increase understanding among non-stigmatised persons.From reimbursements to CPHS to IACUC to even the merit review process, we have no evaluative method that acts as a ceiling on paperwork and faculty time and we don’t probe the upside/downside risks from process requirements.The relationship between infertile men’s sexual functioning and testosterone levels appears to be more nuanced with varicocele repair. Professionals and peer support groups play an important role in organising these events, which can provide information and support to people, but also draw wider attention to the issue in the public domain, and put infertility on the policy agenda, so complementing lobbying with policy makers and governments to improve access to affordable fertility treatment.42 In Myanmar, a reproductive health hotline was established to provide reproductive health information; infertility was the most asked-about topic, and the majority of callers were women.44 In one session participants discussed “general, sexual and marital roles of women” and “its development in recent years” (p.172).38 Their experiences in social and marital relationships with not having children were also addressed (the term stigma was not explicitly mentioned in the article). In addition, they receive information about medical aspects of infertility, so-called psycho-education (about the relationship between infertility and depression) and CBT to shift negative perceptions and build coping behaviours. Naab et al40 evaluate a psycho-educational intervention among women with fertility problems in Ghana called “Oh Happy Day Classes” (OHDC). Three other studies evaluated the effectiveness of interventions (see Table 1 for an overview of the study details). Few interventions had been evaluated to assess their effectiveness and impact, although a positive exception was for intrapersonal level interventions involving counselling, group therapy and support programmes. Kanyaleng membership is considered to offer great coping support to women, because it unites women, enables them to create strong support networks and potentially to improve their long-term status, both social and economic.54 There has not been an evaluation of the project’s impact.Most of these studies9,12–16 have focused on the impact of male infertility treatment on male sexual functioning, measured by tools that also evaluated sexual health and well-being.The manuscript presents male infertility as both a clinical and theoretical challenge, urging nursing to reconceptualize care, vulnerability, and reproductive justice to serve diverse masculinities and reduce structural inequities.Lockheed and other defense industrial base companies were male and white dominant (Lockheed was 85% male and 90% white even after equal opportunity laws were enacted).By fostering compassion, understanding, and openness, we can help men break free from stigma, embrace support, and rediscover their inner strength.Another counselling intervention explicitly focusing on internalised stigma has been implemented and evaluated in Iran.39 This intervention consisted of three sessions of 60–90 min, which were scheduled around medical visits to an infertility clinic for intra-uterine insemination (IUI).For example, the few articles which assessed the effectiveness of counselling interventions (all showing positive effects) were mainly about counselling interventions organised by professional counsellors and provided in the context of fertility clinics. Our efforts are primarily focused on improving access to quality & equitable healthcare solutions… The Merck Foundation, established in 2017, is the philanthropic arm of Merck KGaA Germany, aims to improve the health and wellbeing of people and advance their lives through science and technology. Through ‘Empowering Berna’, the lives of many infertile women have been transformed in many African countries like Kenya, Uganda, Nigeria, Central African Republic, Niger, Malawi, and many more. Merck Foundation has also been empowering childless and infertile women through their “Empowering Berna” initiative under their “More Than a Mother” movement. No interpersonal interventions were found to stimulate contact between stigmatised and non-stigmatised persons to combat prejudices or increase understanding among non-stigmatised persons. Overall, the limited number of interventions in LMICs aiming to tackle stigma were at all three levels (intrapersonal, interpersonal and structural levels) or combinations of these. In-depth interviews were held in English or French with key informants, all recognised experts in the field of infertility and SRHR.g They represented academia, global institutions, NGOs, medical practitioners/providers, and infertility societies, from different regions in the world. Primary data were collected for the initial report through key informant interviews (KIIs) with experts in the field of infertility all over the world and focus group discussions (FGDs) with members of Share-Net International Communities of Practice (CoPs) on Infertility between March and May 2019. All other articles were examined in more depth to check that they covered or focused on the specific priority area of destigmatisation. Men’s sexual well-being and functioning have been evaluated in the treatment settings of surgical sperm extraction and varicocele repair. Men reported that they suppressed their emotional needs to support their partners, who they perceived to suffer more from the situation.11 The outcomes of treatment also had an impact on relationship quality. Therefore, these studies have important implications on the sexual dynamics of intimate relationships. These men described their experience of surgery, including repair of varicoceles and hydroceles, as highly distressing, which could have made a lasting impact on their attitude towards infertility. The need for emotional support and better communication from medical staff were also emphasized. Men struggled with uncertainty regarding the logistics and outcomes of treatment and wished for information on all available treatment options, including alternative approaches, such as donor sperm or adoption, to allow for constructive decision-making. The studies by Stevenson et al.10 and Johansson et al.11 also highlighted the need for information. It was, therefore, suggested that TESE outcomes have an impact on erectile function and other sexual functions, independent of changes in serum TT. In contrast, TESE success patients reported significantly higher levels of intercourse satisfaction, orgasmic function, sexual desire, and overall satisfaction after the procedure. My work has been directly or indirectly supported by many technology companies, including Apple, Google, Microsoft, Palantir, and Nokia. From reimbursements to CPHS to IACUC to even the merit review process, we have no evaluative method that acts as a ceiling on paperwork and faculty time and we don’t probe the upside/downside risks from process requirements. Lockheed and other defense industrial base companies were male and white dominant (Lockheed was 85% male and 90% white even after equal opportunity laws were enacted). Few people know that Lockheed was the largest employer in the Valley until the rise of the .com bubble. To address these silences, this paper proposes an intersectional nursing proposition grounded in reflexivity, cultural humility, couple-centeredness, and structural awareness. On the other