Gender,Family Norms,and Male-Factor Infertility in Japan: An Analysis of Internet Blogs

Abstract

This study analyzes blogs about male-factor infertility posted on a Japanese blogsite on a certain day in April 2014. It focuses on an understudied topic and is the first study of Japanese male infertility based on blogs. The blog format afforded anonymity to the bloggers, and our sample of 97 adults yields the largest number of individual respondents of all cross-cultural studies cited in our literature review. We extract three major themes from the analysis of the blogs, offer suggestions for a redirection of family and infertility policy in Japan, and suggest lines for further research.

Keywords

fertility gender and family family demography culture qualitative family health

Introduction

Pregnancy, childbirth, and parenting are themes widely recognized by scholars to be central to family dynamics, family structures, and indeed, to some core motivations underlying the social institution itself. Such topics are prominently featured in family studies, but equally important to scholarship on family life are investigations into the conditions and experiences under which expected pregnancy, childbirth, or parenting does not occur. As family structures become more diverse, attention to the social causes and consequences of infertility and infertility experiences are warranted.

Despite the fact that half of infertility results from men, the focus remains almost exclusively on women. It results in men being marginalized in discussions and treatments related to reproduction (Hanna & Gough, 2016; Ulrich & Weatherall, 2000). Infertility is clinically defined by the World Health Organization as “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse” (Zegers-Hochschild et al., 2009, p. 1522). Such medical terminology used to describe infertility—such as “barren,” “blocked Fallopian tubes,” and “incompetent cervix”—often places blame on women by describing infertility in terms of women who want, but are unable, to reproduce.

Sociocultural meanings of infertility are important not only for infertile couples but also for voluntarily childless individuals and couples with adopted and biological children. Pronatalist environments strongly encourage women to regard childbearing as their natural, primary role and motherhood as a route to social status and identity. Thus, promotherhood ideology strongly shapes the social construction of infertility (Showden, 2011; Ulrich & Weatherall, 2000). A “motherhood mandate” in the United States becomes noticeable when involuntarily infertile individuals and couples realize that the vast majority of American women expect and desire to have children. Most women rate motherhood as the essential life role, and motherhood remains the symbolic experience of adult life (McQuillan, Torres Stone, & Greil, 2007). In such social contexts, childless individuals often experience social isolation (Balen & Bos, 2009).

As it happens, most medical practices that assist infertile couples to produce a live birth focus heavily on the woman. This is in part because, while parenting is still considered a normative life transition for both sexes, motherhood is traditionally regarded as a woman’s central role (Abbey, Andrews, & Halman, 1991). Commensurate with these traditional gender norms, studies have found that infertile husbands are less disappointed in life without children than are their wives (Abbey et al., 1991; Batterman, 1985; Greil, Leitko, & Porter, 1988). The believed centrality of the motherhood role may in fact lead women to initiate treatment for infertility and to play a strong role in deciding on treatment courses (Abbey et al., 1991). Gender norms about infertility thus reflect two fundamental socio–medical–cultural assumptions by medical practitioners: that infertility is more efficiently cured by focusing on the woman and that parenthood is more central to her adult life than to his (Greil, Slauson-Blevins, & McQuillan, 2010; Parry, 2005).

Family scholars have been interested in studying the impact of stress on couple relationships. “Dyadic stressors” refer to “stressful situations or events that affect both partners of a couple—either directly or indirectly through spillover from one partner to the other” (Greil et al., 2018, p. 1305), and infertility can be an example of a dyadic stressor (Berghuis & Stanton, 2002; Greil et al., 2018; Kim, Shin, & Yun, 2018). Previous studies found that distress and well-being are influenced not only by how individuals view infertility but also by partners’ perceptions (Kim et al., 2018). The experience of infertility provides an important opportunity to study stress and coping processes of marital relationships (Berghuis & Stanton, 2002). Such stress cannot be separated from gender differences in the perception of infertility (Brucker & McKenry, 2004). In Japan, the family system called ie follows a rule of primogeniture in succession emphasizing the continuity of the present family members with the past (Johnson, 2009). This family norm weakened as Japanese women increasingly received higher education and entered the labor force after World War II. However, equal education and employment opportunities increased the risk of infertility as the age of marriage and birth rose. The ie continues to influence Japanese families by regarding children not simply as providing an opportunity for parenthood experiences but also as imperative successors of the family line. Such a pronatalist social context creates an even stronger stressful situation for women here than in the West, as women are frequently met with questions such as “Are you married?” and “Do you have children?” as forms of greeting. Some elders may openly criticize women without children because a lack of successor means the end of a generations-old ie, and women in particular are considered to be responsible for infertility (Matsubayashi et al., 2004). These ie-based family norms may cast shame and guilt on infertile patients, possibly causing particular stress on women (Matsubayashi et al., 2004), resulting in men feeling marginalized in the process of infertility treatment.

