Couples therapy for infertility
Saturday, May 18, 2024. Revised and updated.
I’ve written earlier about what a profound stressor the transition to parenthood can be on a marriage.
Couples therapy for infertility typically grapples with communication deficits, an impaired decision-making process, and issues with sexual politics.
Couples who have crossed the medical threshold to avail themselves of all that medical science has to offer sometimes wind up in couples therapy for infertility.
We see empathetic lapses, power struggles, mixed or hidden agendas, feeling “not on the same page,” gender differences with antagonistic coping skills, secret-keeping, and even toxic caretaking.
But research time and again tells us that infertility is a significant stressor as well (Andrews, & Halman, 1992: Berg & Wilson, 1991; Burns, 1990 Daniluk 1988; Hirsch & Hirsch, 1989; Morse and Dennerstein, 1985; Shaw, Johnston, & Shaw, 1988).
Infertility and defensiveness
Infertility treatment can sometimes be a backdrop to guilt and resentment. Partners may gradually become less open about their innermost thoughts, anger, anxieties, and fears.
Couples trying to get pregnant may be invested in “protecting” their spouse from feeling shame. They also seek to mask their depression, frustration, and pain.
The end result is that while experiencing profound relationship stressors of infertility treatments, partners sometimes “slip out of intimacy” at a time when it is most needed (Diamond, Kezur, Meyers, Scharf, & Weinshel 1999).
The infertility vector
Science-based couples therapy for infertility acknowledges 5 predictable discrete stages to the Couples Therapy of infertility.
Awareness: A couple trying to get pregnant will inevitably notice their failure and become activated, seeking medical help.
Activation: For many couples, the confirmation that they are infertile may be a shocking additional stressor.
Acclimation: The couple enters the medical arena, inhabiting a dark limbo of “not yet pregnant” (Griel, 1999).
Acceptance: What happens if technology fails? Acceptance (Diamond, Kezur, Meyers, Scharf, & Weinshel 1999) has 3 discreet phases; Ending fertility treatment, Grieving the loss of a natural child, and Refocusing on other family life choices.
Aftermath: Research tells us that sadness often follows a poorly grieved loss. Marital struggles, intimacy difficulties, and communication gridlocks are often the legacy of a failed attempt to get pregnant.
However, couples working on their intimate bond often experience a resilient and mature post-fertility growth. Couples therapy for infertility may help couples to achieve this resiliency and commitment.
Couples therapy for infertility and the consolations of externalization
Externalization is a delightful parlor trick of couples therapy. The first crisis of infertility is an emphatic crisis of identity.
Am I infertile? Are we infertile...or are we struggling against infertility? This process of externalization is an invaluable tool in couples therapy.
“We” struggle… but the medical fact is that overwhelmingly, only one spouse is the source of infertility.
The term “Involuntary Childlessness” is a term growing in popularity in the medical arena. It’s a classic example of the linguistic sleight of hand that is externalization. I love externalization because when we change how we talk, we can also help change how we feel.
Couples therapy for infertility and the toxic impact of infertility
Infertility exerts a toxic array of stressors that, unfortunately, unfold over time.
Some spouses experience a crisis of identity. They may feel cursed, broken, or defective.
Infertility takes away the agency of a couple to plan their families. They are in a reproductive limbo.
Technology can make strange bedfellows. The tactics of using donors and surrogates are producing problematic family bonds.
Infertility is an emotional, financial, and temporal swamp. It deflects or depletes the simple joys of everyday life.
Infertility plows up the ground under a couple’s feet. Exposing assumptions, stories, hopes, and expectations to the cold light of day.
Couples Therapy for Infertility…Profound Gender Differences in Coping
Initially, the pain of infertility is unevenly distributed.
Half of the women (but only 15% of men) describe infertility as life’s greatest disappointment (Freeman et al., 1985).
Women report higher levels of distress and less life satisfaction (including sexual). They also show more depression and anxiety (Andrews et al., 1992).
Women initially seem to be the “load-bearing” wall of couples therapy for infertility.
In couples therapy for infertility, we see a sharp gender contrast. Men start with an optimistic, goal-oriented stance, while women are despairing, depressed, or disappointed. Their self-image is dented.
