People who are experiencing infertility sometimes find this difficult to talk about. This article is intended to help you understand some of the medical and emotional issues arising from this sensitive area in reproductive health. It will help you to talk about infertility problems and suggest some ways of addressing the infertility information out there with friends and relatives.

Medical facts

Definition

A couple is regarded as having fertility problems when they have not conceived after 12 months of regular, unprotected sexual intercourse.

About 15% of Australian couples of reproductive age have a fertility problem. Find that hard to believe? That’s because most people don’t talk about it.

Male and female infertility: infertility is not just a female problem

For many years it was believed that female infertility was always the problem, as there was little research about infertility. Guilt and false beliefs around fertility and sexual performance and satisfaction have made it even harder to seek help or get an infertility diagnosis.

The latest research shows that the male partner is responsible for approximately the same number of infertility cases as the female. In about 40% of infertile couples, male infertility is the cause; in another 40% of cases the fault is in the female reproductive system. For the remaining 20%, it is either a joint problem or the cause is unknown (‘idiopathic’).

When a couple experiences problems conceiving, finding out the cause and fixing the problem should be the most important issues, regardless of in which body the problem lies.

The causes of infertility are many and varied

Some common causes are:

Problems with the eggs or problems that affect sperm production
Problems with the uterus and fallopian tubes. From a pelvic infection to blocked fallopian tubes, the causes of physical female infertility are varied

Sexually transmitted infections. Some STIs can cause infertility and couples are not aware of the damage until they fail to conceive. Chlamydia, for example, is a completely asymptomatic sexually transmitted infection that damages the fallopian tubes silently
Endometriosis. This is when the endometrium grows outside of the inner lining of the uterus. Endometriosis causes very painful periodsRead more about endometriosis in Endometriosis Stages | 4 Critical Stages
Recurrent miscarriages. If a woman has repeated miscarriages, infertility treatments might fail, as the problem isn’t getting pregnant but keeping the pregnancy. If this is your case investigations should be carried out to find out the cause
Poor sperm quality
Hormonal and autoimmune (antibody) disorders in both men and women
Environmental toxins, which might affect both female and male fertility.

Infertility treatment

Assisted reproductive technology is constantly improving and developing. Reproductive medicine advances fast and varied fertility treatments are making it possible for couples who struggle with infertility to become parents, with the use of different techniques.

Some common treatments are:

Medications to improve the production of eggs or to improve the number or quality of sperm (less common)
Surgery on the fallopian tubes to fix blockages. The American Society for Reproductive Medicine has done vast research in female and male infertility. Check their investigations into surgery on the fallopian tubes to improve fertility outcomes
Intrauterine insemination of the woman with donor sperm or sometimes with her partner’s sperm
In vitro fertilization (IVF) and related treatments, such as gamete intrafallopian transfer (GIFT). IVF has many variants; intracytoplasmic sperm injection is a common choice. When the woman’s eggs are not suitable for pregnancy, donor eggs are commonly used.Many times there are no physical problems in either member of the couple and the stress of not achieving pregnancy can be enough to prevent conception.Having been a fertility expert for many years, I can say this is much more common than you might think.Many couples who have an IVF fertility treatment conceive a second child naturally shortly after the first one is born, simply because the stress of achieving a pregnancy is finally gone and the body goes back to functioning as it should. Natural fertility treatments work very well for couples who don’t have physical fertility problems. We recommend this natural fertility course Natural Fertility.

Infertility information: emotional facts

Infertility is a very distressing and disabling life event. The loss of one’s fertility – the dream of a family – is akin to the loss, by death, of a loved one. The depression experienced by an infertile couple can linger for years.

For most people, having a family is part of the normal process of life: they go to school, grow up, get married, have children, spend years rearing them, retire and watch their grandchildren grow up. The loss of this dream is a devastating experience.

We live in a world in which most people fulfill the dream, so infertile people are constantly surrounded by images of children and families – a painful reminder of what they don’t have. Their friends and family members are often having babies at just the time when they are struggling with the realization that they cannot.

You might, at some time, need to tell your friends or family members about a pregnancy or a new baby – perhaps your own or that of someone close. You will probably feel awkward about it and they will, too. What can you do?

Don’t hide it or put it off for too long. Tell them in a sensitive way – not in front of a group of people, but perhaps when you are alone together, or by writing them a letter. Realize that the news will be upsetting for them, and they might react in a way that is strange or uncomfortable for you.

People sometimes feel their infertility is the ultimate loss of control

Infertility means losing control of your reproductive future. Infertile people often find themselves having to organize their bodies and their lives around a series of investigations and treatment cycles, predetermined by a clinic. They put their sex lives and genital organs under scrutiny, they are instructed when to have sex and when not to, and how and when to masturbate into a plastic jar.

They might have to submit to a government department investigation into their worthiness as parents (if they apply to adopt). Infertile people experience this as an awful loss of control. They sometimes become very angry and might take this anger out on the closest target, which might not always be an appropriate one.

