A diagnosis of infertility is often unexpected and almost always disappointing. Infertility introduces more uncertainty into the family planning process. However, in addition to the medical challenges associated with infertility, there are numerous emotional and relationship challenges that develop too. Unfortunately, very few physicians educate couples about the emotional aspects of infertility or about how infertility treatment can impact their marriage. Many couples aren't even aware that their relationship is deteriorating until it reaches a breaking point.
When couples begin trying to conceive, they do so with the hope and expectation that becoming pregnant will take some time but that it will eventually happen. When conception fails to occur in the time frame the couple and their doctor have established (usually a year), they seek additional medical consultation. If they are diagnosed as infertile, they typically begin a course of treatment.
While infertility treatment is stressful for both partners, there is a qualitative difference in the type of stress each partner experiences. Women often develop anxiety around their menstrual cycles. Each month they experience guarded anticipation that they might be pregnant. But if their period occurs, they feel sad, disappointed and even more anxious about becoming pregnant. This often places stress on the husband who also experiences anticipation and disappointment alongside his wife. But in addition to coping with his own feelings, husbands witness and struggle to cope with their wife's anxiety and disappointment. This recurrent cycle of anticipation and disappointment can be hard on a relationship.
It's not uncommon for women to become insistent about having sex during ovulation. If their husband is unavailable at the appropriate time, they may become irritated or demanding towards him. This may result in the husband developing anxiety related to having sex. The need to perform on demand and under pressure can affect his ability to obtain or maintain an erection. This may further frustrate the wife who percieves this as an obstacle. If she becomes angry or accusatory towards her husband, his anxiety about sexual performance increases AND he may be less willing to cooperate with having sex at a specific time.
In addition to the emotional dynamics I've described above, spouses are not always in agreement about how long to pursue treatment, how much to spend on it, the kinds of interventions to pursue or the alternatives if treatment fails. These are potential sources of marital conflict. Infertility treatment is also physically uncomfortable and sometimes painful for women. Hormonal changes can exacerbate moodiness.
While it's challenging, I encourage women to move away from the monthly focus on their menstrual cycles. It's more helpful to adopt a longer term view - say six months to a year - rather than focusing on a thirty day cycle. Second, it is important for men to realize that their wives will experience more anxiety about getting pregnant than they will. Husbands can help their wives by being patient, caring and understanding. However, wives need to be aware that their husbands are disappointed by the continuing challenge too - even if they don't talk about it. While husbands want to be a source of support and optimism for their wives, they also become burned out, in which case they are more likely to be short tempered and frustrated. If both partners are aware of this dynamic, they may be able to manage their feelings better and maintain emotional equilibrium in the relationship.
It's not unusual for couples to become overly focused on procreation and stop nurturing the other aspects of their marriage. Regular date nights, romantic weekends and other "baby free" zones of relating are an important balance to the often intense process of trying to have a child. Couples whose relationship has deteriorated during infertility treatment sometimes decide to place procreation on the back burner while they concentrate on rebuilding their relationship. While this may feel like a setback, it might also be necessary.
It's advisable for couples to decide on a time frame for pursuing treatment, otherwise the process may feel endless and discouraging. While it may be difficult, it is also wise to decide on family alternatives in the event treatment becomes too stressful, too costly or too risky. Alternatives may include adoption, becoming more involved in the lives of children that already exist in your extended family, or deciding not to have children at all. If this last option becomes the one you choose, the two of you may need to develop a vision for your life together.
One of the best strategies for coping with infertility is to keep your marriage in the forefront and to invest in developing all aspects of your life together. Remember - there can be no family without the two of you!
Copyright Johanna Nauraine, 2010
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Johanna Nauraine is a psychotherapist in private practice. She specializes in premarital, marital and divorce coaching, infertility, addictions and career coaching. Read her relationship articles at: www.johannascouch.com.