There are multiple aspects to infertility, multiple treatments, and also failures. There are roughly three stages to infertility that I have observed in practice- diagnosis of infertility, treatment of infertility, and post-treatment which results either in a baby or not. All three of these stages have unbearable pain emotionally and physically for women. All stages stress marriages and partnerships, and all stages are potentially financially stressful as well.
Diagnosis of infertility for heterosexual couples can occur after one year of trying to conceive without success. Diagnosis of infertility in homosexual couples varies. For lesbian couples it is defined often by insurance companies. For example most will only cover In vitro fertilization (IVF) (if there is infertility coverage at all) after at least three failed Intrauterine inseminations (IUI). Some insurance companies require up to five or more failed IUI’s though. IUI and IVF informal definitions can be found here.
To have gone through potentially a year of trying to conceive before having medical intervention and diagnostic testing done is emotionally draining. If in that year there is a miscarriage it is even worse. If in that year you turn forty or forty-one then women start to despair and feel they will never conceive because they are running out of time biologically. Before a woman or couple can be given the infertility diagnosis they are already stressed to the max, possibly depressed, possibly anxious, and potentially grieving a miscarriage or more than one miscarriage. To be given the diagnosis in order to have testing done and paid for by health insurance companies is often a relief for women and couples.
Testing takes time though. Time off from work. Infertility tests can be exceptionally painful for women especially if there is an underlying medical condition like endometriosis. If a woman has any sexual trauma these tests can be quite triggering of PTSD symptoms.
After the tests are completed which may or may not have been covered by health insurance, comes the diagnoses. Then there are difficult choices to be made. All to be decided as a couple with the fertility specialist that they are working with. These decisions can have lifelong implications in a marriage emotionally and financially.
Decisions are made. Steps are taken to either proceed with interventional methods of conception which can include hormones, injections, and more emotional and potentially physical stress. Then there is waiting for pregnancy test results. Receiving results, positive or negative. If positive there is joy, but also fear, will there be another miscarriage? Is it twins or triplets due to any of the medical interventions? If negative, will there be another cycle? Will there be more hormones and more stress.
Women struggling with infertility often tend to pull into themselves and isolate. They may disengage from social media to avoid seeing happy families with children. They can be depressed because of infertility itself or secondary to hormonal treatments. There can be severe anxiety associated with even entering the fertility doctor’s office if they have been working together for a long time with poor results. There is always hope sprinkled in with moments of deep despair.
Women may present for mental health treatment at any time during their journey. They may need one session only, or several. They may want to do couples work. They may want to not talk at all about infertility or they may just want to cry. I’ve seen the full spectrum in my office. I’ve also seen women on the other end of the journey. Some with children and some without.
What I have seen in women struggling at any stage of their journey is strength coupled with shame. Hope coupled with fear. Deep longing coupled with detachment. Isolation is probably the most common denominator. It’s not something as a society we talk about or support one another around.
If you are struggling with infertility reach out for help. Therapy can help. Having a space to cry, laugh, or just be without pressure or expectation can be helpful. It may be beneficial to create a space in couples work for your relationship as you embark or continue on this journey together. Wherever you are in the journey don’t be afraid to reach out for help.