The current study is interested in understanding the circumstances that make infertility a stressor on marital and family relationships in the Japanese cultural context. In a cultural context where infertility continues to be considered the women’s issue, we are particularly interested in cases of male infertility as male infertility almost always requires both men and women to go through infertility treatment. How do men and women go through the process of accepting their diagnosis, recognizing their role, interacting with the spouse and other family members, and engaging with medical treatment? To answer these questions, we analyzed 97 Japanese bloggers who discuss experiences of being (as yet) unable to have a child due to infertility on the part of the male partner. This focus on coping with male fertility allows us to examine the extent to which partners experience stressors; this is because male infertility requires discussion of the diagnosis and treatment with their partner, whereas female infertility does not necessarily require active participation of the other partner in treatment and experience.

Literature Review

Studies of Infertility in Western Cultures

Previous studies show that conflicts in dealing with infertility influence marital well-being. Traditional gender roles can make it challenging for couples to share their feelings and to support one another (Abbey, Andrews, & Halman, 1994). While infertility can be a stressor on marital relationships, it can also strengthen the relationship if both of them handle the problem together (Greil et al., 2018; Schmidt, Holstein, Christensen, & Boivin, 2005). Tao, Coates, and Maycock (2012) reviewed literatures published from 1990 to 2011 and found that certain coping strategies, such as self-blame, were correlated with marital difficulties for both male and female participants, while seeking social support and planful coping strategies could enhance marital satisfaction.

Prior research also indicates that husbands and wives perceive and experience infertility in gendered ways that are shaped by cultural norms that prevent couples from interacting with one another on the same level. Women feel greater responsibility in infertility treatment to the extent that they feel it is their fault. Infertility “blame” has been traditionally put on women; and since cultural ideals about manhood assume potency, men tend to be protected from the stigma of infertility “blame.” The use of donor sperm challenges these same cultural ideals of manhood and fatherhood and may stigmatize the male partner. However, women tend to prefer the use of donor sperm to adoption because it allows them to experience childbirth (Becker, 2000).

Greil et al. (1988) initially contacted infertile couples in western New York who belonged to a local chapter of RESOLVE, an infertility support group. Constructing a snowball sample, 22 infertile couples were interviewed separately and simultaneously by two different interviewers. The privacy of the interview freed each spouse to report without fear of hurting the feelings of the other spouse. The results showed that wives and husbands reacted quite differently to their infertility as a couple. The wife more likely saw it as her “cataclysmic role failure,” a “challenge to [her] womanhood,” whereas the husband saw it as disappointing but not tragic or identity threatening. Herrera (2013) interviewed 16 men via snowball sampling in Santiago, Chile. After first interviewing four married couples together, Herrera discovered that the wives were dominating the interview; and the husbands seemed reluctant to interrupt or contradict the wives. Thus, she switched to interviewing the other 12 men separately from their wives. Herrera found that the infertile couples began the quest for parenthood at a medical clinic, with the adoption agency only as a backup. All 16 men had become fathers, 9 only by adoption. When the husbands’ narratives were about the usage of an infertility clinic, their role was passive (shown by scant usage of first-person pronouns). The wives scheduled the appointments, bought the medications, delivered semen samples, and underwent the in utero interventions. The husbands took charge in deciding when to move on to an adoption agency and in making appointments and taking phone calls from the agency.

Bell (2013) used advertisements in newspapers and on public bulletin boards to recruit 28 Australian women who had ever used, or were currently using, assisted reproductive services to overcome involuntary childlessness. In the in-depth interviews, they described their experience of cyclical loss—from despair to repair, to hope, and back to despair—with the onset of the next menstrual period. Many (32%) of the women knew that their male partners had a reproductive health challenge but took on a “courtesy stigma,” inviting others to think that the infertility was all her “fault” (Bell, 2013, p. 288). Although the men representing the infertile couples were not interviewed, the findings have significant implications for gendered views of responsibility (Bell, 2013).

In settings where infertility is considered women’s fault, men often feel marginalized in the relationship. Malik and Coulson (2008) studied 28 unique sender names at a “Men’s Room” online bulletin board about male infertility that was hosted in the United Kingdom. The researchers gathered the postings made by the unique senders between January 2005 and June 2006. They found that the men expressed a sex role traditional need to support their “dearest partner” in the endeavor to produce a live birth and sought guidance from other men in filling that need. At the same time, the men complained about being neglected, unsupported, lonely, and dissociated from the fertility treatment process (Malik & Coulson, 2008, p. 23).

Previous studies of infertility tend to focus on men and women separately in understanding individual perceptions of infertility influenced by gendered norms. Focusing on individual perceptions allowed us to see how gendered norms influence their perception differently, but it has limitations for understanding the dyadic relationship. Recently, grassroots movements have emphasized the importance of understanding infertility as a family issue that could affect relationships. RESOLVE, a nonprofit National Infertility Association, underscores the importance of acknowledging infertility beyond a crisis for individuals and couples (Mahlstedt, 2007). Based on the longitudinal study of 12 women pursuing infertility treatment, Rosner (2012) found a significant impact of infertility not only on marriages but also on relationships with family and friends. During a stressful life event, intimate supportive relationships with friends, family, and partners are positively correlated with emotional well-being (Rosner, 2012). Thus, infertility should be understood within the context of relationships with the partner, family members, and friends. How family members react to infertility can be a stressor or enhancer to the couple’s relationships and individual well-being. Japan, with its intergenerational involvement in childbearing decisions of the couple, is a particularly good context in which to explore how family relations shape and are shaped by infertility experiences.