People sometimes say that the emotional highs and lows experienced during their infertility are like being on a roller coaster

You know how a roller coaster goes – the higher it gets, the worse the fall is. Infertile people sometimes refer to their experience as this. They might feel themselves being carried away on a ‘high’ of optimism as they start treatment or a new course of action (eg. an adoption application).

They start to fantasize about prams and birthday parties. Then reality hits. They have another period or the treatment fails; perhaps the adoption social worker starts asking difficult questions. Their feelings are very fragile and they hit a ‘low’ with a big crash.

People deal with the emotional impact of their infertility in individual ways, although there are a few common themes:

Depression

It’s normal – and quite OK – for people to feel depressed about their fertility problems. It’s also normal for them to want to avoid contact with people at times.

Avoidance

Don’t be surprised or offended if certain friends or family members don’t want to spend time with you. If you have a young family or you’re pregnant, it might be just too painful for them to be confronted with your fertility. Maybe they just want time to be by themselves for a while.

Family times such as Christmas, Mother’s and Father’s Days, and christenings are particularly difficult times, as they are surrounded by everyone else’s families. They might feel obliged to attend though they feel very uncomfortable. However, don’t stop inviting them.

Leave the choice up to them. Let them know that you’d like to see them, but will understand if they don’t want to attend. They need to know that you care. They might eventually want to take up some of those invitations, so try not to cut them off, even if you haven’t seen them for some time.

Secrecy

Some people don’t reveal their infertility to anyone, even to close family members. Many choose to tell just a few close people. They might do this because they fear that people will believe the wrong things (eg. that they’re not ‘doing it right’), say the wrong things (eg. ‘Borrow my husband for a night – I only have to look at him and I’m pregnant!’) or put them on the spot about it.

Some simply believe it’s a very private thing, and no one else’s business to know. Others feel too vulnerable and sensitive about it to discuss it with anyone. You should respect your friends’ or relatives’ wishes regarding confidentiality.

What do you say to friends who are struggling with infertility?

Be there. There might be times when they don’t want to see you, but let them know that you’re around for when they do.

Listen. The most valuable gift you can give is your attention. Unfortunately, there is nothing you can say that will make them feel better, so try to refrain from giving advice or reassurance.

This might be difficult when you want to say something comforting. However, sometimes well-intentioned comments will make them feel worse – e.g. ‘I know just how you feel’ (when you don’t); ‘Well, at least you’re luckier than …’ (when they’re not feeling at all lucky); and ‘You shouldn’t feel like that’ (when they do, anyway). It is nice, however, if you know they’ve had bad news, to acknowledge it: a simple ‘I heard about your news and I’m really sorry’ can be incredibly comforting.

Sometimes infertile people are advised by friends or family to ‘just adopt’; they often find this advice very frustrating. Many have considered this option and find that very few children become available for adoption in this country.

Adoption is also a very difficult process, emotionally and financially. It is not as simple as ‘just adopt’.

Try not to judge. Your friends or family members might do things that you think are foolish, even irrational. For instance, they might decide to finish a course of treatment when they could have gone on for longer, or keep going when it seems obvious to you that it will never work.

They might adopt, rather than try IVF or DI. Infertility causes very intense feelings in people. Remember, you have not experienced these feelings.

Your friends might consider in vitro fertilization a terrible emotional strain, or they might decide they need to persist with an unsuccessful treatment in order to prove to themselves that they have tried everything. They might decide not to persist because of financial constraints or the effects of constant failure on their relationship.

Their feelings about their infertility might defy your understanding, so try not to judge. They are probably doing what is right for them.

If their grief or depression seems disabling over a long time, suggest they seek professional help. It’s normal for your infertile friends or family members to experience some depression and grief.

But if it appears to have gone on for a long time and is interfering with their day-to-day lives and relationships, suggest they seek the help of a professional counselor. The staff at the closest Fertility Unit will be able to suggest someone.

How do I talk to my family about infertility?

Be as honest and open as possible. Friends and family will try to comfort you but they need to be aware of what you’re going through.

Having a good support network can be of great help when going through infertility diagnosis and treatment.

Empathy goes a long way. Imagine your friend or your sister is struggling with infertility. Would you like to know as soon as possible or would you like them to tell you about their struggles once they’ve passed?

We tend to overthink when it comes to worrying our loved ones; sometimes, we don’t realize that’s what they’re there for. The moment you need a friend or a close family member, just tell them.

Your relationship can only grow stronger if you lean reciprocally into your loved ones when you need to.

How do you tell friends who have fertility problems that you’re pregnant?

Sometimes when you’re discussing fertility with loved ones who are struggling to become pregnant it might be easier to talk about advanced reproductive technologies, disease control and prevention or hypothetical health problems than it is to share your happy news with them.

Just say it. Tell them as naturally as you’d tell them if they weren’t attending infertility services. It sounds difficult but it’s the best way.

They will be happy for you. They will want to know and, yes, it might hurt but they aren’t hurt because you’re pregnant. They’re hurt because they can’t achieve pregnancy as easily as you can.

An open conversation about feelings can go a long way for both of you. You both need a good friend to be close when you’re going through something important, whether it’s becoming pregnant or navigating infertility.