What Moves Men to Change? A Mixed-Methods Study on Facilitators and Barriers of Lifestyle Changes in Men Seeking Fertility Care.

BACKGROUND

An unhealthy lifestyle negatively affects male fertility. Despite this, men that are part of an infertile couple often fail to improve their lifestyle and evidence on influencing factors is limited.

OBJECTIVES

To identify facilitators and barriers involved in lifestyle changes of men seeking fertility care and in lifestyle counseling by fertility health care providers (HCPs).

MATERIALS AND

METHODS

A mixed-methods study was performed including semi-structured interviews with 14 men seeking fertility care and seven fertility HCPs. Fifty other men completed a questionnaire evaluating various aspects of lifestyle change. Eligible participants were men part of an infertile couple and met at least one lifestyle criterion: BMI ≥ 25 kg/m2, smoker, alcohol use of ≥ 7 units/week, and recreational drug use. Included HCPs provided lifestyle counseling to infertile couples.

RESULTS

The most important facilitators for lifestyle changes in men seeking fertility care are the wish to improve their chances to father a child and their partner's support. The most important barriers are stress, a busy life, an unhealthy lifestyle being part of social activities, and normal semen quality. HCPs experienced limited time, unclear and insufficient scientific evidence on lifestyle and male infertility, and lack of uniform care as barriers. Professional responsibility and societal factors were facilitators.

DISCUSSION: HCPs could use these results to improve and personalize lifestyle counseling of men seeking fertility care. For example, by emphasizing the impact of lifestyle on pregnancy loss and offspring in men with normal semen quality. This study is limited by its small sample size and its confinement to a Dutch context.

CONCLUSION

This study identifies previously unknown facilitators and barriers for lifestyle changes in men seeking fertility care. It also reveals barriers experienced by HCPs when counseling male patients about lifestyle. These results should inspire fertility departments to (re)design lifestyle interventions and policies for men seeking fertility care.