Infertility and Japanese Family

The Japanese family system called ie emphasizes the succession from father to the eldest son. If there is no son, often a daughter’s husband is adopted by her parents to take this responsibility of leadership (Tanaka, 2007). Although infertility problems do not exclusively derive from women’s physical or mental conditions, before World War II a wife who had failed for more than 3 years to bear a child was often divorced by her husband (Muraoka, 2004). When the eldest son marries, he is expected to bring his bride into his parents’ home, where she becomes the “family wife,” taking care of his parents, him, and children born to them. Failure to produce children violates the expectations of the Confucian family and creates strong pronatalist pressures on the childless couple, especially for women.

A recent study pointed out that son preference has diminished in cohorts born after 1945 due likely to the postwar socioeconomic change in Japanese society and the emergent trend toward gender equality (Kureishi & Wakabayashi, 2011). Yet despite the decline in son preference and the rising popularity of the postwar Japanese family model, the custom of male primogeniture continues to influence intrafamilial power (Hashimoto & Traphagan, 2008). Preservation of this cultural model requires the birth of at least one son to each couple. Accordingly, in a survey of women receiving infertility treatment, Tamaue and Matsumoto (2000) found that 80% hoped to bear offspring, 50% hoped to gain a successor, and 40% felt pronatalist pressures from their grandparents. About 40% also replied that they worried about social appearances in the community (Tamaue & Matsumoto, 2000).

Shirai (2012) used a two-step method of obtaining her data on 19 infertile Japanese women. In 2003, Shirai published advertisements in newspapers and organizations for infertile individuals. The advertisements asked infertile women who were willing to talk about their infertility to send their names and addresses by postal mail to Shirai. She used the mailed responses to reply by postal mail to request a face-to-face interview. In the 19 interviews, Shirai found that about half of the husbands had an infertility problem. Shirai was told that the Japanese wife typically initiates the solution to the couple’s infertility by consulting with her obstetrician/gynecologist. If it is determined that the wife has no medical condition that should prevent conception, she is advised to take her basal body temperature to gauge the time of ovulation and to ensure that intercourse occurs then. As a last resort, the husband’s sperm is tested. Some wives brought containers of the husband’s sperm to the clinic because the husbands did not want to accompany them there (Shirai, 2012).

One of the few studies on Japanese male infertility was conducted by Nishimura (2004), who carried out face-to-face interviews with either one or both members of 17 infertile couples recruited from infertility clinics. An important finding was that many husbands reported that they wished to solve the couple’s infertility problem in order to produce a successor for their patriline (Nishimura, 2004). Consistent with that goal, many wives told Nishimura (2004) that they wanted to support their husbands by making their wishes come true. There were two limitations to the external validity of the findings: (1) the men had to be courageous enough to speak face-to-face with a woman interviewer about their stigmatizing condition (infertility) and (2) the couples were recruited from an infertility clinic, which automatically excluded certain categories of infertile couples. Murakami, Yasuda, Mizutani, & Takahashi (2012) located infertile couples through advertisements in newspapers and infertility clinics. They conducted face-to-face interviews with the couples where the wife was aged 35 years or older. Common statements by the husbands expressed feelings of marginality at the infertility clinics due to the focus of the treatments on women (Murakami et al., 2012).

Previous studies share two common threads. All three analyses emphasize that the familial pressure and the medical focus weigh more heavily on the wife than on the husband in an infertile Japanese marriage. Influenced by the custom of primogeniture, wives feel stronger pressure than do husbands to continue their ancestral line and to take the initiative in seeking infertility treatment. Since women’s labor force participation in Japan has been often viewed as temporary—until the birth of the first child—Japanese wives who remain childless for a prolonged period after marriage are an anomaly. Second, most studies involved face-to-face interviews, a social context that required the men in two of the studies to acknowledge to the interviewer (a stranger) that they might be at least partly responsible for the wife’s failure to conceive. The present study departs from the previous three Japanese studies by being the first to use blogs to explore Japanese adults’ feelings about male infertility. Male infertility refers to infertility partly or fully caused by men’s inability to impregnate. In the case of male infertility, both reproductive partners must cooperate with the medical authorities to produce a genetic child. We picked bloggers belonging to infertile couples where the husband is part of the infertility treatment. We analyze how the bloggers tried to use the blogsite and how the results can inform family, demographic, and public health policy in Japan.

Our study seeks to contribute to the literature on family and infertility in two ways: by understanding infertile individuals’ perceptions on infertility in relation to their narratives of interacting with others in a non-Western, Confucian culture and by focusing specifically on experiences of male infertility. Our findings, based on an analysis of core themes openly discussed by Japanese bloggers coping with male infertility, reveal how strongly these experiences remain influenced by how they describe their partner and deeply engrained gender and family norms. Societal constructions of infertility and a “good” family affect not only which member of the couple received infertility treatment but also how each member feels about his or her competencies as a sexual being, a spouse/partner in the couple, and as a son or daughter in the ancestral line. In applied settings, the yield of such research will inform family counselors, policymakers, and medical professionals in establishing best practices and policies for serving infertile couples. In the absence of these social–psychological and cultural understandings, macro- and microlevel attempts to solve social tensions related to Japan’s fertility rates and traditional family norms cannot succeed.