hand, men reported positive associations with the treatment process when emotional support was provided by the immediate health-care team, especially in the form of direct and normalizing communication.10 Phenomenological studies by Stevenson et al.10 and Johansson et al.11 have revealed that partners provide mutual support throughout their infertility journey, characterized by enhanced communication that has led to a strengthened bond. Several studies have exposed relationship dynamics throughout men’s infertility and treatment journey. Our efforts are primarily focused on improving access to quality & equitable healthcare solutions in underserved communities, building healthcare and scientific research capacity and empowering people in STEM (Science, Technology, Engineering, and Mathematics) with a special focus on women and youth. Advocating for Support Workshops, seminars, and community discussions can foster a more inclusive understanding of infertility and its impact on men. Community organizations can play a vital role in raising awareness and providing support. Partners should feel empowered to discuss their feelings, fears, and hopes regarding infertility without fear of judgment. Personal narratives can resonate with others and promote empathy, leading to a cultural shift in how infertility is viewed. This lack of communication can lead to emotional distress and feelings of loneliness, compounding the challenges of infertility. This is an important insight that calls for attentive inclusion of the male counterpart during fertility treatment. The marginalization of men in the fertility setting has been well documented by other studies which focused on men’s experiences during ART treatment.22,23 In the study of Johansson et al.,11 this phenomenon was reported by men even when they were active participants of the treatment journey, requiring invasive TESE procedure themselves. Men’s needs in the health-care setting were clear with complementary themes identified by phenomenological studies. Although phenomenological studies reported general improvements in partner bonds due to enhanced communication and support, the relatively high prevalence of couples who separated among men who discontinued the pursuit of parenthood after non-ART treatments highlights the burden of severe MFI. However, stigma reduction experienced at family level was lowest, which probably reflects the intense familial and social pressure to have children in the country. The first session includes explanations of stigma, women’s experiences of stigma, sources of stigma, talking about fears and concerns, and relaxation techniques. This randomly controlled intervention study showed a decrease in depression and infertility-related stress levels resulting from OHCD.40 Therefore, additional care should be taken throughout the clinical management of men with this condition, including routine screening of their psychological, relationship and sexual well-being, along with follow-up when treatment fails. All three phenomenological studies10,11,18 included in the current study highlighted men’s subjective needs related to patient-centered care during treatment with remarkably consistent themes. Therefore, increased testosterone levels from microsurgical varicocelectomy did not influence the sexual health and function of infertile men in this study. Despite the diversity in the study design, setting, and outcome variables, a consistent pattern of psychosocial strain and redress due to treatment processes is evident among infertile men. In some cases, women also go through physical violence and lacks the family support too. Together with African First Ladies, and other important partners, we are making history and reshaping the landscape of fertility & Reproductive care across Africa and beyond.” Posts were created by all sorts of users, from individuals who are struggling with themes of infertility themselves to accounts that were created by clinics who offered general information on infertility, in the hopes to inform individuals and find new clients. Although not the primary focus of this review, some studies also include childlessness due to other reasons (e.g., losing their child during or immediately after the pregnancy). It is often said that these countries – and their donors – are more concerned with decreasing population growth than with infertility.20 In addition, limited budgets for public health and the plentitude of other more life-threatening diseases in these countries are suggested as other reasons for governments not to invest in infertility. Given the broad geographical area of the review (LMICs), more FGDs and interviews might have revealed more destigmatising interventions. In addition, we found several activities, ranging from TV programmes, films, books, theatre and artwork, to the “coming out” of celebrities and first ladies, all drawing attention to the topic of infertility and ARTs, aiming to decrease stigma. These groups and individuals are making ample use of social media and the internet to spread information, exchange views and experiences, and aim to empower those experiencing infertility. Merck Foundation, the philanthropic arm of Merck KgaA Germany and Africa Reproductive Care society (ARCS) together conducted the Third Edition of “World Infertility Awareness Summit (WIAS) 2024” and Press Conference.Interventions at the intrapersonal and interpersonal levels for people facing fertility problems consisted of counselling and education, mainly provided by practitioners (psychologists, counsellors and medical staff), patient organisations and activist individuals.The evaluation of male infertility includes detailed history taking, focused physical examination and selective laboratory testing, including semen analysis.I am very proud to share that we at Merck Foundation are contributing to building and advancing fertility care capacity in Africa and Asia, to support childless women and couples.However, stigma reduction experienced at family level was lowest, which probably reflects the intense familial and social pressure to have children in the country.A limited number of interventions addressed stigmatisation at a structural level (e.g. empowering infertile women to become financially independent).Merck Foundation has also released about 30 songs, many of these songs have been created with the aim to break the infertility stigma, as a part of their “More Than a Mother” campaign. Several types of awareness and media activity aimed at wider audiences to destigmatise infertility exist at all levels. This culturally adapted OHDC intervention aims to reduce symptoms of infertility-related depression and consists of 12 sessions, during which participants can share psychosocial issues they are struggling with and get emotional support from facilitators and group members. Researchers from the University of Liverpool have developed an extended Fertility Life Counselling Aid (FELICIA) to manage the psychological trauma and stigma experienced by women and men dealing with infertility in African countries.37 FELICIA uses techniques based on cognitive behavioural therapy (CBT). Clinicians should strive to equip patients with a comprehensive understanding of their condition, treatment processes, expected outcomes, and alternative options to allow for constructive planning and decision-making. Evidence on the emotional and communicative aspects of relationships during treatment