"First comes love, then comes marriage, then comes a baby in the baby carriage."
This silly playground chant highlights that from an early age we are taught that becoming parents is a normal step in a couple’s family life cycle. After partnering, most couples “should” plan to have children. The inability to have children when they are wanted due to infertility is a cause of significant psychological distress. The distress can be experienced at the individual level and also manifest as distress in the couple’s relationship. This post will investigate some of the possible struggles individuals and couples experiencing infertility might go through.
Infertility, as defined by The International Committee for Monitoring Assisted Reproductive Technologies (ICMART), is characterized by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or due to an impairment of a person’s capacity to reproduce either as an individual or with his/her partner. It is common; about 15% of couples experience infertility. About a third of the time, the reason for infertility can be traced to the female. In another third of cases, the reason for infertility can be traced to the male. Sometimes there are both male and female factors contributing to the infertility. In about 20% of cases the cause of infertility is unexplained.
Infertility as an identity crisis
All of us have a concept of our identities, formed in response to personal social relationships as well as the larger societal context. When we are prevented from achieving or maintaining a valued identity we will experience distress; the more important the identity, the more distress we experience. (McQuillan 2003). In American society, becoming a parent is central to many people’s identity. Raising children is viewed as a core function of life, something that gives life meaning. When a couple has trouble conceiving a child, it is often an unexpected and stressful experience. Grief, a feeling of loss of control, feeling inadequate, worry about the marital relationship, and deciding if and what medical treatments to pursue are all common issues individuals experiencing infertility experience. Because motherhood is often considered an essential part of femininity, the role of parent is often especially salient for American women. Research shows that in general the female partner experiences greater levels of distress as a result of infertility.
Infertility and social isolation
A common experience of those experiencing infertility is a feeling of social isolation. Couples report feeling alone as all around them their peers are becoming parents. They report feeling jealous of other’s pregnancies and births. Many people feel they are alone in their struggle to conceive since they are in the minority. There is a sense of shame and struggles to conceive are generally not openly discussed. 61% of couples try to hide their fertility troubles from family and friends. 54% said it was easier to tell people they were not planning to have children than admit to their struggle to conceive. Unhelpful comments, questions, and suggestions from friends and family, and even strangers, can unknowingly contribute to the pain of infertility.
Effect of Infertility on the relationship
Infertility affects the individuals experiencing it, but it also can have a strong effect on the relationship. Once the diagnosis is made, the couple needs to decide how to proceed. If they don’t agree on a course of action, it can be devastating for the relationship. Also, how each individual in the relationship experiences and perceives the stress of infertility in comparison to their partner can affect how satisfied they are in their relationship. Congruence between partners’ stress levels is related to higher marriage satisfaction.
Research seems to suggest that infertility has a negative effect on the sexual relationship of couples. If the couple is tracking ovulation to increase the chances of conception, sex can become a chore that has to get done, rather than a spontaneous act for pleasure and expression of love. Sexual dysfunction is higher in both men and women experiencing infertility. Women experience significantly lower levels of desire and arousal. Men experience higher levels of erectile dysfunction and premature ejaculation.
Psychotherapy, both individual and/or couples, is recommended for couples experiencing infertility, especially if they are experiencing high levels of depression or worry, their ability to function is impaired, or they are experiencing increased dissatisfaction in their relationships. A therapist can help explore and make sense of feelings, strengthen already present coping skills and develop new ones, and improve communication.
To find a support group - https://resolve.org/
For information - https://www.reproductivefacts.org
Katie Boland, Student Therapist
Peterson, B., Newton, C., Rosen, k. (2003), Examining congruence between partners perceived infertility-related stress and its relationship to marital adjustment and depression in fertile couples. Family Process. 42: 59-70.
McQuillan, J., Greil, A., White, L., Jacob, M. (2003) Frustrated Fertility: Infertility and Psychological distress among women. Journal of Marriage and family. 65: 1007-1018
Tao, P., Coates, R., Maycock, B. (2011) The impact of infertility on sexuality: A literature review. Australian medical journal. 4, 11: 620-627.
Millheiser, L. et all. (2010) Insinfertility and risk factor for female sexual dysfunction? A case-control study. Fertility and Sterility. Vol. 94, no 6. 2022-2025.