Table 3 Emergent factors influencing male participation in fertility research and supporting quotes

Seeking knowledge but fearing results

Men were interested in participating in PRESTO to gain knowledge on reproductive health, however they expressed fear of receiving results indicating poor semen quality

“I was curious to see what type of results that I would get back.”—Male Respondent

“But when like when there was the whole like sample collection thing, and you got numbers about like, I mean, like that’s cool. Like that’s valuable to me. Like that’s information that I got that I didn’t have before. And so that is motivating to me.”—Male Respondent

“I think it’s very deep rooted, deep seeded, this belief of manliness and virility, and being able to conceive a child and you know, the inability to do so, to be seen as impotent, and you know, not effective, it, it’s sort of, I think it’s, it’s closely intertwined with notions of manliness and masculinity.”—Male Non-Respondent

“I think it’s the same as like all these other things we’re talking about, like the fear of not being masculine. A lot of us have grown up in the world where if you can’t do something like that, then you’re not really a man, which, you know, obviously isn’t true, but, you know, that thought in society.”—Focus Group Participant

Recognizing the importance of fertility issues

Having knowledge on or a personal connection to fertility issues was positively associated with men participating in fertility research and women choosing to invite their male partners

“It’s just like he’s never been around infertility. I mean, his mother and his father didn’t have any problems conceiving. They have three children, so there’s never been anything, like, in his life that would make him think that having a child is a matter of timing, and a matter of patience, and a matter of, you know, anything else that you might need in order to make your body ready to have a child.”—Female Non-Inviter

“We’ve personally benefited from a lot of the research that goes into infertility, you know, learning about how other couples have managed, learning about the statistics and probability of getting pregnant, which helps us to go into it with a more, kind of realistic mindset so we kind of know what we’re getting into and know what to expect.”—Male Respondent

“So, anyway, this being my first time having a child at all, I never had challenges with it before. But I had heard of others who had challenges and figured that that might you know, potentially happen to me.”—Male Respondent

Believing fertility and pregnancy are women’s issues

Men and women perceived fertility and pregnancy to be women’s issues. This was driven by several factors, including that women get pregnant and carry the baby, male fertility is rarely discussed in education or healthcare systems, and because of gender norms related to pregnancy

“So, I feel like he thinks that it’s a woman’s issue. It’s not that he’s not sympathetic and, you know, and wants do whatever he can, especially in our situation to help, but except for taking the survey, I guess. But, yeah, he just thinks it’s more on that end, like, okay, it’s something you have to deal with, and you have to do stuff, and you have to do this and I just, don’t have to worry about”—Female Non-Inviter

“Yeah, and I think it was kind of girlie to him in a sense too, you know, because girls are the ones that are like, hey, let’s have a kid. And this is how you gotta do it.”—Female Non-Inviter

“I’ll add the thought that sperm count is something that isn’t measured in any regular physical checkup normally for guys.”—Focus Group Participant

“Just even in the education system throughout school, that if you look at – at least in Canada, the – the sex education system, there was a lot of focus on, I guess, if you are going to create a baby, , these are the things that could go wrong, but a lot of that focus wasn’t directed directly at potential problems on the male side, at least from my experience.”—Focus Group Participant

“I think that the literature is more geared towards women. And I think that is a very broad statement, it applies to kind of academic research, and, you know, things of that nature. But it also applies to kind of more, you know, consumptive literature, you know, guides on how, how to get pregnant, how to be pregnant, how to be a mom. I think there’s more literature, you know, addressing the women, or the mom’s, kind of point of view than kind of necessarily the fathers. And so, I think for men to participate in this research helps to expand that body of literature to be able to address men more comprehensively. And I think just from a purely scientific basis, it’s probably needed, as well.”—Male Non-Respondent

“Pregnancy is tremendously impactful to all people involved. But especially to women, because it literally changes their bodies and, um, and they sacrifice so much to be able to produce a kid.”—Male Respondent

Avoiding difficult conversations

Pregnancy and fertility were difficult topics for men to discuss, particularly with other men

“I don’t have a single friend that I talk to about this stuff. And so, it feels like a little bit more of like a guarded topic, even though it really should – and it’s just for whatever reason it does feel that way”—Male Respondent

“I guess the global theme has been it might be a bit taboo for men to talk about it, to discuss it, to research, to look into it. I think it’s more seen as that’s something women talk about. Men shouldn’t discuss that amongst themselves.”—Focus Group Participant

“Besides, like I said, the friends probably thinking it silly if he mentioned it and, you know, guys, like, when they talk about stuff, and they might laugh…. Then, you know, they like to sound masculine and cool. So, of course, he wouldn't want to tell them, or at least, wouldn't want to be doing it where they would find out.”—Female Non-Inviter

Supporting their partner

A strong motivation for participation in fertility research was to support the female partner. However women were hesitant to invite their partners because they did not want to “push” them to participate

“I know that it was something that I, by doing it for her, would help her out, in that journey. Both of us want to have kids, obviously. So, it was just something that I knew that she wanted me to do. So, I did it for her.”—Focus Group Participant

“I mean like if – I suppose if my wife had talked to me about it before I got the email, then that absolutely would have put it on my radar and I would have been watching for that email… I suppose just – I think having my wife talk to me about it before the email would have really helped.”—Male Non-Respondent

“Um, probably if I, you know, was like, “Oh, look,” and just told him how important it is. Like– he’s pretty good with that kinda stuff. Like he’s usually willing. It’s just honestly, it was probably more of my own thoughts that I was like, “Oh, he’s busy, you know.” I don’t know if he would have said no or not. I don’t think he would have said – usually, if I ask him to do things, he’ll do it.”—Female Non-Inviter