Method

Atkinson (1998) defined the life story as

the story a person chooses to tell about the life he [or she] has lived, told as completely and honestly as possible, what is remembered of it, and what the teller wants others to know about it, usually as a result of a guided interview by another. (p. 8)

The life story technique places great emphasis on the participants to tell their life stories in their own words and events they find relevant and important without being asked in a structured manner. Since the life story emphasizes telling about one’s life, there are many sources: oral and autobiographical narratives, letters, diaries, personal records, and blogs (Bertaux, 1984). Although blogs cannot be guided like interviews, their strengths lie in the freedom of bloggers to decide what stories to tell and in the anonymity that allows them to escape embarrassment for expressing information that they believe may be unpopular or stigmatizing (Steuber & Haunani Solomon, 2008).

The blogs analyzed in this study were selected from a Japanese blogging website called Nihon Blog Mura, or “Japanese Blogger Village.” Bloggers typically register their blogs free of charge to reach a wide audience. When they register, they have a choice of how to label their blog. The categories include Fashion, Sports, Food, Travel, Health, Pets, Housing, Healthcare, Movies, etc. These categories are further broken down into subcategories. One such subcategory is danseifunin—“male infertility.” We located blogs for our study by using this category. We were unable to determine whether all these blogs were also managing issues related to female infertility.

At the Japanese Blogger Village, the blogger may decide whether or not to allow his or her post to be ranked. Each week the ranking changes significantly—some blogs are removed from the ranking of the male infertility blogs, while other blogs join the ranked listing. In April, 2014, the number of blogs about male infertility ranged around 100 per week. We found little variation in ranking of the 104 blogs listed. We kept a record of all the blog websites and read through all blogs at least twice in the month of April. Two blogs were advertisements for infertility treatments, and three blogs were accessible only to approved members. In April, two blogs became no longer available. These deletions left us with 97 unique, anonymous blogs for further analysis, covering about 97% of blogs listed on the website.

To protect the anonymity of the bloggers further, we kept confidential their unique names and internet addresses. The first author read the blogs of the 97 bloggers and constructed a list of emotions expressed about the husband’s infertility: using this list, the first author reread the blogs to discover three common themes discussed below. A major strength of using blogs is that, unlike studies based on recruitment and snowball sampling, bloggers are not confined by the research agenda. In their most comfortable setting and pace, they write whatever content whenever it is convenient. A major disadvantage of using blogs stems from the inability to verify participants’ identity, age, sex, education, and household setting. Some bloggers may mention personal details, while others may leave clues but not details, thereby preventing us from controlling for particular variables or assessing marital quality based on consistent question sets. Another challenge comes from the inability of researchers to control for the duration of bloggers updating and keeping the blogs. Some bloggers update once a week, while others do not update it anymore. We lost only two bloggers in the month of April, but we may have lost more bloggers if they decided not to participate in the ranking.

Results

Blogger Characteristics

All bloggers appeared to be in heterosexual marriages. Their stated ages ranged from the mid-20s to the 40s. It is important to note that although the blogsites discussed “male infertility,” the vast majority of the bloggers were women (88 out of 97 bloggers). Only seven blogs were written by men, and two blogs jointly by a married couple. These facts coincide with the traditional norms mentioned in earlier sections: although the inability to conceive may be due to conditions of the male partner, the female partner may be held relatively more responsible and be relatively more active with regard to infertility treatment. The dominance of wives on a website about male infertility likely reflects the responsibility that Japanese people put on wives for a couple’s failure to bear children.

Major Themes

Analysis of the 97 blogs revealed a number of commonalities in the experiences, concerns, and coping strategies of the authors.

Emotional Pain in Traditional Pronatalist Contexts

About one third of the bloggers described emotional pain beyond the physical pain and tiredness stemming from the infertility treatment itself. Blogger’s stories suggest that a main source of the emotional pain could be attributed to assumptions by parents or parents-in-law that infertility was an unnatural state. Mina’s parents told her that their neighbor became pregnant with their third child, and her friends became pregnant. They frequently asked her “What are you doing?” Since she did not want to talk about infertility to insensitive parents, she just changed the subject by agreeing with her parents’ remarks. Taro, for example, recounted how, when his wife talked to his parents about his infertility problem, his father was not even familiar with the phrase “infertility treatment.” Taro’s parents simply encouraged his wife to spend whatever money was necessary to have a child, a reaction that she found insensitive. Taro’s parents suggested to his wife that the problem must be bad timing rather than a problem related to their son’s physical condition. His parents’ attitude illustrates the common assumption in Japan that male infertility refutes a man’s virility. Keiko described her stress due to her insensitive in-laws asking about infertility treatment out of curiosity. They would introduce the topic into conversation, whereas her parents, out of consideration, never asked anything about the treatment. Keiko believes that her husband learned his insensitivity from his parents. Yumiko explained that her in-laws were patient and did not have any questions about infertility treatment, but she had decided not to tell her own parents about the treatment out of fears that they would be insensitive; her siblings had become pregnant in the natural way. Satomi compiled a list of hurtful words people had said to her about infertility. Once, in response to sharing that she visited her ancestors’ graves only once or twice a year, someone told her “You cannot get pregnant because you do not treat your ancestors’ spirits well!” Similarly, Yuko resented being told by someone that “You cannot get pregnant because you worry too much!” “You and your spouse have such courage to build a house without any children.” These bloggers expressed anger, distrust, stress, sadness, and frustration deriving from perceptions of others.

