Most people take it for granted that they will be able to have children if and when they choose. However, one in six couples trying to have a baby will experience problems in doing so (1).
A diagnosis of infertility is an extremely distressing event; creating upheavals similar to those associated with a death in the family. Initial denial followed by feelings of shock, disbelief, anger, grief and depression are common. Some people may rush into treatment without first coming to terms with the diagnosis. The individual impact of infertility differs greatly and is influenced by many factors such as cultural background and the importance a person places on having children in their life.
Women may feel angry at not being able to have children and resentment towards other pregnant women. They may also have feelings of guilt, regarding their infertility as punishment for prioritising their career, using contraception or for a previous termination.
A diagnosis of infertility will often lead to feelings of grief associated with the loss of control over reproductive capabilities, plans and goals. Some women may become uncomfortable around children and start to isolate themselves from family and friends with children. This isolation can leave women without social support networks to help overcome the feelings of depression and frustration commonly associated with infertility. Occasions such as Christmas, Mother's and Father's Day can become painful reminders of their infertility.
A woman may develop feelings of inadequacy, perceiving her body as dysfunctional. Similarly, a woman's sense of femininity is often closely associated with fertility. Infertility may therefore have a serious impact on a woman's sexual identity, leaving her feeling less sexually attractive or asexual (2).
Infertility and attempts to overcome it can lead to a loss in perspective. Women may put everything else in their lives on hold, putting all their energy and time into getting pregnant. They may delay making changes in everything from their careers to their current housing situation, deciding to wait until after they have 'had the baby'.
Infertility and, in particular, treatment programs can place women on an emotional rollercoaster of hope and then despair. Women may go through a cycle of hopefulness leading to disappointment at the arrival of their period.
Many of the medical treatments for infertility focus on the woman's body which can leave men feeling helpless and left out of the process. These feelings of exclusion may be escalated by intrusive testing or treatments. If the couple's infertility is a result of sperm dysfunction, the man may feel inadequate and feel that his sense of masculinity is challenged. The strong societal link between fertility and virility causes many men to keep their infertility a secret, in turn increasing their feeling of isolation (3).
Infertility can place great strain on a relationship, particularly where the diagnosis relates to only one partner. The infertile partner may fear being left for another (fertile) person, while the fertile partner may blame or feel anger towards their partner. Differing levels of enthusiasm for pursuing treatment can occur, particularly in couples where one partner already has children. Agreeing on what fertility tests to perform, which treatment options to pursue and when to stop treatment can all cause conflict. If one partner does not want to begin or continue with treatment, the other partner may feel they are being denied the chance to have a child and become resentful.
Treatment for infertility also frequently interferes with a couple's sex life. The initial discussions to identify possible fertility problems involve disclosing details regarding sexual activity. Similarly, the loss of privacy associated with tests such as sperm counts and the post-coital test can destroy feelings of intimacy. Timing sex around ovulation can make it feel like a chore rather than something pleasurable. The lack of spontaneous sex and sex for enjoyment rather than for procreation can lead to sexual dysfunction such as erectile problems in men and vaginal dryness in women.
Although infertility is potentially the source of much strain on a relationship, many couples also report that going through the experience has made their relationship stronger (4).
Infertility can place a strain on relationships with family and friends. Families, in particular prospective grandparents, may place added pressure on people by publicising their expectations for grandchildren. Enquiries from in-laws can feel intrusive and be stressful. Friends who are unaware of the full implications of infertility may appear unsympathetic and offer unhelpful suggestions such as 'go on a holiday' or comment on the fun involved with 'trying'. Friends and family with children may avoid announcing their own pregnancies and issuing invitations to events like children's birthday parties and baby showers.
Employers may not fully understand the issue of infertility and therefore be unsupportive. It can be difficult to arrange time off work for those undergoing diagnostic tests or pursuing treatment. In addition, employees may not feel comfortable revealing to their employer why they need the time off.
Obtaining information about infertility and the various treatment options available helps people feel that they are more in control of the situation. Becoming informed also enables people to make decisions about tests and treatments and to confidently ask any questions they may have.
A diagnosis of infertility will have a permanent impact on a relationship and will be experienced and expressed by each partner differently (5). It is therefore important for couples to feel able to communicate their feelings with each other as well as trusted friends and family. For couples, being able to better understand how both people are feeling can help with decision making around issues such as treatment options and what information they are comfortable sharing with others.
Visiting a counsellor who is experienced in infertility issues will enable people to openly discuss their feelings about being infertile. They can also voice their fears and concerns about approaches to treatment, as well as the possibility of remaining childless. Counselling may also help people to regain their sense of control which may have been diminished with their diagnosis. Counselling may be particularly beneficial to couples whose relationship has suffered as a result of infertility. For couples experiencing disruptions to their normal sex life, advice from a sex therapist may be useful.
Many people confronted by infertility find participating in a support group helpful. An online or in-person support group can provide information on infertility and treatments as well as contact with other people with similar problems. Being able to talk to people who have been through the same ordeal reduces feelings of isolation. Support groups offer strategies for coping with particular problems associated with infertility and can also offer a sense of hope through sharing other people's success stories.
While some couples may not consider treatment, others may spend years pursuing treatment to have a child. Infertility treatment is emotionally and financially demanding. It is therefore important to come to an agreement, preferably before treatment is started, on the types of treatments, number of attempts, overall length of time and amount of money they will commit towards having a child. The advancement of medical techniques can make setting and keeping to these limits difficult. While stopping treatment is difficult, it can allow people to work towards accepting their infertility and pursuing other options such as adoption or living a child-free life.
For help understanding this fact sheet or further information on infertility women in Queensland can call the Health Information Line on 3839 9988 or 1800 017 676 (toll free outside Brisbane).
Last updated: September, 2011
© Women's Health Queensland Wide Inc. This factsheet was revised by Lorraine Pacey and the Women's Health Queensland Wide (Women's Health) Editorial Committee in September 2011.