Infertility is the inability to conceive after at least one year of trying to get pregnant (or six months for women over 35). It impacts virtually every area of a couple’s life, including how they connect sexually. Infertility can cause sexual problems and emotional distance that lingers even after you and your partner end treatment or have a baby. Some ways to reconnect include talking about sex with your partner, prioritizing quality time, and talking with a couples therapist.
Common Feelings When Dealing with Infertility
Individuals with infertility can experience a wide variety of strong emotions, including sadness, anger, grief and loss, guilt, and shame. Infertility is a life-changing experience and challenges a person’s sense of self and identity. Ultimately, experiences of infertility are highly varied and there is no right or wrong way for you to feel.
Invisible Forms of Loss & Grief
For many people, infertility carries with it a major sense of loss, which can have a devastating emotional impact. The losses can vary from person to person but may include loss of the pregnancy and birth experience, loss of the parenthood and grand-parenthood life stage, loss of identity, and a loss of the expected or envisioned family.
Many of the losses associated with infertility are invisible, leaving those affected to deal with a sort of silent grief all on their own. This can create feelings of isolation and loneliness. People with infertility watch their friends and peers have children and move toward a phase of life in which they do not yet belong. They may feel alone and out-of-sync with those around them, especially as more time goes on.
Loss of Control
There is also a sense that the situation is entirely out of their hands and they may feel a complete lack of control. Many people expect that they will be able to have a child when they make the decision to do so.
Feeling “Broken” or Like a Failure
Some individuals feel self-judgment or shame that their body is failing them or otherwise not doing what it is “supposed” to do. Infertility is a very personal experience, in part due to the connection with one’s own body. You may feel broken, defective, and inferior to others who have children or seem to fall pregnant with ease.
Dealing With Social Stigma & Unwanted Questions
Infertility still carries social stigmatization and is often a hidden or secretive topic. There is a general societal assumption that most people will eventually have children, and despite more social acceptability to opt out of parenthood altogether, it is still considered somewhat taboo or controversial to not have children at all. Infertility is often thought to be only a woman’s condition, but for 35% of couples with infertility, both male factor and female factor problems are identified.1 Ultimately, the connections between manhood, womanhood or personhood, and sexuality are all impacted by infertility.
The Psychological Effects of Infertility
Many people dealing with infertility experience stress, and some even develop psychiatric symptoms or conditions. Those with infertility report higher levels of anxiety, depression, and complicated grief. One study revealed shame and self-judgment to be significant predictors of signs of depression in infertile couples.
If you and your partner are experiencing significant feelings of shame, be vigilant in noticing if you also have a depressed mood, loss of interest, or other signs of depression, especially if you are undergoing fertility treatments. Ultimately, stress is a very common reaction to infertility and the time spent undergoing fertility treatments or actively trying to conceive may be challenging and painful. Many people are able to eventually adjust and cope with their infertility, although the emotional pain may persist long-term.
How Infertility Complicates Your Sex Life
Infertility impacts many areas of life, including your sexual relationship with your partner. When trying to conceive or while undergoing fertility treatments, it is common for couples to have timed intercourse. In other words, the couple plans to have sex during the time that is optimal for conception. Timed intercourse can put pressure on the couple because they must have sex even if they are not in the mood to do so. Sex that was once pleasurable and intimate is now associated with predictability or failure, often leading to sexual frustration. Infertility changes the meaning of sex in the relationship, which some couples may find difficult to adapt to.
Common complaints by couples who are trying to conceive are:
- Sex feels disappointing or unsatisfying
- Sex is too predictable or scheduled
- Sex is mechanical or “on-demand”
- Sex is no longer fun or spontaneous
- Sex feels like a chore
- The focus of sex shifts from pleasure to achieving pregnancy
Some sexual problems are resolved after fertility treatment ends and the pressure to conceive has gone. Other problems remain and require further management or professional intervention.
Infertility & Women’s Sexuality
Infertility can certainly pose major challenges to a woman’s sex life. Infertility is usually caused by problems with the ovaries, fallopian tubes, or uterus. If there is pain accompanying the associated problems, sexual activity may be affected or perhaps not possible at all.