is less clear. Patients should, therefore, be counseled regarding the possible impact TESE may have, not only on psychological well-being but also on sexual and relationship well-being. There were a few limitations in the included studies which may have impacted the accuracy or relevance of findings. By openly discussing infertility as a shared experience rather than a solely female concern, society can reduce stigma and encourage men to seek help. Men with infertility may also face discrimination within the healthcare system. Psychological, social, marital, and sexual implications were highlighted, as well as male-specific needs in the clinical setting. The counselling and education formats presented in this review might be good starting points to build on. The most extensive cross-country multilevel intervention (the MTM Project), which has an impressive scope and visibility of activities, seems thus far not to have published any effectiveness studies to assess the project’s impact. However, from a reproductive rights perspective, as we have argued elsewhere,43 this argumentation is not convincing. In many countries, TV programmes, documentaries, films, and soap operas discuss infertility and show how people react to it and attempt to resolve it.47–50 For example, the highly watched “The UFO Fertility Show” in China, draws attention to infertility, its high prevalence in the country, and ways to prevent and handle it.s Although some studies in the global North have examined how infertility is portrayed in television shows and how this affects the audience (e.g. Weihe Edge50), no studies in LMICs are available. In 2018 in The Gambia, the Dimbayaa Project marked the International Infertility Awareness Week by showing a film on the role Kanyaleng groups play in supporting childless women.q,r Little is known about the impact of such infertility weeks or days. Examples of these activities are infertility awareness weeks and days (mainly in the Global North),p television and radio programmes, and working with role models and social influencers. Likewise, several patient support groups in our review are connected to clinics, and so their activities also do not reach people who cannot afford treatment. Thus, people who do not have access to these clinics (and for most people in LMICs infertility treatment is too expensive), do not have access to this counselling. They aim to counteract the idea that women and men facing fertility problems are worthless and do not deserve to be treated respectfully and to change infertility into a topic that people (dare to) speak about, instead of hiding or neglecting. Merck Foundation We identified several types of peer support groups in LMICs, mostly created during the last decade and still rather small. Online contact is also becoming an important way to get support and information. The Research Ethics Committee of the Royal Tropical Institute in Amsterdam exempted the initial study proposal (S-109A) from full ethical review based on the consideration that key informants and FGD participants in the primary data collection methods would be involved in their professional capacity only. These searches yielded information from NGOs, newspapers, blogs, podcasts, social media accounts, and additional academic sources. In addition to the systematic search, we also included articles identified from cited references in the articles and personal knowledge of relevant articles. Interventions should be undertaken by policymakers, professionals, activists, and others working on infertility in LMICs, and accompanied with evaluation research to assess their effectiveness. Male factors are estimated to contribute to 30–50% of cases of infertility. Clinical infertility is the inability of a couple to conceive after 12 months of trying. By fostering compassion, understanding, and openness, we can help men break free from stigma, embrace support, and rediscover their inner strength. The emotional weight of infertility can lead to depression, strained relationships, and reduced self-esteem. Again, the association between successful surgical treatment of subfertility and sexual functioning is yet to be examined in the context of varicocelectomy. Available studies mostly focused on men’s sexual function and health, which have direct implications for the sexual dynamics of intimate relationships. Phenomenological studies have also provided important insights into the challenges experienced by infertile men receiving treatment. Infertility is a reproductive health concern that deserves attention, as reconfirmed by the 2018 report of the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights (SRHR). Infertility and mental health are not just women’s issues; they are human issues. In my practice, I strive to approach male fertility with the sensitivity and care it truly deserves. This hesitation allows mental health struggles to remain a “silent killer,” with stigma acting as a persistent and unyielding barrier to care. However, high costs of ARTs will remain “the biggest barrier to increasing access” to ARTs in LMICs (p.29).2 In addition, many couples seek treatment so late that even ARTs become ineffective. Sorry, a shareable link is not currently available for this article. Björndahl, R. Henkel and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. D.J.L. is supported in part by the Frederick J. We found a limited number of interventions addressing infertility stigma in a systematic way. The project approaches infertility care in all its aspects, and also attempts to enhance infertility awareness at societal level. Nevertheless, no research has assessed the effects of role models or influential people for decreasing infertility-related stigma. It also aims to educate and train embryologists and fertility specialists, improve access to regulated, effective and safe fertility care, and encourage formulation of national level ART policies.57 Up to 2021 the project had reached out to 37 countries, mainly in Africa and Asia, working in dialogue with governments, policy makers, parliaments, healthcare providers and the media, and also often specifically liaising with the countries’ first ladies, ensuring broad media attention. Using art to break the silence around infertility was also identified in our review, but only in the global North. For example, the first National Infertility Awareness Week in South Africa (NIAW SA) took place in 2020, organised by IFAASA in association with the House of Fertility (an advice and support service for people considering surrogacy). Many of the intervention studies reviewed by Cook et al23 dealt with stigmas related to HIV/AIDs, mental health, obesity, ethnic minorities and LGBTQI people. We offer a scoping review of existing interventions that are intended to decrease the stigmatisation of infertility. Therefore, other interventions are needed that reduce infertility stigma and the negative effects such stigma has for the lives of people facing fertility problems. Second, we must challenge the stigma surrounding men's mental health and infertility. While societal focus tends to fall on female fertility, male infertility contributes to nearly half of all cases where couples face challenges conceiving. Open conversations and increased visibility will help normalize male infertility, allowing men to seek help, share their experiences, and ultimately, reduce feelings of isolation. The stigma and discrimination faced by