People decide whether or not they want children well in advance of marriage. People that want children tend to make sure that a potential spouse also wants children. Biological versus adopted may be a discussion point, but most couples only ever discuss having “biological” children. The underlying assumption is that both people are physically able to have children.
Most never consider the possibility of infertility and definitely don’t have their reproductive health checked prior to marriage. So when the infertility bomb is dropped, marriages often crumble. The news is devastating for both parties. The infertile spouse may experience feelings of failure, inadequacy, shame, despair, grief, and anger. The other partner may experience feelings of helplessness, anxiety, confusion, frustration, and grief. A common outcome is increased arguments and withdrawal from one another. This tends to lead to decreased marital satisfaction.
According to Domar, Zuttermeister, and Friedman (1991), the psychological distress associated with infertility is similar to the distress that results from a life-threatening illness such as cancer or heart disease. The distress is housed in the union so it’s no wonder that the marriage struggles.
Many couples who receive this diagnosis often engage in infertility treatments. These treatments can be invasive and stressful in and of themselves. If no pregnancy results, further stress can result. First line interventions typically include taking Fertility Drugs such as Clomid, which increases ovulation. Intrauterine insemination (IUI) is another option. IUI involves placing the sperm directly a women's uterus and injecting her with a medication to force ovulation.
Another common type of intervention is In Vitro Fertilization (IVF). Success rates for IVF go down as women increase in age (41-43% for women under age 35; 33-36% for women ages 35 to 37; 23-27% for women ages 38 to 40; and 13-18% for women ages over 40). Other types of infertility interventions include Surgery, Intracytoplasmic Sperm Injection (ICSI), and Gamete Intrafallopian Transfer (GIFT). Zygote Intrafallopian Transfer (ZIFT) and Donor Eggs and Embryos are also options.
Undergoing infertility treatment often increases the women's physical discomfort and is stressful for both partners. Studies have shown that infertile women report higher levels of stress and anxiety than fertile women. Similarly, women that are infertile are more likely to become depressed.
Infertility has also been shown to be a predictor of divorce. A study was conducted by Kjaer and colleagues published in 2013 evaluated Danish women with fertility problems. They found that women who did not become pregnant were three times more likely to divorce, or end cohabitation, during the first 12 years following an initial evaluation of infertility than those that did become pregnant. Divorce is an additional stressor.
In 1967, Holmes and Rahe (Psychiatrists) were researching the link between stress and illness. They developed a Stress Scale of 41 possible life events with subsequent "life changing units." This scale indicates how the experience of stressors can increase your risk of illness. According to this scale, divorce is the second most stressful life event, with the first being death of a spouse. Divorce is extremely stressful and is a symbolic death. A diagnosis of infertility, then undergoing infertility treatment, and an ultimate divorce added together can feel impossible.
Many people will face infertility. The research shows that about 6% of women and approximately 4.5% of men in the United States are infertile. Infertility of couples around the globe has been estimated at 15% of couples. Epidemiological reports indicated that 50% of all infertility cases are solely due to female factors, 20-30% solely due to male factors, and 20-30% due to a combination of female and male factors. Accessing a support system, self-care, and seeking therapy are highly recommended.
By Delicia Mclean, Ph.D., MHA