Infertility is incredibly common. It’s ironic, then, that struggling to conceive can be such an overwhelmingly lonely experience. And while many IVF patients are single, couples often find themselves feeling just as alone throughout the process – alienated from their partner due to different coping mechanisms or complicated feelings of guilt or regret.
For couples in heterosexual relationships, gender dynamics can play a role in the way they approach IVF. We spoke to Genea Fertility Specialist Associate Professor Lionel Reyftmann and Genea Counselling Services Manager Evelyn Zwahlen about how infertility can impact relationships.
The good news? They both had the same answer when we asked if IVF can bring couples closer: that’s a resounding yes.
A lot of couples feel shame about infertility and don't want anyone to know they're having trouble conceiving naturally. What are your thoughts and also your advice to your patients?
Lionel: Most couples find it hard to open up and share their difficulties. That is definitely something that I can understand, it is a very intimate issue and I always respect their choice. However, I often see a sense of relief on their faces at the end of a consultation, when I acknowledge that their situation is not unique and that other couples have been through similar experiences and journeys. I like to share stories and give anecdotes to illustrate how other patients may have reacted in a similar situation. I have also learned a lot from the reactions of the audience when we give a fertility information presentation. At the end of the presentation, there is generally a Q&A time, and there is always an awkward silence at first. As soon as someone is bold enough to ask the first question, people in the crowd can relate to someone else’s experience and the questions come rapidly!
I suppose that these days, being able to share your experience on the internet, on a blog or in a protected group makes it easier. The comfort of the anonymity, and the possibility of sharing your experience with people living all around the world, who share your struggles, can be very rewarding.
Evelyn: Couples differ on how open they are willing to be about their fertility challenges and it is also not uncommon for partners to not be on the same page about this. From a counseling point of view, it is useful to help patients explore whether this may be coming from a place of shame or a need for privacy, and to help them work through the shame if it is an issue. They also need to consider the impact of a lack of a support network if they feel unable to share. We recognize that people may change their minds as they move through this journey and may become more or less open at different times.
Why do some women feel their partner doesn’t understand what they are going through - and why can they feel alone through the process?
Lionel: Men and women have very different ways to cope with the situation of stress. Our emotional response as men is to internalise it and not to display feelings. You want to appear strong for your spouse or partner, and the general trend is to try to provide reassurance. Women who basically feel as if they have not been heard can misinterpret this as a lack of attention. They can feel as if their concerns have been dismissed. Listening without trying to solve the problem, or sharing some of your personal feelings, can be difficult for a bloke.
Evelyn: Men and women tend to cope differently with infertility and treatment, even beyond the obvious fact that most of the treatment is happening to the woman, who by default carries the major burden. Men tend to focus on the positive and remaining hopeful regardless, while women are more likely to try to protect themselves by preparing for the worst, afraid of being hopeful. It is this that is often a source of tension between partners, leaving women feeling alone, unsupported and invalidated. It is useful to help couples to understand the different coping mechanisms.
IVF has become more advanced in recent years, but it isn't a magic bullet and there may still be disappointments along the way. How can these disappointments impact a relationship?
Lionel: It is, in my experience, the main reason why people stop IVF before getting to their goal of having a baby. When I prepare a couple for a first cycle of IVF, we spend a great deal of time talking about side effects of the drugs, risk and complications like ovarian hyper stimulation syndrome, etc. However, I always explain that the main complaint expressed by my patients after a failed cycle is not the impact of the treatments, it is the emotional distress and the frustration.
We all have different strategies to cope with failure and uncertainty, regardless of our gender. But when you have to go through such a demanding journey as a couple, the channels of communication must be very strong. Otherwise, there is a risk of feeling disconnected and progressively drifting apart from each other.
Evelyn: The psychological burden of IVF treatment is significant. It can impact in every single area of a person’s life, so it is not surprising that it can negatively impact not only the relationship within the couple but their other relationships too, with friends, family and colleagues. Counselling support (available to every Genea patient) can help to reduce these impacts.
The emotional toll of infertility can be extremely difficult on a couple's relationship. In your experience does it affect each partner differently?
