The word brings incredibly deep despair, discouragement, pain and heartache. A diagnosis of infertility brings with it a drastic change in identity. Men and women’s identities are biologically, psychologically, socially, and often spiritually entwined in being able to create life. And while 85% of couples are able to get pregnant without extraordinary measures, often “accidentally”, the other 15% of couples are emotionally exhausted, stressed, and lonely.
I want you to understand the stress that your loved ones are facing. The sense of loss is great. The struggle is significant. And if you can understand, then you can really help. And we want you to understand and help.
How bad is the stress?
Turns out, that women undergoing infertility treatment exhibit the same stress levels that cancer patients do. And many cancer survivors who struggled with infertility after their cancer reported that their stress during infertility was higher than when they were undergoing cancer treatment. They reported feeling more isolated, having less support from loved ones, and reported a significant impact on their sense of individuality and identity (Gurevich, 2016). The likelihood of an infertile woman experiencing a severe depressive episode is estimated to be nearly four times higher than for fertile women (Domar, et al., 2005). Men are more likely to receive hurtful comments about their infertility than women are. Many men dealing with infertility experience stress, particularly if they withdraw, do not seek social support, and desire children comparable to the degree their female counterparts do. Men receive less support and are subject to more thoughtless commentary than women, especially in the workplace (Fisher & Hammarberg, 2011).
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Infertility is a crisis, affecting not only physiology, but also finances and other resources, couple relationships, sexual functioning, social connections, immediate and long term goals and life plans, and family and social relationships (Rubin, 2001).
Finances
Finances are another obvious stressor. Most insurance companies do not cover infertility treatment because it is “elective”. Currently, 35 states do not require insurance companies to provide any kind of fertility coverage. The 15 states that do mandate insurance coverage vary in their requirements, and across the nation, very few companies cover more than testing for the diagnosis of infertility issues. The few companies that do cover IVF (in vitro fertilization) usually have a lifetime cap of $10,000-$25,000. When you consider that one cycle of IVF costs $12,000-$15,000, and that two-thirds of women don’t have a successful birth until after the 6th cycle, the numbers quickly become overwhelming. With these odds, a couple could easily pay $50,000 out of pocket, IF they live in one of 15 states covering IVF, with the very best case scenario of a $25,000 lifetime coverage plan And this doesn’t even include prenatal or postnatal care, by the way. This is just getting the bun in the oven.
Sex
Another contributing factor to infertility-related stress is the dramatic change in sex life. For most people, sex is a fun, and extremely meaningful part of a relationship that helps people connect and bond with one another. It is an expression of love, trust, and vulnerability. But when going through infertility, sex becomes a scheduled medical procedure based on body temperature and ovulation schedule, rather than intimacy and love (Rubin, 2001).
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Biological Factors and Medical Treatments
Do not even get me started on the hormone levels. That’s a whole other rabbit hole. Imagine your wife having those wild pregnancy hormones and crippling stress….but no baby. Nothing to show for it. Just persistent hormones and mood swings…and an empty uterus. Whether it’s a couple of simple medications, IUI, or IVF, infertility treatment is hard, and every failed attempt restarts the hope-despair cycle, contributing to the increase of severe depressive episodes experienced by those struggling with infertility.
Stigma and Hurtful (even if unintentional) Comments and Actions
Because infertility is not normative, those battling it often feel the need to make excuses or explain their conditions because of the way others treat them, as if the condition is somehow inappropriate or wrong. This helps to explain the social aspects, and not merely physical aspects of infertility, and how the stigmas surrounding it can socially and psychologically damage infertile couples further. Researchers have addressed the social psychology of infertility, explaining further that infertility is an unwanted social status, and therefore carries a stigma (Matthews & Matthews, 1986). Because of stigmas and fear of hurtful or unsupportive treatment, 15% of women and 19% of men do not tell their families when they are undergoing IVF treatment and 23% of couples have not told both sets of parents, only one. (Peters, et al., 2005). The trouble with this is that those who are generally expected and hoped to be closest to a couple are not part of their support system, making them more susceptible to mental illnesses like depression. And men are more likely to receive hurtful comments than women (Fisher & Hammarberg, 2011).
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How to help
Increasing positive self-perception is a critical part of managing the negative impacts of infertility (Raque-Bogdan & Hoffman, 2010). Helping your loved ones to identify their positive qualities and working to refrain from insinuating that they are less of a person because of that infertility (it may sound obvious, but people make comments without meaning to more often than they even realize) is essential.
It is unlikely that people will ask, but when possible and appropriate, helping by contributing financially is incredibly helpful. At the beginning of the year, my husband and I were blessed tremendously. Generous friends sent us a check, which immediately went into an account my husband and I have just for infertility treatments. We certainly have a long way to go, but the amount of stress this relieved was indescribable, and our gratitude matched it.