Hitomi and her husband were often invited to the house of her parents-in-law. The families of her sister-in-law and brother-in-law were also invited and would bring their children. The conversation revolved around these seven children. Hitomi wrote that it was very difficult to be in this family circle because she could not join the conversation. She also wrote that had she not known the sperm count of her husband she would have been able to imagine having a future child and not be so upset. One day, Yuko wrote that she had blocked Facebook pages of her friends’ childbirth announcements. She had needed to calm her mind before unblocking these Facebook pages to congratulate them. She described how difficult it was to look at Facebook pages; they all seemed to include videos and photographs of children. In describing sadness and anger for their spouse, family members, and their friends unable to care for their feeling, these bloggers often received comments in response to these distressing experiences. One of the commentators expressed a wish to “fast-forward” her life, and another commented that she felt infertility treatment was like a tunnel without an end. These comments appear to have a positive effect on bloggers making them feel that they are not alone. The bloggers responded to these comments by thanking others for their kind words and encouraging all bloggers to move forward with them.

Blogs and Means to Inspire and Cope

Although many blogs reported emotional pain, the majority of bloggers utilized their sites to describe treatment in detail and thus to “gain perspective” and overcome their feelings of stigma. Overall, more than half the bloggers demonstrated a positive outlook. For instance, Kazumi wrote that she felt envious when a childhood friend became pregnant but was still truly happy for her. And when Kazumi heard that some other friends were in infertility treatment, she realized that she was not the only one in her generation struggling to get pregnant. She commented that she felt invigorated to move forward with treatment. As was common, readers of her blog replied with encouragement to stay optimistic.

Bloggers also encouraged their anonymous readers by sharing their thoughts. Miho emphasized the importance of a couple facing infertility issues together. She had realized her own fear of branching off from a “big safe road to the narrow road”—that is, of being left out of the mainstream. Now she felt strong enough to move forward on her own road, not that of others. Several anonymous readers commented that they were encouraged by her words. Momoko and Noriko described in detail their infertility treatments, as well as the encouraging comments of their nurses. For instance, Noriko blogged,

The nurse wished me luck. She said that as long as we try as a couple, there is a possibility. What an encouraging word. . . . Infertility treatment will greatly influence your mental as well as material aspects of life, but there will be a miracle in the process of treatment. So be patient, don’t give up. Couples should help each other move forward. Because you already know the goal, all you need is to move forward!

Mina, who wrote about her parents frequently asking her questions about pregnancy, also talked about “Baby on Board” stickers on cars. Once she started the treatment, she began to notice these stickers everywhere, making her wonder why everyone else but her was pregnant. Writing the blog, however, encouraged her to realize that her perceptions were skewed. She emphasized the importance of realizing how her views were biased due to her comparisons with others. The majority of bloggers appeared to use blogs to help clear their mind from being controlled by negative feelings based on interactions with others. Although it is possible that bloggers deleted any insensitive comments, all the comments were solidly supportive of the bloggers. When readers responded kindly, the authors thanked them for their supportive words, thus making the experience of blogging positive for both the writers and their audience.

Men’s Ambiguous Role in Infertility Treatment

Although the majority of people blogging about male-factor infertility were women, the blogs still offered clues to the experiences and conditions of male partners. Since the role of men in infertility treatment was not clearly defined, some men felt marginalized while others felt rather positively. Half of the male bloggers wrote about conflicts with their wives, who they felt held an unfair advantage in making decisions about infertility treatments at the female-focused clinics. For example, Hiro wrote that he thought that he and his wife had agreed to stop the infertility treatments. Then, when he was at work, he was astonished to receive an e-mail message from his wife reporting that she had just finished an in vitro fertilization treatment.

Taro felt that his wife believed she was the only unfortunate person, and he found it difficult to get her “out of her shell.” He admitted to feeling unfortunate and left out as his friends became fathers and as their conversations became child oriented. At the same time, he believed that not all the couples with children were happy, and that there were many childless couples who were happy. Quitting the infertility treatment may lead to happiness, he speculated, although he did not seem to share this opinion with his spouse.

Ichiro wrote that he felt denied as a person while his wife was being treated at the infertility clinic, and he began avoiding her at home. He wrote that he wanted to go to work before his wife woke up. His parents did not want to interact with her parents because her parents blamed him for their inability to have grandchildren. He believed that her parents’ emphasis on the importance of protecting the ancestral grave strongly influenced his wife’s views on having a baby. He saw an increased gap in their relationship rather than a strengthening. In realizing that their in vitro fertilization had failed, he at one time wrote that he was happy about the result because they were not ready to have a child when they cannot understand one another. Various anonymous readers blogged their concerns about his relationship with his wife.