Lionel: Indeed. People come to see me with completely different stories and background to begin with. The reaction of a man who suffers from a low sperm count and has to put his wife through the process of IVF generally involves apprehension, and sometimes guilt. On the other hand, when an older woman who previously had children starts a new relationship with a younger man who has never fathered a child himself, the situation is completely different. If the treatments fail, they are keen to repeat cycles after cycles, just because they want to give him this child.
One of the most damaging feelings is the uncertainty. When people are labeled with a diagnosis of unexplained infertility, there is nothing to fight against, and it often feels like your specialist does not know much more about the problem than you do. Our human brain hates this kind of grey area, we like black and white. Knowing how to react when cycles fail one after the other and you don’t have any tangible explanation is very difficult. A woman may try to cope by doing a lot of research on the internet, exploring every avenue, becoming obsessed about trying to find a solution, while her husband may progressively withdraw and appear less and less involved – which may then create incomprehension and tension in the couple.
Infertility treatments can put a financial strain on a relationship - what impact can this have on a relationship?
Lionel: It is a real issue, but most couple react well, together, in the face of adversity. They may get some extra support from their families or put a halt on the treatment while finishing the refurbishment of their house. It is generally well tolerated as long as the communications lines are solid.
However, one of the problems that I have witnessed is when the female is diagnosed with a condition that requires IVF, and her partner or husband is reluctant to go ahead with the planned treatment because of financial reasons. If you want to fix your water heater you always get three quotes before choosing a tradie. For fertility treatments, it is very different; the connection with the specialist, the confidence and the trust, are very personal emotions. Once you have set your mind on a doctor and a clinic, it can be very confronting to hear your partner suggesting that it may be too expensive and that you need to look at other cheaper clinics or withhold treatments. It is generally perceived like a lack of involvement, and appreciation. It can be quite damaging for the relationship.
Evelyn: Money is often a big factor in IVF treatment. This process is expensive, especially if you have to repeat it a few times which is often the case. A partner who feels they carry the fertility problem may feel guilty about the significant cost of the treatment and its impact on their other life goals. Couples may also resent the clinic for how much this is costing them when it is unsuccessful. Partners may not agree on how much they can afford to invest in this process and that will definitely be a source of conflict. Communication between the partners is key to managing this challenge.
What about your sex life during IVF - how can this change?
Lionel: It can go through cycles. The mechanical routine, the timed intercourse, the window of fertility, and the scheduled ejaculation with the Golden rule of “3 days of abstinence” – all of this affects the spontaneity and the enjoyable aspect of something that remains a core component of a couple’s life.
The fertility nurses have clever ways to approach this, in the most tactful or humorous ways. They are much better at this than the doctors, they are with the patients on the ground, on a daily basis!
We often suggest to our patients to step back, count less and try to regain a bit of spontaneity during a holiday for instance. Some of them may benefit from couple’s therapy or counseling.
Evelyn: There is no doubt that sexual intimacy can suffer through IVF treatment, but that can start before IVF, when a couple is trying naturally and sex has to be timed and on demand. Men sometimes feel used and may struggle to perform under pressure. During treatment there are requirements and limitations which hamper much spontaneity, exacerbated by a woman feeling her body is not her own as it is poked and prodded through treatment. The drugs may cause bloating and weight gain and make women feel less attractive to their partners. Communication around these things is critical if problems begin to develop. It can be helpful to remind couples that this process is time limited and that this is an opportunity to explore other ways of being intimate, both sexually and generally.
In your experience can couples become closer through IVF?
Lionel: Yes, definitely. The journey of infertility is one of the most confronting for a couple. Think about the day when you exchanged your wedding vows, how would you have reacted if someone had told you that five years down the track you would still be living in a house with no child? Some of my patients go through difficult times, with failed cycles or complications of the treatments, and for the majority of them, it strengthens the relationship. If your relationship can survive this major setback, you are meant to be together for life.
Evelyn: Absolutely. It is not uncommon to hear couples express the appreciation they feel for their partner on this journey. ‘He is my rock”, “she is awesome”, “he is with me every step”, “she is so strong”. Helping couples to find the positives they have gained from this grueling process is a very valuable coping tool.