Am I crazy or is this the most stressful thing I’ve been through?

The emotional experience of infertility

"Since we have been dealing with infertility, my emotions have been a total roller coaster. I go from peaks of optimism to pits of despair. My husband tells me that I am obsessed with my quest for a baby, my friends don't know how to help me, and I feel isolated, unbalanced, and unhappy".

For many individuals, particularly women, infertility presents an acute source of stress, which often leads to an unexpected emotional crisis. Infertility affects people when they go to the mall and see pregnant women, when they watch a commercial about a parent and a baby, when they listen to a song, when they hear that their closest friends are expecting, when they get ready for a holiday. Infertility often makes people feel isolated from their spouses, from their families, from their friends and co-workers. At times it makes them feel as if they’re isolated from the entire fertile society.

What makes infertility such a stressful experience? The answer may lie in the fact that, almost invariably, a diagnosis of infertility disrupts the normal life course of the individual and the couple. The turmoil that infertility creates often affects every domain of a person's life, from the intimate and personal to the public and societal. The realms that the experience of infertility influences most frequently include one’s emotions; one’s feelings of control; one’s self-esteem; one’s marital relationship and one’s social interactions.

A. Emotional Responses

The most frequent emotional response to infertility involves five recurrent themes: (1) grief and depression, (2) anger, (3) guilt, (4) shock or denial, and (5) anxiety. Often, these emotions combine to create a sequence of reactions that begin with surprise and shock; typically followed by denial; anger and isolation; guilt; grief and depression; and, finally, acceptance and resolution.

Because infertility involves complex and simultaneous losses, sadness and depression comprise the most common response to receiving a diagnosis of infertility. Infertile couples may lose the opportunity for a successful pregnancy experience; they may lose the experience of giving birth to a biological child, of breast-feeding, and of parenting. They may lose the experience of genetic continuity, of biological heritage, and of moving to the next stage in their life cycle. They also may lose some of the ease of casual relationships with acquaintances, friends, family members, and, at times, with each other. As a result of these actual or potential losses, couples often experience grief. This grief is exacerbated by the intangible nature of the loss: in most cases couples mourn a child that they have not yet conceived. Furthermore, society provides no recognized rituals, such as a funeral, for acknowledging these feelings of grief or for providing closure. Also, because it takes time to establish the cause and, consequently, to predict the outcome of infertility, couples vacillate between grieving their infertility and continuing to hope that a pregnancy will still occur. All these elements intensify the pain and make the loss more difficult to endure.

In addition to grief, many studies described anger as an equally common reaction to infertility. The intensity of the anger ranges from frustration and resentment in some people to bitterness and rage in others. At times, acquaintances of the infertile couple incite these feelings through insensitive remarks, teasing, and pressure on the couple to reproduce. At other times, the anger is unprovoked and reflects the feeling that infertility is unfair and unjust. Frequently, infertile individuals do not know where to aim their anger and, therefore, may direct it towards themselves, their spouses, their families or friends, the medical establishment, pregnant women, couples with children, society, or God.

Another typical reaction to infertility consists of feelings of guilt and self-blame. Perhaps in an attempt to regain a sense of control over their lives, infertile people often try to find a cause for their problems in past history. As a result, some people experience guilt about prior sexual practices (e.g., premarital sex, extramarital affairs, sexually transmitted diseases, masturbation); about contraceptive methods (e.g., use of birth control, abortion, a child they gave up for adoption) or about delaying the decision to have children. Others experience guilt with no specific source or blame themselves for unrelated past offenses and see the infertility as punishment for those transgressions.

Infertile men and women frequently experience anxiety, worry, and anguish. These apprehensions may revolve around the success of the medical treatments or around the pregnancy tests, but they often also focus on such concerns as body image, sexual adequacy, or the marital relationship. Couples frequently go through numerous cycles of anxiety and anticipation around ovulation time, followed by disappointment or depression after no pregnancy occurs.

B. Loss of Control

There are two distinguishable types of loss of control experienced by infertile people. The first concerns control over one's present life. The second involves control of one’s future: the ability to predict or plan the future and the capability of meeting life goals.

The feeling of loss of control over present life circumstances can take many forms. For instance, men and women experience a lack of control over their reproductive capacities. They experience a lack of control over their daily activities, bodily functions, and emotions. Also, despite the enormous price they pay in terms of time, persistence, commitment to a schedule, and sacrifice to self and relationship infertile people often realize that they cannot attain what others seem to achieve so effortlessly. This realization often results in the feeling that, no matter what one does one doesn’t have any control over one’s circumstances.

