**Background**
Infertility affects 8%–12% of couples globally, with male factors contributing to 20%–30% of cases. Despite this prevalence, male infertility remains understudied from a gender perspective. Traditional masculinity—defined by strength, dominance, and virility—positions fertility as a core component of manhood. Consequently, infertile men often experience stigma, shame, and a perceived loss of masculine identity. This metasynthesis aims to explore how traditional masculinity shapes the experiences of men with infertility across diverse cultural contexts.
**Methods**
The authors conducted a systematic review and metasynthesis following PRISMA guidelines, registered on PROSPERO (CRD42022327318). Ten databases (PubMed, SAGE, Scopus, Taylor & Francis, Web of Science, ScienceDirect, Emerald, ProQuest, Wiley Online, Springer Link) plus gray literature sources were searched using keywords "gender" OR "masculinity" AND "male infertility." Inclusion criteria were: qualitative studies using in-depth interviews or online surveys, English language, studies addressing gender issues, and studies set in male infertility contexts. Exclusion criteria included review articles, quantitative studies, incomplete data on gender issues, and non-English studies. Two authors independently screened studies using Mendeley. Quality assessment was performed using the Critical Appraisal Skills Programme (CASP) tool. Thematic synthesis employed inductive phenomenology, identifying meaning units and grouping them into themes.
**Key Results**
Twenty-four qualitative studies from Asia, Europe, Africa, and America were included. Sample sizes ranged from 2 to 150 participants. CASP assessment showed that all 24 studies had clearly stated aims, 23 used appropriate qualitative methodology, and 22 had rigorous data analysis. However, only 14 studies adequately considered ethical issues.
TWO MAJOR ANALYTIC THEMES EMERGED
1. **Personal perception and beliefs**: Men equated infertility with loss of manhood. Illustrative quotes included: "I don't think I'm even a guy" and "I wasn't a real man… it all comes down to one word… inadequate." Fatherhood was seen as central to masculine identity: "when you can't impregnate your wife, it makes me feel like less of a man."
2. **Social and cultural norms, values, and expectations**: Societal mandates pressured men to father children. Stigma led to secrecy: "He wouldn't tell people about the cause. He'd just let people's assumptions go." Religious beliefs reinforced this, with one participant citing Genesis: "we should multiply and fill the earth." The perception that infertility is a "woman's problem" marginalized men further.
**Clinical Implications**
Traditional masculinity poses significant barriers to help-seeking and psychological well-being. The review reports that depression (20.8%), anxiety (7.8%), and combined depression and anxiety (15.5%) are prevalent among infertile men. Male infertility is linked to erectile dysfunction and ejaculatory disorders, creating a complex cycle of stigma, sexual dysfunction, and mental health deterioration. The authors recommend couple's therapy, family education, support groups, and media campaigns to challenge traditional masculinity norms. They emphasize that involving men more openly in reproductive research and clinical services is essential. The review notes limitations including cultural heterogeneity and incomplete reporting in some included studies.