Written by Aubrey-Dawn Palmer

Infertility.

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).

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).

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).

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.