While undergoing treatment, women may take hormones or medications that cause fatigue or low libido. Sex may also feel uncomfortable due to soreness from injection sites or suppositories. Certain treatment procedures may feel invasive and provoke negative feelings toward your body, impacting sexual arousal or desire.
Infertility & Men’s Sexuality
Infertility in men is caused by problems with testicular or ejaculatory function, hormonal imbalances, and genetic disorders. As with women, if there is pain associated with these problems, sexual activity may be decreased or impossible. Men in partnerships affected by male-factor infertility have lower sexual satisfaction, less enjoyment of sexual activity, and more feelings of sexual failure.
Timed intercourse places pressure on men to perform sexually and may exacerbate or create problems with premature ejaculation or erectile dysfunction. Masculinity is often tied socially to the ability to reproduce, so men with infertility may feel inadequate or emasculated. Some may experience a loss of sexual desire, guilt, or worry.
Infertility Struggles for Transgender and Gender Non-conforming Individuals
Transgender and gender non-conforming folks face unique risks to their fertility as a result of gender-affirming medical or surgical treatments. Pubertal suppression hormones delay the onset of permanent secondary sex characteristics which may conflict with gender identity. While this treatment is reversible and allows younger individuals more time to explore their gender identity, it also has the potential to affect fertility.
Some transgender men use testosterone therapy to suppress ovulation and may undergo surgical procedures such as a hysterectomy. Estrogen therapy used by some transgender women may result in conditions such as testicular atrophy. It is important to have thorough conversations with your medical professional about how your fertility may be affected and what options are available for preservation before making decisions about treatment.
Transgender and gender non-conforming individuals encounter many barriers and discriminations when seeking fertility care. A lack of knowledge and understanding in medical providers can result in people being mis-gendered or receiving substandard care. The current medical definition of infertility is not applicable for trans people, meaning the diagnostic criteria used by insurance companies for reimbursement of medical procedures will not be met. Trans persons often must decide between paying out-of-pocket for expensive infertility treatments or not undergoing them at all.
There is also an emotional cost or potential for an increased sense of gender dysphoria in situations such as a trans woman needing to masturbate to provide a semen sample, or a trans man needing to take hormones in preparation of an egg retrieval. The challenges to fertility for transgender and gender non-conforming individuals is often a sensitive topic and should be regarded with respect.
Medical Interventions’ Impact on Sexuality
There are fertility treatments available to those who would like to pursue medical intervention. The decision to pursue treatment is a personal one and should take into account your cultural and individual values. The cause of infertility also determines what route for treatment is best suited to you. Injectable hormones and fertility medications may be used to stimulate ovulation or increase production of mature eggs.
Surgery may be done to remove fibroids, polyps, or abnormal uterine growths. Another treatment option is intrauterine insemination, also known as artificial insemination, which is sometimes used in conjunction with medication. All of these treatment options come with their own potential side effects, any of which with the ability to impact sexual functioning or desire.
In addition to the aforementioned treatments, couples with infertility can also elect to use assisted reproductive technology (ART), the most common and effective of which is in-vitro fertilization (IVF).1 To prepare for IVF treatment, many women often take medication or hormones that helps with factors such as ovulation, egg maturity, or preparing the uterus to receive the transfer of the fertilized embryos. Side effects from these drugs can cause hot flashes, mood swings, weight gain, bloating, headaches, or nausea.
Medications that are administered by injection may leave behind tenderness or skin irritation. Any of these physical factors can certainly impact your desire for and enjoyment of sexual activity. In fact, during fertility treatment, the frequency of sexual activity tends to be lower.7 Sexual desire can also be impacted by concerns over the cost of treatment and traveling expenses.7
The Impact of Financial Stress From Fertility Treatments
The financial cost is a huge concern for many couples, as fertility treatments are very expensive. Only a handful of states require insurance coverage for fertility treatments and the extent of coverage is inconsistent. Those without insurance coverage and cannot pay out-of-pocket may feel hopeless or a lack of control. Even with insurance, you may still find yourself paying a significant amount out-of-pocket due to deductibles, co-payments, and coverage limitations.
Source: Choosing Therapy