men with infertility are significant barriers to emotional well-being and support. Increased awareness can lead to stronger advocacy for support systems tailored to men facing infertility. Professional and cultural stigmas further perpetuate outdated views of masculinity, reinforcing barriers to seeking help. Self-stigma occurs when individuals internalize these harmful beliefs, leading to shame and self-doubt. Therapists can guide men in processing their feelings and developing healthy coping mechanisms. Traditional gender norms often equate masculinity with fertility and fatherhood. Many of the most important articles in the privacy law field were workshopped at PLSC. At the structural level, interventions should aim to empower women, for example, to become more financially independent (following the MTM example), and to reshape masculinities. However, while the project emphasises that women should be valued if they cannot achieve motherhood, part of the video and other materials also have a somewhat contradictory, but “happy end” scenario, in which the woman gets pregnant through medical treatment (in some cases made available by Merck), which in a way speaks against the project’s core message.ah A unique feature of their structural approach is their intention to empower and support women to become financially independent and acquire a place and esteem in their family and community, other than based on motherhood. At the same time, in various cultural contexts, the inability for men to become a father is a fundamental challenge to dominant notions of masculinity.30 As a result, infertile men also face stigmatisation, often in the form of internalised stigma.14,16,31,32 Men may feel emasculated, and more so because male infertility is often – wrongly – equated with sexual impotence.11,28,32 To protect their husband’s masculine reputation, some women claim that the fertility problem lies with them. Previous systematic reviews have identified a gap in the understanding of men’s experiences with infertility treatment, especially male-specific treatment.1,6 The findings of this systematic review have focused on the psychological, social, marital, and sexual dimensions of this critical stage of a man’s infertility journey. Various male celebrities, mainly in the global North, have spoken out about their struggles with infertility to open the discussion, create awareness and decrease stigma, including, for example, Mark Zuckerbergw and American television host Jimmy Fallon.x The male initiator of the Association of Childless Couples of Ghana (ACCOG)y referred to the stigma-decreasing effect for himself and his wife, following their television appearances.55,56 Such influencers might also encourage people to seek infertility treatment. At the structural level, interventions should intend “to change social conditions that give rise to stigma”, thus tackling social inequalities driving stigma (p.105).23 Structural interventions can include gender transformative projects to empower women or refashion masculinities, or the introduction of laws and policies that address and protect people who experience stigma, provide them with better access to relevant health care or improve existing legislation. Male infertility contributes to nearly half of the global infertility, yet nursing scholarship continues to marginalize men's experiences, reflecting entrenched assumptions that equate reproduction with femininity. All authors contributed significantly to the conceptualization and design of this systematic review. Continued communication with and inclusion of the male partner throughout the whole management process will also benefit the overall patient experience. Marginalization and appreciation for direct communication and support from clinicians were another set of complementary themes. Beyond the Binary: Intersectional Nursing Approaches to Male Infertility Inhorn and Patrizio6 have argued that the availability of assisted reproductive technologies (ARTs) is an important way of destigmatising infertility in LMICs, as it increases knowledge about male and female infertility, encourages men to become more involved in infertility management and counselling, and positively changes gender relations. Many studies in LMICs have given insights into the social and psychological repercussions for people facing fertility problems and/or being involuntarily childless and the negative impacts on people’s health and well-being.1,3,4,9–12a Those who fail to meet the social expectation to have children experience various forms of stigmatisation, leading to grief, stress, marital instability, verbal abuse, intimate partner violence, isolation, and exclusion.4,12–19 Nevertheless, we found several interventions at intra- and interpersonal levels aiming to support women and men to cope with and mitigate infertility stigmatisation (e.g. counselling, telephone hotlines, and support groups). The review shows that published studies on interventions tackling infertility stigmatisation in LMICs are rare. Raising awareness about male infertility is crucial for normalizing conversations around the issue. The stigma surrounding male infertility often results in silence and isolation. Furthermore, health-care professionals should provide comprehensive education and written resources for patients who have treatment for MFI – not only from a medical standpoint but also from a psychosocial one. The relationship dynamics of infertile men appear to be affected by circumstances surrounding infertility as well as from treatment. Routine psychosocial screening in cases of severe male infertility and follow-up in cases of surgical treatment failure are likely beneficial. In recent years, social research surrounding the consequences of infertility has increasingly focused on the male perspective; however, a gap exists in the understanding of men’s experiences of male infertility treatment. Moreover, Merck Foundation has trained more than 3200 media representatives from more than 35 countries to raise community awareness and break the stigma around infertility and infertile and childless women. Varicocelectomy seems to improve the sexual functions of only infertile men who are hypogonadal preoperatively, which may be due to the normalization of serum TT for this population. It is possible that the strict selection criteria have resulted in an underrepresentation of studies in this topic, especially in relation to medical treatments. Dancet et al.18 interviewed 17 men who had received TESE-related care and found that detailed information regarding the process of TESE and subsequent treatment, success rates, complications, and recovery were highly valued. In the former study, 103 infertile men who underwent microsurgical varicocelectomy were compared with a control of 38 infertile men who refused surgical interventions and pursued ART instead.15 Both groups were also subdivided into hypogonadal (TT −1) and eugonadal (TT ≥300 ng dl−1) men. The relationship between sexual functioning of infertile men and serum TT in the setting of microsurgical varicocelectomy was further investigated by Zohdy et al.15 and Saylam et al.16 using the IIEF. In this article, we use the term people facing fertility problems or infertility; this includes people being involuntarily childless as a result of fertility problems. Based on our review, we suggest that activities geared to individuals who experience infertility themselves should