Many infertile people report that they feel like they have lost control over their future as well. Infertility interferes with many immediate or long-range life decisions that are tied to having a child, such as moving, returning to school or making career changes. Infertility treatment may disrupt both men's and women's career progress, for example by delaying relocations or promotions. Women in particular, experience a loss of control as infertility often disrupts their initial plans to time pregnancy at the appropriate phase of their career. Couples may also become insecure about their financial future, given the burdensome costs of repeated medical appointments, operations, and medications, as well as the lost time from work. On a deeper level, couples frequently experience a loss of belief in the fairness of life, a loss of meaning, and often, of spiritual faith. For them infertility brings about a radical change in their belief that they can control their life goals, and in the basic predictability of the future.

C. Effects on Self-Esteem

The emotional turmoil and the loss of control associated with infertility may generate feelings of failure and inadequacy. Infertile individuals perceive their inability to reproduce as evidence of their impairment. They describe feeling "hollow" and "defective". They feel a loss of status and prestige, and the stigma that our society places on childlessness mirrors the couple's own shame about their inability to parent a child.

In addition to damaging self-esteem, extended infertility may injure a person's sense of self as a sexual being and diminish their sense of femininity or masculinity. For instance, infertile women tend to feel less womanly than fertile women and they tend to describe their lives as less interesting, less rewarding, emptier, and lonelier than the lives of fertile women.

D. Effects on Marital Life

The impact on marital relationships can take several forms. First, feelings of marital dissatisfaction can fester. Couples experience a loss of a basic common dream and find themselves in need to reassess their life-goals and visions as a pair. Some people report increased anger and hostility toward their partner, a sense of blame toward their spouse, a feeling that their spouse blames them, a lack of understanding and emotional support, or a fear that one's spouse has not equally committed to having children.

Second, infertility can create anxiety about the status of the relationship. For instance, if one spouse is diagnosed as the source of the problem, that person may fear that he or she "caused" the infertility and may feel guilty about depriving the other of parenthood. He or she may fear being abandoned and at times may even try to break up the relationship and offer their spouse the "freedom" to parent with someone else.

Third, infertility can bring up conflicting needs within the couple. Some individuals feel unable to disclose their feelings to their spouse, a fact that creates a mutual sense of isolation. Men and women may have different needs regarding the expression of their emotions, as well as different needs for privacy. While one spouse may wish to cope through emotional expressiveness, the other may prefer total secrecy and may feel betrayed by the person who turns outside for help. In other cases, each partner may experience the infertility and its treatment quite differently than the other, or prefer a different type of resolution to the infertility crisis, and, as a result, experience a sense of disharmony or conflict.

Sexually, infertility produces mostly negative effects. Many individuals report a loss of sexual desire, pleasure, and spontaneity. Intercourse often ceases to express affection and closeness when one stops "making love" and instead starts "making babies." Frequently, the medical tests and procedures impair a couple's sexual functioning and create a sense of sexual inadequacy for both partners, resulting in reduced capacity for orgasm for the woman and in episodic impotence for the man.

Yet, infertility does not always affect marital relationships only in negative ways. Many individuals do feel increased intimacy, love, and support from their spouse. For some couples, the strain of infertility provides an opportunity to become closer, leading to mutual encouragement during a period of adversity and for some, it increases the ability to handle conflict and develop healthy communication.

E. Effects on Social Life

Infertility often influences relationships and creates difficulties in interactions with friends, family, and the couple's larger social network One such difficulty involves feelings of deprivation, jealousy, envy, and resentment toward fertile people. The exposure to a fertile society (particularly on occasions such as young children's birthdays, baby showers, or Mother's Day/Father's Day) reminds couples of what they may never have. As a result, family, social, or even work-related outings often become painful reminders for infertile couples of the ways in which they do not belong in the “fertile club”.

A second type of difficulty in social interaction involves feeling socially unworthy and isolated. The unspoken social stigma on childlessness may cause couples to experience real or imagined pressures from friends, families, acquaintances, and even strangers. Other pressures might stem from attitudes that family and friends hold about what constitutes an acceptable solution for infertility. Some people are strongly opposed to the use of such medical treatments as in-vitro fertilization and assisted reproduction techniques, while others may underestimate the seriousness of the situation and offer simple solutions to a complex problem. As a result, couples may become reluctant to reveal their infertility to family members and friends. They may withdraw even further in the hope of avoiding embarrassment, pity, or unsolicited advice. However, this withdrawal not only increases feelings of inferiority and low self-esteem, but it also prevents the couple from receiving any form of emotional support, thus exacerbating the painful loneliness of infertility.

When considering how deeply infertility can affect a person, it is no wonder that many infertile people indeed feel like this is one of the most difficult experiences that they have encountered in their entire lives. Infertility, as we saw, can affect almost every area of life: marriage, work, spirituality, the ways infertile individuals relate to the people around them, their relationships with themselves, with their bodies, with their sexuality. It is very common, when experiencing infertility, to feel alone, isolated and misunderstood.