Conceiving Masculinity: Male Infertility, Medicine, and Identity by Liberty Walther Barnes (review)

With much of the literature on infertility focusing on women, Liberty Walther Barnes’s new book, Conceiving Masculinity: Male Infertility, Medicine, and Identity, is an important addition because it provides an in-depth analysis of the personal and institutional understandings and experiences of male infertility. Barnes seeks to understand how dominant gender norms about masculinity have shaped and continue to shape the field of infertility and how the field of infertility reinforces these dominant gender norms. Hegemonic masculinity is defined by power. Fatherhood, especially biological fatherhood via heterosexual intercourse, is one way for men to achieve and express power since the ideal macho man is both virile and potent. Infertility threatens masculinity by revealing that the male body is vulnerable: it is subject to disease, and it may not live up to the cultural trope that men are always ready and eager for sexual activity.

Barnes begins chapter 2, “Seminal Work,” with a historical analysis to understand why the science and treatment of male infertility lags so far behind that of women’s infertility. The historical pathologization of women’s bodies, especially their reproductive organs, along with the reluctance to medicalize men’s sexual and reproductive abilities have led to the feminization of infertility medicine. Even today, the assumption that infertility is a women’s issue remains strong and is reflected in the education and training of physicians (for example, there are no board certifications available for subspecialties in andrology, male reproductive medicine, and male infertility [32]), the female-centric nature of infertility clinics (for example, reproductive endocrinologists are trained to focus on women’s bodies and women-centric treatments [31]), and the fact that male infertility is generally treated in women’s bodies rather than men’s bodies (even intracytoplasmic sperm injection, which is lauded as “empowering the men,” still requires women to undergo egg extraction and in vitro fertilization [30]).

In chapter 3, “Doctors Doing Gender,” Barnes explores gendered social interactions she observed between patients and physicians while conducting ethnographic fieldwork in male fertility clinics in the United States. Although the male infertility physicians expressed frustration with gender norms, particularly the belief that infertility is a woman’s issue, that prevent the field of male infertility from moving forward, they reinforced these norms in an effort to protect their patients’ masculinity. For example, the doctors would make references to sports and cars as a way of highlighting shared masculine interests, thereby neutralizing other differences (such as class) and promoting trust. Furthermore, doctors would try to ease the emasculating blow of an infertility diagnosis by not using the word infertility with patients during clinical encounters but instead delivering the diagnosis in terms of semen analysis and treatment options. In addition, doctors discussed male infertility as a couple’s issue so as to minimize the perception that male infertility is the man’s individual failure. The men’s wives played the critical role of keepers of medical information during clinical encounters, yet their involvement was also disruptive to the power dynamics at play in the “hypermasculine milieu of urology,” since they could be seen as competing authority figures (77).

In chapter 4, “Just a Medical Condition,” Barnes unpacks the themes that emerged from her interviews with twenty-four infertile heterosexual men who were married or engaged. Perhaps most strikingly, even though all of the men she interviewed met the clinical definition of infertility, two-thirds of them said they never thought of themselves as infertile. Instead, they view their infertility as “just a medical condition”—something based in the body and beyond their control—that can be remedied through medical treatments. By upholding Cartesian dualism, these men separated their infertility from their identity and were thus able to minimize feelings of emasculation. Yet, some of them expressed concern about what a diagnosis of infertility meant for their sexuality, which is in line with other research that shows that infertile men tend to experience infertility as threatening to their virility and sexual...