include women and men and also be offered beyond clinical settings (such as in community and church groups, and NGOs in the field of SRHR). All interventions should be accompanied by evaluations and research, as this is the only way to establish if and how they make a difference for the people who experience infertility. There is thus a need for more interpersonal and structural level interventions to tackle infertility-related stigma at family and community levels. Fourth, the intrapersonal and interpersonal interventions are not directly seeking to address structural causes of stigmatisation (gender structures and the cultural value or mandate of having children, in particular for women), nor do they change the understanding, attitudes and behaviour of people who stigmatise. This societal pressure can lead to feelings of inadequacy and shame when men face infertility. Infertility is often perceived as a woman’s issue, leaving men facing significant stigma and discrimination in a society that emphasizes traditional notions of masculinity and virility. Years ago, I found a literature review (can’t find it anymore) that suggested that all interventions for plantar fasciitis were equally inefficacious, and it is a condition that takes about 18 months to heal. Patel et al.7 studied 300 men, disaggregated by infertility factor, who have completed a nonvalidated psychological evaluation test for infertility. The treatment settings were variable across these studies, and included TESE alone, TESE and intracytoplasmic sperm injection (ICSI), as well as broad or unspecified urological treatment. Open accounts of challenges during treatment have also been analyzed in phenomenological studies of smaller sample size. In general, medical treatments have a limited role except in specific endocrine disorders where hormonal manipulation can be effective in promoting sperm production.5 Invasive interventions include varicocele repair and surgical sperm retrieval techniques, such as testicular sperm extraction (TESE). The inability to conceive children causes significant personal suffering and social repercussions for both men and women. At the intrapersonal level, interventions such as counselling and education can be directed at individuals to either enhance coping strategies of stigmatised people or change attitudes and behaviours of non-stigmatised individuals. It demonstrates men’s agency to rethink and refashion masculine values in their communities during different phases of life to accommodate health-related issues such as HIV (e.g. see Russell33) or infertility.28,34 The fourth component is that the stigmatised groups, such as “women or men who are infertile”, can be inserted into a status hierarchy of inequality, legitimising sanctions and stigmatisation. Secondary infertility is the inability to conceive despite previously doing so,8 and is more common than primary infertility, partly resulting from a high prevalence of reproductive tract infections.2,6 In most societies, it is culturally expected to become a parent. Psychological, social, marital, and sexual implications were highlighted, as well as male-specific needs in the clinical setting.Structural interventions advocating that (destigmatising) infertility deserves attention and investments by policymakers and the public health system – for example, by providing better infertility care or promoting the training of health care practitioners – using mass media to influence stigmatising opinions, were limited, apart from the Merck Foundation’s MTM and MTF project (aiming at 35 countries in Asia and Africa).At the same time, in various cultural contexts, the inability for men to become a father is a fundamental challenge to dominant notions of masculinity.30 As a result, infertile men also face stigmatisation, often in the form of internalised stigma.14,16,31,32 Men may feel emasculated, and more so because male infertility is often – wrongly – equated with sexual impotence.11,28,32 To protect their husband’s masculine reputation, some women claim that the fertility problem lies with them.Merck Foundation also conducts MARS Awards is to empower African young researchers & women researchers, advancing their research capacity and promote their contribution to STEM (Science, Technology, Engineering and Mathematics).Inhorn and Patrizio6 have argued that the availability of assisted reproductive technologies (ARTs) is an important way of destigmatising infertility in LMICs, as it increases knowledge about male and female infertility, encourages men to become more involved in infertility management and counselling, and positively changes gender relations.Years ago, I found a literature review (can’t find it anymore) that suggested that all interventions for plantar fasciitis were equally inefficacious, and it is a condition that takes about 18 months to heal.I am committed to creating a supportive and confidential space for men to explore their emotions and experiences.Other studies,9–11,17 though fewer, have highlighted emotional and communicative aspects of relationships through diverse study designs.Psychological evaluations have found that urological surgery may have a lasting impact on infertility-specific stress, and treatment failure can lead to feelings of depression, grief, and inadequacy. Psychological burden of male infertility treatment Moudi et al39 evaluated the intervention using a quasi-experimental design, which showed an improvement on all measured aspects of stigma at post-test (self-devaluation, social withdrawal, family stigma and public stigma) compared to a comparison group that received care as usual. Another counselling intervention explicitly focusing on internalised stigma has been implemented and evaluated in Iran.39 This intervention consisted of three sessions of 60–90 min, which were scheduled around medical visits to an infertility clinic for intra-uterine insemination (IUI). Under the umbrella term “interventions” we also included activities that had not necessarily been set-up by a formal organisation, but initiated by individuals to share their experiences and break the silence about infertility. The study did not conduct follow-up assessment after TESE; thus, the impact of treatment outcomes was not assessed. Various dimensions have been evaluated, including stress, quality of life, and self-esteem, using self-report questionnaires in cross-sectional and longitudinal studies. Thirty-six studies were retrieved for further analysis and 12 studies fulfilled the inclusion and exclusion criteria (Figure 1). Primary studies with originally collected data, both quantitative and qualitative, were considered for inclusion. Studies which met the inclusion criteria were retrieved in full and references of all eligible studies were checked to identify others not retrieved by the electronic search. