Today, across Europe, more than 25 million citizens are affected by infertility. (https://www.euro.who.int/__data/assets/pdf_file/0010/73954/EN63.pdf). There are many reasons for wanting children including: family lineage and inheritance, siblings for your first child, companionship, religious beliefs and children as a source of joy. Both primary and secondary infertility have profound implications for couples.
Primary Infertility is defined as the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. Secondary infertility (SI) is defined by doctors as the inability to conceive or carry to term a second or subsequent child. It’s on the increase!
Secondary infertility is as common as primary infertility. Infertility affects 1 in 8 couples trying to conceive or about 12.5 percent. Out of all infertility causes, secondary infertility makes up about 50 percent of all cases. In the U.S. in 1995, 1.8 million women suffered from secondary infertility; in 2006, it was 3.3 million. Secondary Infertility now accounts for six out of 10 infertility cases. Couples experiencing secondary infertility already have a child. Their struggle is often downplayed or even ignored by friends, family, couples experiencing primary infertility, and even doctors.
The Language of Infertility: ‘Infertility’ is not a neutral term e.g. medical jargon such as ‘hostile mucus’, ‘blocked fallopian tubes’, ‘incompetent cervix’ and ‘failure to conceive’ indicate physical impairment. In comparison, male causes of infertility are described in less conclusive terms, using concepts such as subnormal or low sperm motility.[i] Everyday terms such as ‘barren’ and ‘sterile’ can convey a sense of emptiness and inadequacy that reinforce the importance of motherhood for womanhood.
In the attempt to become pregnant many couples have undergone rigorous courses of treatment. In addition others try various fertility drugs, acupuncture, hypnotherapy, reflexology, meditation, progressive muscle relaxation, hatha yoga, expressive writing, cognitive coping and relaxation intervention (CCRI)[ii] & Positive Reappraisal Coping Intervention (PRCI).[iii]
For those experiencing secondary infertility there are a range of emotions: Women can experience negative identities; a sense of worthlessness and inadequacy; a feeling of lack of personal control; anger and resentment; grief and depression; anxiety and stress; lower life satisfaction; have envy of other mothers; loss of the dream of co-creating; the ‘emotional roller coaster’; and a sense of isolation, an unanticipated life-course disruption[iv], a sense that time is slipping away[v] and may report that leisure satisfaction is impaired by the process of seeking treatment. Guilt, Inadequacy, Failure, Anger, Anxiety, Stress, Shame, Sadness, and Hopelessness can all appear. These can be accompanied by an almost constant sense of grief. Every 28th day represents yet another failure, another loss. You can feel as though you’re on a treadmill – and when you step off that’s the end of your hope. Often age limits are used to determine whether you still have a hope.
Others can experience themselves as ‘outsiders’, ‘odd’, or ‘different’ when compared to their contemporaries. Less adequate than their child-bearing friends and relatives and less good than their own parents who conceived and gave birth to them. Some experience a loss of control over their life as a result of infertility or may have a raging fury at technology. Some keep their struggle a firm secret because they feel that others simply don’t understand their grief- ‘After all, you already have one child.’
Effect on men: About one–third of secondary infertility cases are related to male factors. [vi] Men are also psychologically affected by infertility, displaying impaired self-esteem and inadequacy in relation to their societal role, eventually feeling responsible for denying their wives a child. Aging, itself, has a significant impact on male sexual function, sperm parameters, and fertility. Some studies indicate lower male self-esteem, higher anxiety and indicate more somatic symptoms than fertile men. There are to my knowledge, no studies on the effect of a wife’s infertility on her husband, nor on a man’s infertility and the effect on his sense of self. The literature that does exist on male infertility places emphasis either on the effect of infertility on men’s sexual functioning or on the impact of psychological conflicts on sexual dysfunctions rather than on fertility per se.[vii]
The challenges of trying to conceive also raise issues that relate to: Self-esteem, Identity, Values, Body image, Grief, Death Anxiety, Interpersonal relationships, or Existential values.
