Lived experiences of assisted reproductive technology treatment among men with azoospermia in Taiwan: a qualitative study

Background
Azoospermia, defined as the absence of sperm in the ejaculate, represents the most severe form of male infertility. Advancements in assisted reproductive technologies (ART) have greatly improved treatment options, allowing men with azoospermia to have biological children. While these men are significantly likely to experience psychosocial challenges due to the dual impact of infertility and ART treatment, few studies have explored their lived experiences in East Asian societies. Our study aimed to explore lived psychosocial experiences of ART treatment among men with azoospermia in Taiwan.

Methods
We conducted qualitative in-depth interviews with ten men diagnosed with azoospermia who have undergone ART at a fertility centre in Taipei, Taiwan. Recorded interviews were transcribed and analysed using a descriptive phenomenological approach.

Results
We found four interconnected themes and nine subthemes. Themes included: psychological turmoil following diagnosis, familial pressures and societal stigma, physical and emotional impact of sperm retrieval processes, compounded guilt from spouse’s suffering and worries about genetic transmission. Azoospermia diagnosis triggered profound emotional distress, disrupting participants’ perceptions of being healthy and adequate. They faced intense familial and societal expectations to achieve fatherhood, compounded by cultural values prioritising lineage and patrilineal continuity. All participants described the pain and discomfort involved in sperm extraction procedures as physically traumatic and emotionally degrading. Many men felt a lack of agency during sperm extraction due to lack of sensitivity and privacy in clinical interactions and environments. Participants expressed profound guilt over the physical and emotional difficulties that their spouses underwent during ART, which further intensified their own feelings of guilt. There were recurrent fears about passing azoospermia to their children, particularly among those with idiopathic or genetic causes.

Conclusion
Our findings provide insights into the physical, emotional, and social challenges faced by men with azoospermia undergoing ART treatment and demonstrate the need for integrating holistic person-centred approaches and interventions in andrological evaluations and ART treatment to enhance patient well-being, self-esteem and resilience. In societies where filial obligations make couples particularly vulnerable, individual and family interventions should be supplemented by wider sensitisation and awareness programmes to challenge the myths, stereotypes and prejudices associated with male infertility.