Expert's Perspective

Sex & Infertility: How to Reconnect Sexually During Infertility

When Lindsey and Gary first were married, they were afraid she would “accidentally” get pregnant before they were ready. They always used birth control because they assumed the moment they got off birth control, Lindsey would conceive. They had the timing planned perfectly: they were both in graduate school and wanted to get their careers on track before they started a family. Gary and Lindsey had a healthy and exciting sex life. Once they felt the timing was right, they were elated for Lindsey to go off birth control and start trying to conceive. They made sexy jokes about how much fun trying to conceive would be. They would send each other provocative texts during the day when Lindsey was ovulating and they would romantically and physically connect when the day was over. After they made love, they’d hold each other and dream about their baby-to- be.

Three years and two miscarriages, four IUIs, two IVFs, tens of thousands of dollars and several surgeries later, there was still no baby. In addition to their empty arms, their sex life was in crisis.

Anyone who has had trouble conceiving knows that infertility can impact relationships. As a couple’s therapist, I see infertility couples in a desperate place.

Infertility is often the first major crisis a couple goes through together. While both partners are impacted, they often deal with the grief of infertility in different ways. Added to the grief is the fact that infertility treatment is expensive and couples often have conflicting relationships to money. All of this drives disconnection. Any disconnection in a relationship will impact its sex life.

Often the worst casualty of infertility is the feelings of failure. Sex will often take a turn from hope and connection to a reminder of failure. Once fears of failure or inadequacy enter a relationship, it will drive further disconnection. This will often rupture the secure attachment between partners and the security of the relationship will weaken. Fears of abandonment may even emerge.

A Stanford study documented the extent to which infertility negatively impacts women’s sex lives. The study found that forty percent of infertile women suffered from sexual problems that caused them emotional distress compared with the twenty-five percent in the control group of non-infertile women.

While infertility often brings increased depression, anxiety and negative self -esteem, few people talk about how it impacts sexuality. In fact, once infertile, if you want to get pregnant you can’t stay in the privacy of your bedroom—reproduction becomes sterile and clinical. What was supposed to be an intimate and private experience between partners now involves doctors, nurses, embryologists and genetic counselors. The intimacy of procreation is now shared with many people at the infertility clinic.

All spontaneity is taken out of sex and couples are often told when they can and cannot have sex. Sex was once a time for a couple to connect and blissfully escape from the troubles around them. It now becomes a painful reminder of the troubles within them. One woman told me, “I have been penetrated by the ultrasound wand way more than with my husband in the past two years! And we may as well take a billboard out for the whole city to know when I’m ovulating.”

Women who have a history of sexual abuse or trauma are often re-traumatized by the invasive nature of infertility treatment. They often disconnect from their bodies during procedures and simply “get through” the treatments while holding on to the ultimate hope of conception. Unfortunately, one cannot selectively “shut down.” Along with disconnecting from their bodies during infertility treatment, women may shut down the sexual side of themselves.

Even women who do not have a history of sexual trauma may experience trauma from the actual infertility treatments. Your body becomes the focus of scrutiny and many women start to feel shame toward their bodies. They may experience weight gain or side effects that leave them feeling “less sexy.” This compounds the feelings of low self-esteem, which will also impact sexuality.

Sex on demand is often stressful for men. It could impact performance. One man told me, ”I never think she wants to have sex with me for me. I think I’m just a sperm machine. Sex has become a means to an end.” Approximately a third of infertility is a result of male factor. While infertility is often a forbidden topic for women, sperm issues are often even more shameful and secretive. When a new dad announces a pregnancy, his male friends will often high-five him and comment, “your boys can swim.”

It may seem that since heterosexual couples can only conceive through sex, that it would impact them more than single men and women or same sex partners. However, being able to reproduce is at the core of many people’s view of their femininity or masculinity. These feelings of failure and negative views of one’s sexual self is pervasive to all who suffer from infertility.