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. To achieve the foundation's goals, we will develop and implement coherent strategies, result-oriented programs and initiatives, provide grants to support projects and help raise funds where needed,” - Rasha Kelej has been appointed Chief Executive Officer of the Merck Foundation. Join the conversation on our social media platforms below and let your voice be heard! Merck Foundation also conducts MARS Awards is to empower African young researchers & women researchers, advancing their research capacity and promote their contribution to STEM (Science, Technology, Engineering and Mathematics). For many, infertility questions their sense of identity and masculinity, amplifying the psychological toll. Social stigma involves societal perceptions that mental health issues signify weakness. HubPharm is a social enterprise birthed with the mission to enhance access to medicines and healthy lifestyles to help Africans thrive Psychological evaluations have found that urological surgery may have a lasting impact on infertility-specific stress, and treatment failure can lead to feelings of depression, grief, and inadequacy. Merck Foundation has also released about 30 songs, many of these songs have been created with the aim to break the infertility stigma, as a part of their “More Than a Mother” campaign. This initiative helps women who cannot be treated for infertility anymore by helping them get trained to establish small businesses so that they can be independent and rebuild their lives. Women are solely blamed for failing to conceive and the social stigma of childlessness, especially for women leads to isolation and stigmatization and results in discrimination and ostracism. Studies with outcome measures concerning psychological, social, and sexual experiences related to treatment settings as well as patient needs were included. Surgical treatments can affect the sexual functioning of infertile men; however, the impact of testicular sperm extraction outcomes appears to be psychologically driven whereas the improvements after microsurgical varicocelectomy are only evident in hypogonadal men. Men tended to have an avoidant coping mechanism throughout fertility treatment, and their self-esteem, relationship quality, and sexual functions can be tied to outcomes of treatment. First, using only two academic databases and English language sources might have limited the number of publications and interventions identified. While information about the MTM Project is widely available on the web and in the 2021 annual report,53 to our knowledge an actual evaluation of the effectiveness of all these interventions has not yet been performed. They questioned, however, where these trained fertility specialists would work, as Burundi did not have a fertility clinic at that moment. The FGD participants in Burundi were aware of the training of fertility specialists and embryologists in their country. To achieve its goals, the MTM Project has initiated several structural interventions. All titles and abstracts were screened for eligibility and discrepancies were resolved through discussion with a third reviewer (DJK). Additionally, this paper aimed to explore the implications of these studies on clinical practice as well as directions for future research. For some men, especially those with severe forms of MFI, these treatment modalities are vital in their journey to achieving biological parenthood. The MTM Project,ac initiated by the Merck Foundation (a non-profit organisation founded in 2015 by the pharmaceutical company Merck) aims to reduce infertility stigmatisation in LMICs among women and men through empowering infertile and childless women socially and economically, raising awareness about male infertility, and through infertility prevention and management, integrating it into (SRHR) healthcare infrastructure. The objective of this review was to synthesize the existing evidence concerning the experiences of men receiving male infertility treatment, particularly, the psychological, social, and sexual burden of treatment, and male patient needs in clinical care. This review aims to synthesize the existing evidence concerning the psychological, social, and sexual burden of male infertility treatment on men, as well as patient needs during clinical care. Most of these studies9,12–16 have focused on the impact of male infertility treatment on male sexual functioning, measured by tools that also evaluated sexual health and well-being. Although telephone hotlines were used by men and are a relatively low-cost way to engage them in reproductive and infertility care (and positively influence gender relations and destigmatisation), counselling interventions are still mainly focussed on women and geared to help them better cope with internalised, anticipated and/or enacted stigma or to become more assertive in social interactions.38 To our knowledge, this scoping review is the first inventory of interventions addressing infertility-related stigmatisation in LMICs.In the former study, 103 infertile men who underwent microsurgical varicocelectomy were compared with a control of 38 infertile men who refused surgical interventions and pursued ART instead.15 Both groups were also subdivided into hypogonadal (TT −1) and eugonadal (TT ≥300 ng dl−1) men.Therefore, increased testosterone levels from microsurgical varicocelectomy did not influence the sexual health and function of infertile men in this study.Screening for psychological, social, marital and sexual well-being may provide valuable information to assist with clinical care throughout fertility treatment, and follow-up after failed treatment may assist in identifying those in need of specialized psychosocial support.Many of our Alumni are trained to be the first local experts in their countries, where they never used to have local embryologists or fertility specialists before our program, such as The Gambia, Burundi, Guinea, Chad, Niger, Sierra Leone, Liberia, Malawi, Congo and more.In Myanmar, a reproductive health hotline was established to provide reproductive health information; infertility was the most asked-about topic, and the majority of callers were women.44Many of the most important articles in the privacy law field were workshopped at PLSC.The review suggests that infertility destigmatisation interventions need to be implemented across all levels. In addition, interventions at this level may aim to strengthen stigmatised individuals’ sense of “belonging” or “value” as a strategy to reduce internalised or anticipated stigma. Cook et al23 provide an interdisciplinary multiple-level approach to tackle stigma in public health that can potentially address the stigmatisation processes discussed above. These four components of stigma are underpinned by a fifth, the power derived from existing social inequalities, such as those based on gender or class. Social theory explaining stigma shows that underlying social inequalities (such as those of gender) underpin stigma.24,25 In line with Link and Phelan,25 we conceptualise and define stigma using five inter-related components of stigmatisation processes. Search terms such as, but not limited to, “infertility stigma”, “infertility awareness”, “involvement men infertility stigma”, “workshops infertility”, “initiatives”, “infertility judgement”, “destigmatise”, and “normalisation”, were used. In this article, we address the question “What is currently being done to tackle infertility stigmatisation? At the structural level, interventions could aim to empower women, reshape masculinities and improve access to and quality of comprehensive fertility care. Kanyaleng membership is considered to offer great coping support to women, because it unites women, enables them to create strong support networks and potentially to improve their long-term status, both social and economic.54 There has not been an evaluation of the project’s impact. The Dimbayaa works with traditional groups called Kanyaleng, which bring together women struggling with infertility