An epistemology of inclusion for nursing: Lessons from male infertility

Male infertility-defined by the World Health Organization as the inability to achieve pregnancy after 12 months of unprotected intercourse due to male-factor reproductive impairment-contributes to nearly half of infertility cases worldwide. Yet within nursing scholarship, men's reproductive experiences remain only partially visible, reflecting longstanding gendered assumptions that equate reproduction with femininity. This epistemic underdevelopment has ethical consequences: it sustains stigma, delays help-seeking, and limits nursing's capacity to provide equitable, relationally attuned care. Drawing on a conceptual synthesis that integrates masculinity theory, cultural humility, and relational care models, this paper advances an epistemology of inclusion for nursing ethics. The analysis interrogates how psychosocial, cultural, and relational mechanisms shape men's experiences of infertility and how their limited representation in nursing knowledge constitutes a form of hermeneutical and testimonial disadvantage. The Integrative Couple-Centered Nursing Framework (ICCNF) is introduced as an ethical praxis that operationalizes inclusivity through assessment, education, counseling, and advocacy. By reframing male infertility as a justice issue and a site of epistemic responsibility, the paper argues that nursing must reconfigure its epistemological boundaries to meaningfully advance equity in reproductive health.