Infertility is a widespread and devastating experience that touches nearly every family in some way. The inability or struggle to bear children can be a major disturbance in the life cycle of adult couples and often demands a complete reorientation to life expectations and plans. Defined as twelve months of failed pregnancy attempts for women younger than 35 and six months of failed pregnancy attempts for women 35 years and older (1), infertility affects up to 15%, roughly one in six, couples.
Infertile couples experience a range of emotions: sadness, anger, grief, shame, guilt, confusion, and sometimes most poignantly, a lost sense of control over their lives. Having children is commonly seen as part of the adult developmental trajectory, and the disruption in how infertile couples perceived their life panning out can bring waves of depression and grief that can last for years, particularly if infertility treatments fail. For women, whose value to society is often marked by their ability to reproduce and bear children, infertility can be especially acute and distressing; in fact, many women consider its diagnosis and treatment the most upsetting experience of their lives (2). Additionally, though the experience of infertility is distressing for both partners in a relationship, women often report higher levels of distress, depression and anxiety than men among infertile couples. This is not to undermine the experience of infertility for men, however, as they, too, experience distress in their own right. Fertility in men can be seen as a sign of their virility; thus, male infertility can be a painful undermining of their masculinity—sometimes so much so that partners will protect the man’s image by telling friends and family their infertility struggle is the woman’s problem.
The degree of distress is not the only difference between the sexes in infertility; so are their means of coping. Whereas women more commonly value conversation and connection in coping, are confrontive in expressing their feelings, and actively seek social support, men typically prefer action over conversation and utilize more self-controlling coping, distancing, and planful problem solving in their management of infertility-related stress (3). These differences in coping style can often lead to conflict in the relationship that challenges couple adaptation through the stress of infertility, and as distress rises, the couple is more likely to experience relationship dissatisfaction and disconnection. Often, the couple’s physical intimacy also struggles through infertility, as sex becomes less spontaneous and unifying and more scheduled, routine, and driven by the motivation to conceive. Because the spouse often becomes the primary and only source of social support through the infertility journey, such emotional and physical disconnection, on top of the financial and emotional strain of tough decision-making and the infertility treatment itself, can be particularly detrimental to the process of healing and resolution through an already challenging experience.
In addition to shifts in couple dynamics, infertile couples can experience dramatic changes in their social relationships. No matter how open the couple chooses to be about their struggle (i.e., whether they carry the burden of infertility in privacy, or share more widely with loved ones), they often develop feelings of jealousy, isolation, and alienation from friends and family, especially those with children. This can create painful barriers between the couple and their communities and support systems, undercutting the relational support so vital to managing the pain of infertility.
If you do not experience infertility yourself, you likely have a close family member or friend who does. With all the challenges, how can we cope? Here are some considerations for navigating this uncertain experience or helping someone you love in their journey through it themselves.
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For Couples
Maintain balance.
Infertility can quickly become the sole focus in the lives of those who experience it. Remember to keep a balance in your journey through investing time in relationships, work, interests, and hobbies that are important to you. Try new experiences, visit new places, eat new foods. Doing so will of course not take away the ache for children, but it can help prevent infertility from consuming your relationship or daily energies. It can also give you space to continue growing as individuals and as a couple in the face of dreams yet unfulfilled.
Learn to develop, love, and practice relaxation and mindfulness skills.
Because enduring infertility can bring a tsunami of emotions, learning how to self-soothe through strengthening the mind-body connection can be an invaluable part of your individual coping through the distress. Simple mindfulness practices such as deep breathing, progressive muscle relaxation, journaling (particularly gratitude journaling), and meditation can be powerful ways to do this. In fact, mind-body techniques such as these have shown to significantly decrease depression, anxiety, hostility, fatigue, headaches, insomnia, and abdominal pain in infertile women! (4) If you don’t know where to begin, an easy place to start is to do a 5-minute meditation from YouTube.
Stick together.
As mentioned before, infertility affects couples differently. Resist the temptation to feel shame if you feel it has driven a wedge between you and your partner. Instead, focus on actions you can take to preserve your partnership through this crucible. As much as possible, attend all doctor appointments together. Create time and space to communicate your open and honest opinions around complex fertility decisions. Schedule regular date nights to do things you love together. Remember that your partner is your number one supporter in this experience—you need each other! Keep your relationship a priority.
Seek an infertility-specific community and social support.
You may understandably feel anxiety, fear, and discomfort with opening up about your journey to friends and family; inferility a deeply personal experience that must be worked through delicately, and well-meaning loved ones may just not understand the intimate pain and nuance of the journey. Even so, social support is a fundamental part of navigating the infertility experience. Whether or not you find support among your loved ones, it can be tremendously healing to engage with an infertility-specific community where you can relate to and connect with others like you. This can bring valuable insight, perspective, and hope to both you and your partner and mitigate feelings of isolation and loneliness you may feel.
Try professional help and counseling.
Sometimes the burden of infertility can be too much to bear without professional help. Marriage counseling in particular can be a powerful resource to help you and your partner strengthen and fortify your bond through so much emotional, mental, and physical exhaustion. If this expense can be budgeted it, it can be well worth the investment.
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For Family & Friends
Respect boundaries.
When you learn about the infertility struggles of loved ones, it can be difficult to know how to respond or help. One of the most generous approaches you can take is to respect the boundaries your loved ones set around what they share, what treatments they choose (or don’t choose), and how they cope. As you lovingly accept their decisions and let them set the pace for their journey, you will create a supportive environment—no matter what degree of involvement you have in the process.
Increase awareness.
Understand that there can be prolonged side effects of infertility on your loved ones as a couple and individually. Grief changes you, and you may notice that your relationships with your grieving loved ones change, too. If you’re their parent, they may feel shame for not being able to carry on the family name and may desire to share fewer details about their lives. If you’re their friend or sibling, they may decline invitations to your baby showers or children’s birthday parties. If you’re their boss, they may seem less attentive or enthusiastic at work. All around there will likely be sensitivity to topics involving family, children, and childbearing. Be aware of how your interactions and conversations may affect your loved ones and be forgiving towards these sensitivities.
Offer pragmatic help.
When you feel there is little you can do to ease the emotional burden of your loved ones, give practical help. Offer to cook dinner for them or help with the house project they have been meaning to do for months. Pick up groceries or meds they need to get from the store. Invite them out for a distracting night out. Whatever you feel comfortable and able to offer, offer. It can go a long way.
Recognize and attend to your own grief.
If you are a particularly close family member or friend of couples experiencing infertility, you may feel grief of your own in the delay to becoming a grandparent, godparent, aunt, uncle, cousin, sibling, or pseudo-relative to their unborn children. This is okay. Give yourself time and space to process and cope in your own way.
The journey of infertility is often painful and nonlinear. Whether you are in the thick of it yourself, or are close to others who are, know that hope, healing, and enduring perspective are possible. Take care of yourself and your relationships during this time and seek the help you need.
1. Cousineau & Domar, 2007
2. Cousineau & Domar, 2007; Freeman et al., 1985
3. Ridenour et al., 2009
4. Domar et al., 1990
LINDSEY ROBINSON
Lindsey received a B.S. in Dietetics from Brigham Young University and will graduate with a M.S. in Marriage and Family Therapy from Auburn University this summer.
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