Infertility and the accompanying treatment is emotionally, physically, and financially stressful and often experienced as a source of distress.  While individual responses vary, feelings of anger, sadness, guilt, shame, and anxiety are common.  Over time, self-esteem may plummet, social relationships can falter, and one’s sense of femininity or masculinity may be affected.  Yet infertility is not just an individual trauma, the strain on a couple’s relationship can be profound.  Although many couples ultimately feel their infertility journey has drawn them closer together, at times they still grapple with feeling alone and isolated in their desperation.  Because each member of the couple is dealing with this significant life crisis in her or his own way, they may not be aware of how to support their partner or meet their partner’s emotional needs.

Gender Differences in the Experience of Infertility

Women and men often experience infertility in distinct ways.  The question often arises, “do women suffer more than men?”  Studies confirm that women tend to experience greater levels of infertility-specific stress than men.  They also report more symptoms of depression, anxiety, and low self-esteem, irrespective of whether the diagnosis is female, male or a combined factor.  Contributing to a woman’s increased distress may be her monthly cycle, which serves as a physical reminder of what is missing and often facilitates a seemingly endless emotional roller coaster of hope followed by despair.  Women also usually undergo the majority of the medical work-up and procedures, which can be time consuming, invasive and sometimes physically painful.  In addition, we must acknowledge the societal and cultural norms about motherhood that shape women’s expectations of adult life.

Men also experience emotional struggles with infertility, although they express them differently than women.  Men commonly worry about aspects of the process, such as the stress of providing a sperm sample on demand in a medical office, and the costs associated with treatment.  They often feel the need to provide emotional support to their spouse and consequently, minimize their own feelings of sadness.  Overall, while research indicates men experience infertility-specific stress and distress, they are usually less emotionally affected than women.


Gender Differences in Coping

Men and women also tend to use different techniques to cope with infertility.  Women seek information, assistance and social support.  They turn to others for help and want to talk about their feelings, especially following an unsuccessful treatment cycle or pregnancy loss.  Men, however, utilize coping strategies that include distancing, minimization, and problem-solving.  They tend to remove themselves from the negative emotions associated with infertility by downplaying its significance.   They may become more involved in their work or other tasks as a way to feel productive and effective.  Men also often view their primary role as that of supporter or protector.  Thus, in an effort to shield their wife from increased emotional pain, they may be hesitant to express their own feelings.  When noting differences in the way men and women cope it is important to remember that difference does not indicate better or worse, it only means not the same.  It is also necessary to understand how your partner copes so you do not misinterpret his or her behavior.


Challenges in Communication

Unfortunately, what frequently happens is that spouses will misinterpret one another’s coping styles, emotional needs, and behaviors and get caught in a negative cycle of communication.  For example, a couple experiences an unsuccessful IVF cycle and the woman feels sad and discouraged.  She is looking for someone with whom she can share her sadness and feel emotional validation, support, and connection.  She naturally turns to her spouse and is looking for him to “just listen,” and to express empathy.  She would like him to be emotionally and physically present.  However, it is very difficult for a husband to see his wife in such emotional pain.  He loves her and wishes to help her; he wants to fix the problem.  He may talk about making the best out of the difficult situation, finding a silver lining, or offering solutions, such as proceeding with more fertility treatments as quickly as possible.  His well intentioned attempts at problem-solving backfire because ultimately, he cannot solve the couple’s fertility problem, or the feelings of sadness and grief they each feel.  The result is his wife feels alone and unsupported and he feels disappointed and ineffective.

While there are times when you and your spouse innately know the form of support one another needs, sometimes it is necessary to clarify the type of support you are seeking.  There are four types of support: emotional (listening, empathizing, hugs); esteem (expressing admiration or respect); informational (problem-solving, giving advice, gathering information); and tangible support (cleaning, planning a dinner, making doctor’s appointments).  If you are looking for emotional support and need your spouse to listen, empathize, and hold you, and you do not want them to problem-solve, then you need to state your preferences.  For example, “I need you to just listen for a while as I talk about how much I’m hurting.”  And what is “a while?”  Is it five minutes or a half-hour?  It is important to clearly identify your preferences.

When this occurs, the negative cycle of communication evolves into a positive cycle of connection.  Let us return to the previous example where a couple has had an unsuccessful IVF cycle.  The woman feels devastated and discouraged and explains to her partner her need for him to just listen and empathize.  The husband provides the emotional support his wife seeks.  She feels supported and he feels helpful.  They feel connected to one another as they continue on their journey through infertility.


Identify How You and Your Partner Cope

It can be constructive for you and your spouse to identify your preferred coping styles.  Think about how your ways of coping may impact your spouse and the relationship.  Do your coping techniques have a positive or negative effect on your partner and can this change based upon the situation?  You want to replace individual coping strategies that have a negative influence on the relationship with those that have a positive effect on the couple.

As I noted earlier, women tend to seek social support as a coping strategy, and this includes talking to their husbands about infertility.  While this can be an effective strategy to validate a woman’s feelings and help the couple feel more connected, at times it can negatively impact the relationship.  This occurs when talk of infertility begins to dominate a couple’s conversations.  While women find it helpful, men often note it increases their stress level (remember, men frequently cope by using distancing and minimizing techniques).  In response, men will often try to avoid infertility talk or disconnect from the conversation, which leads women to believe their spouse does not care.  One effective strategy is for the couple to limit infertility related talk to 20 minutes a day.  You might decide to schedule the 20 minutes for the same time every day or just see when the topic arises.  Some couples keep a general eye on the time, while others set a timer.  Either way, this is a strategy that allows women an opportunity to receive the emotional support they seek, while placing boundaries around the length of the discussion.


Take Away…

  • Infertility can create significant strain in a couple’s relationship.
  • Women and men often experience infertility in unique ways and tend to utilize different coping styles and strategies.
  • A coping style may be effective for an individual, but harmful for the relationship.
  • Identify and consider how each of your coping styles may effect the perceptions of the support you give and receive, and be aware that a change in your coping strategy may be necessary.


Dr. Erica Mindes is a Licensed Clinical Psychologist and an Associate with the psychotherapy practice of Covington & Hafkin, which specializes in reproductive health issues. She has an office in Richmond, Virginia where she provides counseling to individuals and couples struggling with infertility, pregnancy loss, and other areas of reproductive medical care. She has conducted research and written on the psychological responses to infertility and infertility treatment, and recently co-authored the chapter, “Counseling Known Participants in Third-Party Reproduction” for Fertility Counseling: Clinical Guide and Case Studies. Dr. Mindes is a member of the American Society for Reproductive Medicine Mental Health Professional Group (MHPG) and serves on the MHPG Executive Committee.



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