or repeated child mortality. The second project found to be tackling infertility stigma at multiple levels is the Dimbayaa Fertility Project in The Gambia, run by a collective of fertility practitioners from The Gambia and the Netherlands.ag This project was also mentioned in one of the KIIs. To underline the importance of male involvement in infertility, the Merck Foundation recently also initiated the More Than a Father Project.ad The MTM Project has developed a wide range of resources and activities, including brochures, posters, songs, videos with testimonies of women sharing their personal infertility stories, artwork, children’s books, fashion shows, publications and news updates. The authors contributed equally to all aspects of the article. The authors thank V. Ruthig for helpful pre-review comments. Receive 1 digital issues and online access to articles This is a preview of subscription content, access via your institution Treatments include lifestyle optimization, empirical or targeted medical therapy as well as surgical therapies that lead to measurable improvement in fertility. According to WHO data, more than 180 million couples in developing countries - that is 1 in every 4 couple, suffer from infertility. It was conducted under Merck Foundation “More Than a Mother”, a powerful campaign that defines interventions to build quality and equitable Reproductive and Fertility Care Capacity, Break Infertility Stigma and Raise Awareness about Infertility Prevention and Male Infertility. The online program was attended by over 350 participants including Merck Foundation partners and Alumni who are future Fertility Specialists, Reproductive and Sexual Care Specialists, and Embryologists, Healthcare Providers, Policy Makers and Media Professionals from over 25 countries in Africa and beyond, and over 4500 online viewers on our social media platforms. Infertility is not only a medical issue but also a social issue. I appreciate the efforts of Merck Foundation for breaking the stigma around infertility and also raising awareness through various campaigns and efforts around infertility stigma.” Prof. Oladapo Ashiru OFR, President of Africa Reproductive Care Society (ARCS) said, “Infertility has a great psychological impact on the women suffering from infertility stigma due to emotional and physical distress caused to her. I am very proud to share that we at Merck Foundation are contributing to building and advancing fertility care capacity in Africa and Asia, to support childless women and couples. I appreciate the efforts of Merck Foundation for breaking the stigma around infertility and also raising awareness through various campaigns and efforts around infertility stigma Infertility is a condition, not a reflection of a man’s worth. Societal myths—like equating fertility with masculinity—must be dismantled. This dynamic is particularly evident in the deeply personal issue of in/fertility. Suppressing emotions doesn’t make them disappear—it intensifies them, often manifesting as anxiety, depression, or even physical health complications. As a part of “More Than a Mother” Campaign, Merck Foundation has launched many initiatives to break this stigma and create a culture shift. Many of our Alumni are trained to be the first local experts in their countries, where they never used to have local embryologists or fertility specialists before our program, such as The Gambia, Burundi, Guinea, Chad, Niger, Sierra Leone, Liberia, Malawi, Congo and more. I am very happy to share that we have provided till today more than 574 scholarships of Embryology, Fertility and Reproductive care to young doctors from 39 different countries. Senator, Dr. Rasha Kelej emphasized, “We marked World Fertility Awareness Month with the experts in the field and our media community through our third edition of World Infertility Awareness Summit in partnership with Africa Reproductive Care Society (ARCS). Merck Foundation, the philanthropic arm of Merck KgaA Germany and Africa Reproductive Care society (ARCS) together conducted the Third Edition of “World Infertility Awareness Summit (WIAS) 2024” and Press Conference. Similarly, at a structural level, improving access to and quality of comprehensive fertility care, including the training of practitioners involved in fertility care and legislation for ARTs, are crucial, both to meet the urgent needs of people with fertility problems, and as a way to decrease stigmatising public opinions at larger scales.23 It is timely and critical for governments and SRHR organisations to move forward from neglecting infertility stigma and include it in their policies and interventions. Structural interventions advocating that (destigmatising) infertility deserves attention and investments by policymakers and the public health system – for example, by providing better infertility care or promoting the training of health care practitioners – using mass media to influence stigmatising opinions, were limited, apart from the Merck Foundation’s MTM and MTF project (aiming at 35 countries in Asia and Africa). Another randomised controlled trial in Iran addressed the effects of group counselling on stress and gender-role attitudes among infertile women.38 This intervention was conducted in hospitals and consisted of five sessions offered only to women who were diagnosed with “female infertility”. Dominant notions of masculinities and the resulting non-acceptance and stigma might discourage men from engaging in infertility examinations or treatment.32 Social science research on masculinities in LMICs, however, also reveals possibilities for stigma mitigation interventions and support for men to better cope with infertility. Also, activist individuals and support groups often share information and experiences through the internet or social media, and so this support does not reach people who have no or limited access to these media. For example, the few articles which assessed the effectiveness of counselling interventions (all showing positive effects) were mainly about counselling interventions organised by professional counsellors and provided in the context of fertility clinics. Nevertheless, the review found an overall increase in the development and provision of interventions in LMICs in recent years (including the initiation of support groups), pointing to a growing interest in this field. As a result, attention for prevention of infertility and/or destigmatising infertility tends to disappear. Interventions geared to individuals experiencing infertility should include women and men and also be offered beyond the clinical setting; and interventions should also aim to combat stigmatising attitudes of family or community members. The review suggests that infertility destigmatisation interventions need to be implemented across all levels. We conducted a scoping review of existing interventions aiming to decrease the stigmatisation of infertility in low- and middle-income countries (LMICs). Compounding the issue, men frequently feel overlooked during fertility treatment, with healthcare systems often centring on female partners. Encouraging open dialogue about male infertility within families and relationships can promote understanding and emotional support. In my career at Berkeley, I have taken specific, sustained action to promote women in higher education, to raise awareness of SES issues in technology, and to include underrepresented and minority students