Barriers to Male Involvement in Infertility Care: A Qualitative Study of Men Attending Fertility Clinics in Calabar, Cross River State, Nigeria A Qualitative Descriptive Study

Background: Infertility affects a substantial proportion of couples in sub-Saharan Africa, yet male involvement in its diagnosis and management remains limited. In Nigeria, where infertility is culturally framed as a woman's problem, men's engagement with fertility services is poorly understood. This study explored the barriers to male involvement in infertility care among men attending fertility clinics in Calabar, Cross River State, Nigeria. Methods: A qualitative descriptive study was conducted among men attending fertility clinics affiliated with the University of Calabar Teaching Hospital (UCTH) and selected private fertility centres in Calabar. Twenty-four men purposively sampled across primary and secondary infertility categories participated in four focus group discussions (FGDs) and eight in-depth interviews (IDIs). Of the 24 men, 14 had primary infertility and 10 had secondary infertility. Data were analysed using Braun and Clarke's six-phase reflexive thematic analysis. Expand the analysis subsection to specify the coding approach (e.g., initial inductive coding followed by deductive mapping to the Addis and Mahalik framework), the number of coders, and any reliability or consensus procedures. The Addis and Mahalik contextual model of men, masculinity, and help-seeking informed data interpretation. In the results, map each theme to the relevant Addis and Mahalik construct (e.g., Theme 1 to 'threat to masculine identity', Theme 5 to 'disclosure risk'). Add a sentence in the discussion explaining how the model helped interpret the findings. Reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results: Five interrelated themes emerged: (1) threats to masculine identity and fear of "unmanning"; (2) cultural and religious attribution of infertility to women; (3) the financial burden of investigations and assisted reproductive technology; (4) a female-oriented clinic environment and provider attitudes that discouraged male engagement; and (5) stigma, secrecy, and social isolation. These barriers operated across individual, interpersonal, health-system, and sociocultural levels, converging to delay men's presentation for evaluation, discourage disclosure of a male-factor diagnosis, and reduce sustained engagement with treatment. Conclusion: Male involvement in infertility care in Calabar is constrained by intersecting masculine, cultural, financial, and health-system barriers. Gender-responsive clinic environments, subsidised andrology services, provider sensitisation, and community-level myth-correction messaging are needed to improve men's engagement with infertility care and to support couple-centred management of infertility.