Please do not attempt to help with the sex life portion of stress. Leave that one to us. Frequently men have suggested sex positions to my husband. Sex positions aiding in fertility are myths, and a couple’s sex life is their own. It is not a conversation for you to initiate.
Ask appropriate questions. Sometimes we need to talk about it. I know it can be awkward for you, but it means a lot when you say, “Hey, how are you doing with the infertility stuff?” And you can even say “stuff” if you don’t know what to say. And if we say, “okay” or “fine”, take it with a grain of salt. A coworker recently approached me and asked how my “infertility journey” was going. She didn’t give advice. She just listened and validated. We only spoke for about five minutes, but I cannot tell you how much that simple conversation meant. Please be mindful that your questions do not become intrusive: “When are you going to take on a more intense form of treatment?”, for example, is a deeply personal question.
We’re going to be okay. We know that. But for now, we press forward. We look for temporary distractions, many of us attend grief and/or marriage counseling, and central to our health is finding other parts of our identity, searching for meaning in other places. It is hard – some days it seems impossible – but we will be okay. And we greatly appreciate all the love, generosity, support and empathy you provide.
Check in with a friend or family member struggling with infertility. Take a moment to be a good friend: an active, empathetic listener.
References
DOMAR, A., PENZIAS, A., DUSEK, J., MAGNA, A., MERARIM, D., NIELSEN, B., & PAUL, D. (2005). The stress and distress of infertility: Does religion help women cope? Sexuality, Reproduction and Menopause, 3(2), 45-51. https://doi.org/10.1016/j.sram.2005.09.007
Gurevich, R. (2016, August 2). What Infertility, Trauma, and Cancer Survivors Have in Common. Retrieved February 16, 2017, from https://www.verywell.com/how-infertility-Cancer-trauma-survivors-are-similar-1959993
Fisher, J. R., & Hammarberg, K. (2011). Psychological and social aspects of infertility in men: An overview of the evidence and implications for psychologically informed clinical care and future research. Asian Journal of Andrology, 14(1), 121-129. https://doi.org/10.1038/aja.2011.72
Matthews, A. M., & Matthews, R. (1986). Beyond the mechanics of infertility: Perspectives on the social psychology of infertility and involuntary childlessness. Family Relations, 35(4), 479. https://doi.org/10.2307/584507
Peters, C., Kantaris, X., Barnes, J., & Sutcliffe, A. (2005). Parental attitudes toward disclosure of the mode of conception to their child conceived by in vitro fertilization. Fertility and Sterility, 83(4), 914-919. https://doi.org/10.1016/j.fertnstert.2004.12.019
Raque-Bogdan, T. L., & Hoffman, M. (2010). Self-Perception, Hope and Well-Being in Women Experiencing Infertility. American Psychological Association 2010 Conference Presentation.
Rubin, H. D. (2001). The impact and meaning of childlessness: an interview study of childless women (Unpublished doctoral dissertation).
Aubrey-Dawn Palmer was born and raised in Farmington, New Mexico, and she has a bachelor’s degree in family studies from Brigham Young University. She has two younger brothers and is married to her best friend, Richard. In addition to her research on relationships, human attachment, and healthy sexuality, Aubrey-Dawn volunteers with her husband as a teacher for the Strengthening Families Program, is a research director for a counseling center, and works as a home counselor at a residential treatment center.
Infertility is typically defined as not being able to get pregnant after one year (or longer) of unprotected sex. Just about everyone knows at least one person who is struggling to get pregnant. And if you can’t think of someone right off the bat, I can guarantee that there is someone close to you that maybe just hasn’t told you they are struggling. In fact, according to the CDC, 1 in 8 couples have trouble getting pregnant or sustaining a pregnancy.Furthermore, after six months of trying, only 60% of couples will conceive without medical assistance. That leaves 40% that may end up needing some type of fertility treatment! Usually when we think about infertility we only think about the woman’s side of things. While this is very important and we should be sensitive with this topic, men are often forgotten in the equation. Truth be told, infertility is oftentimes just as hard on men as it is on women. In this article, I’d like to share about some of my own personal struggles with infertility, and address some of the common responses that I have received as I have opened up to people about the battle my wife and I are enduring.
Note: This post largely consists of my own personal experiences. Be aware that everyone’s journey with infertility is different, and therefore, someone may wish to be approached about their own personal journey in a different way from mine.
First reactions.
