Infertility is actually a relatively common occurrence: it affects one in six couples. The popular impression however is the opposite and the social and educational drives are towards preventing unplanned and unwanted pregnancies.

Couples given the unwelcome news that they are unlikely to conceive naturally have spent most of their young adulthood using contraceptives. The irony is not lost on them.

When they come for psychotherapy following the diagnosis of infertility they are very often bewildered, confused and dismayed. Their assumption all along had been that once contraceptives were withdrawn the automatic result would be pregnancy.

Infertility is not life threatening but an exquisitely painful condition similar to grief. Infertility or involuntary childlessness is similar to mourning and yet, unlike mourning, resolution and acceptance is not always the final stage. Couples’ hopes are raised again and again with new technologies, new advances in reproductive medicine making it very hard for them to draw their treatment to a close and face a different option.

Infertility impacts on the couple’s relationship and their physical and emotional health. Their inability to fulfill society’s expectations leave them struggling with an identity crisis and a sense of betrayal. “That’s not how life was supposed to be”. Anger, isolation and difficulty adjusting to this new reality take a toll in their daily functioning.

An estimated 5% of couples in the Western World experience either primary infertility (the total inability to conceive and bear children) or secondary infertility (the inability to conceive or to carry through a pregnancy following the birth of child/children).

The causes of infertility are generally viewed and treated overwhelmingly as physiological and the psychological effects of the diagnosis and the treatments are not always well understood and/or considered by the couple themselves or their advisors.

It is often assumed that men are less distressed by the diagnosis than women and men themselves are likely to believe this to be true. Infertility studies however have shown that male reactions depend on whether infertility diagnosis was given to them or to their partners. When the problem was found to be in their partners, men did not report high levels of distress. When they were the ones found to be infertile, they experienced the same levels of anxiety and depression, low self-esteem and the stigma associated with female infertility.

Infertility treatments are often invasive, time consuming and expensive. Most couples are initially treated by conventional methods of timing of intercourse, drugs to promote ovulation or prevent miscarriages. Their private and intimate life becomes the focus of the treatment. An area of the couple’s life that was off limits to others is then exposed leaving them feeling vulnerable and out of control.

Individuals being investigated for fertility problems or the ones undergoing treatments may at some stage find themselves struggling with their sexual sense of self. They may also find it difficult to function well within their sexual relationship. Timing of intercourse interferes with spontaneity and the drugs can have a negative impact on mood and irritability.

Stress, chronic tension and anxiety are strongly associated with difficult conception and often predate and greatly contribute to the infertility diagnose. Sexual problems in response to the stresses involved in fertility treatment and interventions are not uncommon adding another layer of discomfort.

It is also often that sexual problems were already present in the couple’s relationship but they could either circumvent it or avoid it all together. Once they decided on having a baby however that option wasn’t anymore available increasing the level of tension and anxiety between them.

Psychosexual therapists working with individuals or couples experiencing infertility are well positioned to offer their expertise in identifying and working with these issues. During the assessment session the therapist may very well find that their problem is based on misinformation or fear of failure. Sexual education focusing on validation and normalization can be of great help to these clients.

Issues around masculinity and femininity are sometimes revealed indirectly and although not exactly a sexual problem it can indicate an underlying concern about desirability and body image.

Infertility is a highly individual process affecting each couple in their own way and exacerbating their idiosyncrasies and their relationship dynamics. The inability to procreate can trigger both anxiety and depression.

In fact depression very often follows a failed IVF treatment and the see -saw between hope and despair leaves deep psychological scars.  Individuals can be overwhelmed by a sense of futility in life. Shame often accompanies these feelings and magnifies the desire to “be like everyone else” and the frustration of being prevented from doing so.

The psychological impact of infertility diagnosis and treatments on the couple’s relationships need to be addressed to avoid the negative consequences on their ability to function comfortably during such difficult period in their lives.

It is essential that these difficulties are assessed and addressed appropriately and that the individuals and couples are not left to cope with it on their own.