Having a family is a dream that is instilled in many women from early childhood when they are first introduced to dolls and watch movies about princesses falling in love with a life partner. When women reach adulthood, small talk in social settings where women interact generally focuses on relationship status and when a woman plans to have children. Discussing having children is often seen as a safe, common ground for small talk when a woman is present. Most women have ideas of when they might conceive and assume it will happen for them just as it appears to have easily happened for nearly everyone else around them.
When a woman who desires to have children is diagnosed with infertility, the dream she had of being a mother is shattered. She is suddenly faced with the realization that she is different from women who have conceived and grieves the loss of a dream. Despite all of her other important life roles and accomplishments, she must now figure out how to redefine who she is through the process of coping with infertility.
If she is in a relationship, she and her life partner experience a life crisis that is often suffered in silence. Infertility is an infrequent topic of discussion for a number of reasons, including its relationship to sexual intimacy, the level of conflict it can cause between relationship partners, potentially emotionally dismissive responses received from family and friends, and the feelings of personal failure a couple may have related to their diagnosis. If a couple is facing infertility, they are tested on nearly every level of their relationship—medically, financially, sexually, spiritually, socially, and interpersonally.
When couples are trying to handle the onslaught of the grief from infertility, a woman may decide to contact a mental health professional in order to get relief from the emotional pain she is experiencing. Frequently, romantic partners are present at these visits as well because they are struggling with how to “be there and fix it” as well as silently managing their own personal grief.
As a psychologist specializing in reproductive health issues, I am often asked how counseling will be helpful in reducing the distress and stress of infertility. I feel a great deal of empathy for any couple or individual experiencing infertility because of my own personal experience with it. However, even more than providing a couple with empathy, the goal of counseling is to provide individuals and couples with coping skills and education about handling the minefield of emotions that accompany infertility.
It is important to focus on educating partners on how individuals often grieve differently. It is not uncommon for one partner to have a strong desire to openly discuss emotions as a coping mechanism, while the other partner may prefer to avoid discussing emotions by changing the subject or asking not to have these discussions. These different coping skills can become a source of conflict for the couple. As a result, counseling can help them appreciate both styles of coping so both partners can get their needs met. It is also important to have a balance between being able to discuss emotions and being able to do other activities that allow a break so they are not so overwhelmed. Counseling interventions help a couple learn to express their needs and feelings in such a way so that neither person feels attacked; so they can better empathize with one another. Finally, couples struggling with infertility may have difficulty with sexual intimacy because of the feelings of failure and pressure related to conception. Counseling can provide ways for the couple to still maintain the gift of intimacy as a way of showing love, even during the turmoil of infertility.
Another area where counseling can help an individual or a couple is in decision-making about treatment options. Common areas for discussion include how many treatment cycles they will attempt to have a child, how much of a financial and emotional commitment they will make to the process, and whether a couple or individual plans to continue with treatment, work with a donor or gestational carrier, adopt or remain child-free. The goal of the infertility counselor is to provide the couple with resources to help make these decisions. Resources used include websites, support groups, books, and articles.
If a woman is presenting for infertility counseling as an individual, self-care techniques such as mind-body exercises to cope with the stress, anxiety, and depression that can accompany infertility are often discussed. Individual therapy sessions can be helpful by addressing a woman’s concerns surrounding social events such as managing emotions when she is around pregnant women and children and whether to attend a baby shower or an event that is child-centered. Counseling can also address setting boundaries with how much or how little she wishes to share about her fertility treatments with extended family, friends, and acquaintances. Finally, if she struggles with communicating with the medical team involved in her treatment, counseling can help empower her to ask for what she needs and help her determine which questions she would like to ask prior to a doctor’s visit.
Counseling can greatly improve the lives of individuals and couples struggling with infertility in a number of ways. Infertility is a major life crisis that is often unrecognized. Taking care of emotional health is as important as taking care of physical health during the process. When searching for a mental health professional to help in coping with infertility, The American Society of Reproductive Medicine (ASRM) and Resolve are both excellent referral sources.