Coping with the Psychological and Social Impact of Infertility
The term infertility refers to a woman being unable to conceive or become pregnant after one year of unprotected, regular sexual intercourse. The clinical definition of regular intercourse is considered to be 2 to 3 days a week. Infertility can be considered as either primary infertility, which is the inability to have any children, or secondary infertility which is the inability to conceive or carry a pregnancy successfully to term following the birth of one or more children. About 5% of couples living in the developed world experience primary infertility.
In the UK about one in seven couples have difficulty conceiving, which translates to 3.5 million people. Approximately 84% of couples will conceive naturally after one year of regular sex, with this figure rising to 92% after two years and rising again to 93% after three years. After 3 years of not conceiving, the likelihood of couples achieving pregnancy in the following year falls down to 25% or less. There are similar figures in the US. After a year of attempting to conceive, about one in seven US couples don't become pregnant. It is estimated that 7.5 million women between the ages of 15-44 years’ experience infertility. Worldwide, it is estimated that around 70 to 80 million couples are experiencing infertility currently.
There can be many potential causes for infertility, which may involve the woman, the man or both partners. Common causes for women are irregular ovulation, endometriosis and blockage of fallopian tubes. Among men the most common cause is a sperm disorder. When no cause can be found for the infertility it is described as being “unexplained.”
Infertility can have a profound impact on a woman's identity. Individual women who learn they are infertile will experience distressing feelings and emotions, similar to those who are grieving any significant loss, such as the death of a loved one. In this case, the woman is experiencing the loss of the ability to procreate. According to Rosner (2012) in her study “Recovery from Traumatic Loss: A Study of Women Living Without Children After Infertility,” Rosner explored how women living without children were affected psychologically and socially. Women often begin to imagine themselves as mothers long before actually trying to have their children. This identity is influenced by implicit cultural and societal messages that idealizes motherhood. When this imagined self of a mother is withdrawn, it may result in feeling a loss of control, threaten her imagined future, and cause her to doubt her womanhood. A woman or couple also miss out on expected experiences relating to having children. These include the loss of the experience of pregnancy and birth, loss of opportunity to pass on family genetics, and loss of contributing to the next generation.
A variety of psychological side effects can occur due to the drugs and hormones used to treat infertility. For example, the synthetic estrogen clomiphene citrate, is frequently prescribed because it improves ovulation and increases sperm production. It may also cause mood swings, anxiety, sleep disorders, and irritability in women. Other infertility medication can cause mental health disorders such as depression or mania. It can also be difficult for women to correctly identify which reactions are caused by the medications and which are psychological in nature.
Impact of Infertility on Relationships
The emotional toll of infertility can be extremely difficult on a couple’s relationship and each partner may be affected differently. Feelings of inadequacy are common, especially when medical tests show the infertility to be the “fault” of one partner. Another aspect of a couple's relationship that infertility can profoundly affect is their sex lives. A couple trying to conceive naturally, while tracking ovulation, and the pressure to have sex at a specific time can cause considerable strain. Sex in these circumstances becomes less of a pleasure and more of chore to be completed within the fertility time-frame.
For couples who seek fertility treatment, such as IVF, there is the added pressure that couples who already have children do not experience. Whether the fertility treatment is successful or not, the treatments are very challenging for the couple. In addition to being grueling and long drawn out, infertility treatments are also extremely expensive. Financial stress can be overwhelming for couples seeking fertility treatments.
In the U.S., only 15 states have mandated insurance coverage for infertility treatment. The costs of infertility treatment, such as IVF, are significant. In the U.S., the average cost for an IVF cycle using fresh embryos is around $8000 with an additional $3000 to $5000 for the fertility drugs per cycle. Couples who do not have suitable insurance coverage or any other means to pay for treatment may end up delaying or forgoing the treatments altogether, which can contribute to emotions of helplessness and hopelessness.
Infertility interventions help about half of the patients become parents, with the likelihood of conception decreasing with age. With each attempt, anxieties and despair can increase, especially when women have suffered multiple miscarriages. Women have reported feelings of guilt and failure at being unable to carry a pregnancy to term. Couples may also find it difficult to know when it is time to stop seeking treatment. Sometimes, one partner will want to end treatment before the other, leading to additional strain on the relationship. Another strain on the relationship can come from the realization that the couple's priorities are different. For example, one partner may feel that they must try every single avenue if there is even a little chance of becoming pregnant, while the other person in the relationship may find it easier to accept the notion of being childless. Sometimes these challenges can actually make a couple develop a deeper mutual understanding, empathy and appreciation for each other. Other times infertility and the relating issues that come with it can be too much pressure and the couple's relationship or marriage cannot remain intact.
Infertility can also impact a woman's relationship with other family members. Even in a strong family dynamic, the woman who is infertile may notice a change in how her family relates to her. For example, the woman's parents may give more attention to her siblings with children or the woman may feel disconnected with her siblings as developmental stages are no longer shared. Women can feel enormous responsibility to fulfill their genetic duty and ensure their genes are passed down to preserve their bloodline, especially if they are an only child themselves.
Women experiencing infertility will often notice significance shifts in their friendships, as well. Women can find a lack of empathy, support and insensitivity from close friends. Women may feel disconnected and isolated from their friends with children as well as a sense of resentment. There are also emotional triggers for infertile women, as it can be hard for them to go out in public without constantly seeing mothers and their children. According to Rosner, “We live in an incredibly pro-natal society, and the emphasis on families with children is everywhere. Commercials, TV shows, and movies for instance. A woman of childbearing age is often bombarded with reminders that she is not a 'member of the club.' The feelings are quite complex and often include tremendous envy, which can contribute to depression.”
There should be a focus on normalizing, validating and empathizing with the infertile woman. A woman experiencing infertility often feels she may need permission from her friends and family to avoid certain situations or events such as a baby shower. Friends and family of an infertile woman may also need to recognize that it is her and her partner’s decision to stop treatment and theirs alone. It is also psychological importance for the woman not to allow their infertility to become the primary component of their identity.
Robertson, Sally (2015) Infertility Social Impact, News Medical Life Sciences http://www.news-medical.net/health/Infertility-Social-Impact.aspx
Genevra Pittman (2013) Almost one in six couples face infertility: study, Reuters Health News http://www.reuters.com/article/us-couples-infertility-idUSBRE90A13Y20130111
Marni Rosner (2012) Recovery From Traumatic Loss: A Study Of Women Living Without Children After Infertility, University of Pennsylvania’s School of Social Police and Practice http://repository.upenn.edu/cgi/viewcontent.cgi?article=1020&context=edissertations_sp2
Amy Marturana (2016) 6 Ways Infertility Impacts a Relationship, Self-Website http://www.self.com/story/how-infertility-impacts-a-couples-relationship
Lindsey Getz (2012) The Impact of Infertility, Social Work Today Vol 12 Number 6 http://www.socialworktoday.com/archive/111312p30.shtml
Center for Disease Control and Prevention Website https://www.cdc.gov/nchs/fastats/infertility.htm