In contrast, some men expressed a great deal of appreciation for their wives’ understanding. Kenji expressed regret at the possibility that his wife might never become a mother and acknowledged the moral support he received from family and friends. He wrote about the importance of telling them the truth about his infertility, because it is very often attributed incorrectly to the woman in Japan. Hiroshi wrote that his wife told him that she married him regardless of children, and there was always the option of being a couple without them. He was touched by her words and thanked his wife for marrying him and encouraging him to continue the infertility treatment. Kenji and Hiroshi informed their readers that male infertility does occur and would not ruin their lives. However, as they strongly wished to have their own biological children, they both felt alone while their friends became parents. Hiroshi’s close friend who had just welcomed his second child asked him why he wasted his money on the infertility treatment. Surprised by his friend’s question, he shared his honest feeling that he wanted to see his own son even if it required him and his wife to go through expensive and tedious treatments. At the same time, he too described infertility treatment as a tunnel without an end. He felt that he and his wife were isolated in this tunnel, and he worried about her sacrifices and the hurtful remarks that she received from her friends, such as “When you are you going to have a baby?”

Discussion and Implications

Japanese infertility clinics—sometimes referred to as “ladies clinics”—often display advertisements of women holding babies and host websites colored in feminine pastels and photos of bouquets. Under the FAQ (frequently asked questions) sections on some of these clinics’ websites are questions about whether they treat male infertility, and the response is “Yes because 50% of infertility derives from men.” Yet findings from this study support the potential for infertile men to face marginalization not only from general society but also from the subcultures and practices of infertility treatment providers. At the same time, their female partners continue to shoulder disproportionate responsibility and “culpability” in cases of male infertility. Thus, enduring family norms and attitudes about gender, fertility, and responsibilities may produce negative repercussions for both partners. In the Japanese context and elsewhere, counselors and family professionals should give attention to the potential marginalization of men and stigmatization of women in cases of male infertility. There may be a need for campaigns to raise awareness of male infertility that challenge its construction as a “virility problem.” Moreover, government policies and campaigns that seek to ameliorate the nation’s low fertility rates would be wise to avoid supporting misconceptions that fertility challenges are due mainly to women, or that higher age is a fertility concern for a woman but bears no influence on a man’s fertility. These ideas appeared to have contributed, however indirectly, to some of the stigma and strain felt by bloggers.

Evidence from our review of these blogs also suggests the continued importance of the Japanese extended family in shaping fertility decisions and experiences. In many cases, the comments and expectations of parents and parents-in-law had significant effects on the experiences of couples coping with male infertility. Pressure from older generations, as well as traditional obligations to ancestors, appeared to have motivated some couples to pursue treatment when they otherwise may not have done so with such diligence or expense. This persistence of traditional family roles and norms in the context of a highly modern and technologically developed society is a general theme that should be of interest to scholars seeking to understand change and continuity in family life. Whereas practices related to Japan’s ie family system have long been abandoned for the relatively more couple-focused, Western family model, narratives from the blogs show technologies of infertility treatment being used in the service of lingering values and beliefs about the reproductive obligations and responsibilities of daughters-in-law.

Of course, the technologies of blogs and the Internet may also have been seen as a venue in which family norms and roles can be challenged. The examples of Kenji and Hiroshi hint at the use of blogs for promoting the redefinition of the role of men in infertility treatment, for instance. In addition to providing therapeutic experience to bloggers and readers coping with infertility, treatment practices, and surrounding stigma, they are relatively unrestricted spaces that might foster grassroots social change. The intimate but public nature of blogs provides unique opportunities for open discussion and renegotiation concerning family life and gendered experiences.

Strengths and Limitations of the Study

Our study is limited with regard to sample size and variation, especially to the extent that we were able to gather relatively little data from men coping with male infertility. At the same time, the fact that most bloggers writing about male infertility were women in heterosexual marriages does offer some insight into family norms and gender roles in contemporary Japan. In this regard, the sample’s weakness may provide some degree of understanding about Japan’s social landscape.

One strength of our data set is that it reaffirms findings from other infertility studies in Australia, Chile, the United Kingdom, the United States, and Japan. Namely, husbands feel dissociated from the medical process of diagnosing and treating infertility. In Japan, the clinical examination of the husband in the infertile marriage begins only after two earlier stages have failed to produce a pregnancy—after the wife has undergone testing and, if lacking diagnosable reproductive-health problems, has been taught how to practice the rhythm method to increase her chances of conception (Shirai, 2012). Given the exponential increase in government-sponsored infertility treatments that has led to a legislative cap on benefits, further government savings could be achieved by examining both members of the infertile couple simultaneously at the first stage. It would hasten the diagnosis of infertility when it is due to a male factor or a male-plus-female factor and would reduce the number of paid visits to the clinic before his reproductive-health problem is found. We agree with Herrera (2013) that the integrated services to couples visiting an infertility clinic should not mean that the husband is sent off to a urologist at another clinic.

