Most couples know that infertility treatment will take a toll on them physically and emotionally—but many are unprepared for the effect it has on their sexual intimacy. The hyper-focus on fertility can considerably impair desire and arousal in women and can prompt sexual dysfunction in men. The following stressors explain why:
Spontaneity is gone. During infertility treatment, desire is no longer the main reason for love making. Instead, clocks, thermometers, medications, ultrasounds, and tests govern the best time to have sex. Infertile couples have sex to maximize fertility when ovulating and increase sperm counts, and they do it in positions that better facilitate sperm to egg movement. While this amount of planning may be necessary to increase the odds of conceiving, it takes a toll: 45 percent of couples struggling with infertility treatment report that sex "by the clock" is stressful. Sex on demand can cause men to develop erectile dysfunction and premature ejaculation. Women frequently lose desire and have sex without arousal simply to time it correctly.
Medicalization of sex. Couples suffer intimate invasions of their bodies, genitals, and even the details of their sex life. Their sexual organs are tested and evaluated for functioning, often with procedures that hurt or border on humiliation. Hormonal medications that increase ovulation, change the acidity of the vagina, or build the uterine lining often create mood swings that lower desire. At some point in this medical process, the body starts to get viewed mechanically, as functional or not, and sexual intercourse is only "good" if a product results from it—a pregnancy. The process of helping a couple create a child, ironically, can be dehumanizing.
Changes in sexual definitions of the self. Research shows that women in infertility treatment often view themselves as more feminine if they ovulate in a month, but less feminine on months without an egg release. Men can begin to feel less confident about themselves sexually if they are unable to create a child through sexual intercourse, regardless of whether it is due to their sperm count or not. Often when pregnancy results without sexual intercourse but through interventions like intrauterine fertilization or in vitro fertilization and implantation, couples may view themselves as having failed sexually.
How to recover sexual intimacy during and after infertility treatment
Acknowledge the crisis. Infertility usually happens within a young marriage or partnership and is often the first unexpected test of the strength of their joint coping skills. Sexuality and emotional connection are intrinsically inseparable. The couple has to accept that their path to pregnancy will be complicated and more mechanical than they might have hoped for, giving each other permission to talk about it and express their disappointment without false reassurances from the other in order to stay connected.
Guard the union against further intrusion. Couples might need to shield one other from hurtful comments or judgment from their families. Likewise, well-meaning people often make incredibly naïve remarks like, “As soon as you stop trying, you’ll probably get pregnant.” Be selective about who to reveal your plans to as you form your support system. It’s hard enough to endure month after month with no pregnancy, let alone if you have to report to an audience that is also wondering about the outcome of your sex life.
Separate intimate sex from baby-making. If you can, reserve your bed as the place to try to get pregnant, and make love for fun on the couch, on a rug in front of the fireplace, or book a hotel room—anything more creative that relieves you of the “have-to" sex. Try to have one pleasuring experience a month as a time to talk, touch, reconnect, and reassure each other of your love and desire without the pressure of an outcome.
Share your feelings. Don’t try to be strong for your partner. Be open about the worries in your head and ask about your partner’s fears. Couples that fall into a cycle of communication with one partner complaining or criticizing and the other defending or withdrawing are at risk for derailing both sex and their relationship. You may want to seek therapy to help become clearer communicators during this stressful season.