The Most Difficult Issue For Couples


How can couples deal with the pain of infertility?

I once attended a seminar on working with clients who are dealing with infidelity. The speaker was a well-known expert on marriage, and the room was packed. In the midst of his teaching on infidelity, he stopped, turned to the audience and said, “You know, as hard as this is, infidelity is not the hardest issue for a couple. That would be infertility.”

I think he’s right. Don’t get me wrong – there are definitely couples who have braved the tortuous battlefield of infidelity; I see them in my practice every day, along with a myriad of other serious, real, and challenging issues. But infertility carries with it a unique and particular heartbreak, both for individuals and for couples.

Some statistics cite that marriages that have to deal with infertility have a higher than 50% chance of ending in divorce (, 2011). Perhaps this is because the issue is not only around and between the couple – it is inside them. And most devastating of all, it is out of their control. A couple has no idea at the start where their journey will end, or if it will end with a child. This lack of control is one of the primary challenges of infertility.

I have seen individuals who have experienced fast and easy success in other areas of life come to a crashing stop at the brick wall of infertility. Infertility is the great equalizer – it knows no boundaries of gender, class, socioeconomic status, or simply how badly one wants a child.

According to the American Society for Reproductive Medicine (ASRM), infertility affects about 7.3 million women and their partners in the U.S. -- about 12% of the reproductive-age population (Source: National Survey of Family Growth, CDC 2002). ASRM defines infertility as “the result of a disease (an interruption, cessation, or disorder of body functions, systems, or organs) of the male or female reproductive tract which prevents the conception of a child or the ability to carry a pregnancy to delivery.”

Despite the fact that infertility affects more than 1 in 10 adults, it is still a shock when it happens. No one anticipates having a problem getting pregnant; it is expected to happen easily and quickly. True infertility is diagnosed only after 12 consecutive months of trying to conceive. This means that for at least a year, a couple is trying to get pregnant and failing – 12 times of hopeful anticipation followed by crushing disappointment. This type of disappointment adds up – its effects are cumulative, and cannot help but have an effect on the couples’ emotional and especially sexual relationship. Suddenly, what was playful, fun, and a source of comfort for a couple can quickly turn into a stressful, anxiety-producing event, one that must be undertaken on a regular schedule in order to maximize chances for conception.

Often partners are still reeling from the diagnosis of infertility when they have to start wrapping their minds around the possibility that they may never conceive. This is a tremendous loss, and in many cases the threat of the death of a dearly held dream. Everyday life does nothing to lessen the pain for these couples, as family and friends around them seemingly conceive quickly and effortlessly. Women share with me that everywhere they go, they see pregnant women or moms with children; men say that they feel like “less of a man”, particularly around their friends with children. Often the partner who has the infertility issue feels ashamed, guilty, and responsible for the pain of the other. The grief over this part of life not happening quickly – or maybe never happening – takes on a life of its own, and can alienate partners from each other as each deals with the issue in their own way.

The longer a couple tries unsuccessfully to conceive, the more difficult the process can be on a marriage. No one truly knows the pain of infertility except those who have gone through it themselves, and that is why each partner is in a unique place to help the other, if they can reach out to each other in their grief.

I worked with a couple in which the man didn’t seem as devastated by the infertility as the woman, and this was a source of pain for her – she interpreted his quiet as a lack of caring. In therapy, it soon became clear that he was also devastated, but felt the need to be “the strong one” for his wife, and adopted a position of what he hoped felt to her like quiet strength. In actuality, she felt alone in her grief. When they were able to share with one another what they really felt, thought, and needed, he realized that what she needed most was a witness to and a partner in her pain – someone who could understand hers and share his own pain too.

Oftentimes men don’t feel the pain in the same way as their partners, and that’s okay. Each person doesn’t have to feel the exact same thing as the other, or feel it to the same extent, whether the issue at hand is infertility or something else. Indeed, it can be a blessing that each doesn’t feel the same amount of pain as the other at the same time – that way one can be a support and sounding board when their partner is struggling. The most important thing for couples to communicate and live out with one another is that each is not alone in the struggle.

As in other issues facing couples, communication is key to finding a way out of the pain caused by infertility, regardless of the outcome of the infertility itself. It’s okay for one or both partners not to know what they want or feel at any given time – dealing with infertility is like being constantly bombarded by artillery. Like any drawn-out, constant stressor, infertility can cause an “emotional sunburn” – where one is so raw, so spent with emotion, that they are intensely sensitive to what would otherwise be harmless comments or incidents.

It’s important for each person to treat their partner with care and sensitivity as they carefully examine their unique situation and options for moving forward together. Information is often the antidote to anxiety, and partners need to arm themselves with a wealth of data in order to accurately understand what their childbearing options are: drug treatment, assisted reproductive technologies, or adoption.

The couple must be in agreement as to what is their ultimate goal, and united in their understanding that this is a marathon, not a sprint. They need to preserve their marital connection as best they can while they also deal with the infertility, which is no small feat. A good couple’s therapist can be invaluable in providing a safe place where partners can talk, share, vent, and challenge one another, all while protecting their most valuable asset, their bond.

For those with friends or loved ones dealing with infertility, the following are the worst things to say to an infertile couple:
1. “You can always adopt!”
2. “Maybe it just wasn’t meant to be.”
3. “You don’t know how lucky you are – kids are a hassle!”
4. “You should just relax.”
5. “You want this too much.”

In contrast, the top 5 most helpful things to say are:
1. “I’m here for you.”
2. “I don’t know why this is happening, but I know it’s not your fault.”
3. “How can I best support you?”
4. “We will get through this together.”
5. “I love you.”

Remember, that walking in the shoes of someone experiencing infertility is truly difficult, but you can be compassionate to their sensitivities and support their process of grieving and healing.

How has infertility affected you? How have you dealt with infertility issues or supported those you love who have had to deal with them? What additional advice would you offer people dealing with such a painful issue?