Second, because our study of male infertility is the first one based on a Japanese-language blogsite hosted in Japan, it offers new findings previously unreported from face-to-face interviews in Japan (Murakami et al., 2012; Nishimura, 2004; Shirai, 2012). To wit, resentment was expressed against parents-in-law for the pronatalist pressures exerted on the daughters-in-law, plus husbands acknowledged themselves as infertile and affirmed support for the notion of remaining a member of a childless but fulfilled couple. These expressions lay the foundation for undermining the cultural ideal of the patrilineal, patrilocal, patriarchal, and primogenitural family in Japan.

Finally, the present study highlights new questions for further study. Given the historical practice of adopting a son-in-law or a nephew when a Japanese couple could not produce their own son, we were surprised that no bloggers in our data mentioned thoughts of adoption. If the process of becoming a parent in a nonnormative way leads contemporary Japanese couples to apply to an adoption agency, the husband may be the first spouse to propose it, as seems typical in Chile (Herrera, 2013). Future data from interviews and blogs can explore these questions. Formally linking infertility clinics with adoption agencies would be one more way to stem the government’s costs of paying for infertility treatments.

Conclusion

The current study analyzed 97 adults posting a blog on a particular day in April 2014 at an online blogsite hosted in Japan to discuss male infertility—a rarely studied topic. Our analysis of this data set is the first one to use data from a blogsite to study male infertility in Japan. Our sample also yielded the largest number of individual respondents of all the above-cited Eastern and Western studies on the topic of male infertility. Notably, most of the bloggers writing about experiences of treatments for male infertility were the female partners in the couple. Blogging afforded anonymity to the authors, who could write under a pseudonym and, thus, could freely express without fear of embarrassment or retaliation their personal sadness over the reproductive challenge and their frustration at being stigmatized.

Three major themes emerged through our review of these blogs: (1) strong social pressures, perhaps particularly on women, linked to an enduringly pronatalist, patriarchal society; (2) the use of blogs as a coping strategy and means to inspire self and others; and (3) the ambiguous role of men in male infertility treatment. We suggest that additional attention to these experiences on the part of policy makers, demographers, and family counsellors is needed in order to promote a healthy family life in Japan as well as to address the nation’s demographic challenge of rapid population aging. A continued focus on women in the treatment of male infertility risks stigmatizing women, marginalizing men, and perpetuating misunderstandings about male infertility.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

References

Abbey

Andrews

F. M.

Halrnan

L. J.

(1991). Gender’s role in responses to infertility. Psychology of Women Quarterly, 15, 295-316. doi:10.1111/j.1471-6402.1991.tb00798.x

Abbey

Andrews

F. M.

Halman

L. J.

(1994). Psychosocial predictors of life quality: How are they affected by infertility, gender, and parenthood? Journal of Family Issues, 15, 253-271. doi:10.1177/0192513X94015002006

Atkinson

(1998). The life story interview. London, England: Sage.

Balen

F. V.

Bos

H. M. W.

(2009). The social and cultural consequences of being childless in poor-resource areas. Facts, Views & Vision, 1, 106-121.

Batterman

(1985). A comprehensive approach to treating infertility. Health & Social Work, 10, 46-54. doi:10.1093/hsw/10.1.46

Becker

(2000). The elusive embryo: How women and men approach new reproductive technologies. Oakland: University of California Press.

Bell

(2013). Constructions of “infertility” and some lived experiences of involuntary childlessness. Affilia: Journal of Women & Social Work, 28, 284-295. doi:10.1177/0886109913495726

Berghuis

J. P.

Stanton

A. L.

(2002). Adjustment to a dyadic stressor: A longitudinal study of coping and depressive symptoms in infertile couples over an insemination attempt. Journal of Consulting and Clinical Psychology, 70, 433-438. doi:10.1037//0022-006X.70.2.433

Bertaux

(1984). The life story approach: A continental view. Annual Review of Sociology, 10, 215-237. doi:10.1146/annurev.soc.10.1.215

10.

Brucker

P. S.

McKenry

P. C.

(2004). Support from health care providers and the psychological adjustment of individuals experiencing infertility. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 33, 597-603. doi:10.1177/0884217504268943

11.

Greil

A. L.

Leitko

T. A.

Porter

K. L.

(1988). Infertility: His and hers. Gender & Society, 2, 172-199. Retrieved from https://www-jstor-org.web.bisu.edu.cn/stable/190494

12.

Greil

A. L.

Slauson-Blevins

McQuillan

(2010). The experience of infertility: A review of recent literature. Sociology of Health & Illness. doi:10.1111/j.1467-9566.2009.01213.x

13.

Greil

A. L.

Slauson-Blevins

McQuillan

Lowry Michele

Burch

A. R.

Shreffler

K. M.

(2018). Relationship satisfaction among infertile couples: Implications of gender and self-identification. Journal of Family Issues, 39, 1304-1325. doi:10.1177/0192513X17699027

14.

