Book Review: Conceiving Masculinity: Male Infertility,Medicine,and Identity by Liberty Walther Barnes

In Conceiving Masculinity, Barnes deftly analyzes the bind that male infertility doctors encounter: they need to debunk the stereotype that infertility is a women’s issue in order to attract clients and advance their profession, yet they feel compelled to protect the masculinity of their clients in face-to-face interaction. Drawing on the theoretical work of Ridgeway and Correll (2004), Barnes shows us how the multilevel gender system reproduces by shifting unevenly. When one level of the system shifts, “the other levels of the system do not budge, making large-scale social changes in gender beliefs practically impossible” (p. 77). Even as male infertility clinics break down, by their very existence, cultural constructions of aggressive, virile, and uncontrollable male sexuality, they reconstruct this ideology through their policies and interaction strategies. For example, most infertility clinic staff assume that a man can enjoyably produce a semen sample at a moment’s notice in a broom closet, which belies the experience of many of Barnes’ interviewees, who found the process uncomfortable.

Barnes observed doctor–patient interactions in five male infertility clinics in the United States. She interviewed 24 married, heterosexual, white men and their wives (separately) via telephone about their experiences with infertility. Findings are organized into chapters focused on different levels of the gender system. Chapter two examines the history and current status of the profession and argues that the assumption that reproduction is a women’s issue has slowed advances in the science and treatment of male infertility. Chapter three focuses on gendered social interactions. Barnes finds that male infertility specialists re-create the construction of infertility as a women’s issue by protecting their male clients from emasculating terms such as “infertile.” Doctors do masculinity through the jokes and metaphors (cars and sports) that they use to describe the medical conditions clients face. Barnes suggests that this may reflect the structural level of gender, which disproportionately funnels men into urology.

In chapter four, Barnes analyzes the experiences of men who use infertility clinics. The key findings here are that interviewees reject the label of “infertile” even when they have zero sperm, define their infertility as “just a medical condition” that can be corrected, and separate their identities as men from their ability to impregnate their wives. Barnes also finds that when asked directly whether their experiences with infertility ever caused them to question their masculinity, the majority of men answered “no” even in the context of interviews in which they shared their feelings of inadequacy in response to other questions. Barnes correctly notes that this may be a reflection of a layperson’s understanding of gender—her interviewees are not gender theorists. Yet this chapter also made me question the argument that “biological fatherhood is a salient aspect of hegemonic masculinity” (p. 101). I wondered whether childless men regularly encounter questions about when they will have children to the same extent that women report, and whether fatherhood matters as much as for masculine identity as money, control, or athleticism. The final two chapters examine power and the decision-making process reported by husbands and wives and attempt to situate the findings in the larger context of the politics of reproduction.

A substantive concern is the focus on gender in isolation from race and class. Barnes acknowledges that her sample reflects the privilege of those who seek medical help for infertility, but her analysis would benefit from an intersectional lens. She uses the work of Martin (1987) to criticize the historical framing of women’s bodies as “factories” for reproduction because it resulted in women’s alienation from their bodies. Infertility doctors use similar metaphors to explain infertility to patients, yet Barnes argues that it is not alienating: “The metaphor of the factory/bridge works because it celebrates technological achievement. It invokes movement, action, production, and progress, which are masculine and empowering” (p. 63). References to bodies as factories may work for men who do not labor on the factory floor, but less privileged men might not find this usage empowering. In their study of prospective professional football players’ experiences of the draft, Dufur and Feinberg (2009) find that African American men felt disempowered by practices that defined them by their bodies and treated them as machines. White men were less critical of practices such as using numbers to identify players and requiring athletes to parade near-naked in front of coaches.

Conceiving Masculinity is an accessible read that could inform students in gender, health, and sexuality courses. Barnes’ attention to the interactions between levels of gender results in an intriguing analysis of how gender is reconstructed even in context where it is professionally beneficial to challenge cultural assumptions about men and reproduction.