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Section 7
Considerations in Infertility

Question 7 | Test | Table of Contents

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In the last section, we discussed a therapeutic approach to mobilization.  This included externalizing the infertility, eliciting the story, evoking the future and curtailing the shame.

In this section, we will discuss couple issues in early and middle immersion phase.  This will include the roller coaster of hope and despair, loss of innocence, miscarriages and secrecy and protection.  In the next section, we will discuss a therapeutic approach to consider in the early and middle immersion phase. 

In the immersion phase, couples may become increasingly absorbed in the world of medical treatment.  Relatively simple, inexpensive procedures give way to more complicated, costly treatments.  A couple’s decision to proceed may be propelled not only by the wish to have a child, but also by the desire to avoid the pain of loss that is implicit in the termination of the treatment. 

Consequently, some couples may undertake more invasive and financially burdensome procedures than they would otherwise.  The social isolation seen in mobilization becomes more pronounced, and the infertile identity takes a firm hold, driving out other interests and activities in the couple’s life.  The alternating cycle of hope, with each new protocol, and despair, with each treatment failure, can create tremendous distress, and the couple relationship is subjected to acute pressures.

At the start of immersion, few realize how long their journey may last or how much distress they may encounter.

4 Issues Encountered in Early & Middle Immersion

♦ #1 The Roller Coater of Hope and Despair
First, nearly every couple who struggles with infertility describes the roller coaster of emotion that they undergo.  The promise of a new treatment technique or a consultation with a different physician may mitigate their hopelessness about having a baby, and even though a treatment trial has failed, the next one might succeed.  The oscillations between hope and despair are so constant that many couples use the metaphor or a roller coaster to describe the radical shifts in their emotional state.  One day their hopes soar, another day they are overcome with despair.

Gabrielle, age 37, stated, "Neither my husband, Ken, nor I can ever be sure how we’re going to feel the next minute…Sometimes my mood changes suddenly without warning, with or without the hormones, and sometimes it’s the direct result of finding out bad news!"

After experiencing several ups and downs on the roller coaster, couples often try to keep painful disappointments in check by lowering their expectations.  Ken, age 40, stated, "We’re trying to keep our hopes real small, just in case it doesn’t work.  We don’t want to set ourselves up for another crash like last time."  However, every baby they see is a reminder of their desired goal, and each new procedure raises the hope that this may be the ones that finally achieves that goal.

♦ #2 Loss of Innocence
Second, couples who face infertility often experience a loss of innocence, or a loss of the sense that the world is a safe and just place, and that life is basically good.  During immersion, these feelings are usually most pronounced.  Gabrielle’s husband, Ken, age 39, stated, "A few months ago, we realized we reached a point of no return.  Even if we have a baby, we’ve passed the place where we can just get back to our lives as they were before."  Gabrielle stated, "Life has taken on a sadness and a seriousness that I know will last even if we succeed at having a baby…I feel like we lost our innocence."

♦ #3 Miscarriages
Third, in addition to the roller coaster of hope and despair and a loss of innocence, let’s discuss miscarriages.  The miscarriage rate for all pregnancies is 20-25%.  Couples who have struggled with infertility may not only have especially strong feelings and fantasies regarding the developing life, but if a miscarriage or stillbirth occurs, their grief may be amplified because they know how difficult it will be to get pregnant again. 

Unfortunately, our culture offers few mourning rituals for couples grappling with repeated miscarriages, which has been termed the "forgotten grief."  After a miscarriage, the grief can be overwhelming.  Many who thought they were keeping their feelings in check are often surprised at how deeply they experience their loss.  Some hospitals compound the grief by placing a woman who has miscarried on a maternity ward, which is especially agonizing for infertility patients.

Gabrielle stated, "I was put in a room with another woman who miscarried too.  She already had a child.  She was upset but kept saying, ‘I’m going to get pregnant right away, and I hope to be back here in a year to have my baby.’  I couldn’t comfort myself that way….When I could go home, I walked down the hall and saw the nursery.  I didn’t feel like ‘Next time it’s my turn.’  I felt that from now on, I’d probably be staring through the glass at other people’s babies.  Giving me a taste of pregnancy was a terrible trick nature played!  I wonder if I’d be better off if it never happened."