Hanna

Gough

(2016). Emoting infertility online: A qualitative analysis of men’s forum posts. Health (London), 20, 363-382.

15.

Hashimoto

Traphagan

J. W.

(2008). Changing Japanese families. In Hashimoto

Traphagan

J. W.

(Eds.), Imagined families, lived families: Culture and kinship in contemporary Japan (pp. 1-12). Albany: State University of New York Press.

16.

Herrera

(2013). “Men always adopt”: Infertility and reproduction from a male perspective. Journal of Family Issues, 34, 1059-1080. doi:10.1177/0192513X13484278

17.

Johnson

(2009). The stem family and its extension in present Japan. American Anthropologist, 66, 839-851.

18.

Kim

J. H.

Shin

H. S.

Yun

E. K.

(2018). A dyadic approach to infertility stress, marital adjustment, and depression on quality of life in infertile couples. Journal of Holistic Nursing, 36, 6-14.

19.

Kureishi

Wakabayashi

(2011). Son preference in Japan. Journal of Population Economics, 24, 873-893. doi:10.1007/s00148-009-0282-3

20.

Mahlsted

P. P.

(2007). Coping with Infertility: How Family and Friends Can Help? RESOLVE Facto Sheet 6. Retrieved from http://familybuilding.resolve.org/site/DocServer/06_Family_and_Friends.pdf?docID=5702

21.

Malik

S. H.

Coulson

(2008). The male experience of infertility: A thematic analysis of an online infertility support group bulletin board. Journal of Reproductive and Infant Psychology, 26, 18-30. doi:10.1080/02646830701759777

22.

Matsubayashi

Hosaka

Izumi

Suzuki

Kondo

Makino

(2004). Increased depression and anxiety in infertile Japanese women resulting from lack of husband’s support and feelings of stress. General Hospital Psychiatry, 26, 398-404. doi:10.1016/j.genhosppsych.2004.05.002

23.

McQuillan

Torres Stone

R. A.

Greil

A. L.

(2007). Infertility and life satisfaction among women. Journal of Family Issues, 28, 955-981. doi:10.1177/0192513X07300710

24.

Murakami

Yasuda

Mizutani

Takahashi

(2012). Shirarezaru Dansei funin [Invisible male infertility]. In Umitainoni Umenai [Untold storied of infertility] (pp. 100-130). Tokyo, Japan: Bungeishunju.

25.

Muraoka

(2004). Funin to Dansei wo meguru Mondai-kei [Social problems associated with male infertility]. In Funin to Dansei [male infertility] (pp. 101-150). Tokyo, Japan: Seikyūsha Library.

26.

Nishimura

(2004). Funin Josei wo Sasaeru Danseitachi [Research on men supporting their spouses during the infertile treatment]. In Funinto Dansei [Male infertility] (pp. 101-150). Tokyo, Japan: Seikyūsha Library.

27.

Parry

D. C.

(2005). Work, leisure, and support groups: An examination of the ways women with infertility respond to pronatalist ideology. Sex Roles, 53(5-6), 337-346. doi:10.1007/s11199-005-6757-0

28.

Rosner

(2012). Recovery from traumatic loss: A study of women living without children after infertility (Doctoral dissertation, Penn State). Retrieved from http://repository.upenn.edu/edissertations_sp2/20/

29.

Schmidt

Holstein

Christensen

Boivin

(2005). Does infertility cause marital benefit? An epidemiological study of 2250 women and men in fertility treatment. Patient Education and Counseling, 59, 244-251. doi:10.1016/j.pec.2005.07.015

30.

Shirai

(2012). Funin wo Kataru [Interviews with infertle individuals]. Tokyo, Japan: Kaimeisha.

31.

Showden

C. R.

(2011). Choices women make: Agency in domestic violence, assisted reproduction, and sex work. Minneapolis: University of Minnesota Press.

32.

Steuber

K. R.

Haunani

S. D.

(2008). Relational uncertainty, partner interference, and infertility: A qualitative study of discourse within online forums. Journal of Social and Personal Relationships, 25, 831-855. doi:10.1177/0265407508096698

33.

Tamaue

Matsumoto

(2000). Feelings of women under infertility treatment: Focusing on maternity. Bulltin of Osaka City Univerity, College of Nursing, 2, 33-38. Retrieved from http://dlisv03.media.osaka-cu.ac.jp/contents/osakacu/kiyo/DB00000948.pdf

34.

Tanaka

(2007). Graves and families in Japan: Continuity and change. The History of the Family, 12, 178-188.

35.

Tao

Coates

Maycock

(2012). Investigating marital relationship in infertility: A systematic review of quantitative studies. Journal of Reproduction & Infertility, 13, 71-80.

36.

Ulrich

Weatherall

(2000). Motherhood and infertility: Viewing motherhood through the lens of infertility. Feminism & Psychology, 10, 323-336. doi:10.1177/0959353500010003003

37.

Zegers-Hochschild

Adamson

G. D.

de Mouzon

Ishihara

Mansour

Nygren

. . . Vanderpoel

(2009). International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART technology, 2009. Fertility and Sterility, 92, 1520-1524. doi:10.1016/j.fertnstert.2009.09.009