Many years ago, a popular parenting magazine asked to interview me on an article they were writing called, “How to have fun while conceiving.” I went into my therapeutic stance citing all of the statistics of how hard it can be for couples sexually during infertility. I shared all of the challenges that infertility can bring in the bedroom. The young journalist pleaded with me, “But I want my readers to make fertility fun. What are some cool sex positions or creative sexy ideas to make conception exciting?”

Sure, I understood what the author was after. Unfortunately, I had seen too many people lose all sexual identity during infertility; it was hard for me to give the author what she wanted. Trying to conceive can often start out fun, however, infertility simply is not. I realized that as human beings, we are sexual beings and it is imperative that we don’t trade our sexuality for our fertility.

How to we get through infertility and find a connection to our sexual selves and our partners while going through infertility?

Throughout my years as a couples and infertility specialist, I have found the following to be helpful:

  • Don't wait to address sex until after you have resolved your infertility.  People will often tell me that only after they get pregnant and have completed their families, they plan on working on improving their sex lives. This never works. While your sex life may be different during infertility, it does not have to be nonexistent or unsatisfying.

    Consider having sex outside of your "fertile" times to take the pressure off of conception.  Avoid only having sex on a schedule. Many couples have told me that once they start infertility treatment, they are relieved to separate sex from conception. Sex can return to being solely for pleasure and connection.

  • Familiarize yourself with common challenges that couples face with sex and infertility. Sex is such a private topic so many people don’t talk about it. Of course, it is obvious that infertility could impact sex. However, I find that it is helpful to know that you are not alone in this. Also, since infertility treatment impacts such vulnerable parts of ourselves, it is helpful to educate ourselves on what aspects of our lives might be impacted. For example, I had a couple plan an anniversary trip away after an IVF retrieval. She was devastated when her RE told her that she could not have intercourse or even orgasm for two weeks after the retrieval. When we are able to normalize ANY issue we are facing, we feel less shame. Shame keeps us small and frozen and less able to be proactive to make changes in our life. Joining a support group, online groups, or reading articles can help normalize the impact that infertility has on sex.

  • Increase sensuality and spirituality in your relationship.  Consider a couple's retreat or spend a weekend at a romantic destination. Take sex off of the table if you are not ready. Cuddle, massage, and hold hands. Remove fertility books, injections, medications, thermometers, and note pads, ovulation kits from the bedroom. Take the pressure off of intercourse by expanding your sexual relationship to increased foreplay, erotic touch, role plays (find ways to be sexual with one another without even the possibility of getting pregnant)

  • Have an agreement with how much you will share with your friends about your sex life.  While it is important to get support, it can be vulnerable and exposing to your spouse if you share details about your sex life without their consent.

  • Let go of expectations. There is no right number of times for a couple to have sex. Nor is there one right way. Let go of comparing your sex life to earlier years and open yourselves to sexually connecting in new ways as your relationship evolves.

  • Consider seeing a therapist. People may be reluctant to add yet another person into their sex life after doctors, etc., however it is important to address all aspects of infertility. Many people are only willing to treat the medical side of infertility. Therapists that specialize in infertility, sex, and couples therapy could help guide and support you through the isolation and despair that infertility can bring. The couples that I treat at the beginning of their infertility treatment fare much better in their relationships compared with the couples who crawl into my office after years of grueling infertility with no psychosocial support.

While infertility can be quite traumatic, it can also offer an opportunity for couples. Since infertility is often the first crisis the couple face together, how the couple reaches for one another during this time of crisis can set a tone for the future of the relationship.

While it may be hard to share our deepest and most vulnerable fears of inadequacy and failure, if we can move toward sharing these fears in meaningful ways, it could actually strengthen the couples bond in the long run. Nothing connects a couple more than feeling met and understood during dark times. I find that couples that are willing to share their most vulnerable and scary feelings around infertility are able to secure their emotional bond. When there is a secure bond within the couple, a new and even more connected sexual connection could emerge.

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