When talking to people about future plans or about any topic related to families, most people will ask “so do you want kids”? Before I say anything else, let me first address the fact that someone else’s family planning is not your business. You never know what someone may be going through, so unless they bring it up themselves, or it is someone that you are really close with, don’t ask that question in the first place. Whenever I am asked this question, my response is always the same, “Of course I do. Unfortunately, my wife and I have been blessed with infertility and are currently going through treatments so that we can.” (More on why I say “blessed with,” later) More often than not people will get very quiet and give me a look as if I had told them that I enjoy sticking pencils up my nose. Then, without a doubt, I get one of three responses. First, I will either get a question about adoption, second, I’ll hear a statement about how lucky I am, or lastly, I’ll get a story about how they knew of someone else who did this random thing and got pregnant. To be honest, these responses are incredibly frustrating. I do understand that people are trying to help and be comforting. Let’s be real, though, these responses are not helpful. All I really want is for someone to say, “Dude that sucks, I am sorry that’s happening,” and move on.
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“You could always just adopt.”
Adoption is a wonderful blessing for so many people. And I can guarantee that the majority of couples who are struggling with infertility have had many conversations with each other about the possibility of adoption. But to someone in the thick of a battle with infertility, saying things like, “Well, you can always adopt!” can really hurt. For some, adoption is just not a currently viable option due to cost or living situation. For others, the pain of thinking about giving up on having their own biological child is just too much. The best move is to assume that the couple has already considered this option, and to allow them to bring it up themselves if it is something they want to discuss with you.
I am lucky?
Hearing that I am lucky that I can’t have kids right now is one of the most frustrating comments to receive. Oftentimes, the people who tell me I am lucky are single and have no ambition to have a family in their current lifestyle (note that I have gotten this comment from both men and women). To me, infertility is not luck, it is a difficult and unfortunate part of life that my wife and I have to struggle through together. I do not care that we’re not at risk of having an “oops baby”, or that I get “unlimited sex”. I do not care that it means my wife and I don’t have to take care of a crying baby all through the night. I would take an “oops”, I would give up “unlimited sex”, I would gladly rock my crying baby all through the night if it meant that I got to be a father. If you are ever tempted to tell someone who is struggling with infertility how lucky they are, stop and think. Try stepping into their shoes to gain an understanding of what it means to feel such an incredible yearning and loss for something that can’t yet be part of your life.
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Why advice does not help…and what you can do instead.
Oftentimes, we use advice as a defense mechanism. When we are uncomfortable, we try and offer a bit of wisdom to help make a trial that someone is going through seem a little more manageable, and a little less scary. While advice-giving is well-meaning, it can feel like a punch to the gut. As if my wife and I haven’t already tried everything we could think of (and that the internet and doctors could think of) to help us get pregnant. Almost two years ago, I was talking to an older man who had gone through the same thing earlier in his life. After struggling with infertility, he and his wife chose to adopt two girls from Korea (where his wife is from). As we were talking, he said a few things that stood out to me. First, he said that “he and his wife were blessed with infertility”. Second, he mentioned that, “It’s a pain no one can understand without going through the fire of doctors and medicine”. And third, “People’s advice is the hardest thing to hear. They speak on a matter they know nothing about, but act as if they are experts. Talking about their friend’s sister’s uncle who had issues and miraculously got pregnant because of a diet they did, or a sex position they tried.” For me, this man hit the nail on the head. Unless they have gone through it themselves, people don’t truly understand the pain of battling the “blessing of infertility”, but they still talk like they get it. Rather than acting like you know how to solve the problem, instead reach out with love, kindness, and a desire to understand. You don’t have to fix someone’s struggle in order to help them. Silent solidarity, a hug, or even just an acknowledgment of their struggle (again, “Man, that sucks. I’m sorry you have to go through that”) is often far better than trying to offer up what will most likely be not very helpful advice. Also, it’s important to remember that unless someone directly asks for ideas for sex positions to try, assume they don’t want to know. That is a private and intimate part of life that should remain between partners.
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So What DO You Say?
When discussing someone’s struggle with infertility (or any struggle really), the best policy is to “Be kind, for everyone you meet is fighting a hard battle.” Personally, all I really want is to be treated normally. And I believe that the majority of people who are experiencing infertility are in the same boat. We are not a ticking bomb that you have to walk on eggshells around. It’s lonely knowing that you are part of such a small community in the world that has this issue, and the best way to remedy that loneliness is through genuine connection. Be honest about your comfort level with the subject — if it makes you uncomfortable to talk to someone about their infertility, then let them know. That is okay! And feel free to ask non-invasive questions. Stop, think, and reach out in empathy.
Figure out where you are with talking about infertility. Talk to your partner about what it means to you to have a child or to want a child, and cherish the heck out of your family or significant other.
Richard Palmer was born and raised in Farmington, New Mexico, and then moved on to live in Alaska and Texas before finally marrying his high school best friend, Aubrey-Dawn. He works at a residential treatment center, and specializes in working with ASD adolescents. He is studying recreational therapy and art.
