Infertility, or the inability to conceive after at least one year of trying to get pregnant, impacts virtually every area of a couple’s life, including how they connect sexually. For women over the age of 35, the time frame for meeting the minimum criteria for infertility is six months, rather than one year, to account for the changes in fertility with age.1
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. For many individuals, 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.
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. 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.
Additionally, 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.
Infertility is a life-changing experience and challenges a person’s sense of self and identity. Long-term adjustment can be achieved by exploring and creating a new self-identity, pursuing alternative paths to parenthood, re-envisioning life without children, and finding purpose and meaning in your infertility. Ultimately, experiences of infertility are highly varied and there is no right or wrong way for you to feel.
The Psychological Effects of Infertility
It is apparent that many individuals with infertility experience stress, and some even develop psychiatric symptoms or conditions. Those with infertility report higher levels of anxiety, depression,2 and complicated grief.3 One study2 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.4,5
If you are troubled by the psychological effects of your infertility, treatment options are available. Medication may be prescribed by your primary care physician or psychiatrist, which balance the chemicals in your brain that affect your mood. Psychotherapy with a licensed clinician can provide you with support and coping tools for managing your stress, grief, and other psychological symptoms. For some individuals, a combination of medication and psychotherapy is appropriate. Consult with your doctor or other clinical professional to take steps toward attaining the treatment best fit for you.
Infertility & 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, to which some couples may find it difficult to adapt.
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. Sex therapists are clinical professionals who have completed training to assist people with sexual problems. A sex therapist will spend time doing a thorough assessment with you and your partner to evaluate what issues you want to address.
Couples counseling can also be a helpful option if your relationship has been negatively affected by infertility. A couples counselor or therapist can help you and your partner with a litany of issues either created or exacerbated since the onset of infertility. While attending counseling together, you and your partner can improve your communication habits, learn how to support one another, and resolve conflict over disagreements or distance in the relationship. Not all couples with infertility struggle, but if you and your partner are having a difficult time coming together you may want to consider exploring options for mental health treatment near you.
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.1 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.1 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.6
Timed intercourse places pressure on men to perform sexually and may exacerbate or create problems with premature ejaculation7 or erectile dysfunction. Masculinity is often tied socially to the ability to reproduce and 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 individuals 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.8
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 individuals being mis-gendered or receiving substandard care. The current medical definition of infertility is not applicable for trans persons, 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 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.
Who Should I Consult for Help?
The medical professional best suited to work with you and your partner depends on the problems you are experiencing. Physical problems should be dealt with by an appropriate medical professional. If you are looking to take the first steps in talking with someone about infertility, you may be able to get a referral from your primary care physician.
The medical professionals you may work closely with include reproductive endocrinologists, gynecologists, urologists, and other fertility specialists. If you are undergoing fertility treatment, it is important for your doctors to prepare you for what to expect. Many couples with infertility face challenges regarding their sex life and the more prepared you are, the better you can adjust throughout treatment.
Problems in emotional and relational aspects can be addressed by a mental health clinician. A marriage and family therapist has specialized training in couple and family systems, and can assist you and your partner with any problems in the relationship that have arisen or were exacerbated by the infertility.
Sex therapy may be an appropriate option for couples whose physical or emotional intimacy have been negatively impacted. A sex therapist is a mental health clinician with specialized training in sexual disorders and therapy. They have a master’s or doctoral-level degree and may be licensed in professional counseling, marriage and family therapy, social work, or as a psychologist.
Group counseling and peer support can provide a space for individuals and couples struggling with the impact of infertility to meet other people with similar walks of life. Some groups connect participants with professional counselors and others are led by peer leaders with personal experience. Ultimately, the medical and mental health treatment that is most appropriate for you and/or your partner depends on your unique experience and what you hope to accomplish.
10 Ways to Reconnect Sexually with Your Partner
Reconnecting sexually with your partner requires patience and intention. While not every couple experiences sexual dysfunction, it is very likely that your sex life with your partner will, at the very least, be different than it was before. Even if the difference in your sex life is small, it is still important to be adaptable to changes as time goes on.
Here are 10 ways that you and your partner can reconnect sexually:
1. Remind Yourself that Sexual Challenges Are Common During This Time
When our problems are normalized we feel less shame and personalization. It is very likely that your sex life is going to look different while trying to conceive and normalizing these changes will give you the best shot at adjusting to them.
2. Focus on Yourself and Your Relationship—Not on Your Infertility
Remember that infertility is just one part of you and one part of your relationship. It may affect many areas of your life, but if you focus on it or obsess over it, your infertility is likely to dominate your thoughts or conversations. Make sure that you and your partner enjoy activities and conversations with one another that do not include infertility.
3. Talk About Sex With Your Partner
Talk about what you want and what you find desirable. Share with your partner what you miss about your sex life. Communicating with each other will help you talk through your expectations and process your feelings together.
4. Do Not Fixate on the Act of Sexual Intercourse Itself
Instead, focus on building sensuality, romanticism and eroticism between you and your partner. An easy way to start is by increasing affection such as hand-holding, cuddling, or giving each other a gentle massage.
5. Have Sex During Times Other Than When You Are Ovulating
If you are only having sex for purposes of procreation you might be missing out on sex that emphasizes pleasure and enjoyment.
6. Limit the Presence of Infertility in the Bedroom
Ensure it remains an area associated with love, passion, and romance. You can start by relocating any fertility books, medications, injections, or thermometers to another area of your home, or keeping infertility talk to a minimum while you are in the bedroom together.
7. Take a Break From Trying to Conceive When Needed
The pressure to achieve pregnancy, sometimes combined with the physical and emotional side effects of fertility treatments or medical procedures, can weigh heavily on your physical and mental health. It’s okay to pause and focus on the health of your relationship for the time being.
8. Re-shape Your Expectations
Understand that your sex life may not be the same as it was before infertility or infertility treatment. Avoid comparing your sex life now to how it was at an earlier time and instead reshape your prior expectations for your sex life to better fit where you and your partner are today.
9. Engage in Self-Care
You are not going to feel sexy or be in the mood to have sex if you are not taking care of the essentials for your mind and body. Eat nutritiously, get plenty of sleep, exercise regularly, and participate in fun activities that nurture your soul.
10. Consult With a Couples Therapist
Early initiation is best. You do not have to wait until your fertility treatment has ended to consult with a professional about your sexual problems. Your treatment will be unique based on the therapist you see and your personal counseling goals.
Some general areas a therapist may help you and your partner is increasing healthy communication, managing disagreements over things such as finances or whether to take a break and managing differences in how you are grieving and coping. Specializations in sex, infertility, or couples therapy are areas you may want to look for in a professional.
