When dealing with highly challenging life situations, it is often said—both by laypeople and even by professionals—that men tend to avoid problems, while women “approach” them by openly expressing their emotions. Attempts to define differences between the emotional worlds of men and women have existed since early human societies.

In medieval societies built on patriarchal authority, certain behaviors were expected from both men and women. Men were assigned the role of the “stable oak”, responsible for protection and security, while also suppressing the genuine expression of emotions. Women—central figures in courtly poetry—were expected to represent the supportive, compliant, and more emotionally expressive side.

These deeply rooted cultural gender roles can still be observed today. In the context of impaired fertility, it is often noted that women experience the events and accompanying emotions much more intensely, while men tend to withdraw, distance themselves, and engage in distraction-oriented activities (e.g., more work, exercise).
Such observations arise partly from personal experience and partly from the human need for understanding—since creating categories (such as approaching vs. avoiding) helps simplify information processing and makes situations easier to understand.

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Emotional burden in infertility

Psychological research among couples experiencing fertility problems clearly shows that emotional and mood disorders occur more frequently in women than in men, most commonly depression and anxiety disorders.

Depression may appear in up to 40% of affected women and in up to 23% of affected men.
Thus, there is a difference between the sexes; however, the mental health of both groups is seriously affected. Compared with healthy populations, men with infertility experience up to seven times higher rates of depressive symptoms, while women may experience up to ten times higher rates.

The emotional burden of infertility is therefore exceptionally high for both women and men.
Significant differences—both between and within genders—exist in how this burden is carried, that is, in emotion regulation and coping strategies.

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The conductor of our emotions

Emotion regulation (the ability to manage and keep our emotions within bounds) is centered in the brain. A major scientific question is how much the behavioral differences between men and women are due to biological sex—that is, the fact that we are biologically male or female.

Biological sex influences brain function through three main pathways.

1. The hormonal pathway

This pathway influences sexual behavior and the expression of aggression through reproductive hormones (such as testosterone).
We have more extensive knowledge about the relationship between hormones and mood in women. For example, depressive symptoms before menstruation and after childbirth are clearly linked to ovarian hormones, making women more vulnerable to certain psychological disorders.

2. The genetic pathway

The presence of X (female) and Y (male) chromosomes shapes brain activity.
In men, for example, there is a gene whose instructions regulate testicular development and testosterone production, and also influence neural stress responses. In this sense, the regulation of how we later emotionally cope with stressful situations already begins at the chromosomal level.

These hormonal and genetic pathways operate largely outside our conscious control.
However, beyond what we are born with, environmental factors also strongly shape our emotional states. The environment provides both supportive inputs (e.g., relationships) and stress-inducing factors (e.g., workplace difficulties), since we constantly interact with our surroundings.

Therefore, how stressful infertility is for a woman or a man depends partly on:

• how unexpected the diagnosis was
• what their experiences are during investigations and treatments
• what supportive activities and people surround them

It also depends on their “biological package”, since one of the body’s central stress-response systems—the hormonal stress axis—also shows sex differences. Reproductive hormones regulate the “on-switch” of stress responses differently in men and women.

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Does it matter who is more emotional or more avoidant?

The answer is no.
What matters most is that, regardless of the cause of infertility, coping with the stress of this life situation must happen as a couple—with as much mutual understanding and communication as possible. This allows partners to jointly buffer the difficulties of tests and treatments as environmental stressors.

That shared relationship is the area where we truly have influence.

Sources:

Rubinow DR, Schmidt PJ. Sex differences and the neurobiology of affective disorders. Neuropsychopharmacology. 2019 Jan;44(1):111-128. doi: 10.1038/s41386-018-0148-z. Epub 2018 Jul 9. PMID: 30061743; PMCID: PMC6235863.

Kiani Z, Fakari FR, Hakimzadeh A, Hajian S, Fakari FR, Nasiri M. Prevalence of depression in infertile men: a systematic review and meta-analysis. BMC Public Health. 2023 Oct 11;23(1):1972. doi: 10.1186/s12889-023-16865-4. PMID: 37821902; PMCID: PMC10568846.

Nik Hazlina NH, Norhayati MN, Shaiful Bahari I, Nik Muhammad Arif NA. Worldwide prevalence, risk factors and psychological impact of infertility among women: a systematic review and meta-analysis. BMJ Open. 2022 Mar 30;12(3):e057132. doi: 10.1136/bmjopen-2021-057132. PMID: 35354629; PMCID: PMC8968640.