in my work. For example, queer and trans men remain largely invisible in heteronormative reproductive discourse, while men from low-resource settings face systemic barriers to psychosocial support. These recommendations are pivotal in addressing the likely unmet psychosocial needs of infertile men. It has been shown that infertile men feel involved as an equal partner when clinicians take the initiative to discuss the male partner’s concerns, provide information on the general experiences of infertile men, and provide the opportunity for men to talk about their wishes for fatherhood.22 Uncertainty regarding treatment and appreciation for information were important matters to infertile men. The academic database searches, Google and social media searches, and primary data collection resulted in 15 peer-reviewed academic articles, 28 other sources through Google and social media searches, 18 interviews with key informants (ranging from 30 to 120 minutes, with an average of 75 minutes), and 3 FGDs with Share-Net International CoPs on Infertility. FGDs with the Share-Net International Communities of Practice (CoPs) on Infertility in respectively Jordan, Bangladesh and Burundi, were held in English or French through Skype or Zoom and focussed on existing interventions to address infertility in their respective countries.22 For the current study, we only used the data regarding the questions in the KIIs and FGDs on their experiences with and knowledge of interventions to destigmatise infertility and childlessness. It should be noted that as the academic search yielded limited articles on destigmatising interventions in LMICs, we also included interventions in high- and middle-income countries (HMICs) in the Google and social media searches, as these might still inform or inspire stakeholders in LMICs. About this article The summit has been our effort towards raising awareness about infertility.Male factors are estimated to contribute to 30–50% of cases of infertility.Community organizations can play a vital role in raising awareness and providing support.Search terms such as, but not limited to, “infertility stigma”, “infertility awareness”, “involvement men infertility stigma”, “workshops infertility”, “initiatives”, “infertility judgement”, “destigmatise”, and “normalisation”, were used.Further studies are required to explore the emotional well-being of relationships during infertility treatment, especially for the more vulnerable patient groups, and verify the need to support not only the patient but also the couple confronting the issue together.This randomly controlled intervention study showed a decrease in depression and infertility-related stress levels resulting from OHCD.40 A limited number of interventions addressed stigmatisation at a structural level (e.g. empowering infertile women to become financially independent). The results distinguish between infertility stigma interventions targeted at intrapersonal, interpersonal and structural levels of stigma. The evaluation of male infertility includes detailed history taking, focused physical examination and selective laboratory testing, including semen analysis. Impact of treatment on intimate relationships and sexual functioning By raising awareness, advocating for understanding, and creating supportive environments, society can begin to dismantle these stigmas. Providing access to mental health resources tailored to men can help address the emotional toll of infertility. Encouraging men to share their stories can help humanize the issue of infertility, breaking down barriers of stigma. These men also had significantly lower scores in the IIEF-15 domains of sexual intercourse satisfaction and orgasmic function after the procedure. It was revealed that the predominant reason for discontinuation of non-ART treatment was separation of the couple, whereas this was relatively uncommon in the ART treatment group (18% vs 7%, P ≤ 0.05). Other studies,9–11,17 though fewer, have highlighted emotional and communicative aspects of relationships through diverse study designs. All other articles were examined in more depth to check that they covered or focused on the specific priority area of destigmatisation.Evidence on the emotional and communicative aspects of relationships during treatment is less clear.Moreover, Merck Foundation has trained more than 3200 media representatives from more than 35 countries to raise community awareness and break the stigma around infertility and infertile and childless women.In this article, we address the question “What is currently being done to tackle infertility stigmatisation?In contrast, TESE success patients reported significantly higher levels of intercourse satisfaction, orgasmic function, sexual desire, and overall satisfaction after the procedure.Although telephone hotlines were used by men and are a relatively low-cost way to engage them in reproductive and infertility care (and positively influence gender relations and destigmatisation), counselling interventions are still mainly focussed on women and geared to help them better cope with internalised, anticipated and/or enacted stigma or to become more assertive in social interactions.38Another randomised controlled trial in Iran addressed the effects of group counselling on stress and gender-role attitudes among infertile women.38 This intervention was conducted in hospitals and consisted of five sessions offered only to women who were diagnosed with “female infertility”.All titles and abstracts were screened for eligibility and discrepancies were resolved through discussion with a third reviewer (DJK). The authors argue that the interventions of talking and social advice, combined with the psycho-education about the medical aspects of infertility, helped to decrease internalised stigma. Four recent studies describe or evaluate counselling, group therapy or support interventions in LMICs for coping with intrapersonal (internal) and interpersonal stigma.37–40 These interventions are (mainly) implemented within medical settings, often in combination with medical treatments.38–40 All the methods (academic database search, Google and social media searches, key informant interviews and focus group discussions) revealed that interventions aiming to break the silence about infertility and address its stigmatisation in LMICs are rare. However, this was mostly driven by the group of men with sexual dysfunction; infertile men did not have significant improvements in any domains of MSHQ, despite a significant increase in testosterone levels for both groups. The relationship between infertile men’s sexual functioning and testosterone levels appears to be more nuanced with varicocele repair. The impact of the procedure on the sexual functioning of men with NOA was evaluated by other longitudinal studies that compared the International Index of Erectile Function (IIEF) scores and hormonal profiles before and after TESE. This systematic review has synthesized the available evidence on men’s experiences of male infertility treatment. Screening for psychological, social, marital and sexual well-being may provide valuable information to assist with clinical care throughout fertility treatment, and follow-up after failed treatment may assist in identifying those in need of specialized psychosocial support. The psychological states of men receiving male infertility treatment have been assessed in both quantitative and qualitative studies.