As failure becomes more real, over time, many men seek to distance themselves from the awareness of infertility, lest it settles as a comment on their manhood.
Consequently, men typically project their anxiety and become careful students of their wive’s shifting moods. In couples therapy for infertility, men can often vividly describe the minute emotional shifts of their wives. They are more aware of their wives’ feelings than their own.
The most toxic stressor…gender-specific distress (GSD).
Women engaged in couples therapy for infertility initially display higher levels of anxiety and depression.
A large block of research (Abbey et al., 1992; Griel, 1991; Matthews & Matthews, 1993; and Wirtberg, 1992), suggests that many women link their self-worth to their ability to conceive and raise a child. In other words, the GSD of infertility can be particularly acute.
As it is for men as well.
Research shows that early “can-do” optimism often sinks under a pile of medical bills (Abbey, 1992). After all, the struggle to pay for it all is more a comment on their manhood than their investment in the process, isn’t it?
Men get stressed, too…
Berg (1991) suggested that men are exhibiting their “normative male Alexithymia” and might be enduring a stress level as deep as their wife.
Working with GSD is a core task of science-based couples therapy for infertility. However, the therapist must have a flexible and open stance.
Not every couple will neatly conform to the contours of the research. It’s just as important for therapists to examine their own assumptions as well.
What spouses have in common
Infertility feels like a failure (Nachtigall et al.,1992). Over time, the lingering sentiment of loss and inadequacy is the dominant legacy for both partners. But intimacy deepens as sadness is shared.
The longer a couple struggles with infertility, the more the emotional chasm between them closes.
Couples therapy for infertility invites a couple to deepen their intimacy and understanding of one another by having a series of deeply intimate conversations along the way.
It’s another task of couples therapy for infertility to explore such complicated notions as the value and meaning of children and what it means to be a parent.
Predictable couple issues for infertile couples seeking treatment
One of the most pervasive issues is when wives who are seeking to get pregnant feel that their partner isn’t as concerned about the problem as they are.
With heterosexual couples, this often manifests along with predictable gender tendencies. Consequently, wives feel emotionally isolated while their husbands generate internal pressure to contain and compensate for what they perceive as their partner’s intense and sometimes escalating emotionality.
Fertility treatments are invasive and uncomfortable. Research indicates that the emotional experience of women facing infertility is comparable to the anxiety and depression felt by women facing cancer, cardiac-event rehab, and hypertension (but less than HIV).
The study concludes that the experience of infertility treatments often requires similar psycho-social interventions as those used for patients with chronic and serious medical illnesses. One of the most important psycho-social interventions is science-based couples therapy.
Lasting Impact on Intimacy
I know this may seem to be a bizarre analogy, but couples therapy for infertility is structurally similar to couples therapy for infidelity.
How so?
In these otherwise profoundly dissimilar life experiences, there is often a profound sense that reasonable expectations were unexpectedly thwarted.
This is in addition to a feeling of being invaded, a nagging sense of self-doubt for one partner, and a sometimes concurrent overly robust desire to “soldier on” and “muddle through” on the part of the other.
The emotional mismatch from this Gender-Specific Distress can be daunting.
The experience of the “hurt” partner in infidelity is paralleled by the anxiety, depression, and physical discomfort of women seeking to conceive.
Date nights… and let’s talk about something else for a while…
In both cases, an agreement to occasionally shift from what seems like a perpetual, problem-saturated conversation to ordinary, mundane, and even spontaneous enjoyment of each other by “not talking about it for a little while” can give both partners a needed respite.
Some couples benefit from having a regularly scheduled date night where baby talk is off the table.
When couples have “failed” to conceive and exit the medical turnstile, they are often united in their shared grief and disappointment. Consequently, post-fertility relationship growth is often observed.
These couples often report higher marital satisfaction and better communication (Griel, 1999). Research seems to be telling us that having a series of intimate Generative Conversations can improve these marriages long term.
We are learning more about working with the emotional trauma that infertile couples experience. Canada has a wonderful new approach that is research-based and is a model for the USA.
And doesn’t that make sense? Unlike other couples effortlessly gliding through life, these couples have had to deal with everything that the “plow of infertility” unearthed. Why did nature not keep faith with us? is an agonizing question best answered by sharing and grieving together.
