Severe male infertility after failed ICSI treatment-a phenomenological study of men's experiences

Eight men with obstructive azoospermia, who had terminated Swedish public health system ART treatment two years previously without subsequent childbirth, were interviewed using a descriptive phenomenological method.The essence of the phenomenon is expressed with a metaphor: climbing a mountain step by step with the aim of reaching the top, i.e. having a child and thus a family with a child. Four constituents are included (1) inadequacy followed by a feeling of redress (2) marginalisation, (3) chivalry (4) extension of life and starting a family as driving forces.Knowledge of men's experiences of their own infertility is important as a supporting measure to increase the quality of care of infertile couples. By adopting this facet of gender perspective in fertility treatment guidelines, care can hopefully be optimized.Reproduction and childbirth is one of the central themes of life [1], occurring when planned and wished in many but not all cases. The prevalence of infertility is debated. A recent study by Boivin et al. [2]reported that 9% of fertile-age couples suffer either primary or secondary infertility, a prevalence that is confirmed by the authors of this article [3]. Insemination with donor sperm was the only treatment for severe male-factor infertility before the in vitro fertilization (IVF) era [4]. However, while childlessness associated with female-factor infertility has often been solved by IVF, conventional IVF has not yielded the same successful outcome in cases of male-factor infertility [5]. Today, biological fatherhood is possible in certain cases of severe male-factor infertility due to the development of intracytoplasmatic sperm injection (ICSI) [6]. Azoospermia, i.e. the absence of sperm in the ejaculate, is seen in 10% of male-factor infertility cases [7]; it can be either obstructive or non-obstructive/testicular. Surgical sperm retrieval, i.e. spermatozoa collection from either the epididymis or the testis, is required to treat obstructive azoos