♦ #4 Secrecy and Protection
Fourth, in addition to miscarriages, let’s discuss secrecy and protection.  By introducing a climate of secrecy and withholding, the dynamic of protection, when partners conceal negative emotions and thoughts in an effort to protect each other, can put a strain on the couple’s communication.  Because couples tend to be optimistic and action-oriented in early immersion, there may also be a tendency to set disturbing feelings aside so that medical testing and treatment can progress.

An imbalance in medical involvement is typical of the immersion phase.  For example, Ken, unlike Gabrielle, was spared most of the medical procedures.  Therefore, Ken was subjected to less physical discomfort and pain, he was not subject to hormone-induced mood swings, and fewer limitations were placed on his travels and career as a salesman. 

The differences between Gabrielle and Ken produced difficulties within their relationship.  Gabrielle resented Ken because he was spared so much of the ordeal.  Ken, on the other hand, felt guilty for being spared.  When their feelings remained unexpressed, tensions and rifts developed between Ken and Gabrielle.

Partners like Ken and Gabrielle may have difficulty talking together about their losses.  Sorting out one’s own feelings can be difficult enough without having to express them to a partner who is already suffering.  When couples stifle these powerful thoughts and feelings, they tend to withdraw from each other.  The protection dynamic may then backfire as censored thoughts tend to magnify when unexpressed.

Another dynamic at play between the carrier and non-carrier of infertility is that the carrier often feels less physically attractive and less masculine or feminine.  It is especially difficult to deal with this diminished sense of oneself as a sexual being when carriers sense that their partners’ sexual attraction has lessened.  Ken stated, "I feel really terrible about this…I love Gabrielle, but the fact that she can’t get pregnancy makes me find her less sexy."

When the reason for the infertility is interactive, one partner, typically the woman, may feel more at fault, or partners may blame each other in an effort to avoid taking on the infertile identity.

During immersion, many people try to erect protective emotional barriers in order to shield themselves from embarrassment, loss of privacy, physical distress, repeated disappointments, and the insensitive remarks of others. 

In this section, we have discussed couple issues in early and middle immersion phase.  This has included the roller coaster of hope and despair, loss of innocence, miscarriages and secrecy and protection.

In the next section, we will discuss a therapeutic approach to early and middle immersion.  This will include separate sessions, using metaphors, tracking losses and the "mourning a miscarriage" technique.
Reviewed 2023

Peer-Reviewed Journal Article References:
Casu, G., Zaia, V., Fernandes Martins, M. d. C., Parente Barbosa, C., & Gremigni, P. (2019). A dyadic mediation study on social support, coping, and stress among couples starting fertility treatment. Journal of Family Psychology, 33(3), 315–326. 

Chazan, L., & Kushnir, T. (2019). Losses and gains of psychosocial resources: Effects on stress among women undergoing infertility treatments and participating in social network systems. Psychiatric Quarterly, 90(4), 717–732.

Crespi, B., & Dinsdale, N. L. (2021). The sexual selection of endometriosis. Evolutionary Behavioral Sciences. Advance online publication.

Darwiche, J., Favez, N., Maillard, F., Germond, M., Guex, P., Despland, J.-N., & de Roten, Y. (2013). Couples’ resolution of an infertility diagnosis before undergoing in vitro fertilization. Swiss Journal of Psychology, 72(2), 91–102. 

Flykt, M., Lindblom, J., Punamäki, R.-L., Poikkeus, P., Repokari, L., Unkila-Kallio, L., Vilska, S., Sinkkonen, J., Tiitinen, A., Almqvist, F., & Tulppala, M. (2011). Prenatal expectations in transition to parenthood: Former infertility and family dynamic considerations. Couple and Family Psychology: Research and Practice, 1(S), 31–44.

Galst, J. P. (2018). The elusive connection between stress and infertility: A research review with clinical implications. Journal of Psychotherapy Integration, 28(1), 1–13.

QUESTION 7
What are four issues that couples often face during the early and middle immersion phases? To select and enter your answer go to Test.

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