Article by Kate Ernstrom, LCSW, PMH-C, CST and Gabby Pendley, LCSW, CADC, PMH-C
Infertility is a highly personal journey, impacting not only one’s hopes for the future but also emotional, relational, and sexual health. In today’s world, an estimated 10-15% of couples experience infertility (ASRM, 2023), a reality that often creates a ripple effect across multiple areas of well-being. For women, in particular, the experience of infertility can lead to significant mental health challenges, with symptoms of depression and anxiety reported at rates comparable to those undergoing treatment for chronic illnesses like cancer. Between 21-52% of women experiencing infertility report depression, while up to 76% experience severe anxiety during treatment (Lin & Susser, 2022; Yahya, 2022). Assisted Reproductive Technology (ART) treatments, which often involve multiple medical appointments, invasive procedures, and hormonal medications, can exacerbate these feelings, making the infertility journey especially taxing.
The Sexual Toll of Infertility
Infertility doesn’t just affect emotions and aspirations; it often impacts couples’ sexual relationships. Between 10-60% of couples report sexual difficulties, with decreased desire, arousal challenges, and reduced satisfaction as common concerns (Wischmann, 2010). These difficulties can linger even after treatment ends, affecting both men and women. Women frequently experience reduced interest and painful intercourse, while men may face erectile or ejaculatory issues (Schanz, 2011). A combination of factors—including the physical toll of treatment, emotional strain, and the shift from spontaneous intimacy to clinical, goal-oriented intercourse—can turn intimacy into a source of pressure rather than pleasure.
Emotional Impact: Guilt, Shame, and Isolation
Beyond the physical aspects, infertility often brings feelings of guilt, shame, and isolation due to societal expectations surrounding family-building and gender roles. These feelings are compounded when couples feel inadequate for not achieving parenthood naturally, resulting in increased psychological distress and sometimes relational discord. In fact, studies indicate that couples who remain childless after treatment are three times more likely to separate than those who conceive (Kjaer et al., 2014). These emotions often feel amplified due to the stigmatization surrounding infertility and the assumption that everyone should be able to start a family effortlessly.
Therapeutic Strategies for Navigating Infertility
Therapeutic support can make a world of difference in helping couples navigate the physical and emotional complexities of infertility. Here are some effective strategies for addressing these challenges:
- Normalize Sexual Challenges: It’s crucial to understand that infertility treatments may impact sexual function. By normalizing these experiences, couples can reduce feelings of shame and emphasize that they are not alone.
- Reframe Intimacy Goals: Shifting the focus away from reproduction and toward shared enjoyment can help couples reconnect. This reframing fosters a sense of intimacy that is centered on connection and pleasure rather than conception.
- Manage Mental Health Symptoms: Techniques like Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) are effective for managing anxiety and depression, providing couples with the resilience and skills to navigate infertility.
- Promote Physical Comfort: Physical discomfort is common during fertility treatments, so using silicone-based lubricants to prevent pain and foster arousal can enhance the sexual experience.
- Reduce Timed Intercourse Pressure: Creating a balance between conception-focused intercourse and spontaneous intimacy can ease the pressure around “scheduled” sex, helping couples reclaim intimacy.
- Set Realistic Expectations and Stay Present: Infertility often shifts intimacy toward a clinical focus, but developing realistic expectations and practicing mindfulness can allow couples to enjoy the present without the burden of a specific outcome.
Rekindling Desire in the Relationship
Sexual intimacy thrives when each partner takes an active role in nurturing and enhancing desire. Couples can build “bridges” to reconnect, creating personal rituals and positive anticipation around intimacy. Consider the following ways to cultivate desire:
- Establish “My,” “Yours,” and “Ours” Rituals: Develop unique ways of thinking and talking about intimacy. Shared memories, celebratory moments, and small daily gestures can strengthen the emotional and physical bond.
- Identify Personal Turn-Ons: Rediscover what brings excitement and connection into the relationship, such as shared laughter, moments of closeness, or planning a special date night.
- Practice Non-Demand Pleasuring: Create a space for touch without expectations of intercourse. Enjoy massage, cuddling, or simply holding hands to reconnect physically and emotionally.
Building a Compassionate and Informed Space
Navigating infertility is challenging, and a supportive, informed approach to mental health and intimacy can help individuals and couples build resilience. Wildflower therapists specializing in infertility, sexuality, and mental health offer compassionate, evidence-based care to guide individuals and couples through this journey, helping them process their experiences, reclaim their identities, and foster a sense of hope. Infertility does not define one’s worth or the strength of a relationship, and with the right support, couples can navigate this experience with greater resilience and connection.
References
American Society for Reproductive Medicine (ASRM). (2023). Definition of infertility: A committee opinion.
Kjaer, T. K., Jensen, A., Dalton, S. O., Johansen, C., Schmiedel, S., & Kjaer, S. K. (2014). Divorce or end of relationship in Danish women evaluated for fertility problems: A longitudinal cohort study. Acta Obstetricia et Gynecologica Scandinavica, 93(3), 269-276.
Lin, S. & Susser, E. (2022). Depression in women facing infertility: A systematic review of prevalence and risk factors. Journal of Women’s Health.
Schanz, S., Reimer, T., Eichner, M., Hautzinger, M., & Riedinger, C. (2011). Long-term adjustment of infertile couples after assisted reproductive technology treatment. Fertility and Sterility, 96(3), 604-610.
Wischmann, T. (2010). Sexual disorders in infertile couples: An update. Current Opinion in Obstetrics and Gynecology, 22(4), 293-297.
Yahya, B. (2022). Mental health impact of ART on women: Anxiety, depression, and coping mechanisms. Fertility Research and Practice.
