Infertility and relationships can be hard to navigate. Psychologist Alison Bough advises on how a couple can stay strong while coping with fertility issues.
The path to starting a family can be extremely trying for couples who are struggling with fertility problems. The physical, emotional and financial stress of infertility can affect your relationship with your partner, but there are ways to keep your connection strong through these challenging times. Medical professionals define ‘infertility’ as the inability to conceive after two years of regular, unprotected sexual intercourse.
Primary infertility is the term used to describe a couple who have never been able to conceive.
When a woman has a previous child or pregnancy (even if not carried to term), and is now having difficulty conceiving, the term secondary infertility is used.
The causes for secondary infertility are often the same as the causes for primary infertility; fallopian tube disease can occur after a prior pregnancy, there can be uterine abnormalities including scar tissue, ovulation dysfunction, or there may be a poor number of eggs. Men can also experience secondary infertility as a man’s sperm count and quality can decrease over time.
Psychologists have identified that there are particular patterns that couples classically go through when experiencing infertility:
- Realising – becoming aware that there are problems conceiving.
- Mobilising – seeking medical advice, visiting specialists and doing things to try to optimise fertility.
- Immersing – going through tests and fertility treatments, considering all options such as egg and sperm donation.
- Resolving – achieving a pregnancy or becoming parents, deciding to end treatment, or living childfree. A large number of couples deal with the emotional fallout of going through any – or all – of these stages. Fertility problems can cause sexual difficulties, relationship conflict, financial stress, infidelity, and even addiction issues. Couples who stay in denial, suppress their feelings, or who simply don’t communicate or deal with conflict, are more vulnerable to relationship breakdown.
Because women are often the focus of medical procedures, hormone and fertility treatments and pregnancy, the female sense of grief and loss with the dreaded arrival of a monthly period or after unsuccessful fertility treatments can differ significantly from the male partner. Women going through fertility problems or unsuccessful treatment often feel they have ‘failed’ their partner and family in some way. Some may even feel that they have failed at being a woman, particularly if they come from a background where there is great cultural emphasis on being a mother.
It’s really important that women talk through all of these feelings, but also that they remember that fertility problems do not define them and that their partner chose them for more than childbearing reasons.
Many men find their emotions connected to what their partner is going through during infertility, treatment or miscarriage. Men often initially assume that they will not be affected by infertility simply because of their gender, e.g. she goes through treatment, so it doesn’t impact on me, however it can be very worrying to see their partner in discomfort coupled with the loss of unsuccessful attempts to conceive, invasive treatments or miscarriage.
It is not only women that develop powerful attachments to the dream of parenting, embryos and pregnancy; men do too but they may not demonstrate their emotions as clearly. Some men allow for their feelings, while others immerse themselves in work or other activities and want their partner to prematurely ‘move on’. Men need to realise that being strong for their partner is great, however, there is also strength in dealing with their own thoughts and feelings and then moving forward together.
Fertility problems are an individual, couple, and family issue. A lot of couples have families who are helpful during fertility challenges, but unfortunately, in some families, individuals may (despite their underlying care and love) say things that are hurtful. Couples can encounter total avoidance, reduced contact, silence, and insensitive or unwanted advice from family members.
Gently educating, providing resources, and setting clear boundaries can help couples to cope in these situations. Families can feel they have a ‘right’ to know about progress and whilst some couples keep certain details private to help cope with intrusive behaviour, others may want to communicate openly.
Either way, it is important for the couple to communicate what they do and don’t want or need from family members; partners can ‘tag‐team’ or ask each other’s family/friends to not ‘ask’, e.g “we will let you know any news when we have any”. Some people want to communicate difficult news directly, while others choose indirect methods such as emails, and request space before being able to visit or talk on the phone.
Sometimes couples can forget to allow for their family members’ grief‐during infertility; unsuccessful treatment, miscarriage, or the choice to adopt/foster, or living childfree may be difficult for some family members to absorb. Giving space for their feelings is important, but couples should set limits if they feel pushed to do something they have already decided they do not want to do. Going through fertility problems can really expand the notion of family – it takes time for a couple to decide how to resolve the infertility journey, it takes some effort to expand the notion of who ‘family’ are.
Some couples need to include ‘chosen’ family in their journey, i.e. friends and support people who may be able to step in when other family members are unavailable physically or emotionally. For couples, families and social groups with strict cultural rules regarding what family is and who belongs, education and time may be needed to adjust to new ideas of donors, adoption/transracial adoption, fostering and/or childfree living.
When it comes to friends, work colleagues and other networks couples should discuss their boundaries regarding information sharing – one partner may not appreciate having their sperm details discussed with the neighbours! It is possible to negotiate a balance of using support whilst maintaining privacy; this can offset the intrusiveness and loss of control that comes with fertility problems. It is okay to delay attending christenings/birthdays/children’s parties and other social events, if the individual or couple is just not ready. Politely communicating well wishes and then taking space may be necessary, but there is a difference between taking space and permanent isolation that can be damaging to the couple and those around them in the long term.
Infertility can intensify any small cracks that may have already been present in a relationship, so it is particularly important that couples should make time to be as communicative as possible. Couples who take care of their individual physical and mental health and communicate clearly with each other cope more constructively with stress, grief, and the feelings of powerlessness that fertility problems can bring. Counselling and professional support can be very beneficial for a couple to work through any outstanding issues and help them through the emotional rollercoaster and to stay connected.
About Alison Alison Bough is a psychologist, cognitive behavioural therapist and specialist fertility counsellor. She specialises in health psychology, particularly in the mental and emotional outcomes of women’s reproductive and sexual health. She is the clinical director of The Mindfulness Centre in Naas, Co. Kildare. www.alisonbough.ie. Email: firstname.lastname@example.org.
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