How you cope is important: there are typically four coping styles:
- active-avoidance strategies e.g. avoiding pregnant women or children;
People who have suffered primary infertility often say that the only way they cope is to avoid everything and anything to do with babies. But for the secondary infertility sufferer, this is not an option. You are confronted on a daily basis at the school gates by pregnant women, and people with babies. School drop-off can become a terrible tableau of everything you cannot have. While women use avoidance strategies to reduce their psychological distress research consistently shows that the use of avoidance coping strategies actually increases psychological distress[viii]. So there is a paradoxical relationship to avoidance coping strategies – namely, the more you try to avoid reminders of the infertility to protect yourself from psychological distress, the more distress it is likely to produce.[ix] These strategies can include:
- active-confronting strategies e.g. showing feelings, asking others for advice; and
- passive-avoidance strategies e.g. hoping for a miracle; and
- meaning-based strategies e.g. growing as a person in a good way as well as finding other goals in life.
A Meaning based strategy is more beneficial for women than for men at both the individual and the partner levels. When a woman engages in meaning-based coping, she will often report that the experience of secondary infertility helped her grow as a person. She will find other goals in life and ultimately think about infertility in a positive light. Women in these couples may more successfully integrate the experience of infertility into their identity. This is a crucial developmental task when coping with this life transition.[x]
How do YOU cope? How does YOUR PARTNER cope?
Here at the Gingko Leaf we explore your emotional landscape, the impact on your relationship, reactions from others and how you perceive those reactions, finding a place for your child-wish and we discuss the limits of treatment.
[i]Shattuck JC, Schwarz KK. Walking the line between feminism and infertility: Implications for nursing, medicine, and patient care. Health Care for Women International. 1991 Jan 1;12(3):331-9.
[ii] Rooney KL, Domar AD. The relationship between stress and infertility. Dialogues in clinical neuroscience. 2018 Mar;20(1):41.
[iii] Ghasemi M, Kordi M, Asgharipour N, Esmaeili H, Amirian M. The effect of a positive reappraisal coping intervention and problem-solving skills training on coping strategies during waiting period of IUI treatment: An RCT. Int J Reprod Biomed. 2017 Nov;15(11):687-696. PMID: 29404530; PMCID: PMC5780554.
[iv] Ulrich M, Weatherall A. Motherhood and infertility: viewing motherhood through the lens of infertility. Feminism & Psychology. 2000;10(3):323–6.
[v] Martin-Matthews A, Matthews R. Living in time: multiple timetables in couples’ experiences of infertility and its treatment. In: Daly K, editor. Minding the Time in Family Experience: Emerging Perspectives and Issues. New York: JAI and Elsevier Science; 2001 and
Earle S, Letherby G. Conceiving time? Women who do or do not conceive. Sociology of Health & Illness. 2007;29(2):233–50. and
[vi] Peterson BD, Newton CR, Rosen KH, Skaggs GE. Gender differences in how men and women referred with in vitro fertilization cope with infertility stress. Hum Reprod. 2006;21:2443–2449.
[vii] Shapiro S.A. (1988) Psychological Consequences of Infertility. In: Offerman-Zuckerberg J. (eds) Critical Psychophysical Passages in the Life of a Woman. Springer, Boston, MA. https://doi.org/10.1007/978-1-4684-5362-1_18
[viii] Jordan C, Revenson TA. Gender differences in coping with infertility: A meta-analysis. J Behav Med. 1999;22:341–358. doi: 10.1023/A:1018774019232.
[ix] Peterson BD, Pirritano M, Christensen U, Boivin J, Block J, Schmidt L. The longitudinal impact of partner coping in couples following 5 years of unsuccessful fertility treatment. Hum Reprod. 2009;24:1656–1664. doi: 10.1093/humrep/dep061.
[x] Peterson BD, Gold L, Feingold T. The Experience and Influence of Infertility: Considerations for Couple Counselors. The Family Journal. 2007;15(3):251-257.