The painful psychological ramifications of infertility on the individual and on the couple
Emma and Jonathan are trying to have a baby. Emma is a bright, bubbly, 28 year old woman with long blond curls and a winning smile. She has been married to Jonathan for just over 3 years. She works as an advertising executive at a major corporation. Jonathan, 31, is the more laid back of the two. As a successful cinematographer, he tends to more of an observer. His dark eyes and curious nature absorb the world in a reflective and deliberate manner. In contrast, Emma is very energetic, and vocal—even impulsive. Their differences have always amused and complemented one another. They have relished a relationship full of laughter, support and hope for the future.
Emma and Jonathan began to try to conceive about a year ago. In the beginning the process was full of excitement and romantic moments. Their attempts at conception were sexy and soulful, meaningful and playful---full of hope for the future. The couple was disappointed when the first 3 months passed with no good news. However, they were optimistic and took the lack of immediate results in stride. After six months, Emma started to worry. She insisted they seek medical attention in spite of Jonathan’s reluctance. Jonathan believed more time and less stress would produce the results they so yearned for. But Emma insisted.
For both, the news was shocking and devastating. Something was wrong. Tests revealed that Emma had an ovulation disorder that was preventing a regular production of eggs as well as compromising the quality of eggs that were produced. The couple learned that their best chance of conception was through in vitro fertilization—a costly, invasive, and lengthy process. Both agreed to begin the process immediately. At the onset, the couple remained very close---united in their sadness, fear, and hope. They supported and comforted eachother as they faced the biggest challenge of their young relationship. However, over time, after three failed in-vitro attempts, things began to change.
Emma began to exhibit serious symptoms of depression. She was often tearful, hopeless, irritable and withdrawn. She began to isolate from friends, family, and even Jonathan. She felt deep shame about her inability to conceive and began to question her own womanhood. Emma was barely recognizable…both physically and emotionally. She looked drawn and tired from lack of sleep and regular nutrition. Her once bubbly exterior was replaced by a deep sadness and disconnection. Jonathan, on the other hand, had assumed the role of cheerleader. He remained optimistic and hopeful and believed that positivity was a key ingredient in successfully conceiving. He grew frustrated at Emma’s negativity and hopelessness. He felt rejected and angry when he reached out for her emotionally and sexually and she refused to respond. Emma began to feel Jonathan simply didn’t understand, didn’t want it as much as her. How could he want sex outside of sex that was aimed at baby-making? How could be positive, even cheerful at times, when things were so awful? She started to feel she was in it alone. And so did he. Both withdrew from eachother. Sexual and emotional intimacy came to a halt. As did communication. The once vibrant couple were now disconnected and miserable.
Infertility. Defined as: sterility: the state of being unable to produce offspring; in a woman it is an inability to conceive; in a man it is an inability to impregnate. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term.
The International Council on Infertility Information Dissemination (INCIID) recognizes a couple as infertile if they have not conceived after 6 months of unprotected intercourse, or after 12 months if the woman is over 35 years of age; or if there is an inability to carry pregnancy to term.
Infertility is painfully pervasive in the United States. According to the American Society for Reproductive Medicine, infertility impacts approximately 6.1 million people in the U.S., equivalent to ten percent of the reproductive age population. Female infertility accounts for one third of infertility cases, male infertility for another third, combined male and female infertility for another 15%, and the remainder of the cases is "unexplained".
The struggle with infertility is a messy process….endless trips to specialist after specialist, intensive research to uncover the latest or most successful treatment approaches, and ongoing procedures involving injections and extractions. The process starts to look and feel like an interminable clinical exercise, a protracted science project.
But behind this frenetic quest for parenthood is an immeasurable world of emotional pain. The psychological toll that this devastating journey takes on those going through it is frequently lost, even ignored amidst the chaos of the medical procedures and relentless pursuit of pregnancy. Individuals engaged in this struggle are suffering with symptoms as painful as the infertility itself—debilitating sadness, anxiety, grief, shame, rage, isolation, and hopelessness.
Individuals who are struggling with infertility are suffering. Psycholgoically.
It is often not talked about. Or recognized. Thus (and most concerning) it is not being treated. There are reasons for the silence or lack of recognition. Shame is the primary motive for silence around this issue. Men and women alike are ashamed of their infertility—profoundly embarrassed that they are unable to conceive a child. Both sexes often experience this as a fundamental inadequacy in themselves (or their partner) and are therefore reticent to share this plight with others due to this deep sense of humiliation and disgrace.
Other causes for neglecting the psychological impact of this struggle are related to the all-consuming nature of the medical process associated with addressing infertility. Those pursuing a successful pregnancy tend to have a razor like focus on the biological issues surrounding infertility. As a result, the psychological impact is ignored as the desperation to conceive compels couples to solely concern themselves with the medical process, thus denying or ignoring the oft-emotional consequences.
Thus they suffer with debilitating symptoms of depression and/or anxiety alone—with no help from a mental health professional. Without intervention the depression may become more incapacitating and treatment resistant. More troubling, a compromised psychological state can negatively impact the probability