The impact of infertility on your relationship

Mandy Rodrigues, MA
Clinical Psychologist, Mandy Rodrigues, Private Practice

Emotions and Support

The impact of infertility on your relationship #IVFWEBINAR
From this video you will find out:
  • studies on relationships and depression, anxiety, and PTSD
  • support of a psychologist before, during, and after the (un)successful IVF treatment
  • stages of acceptance of infertility
  • the stages after acceptance of infertility
  • The kubler-Ross cycle of loss vs. reality

How infertility impacts your relationship?

Mandy Rodrigues, a clinical psychologist, talks about the impact of infertility on your relationship and shows you ways in which you can handle the issues.

The main aspect to consider when thinking about infertility is that it is a relentless journey. We always need to have in mind that:

  • Infertility is known for inducing an emotional Rollercoaster.
  • Fertility treatments are known for the constant grief cycle patients undergo
  • Anticipating feelings of hope before commencing with invasive treatments

According to some studies presented during the event, before invasive treatment – 40% of patients had a psychiatric disorder. It was found in one of the studies that 40% of new patients presenting to infertility clinics have a psychiatric disorder diagnosed. This is always making them vulnerable & possibly compromising their IVG cycles going forward. This shows how important it is to manage couples psychologically during treatment and not to exclude the men.

During the treatment

Another study showed that 57% of women and 32% of men were presenting the clinical diagnosis of depression, while 76% of women and 60% of men were presenting anxiety symptoms. It’s important to remember that if these two psychiatric disorders are combined, there is a risk of developing major depressive disorder.  Another study reported that 31% of patients had a psychiatric diagnosis before starting treatment just by the fact of accepting infertility, even if they were not exposed to invasive treatments. These studies show the importance of managing patients before during and then beyond their fertility treatment

During ESHRE annual meeting in 2019, patient Jessica Hepburn, who underwent numerous unsuccessful treatments, mentioned that doctors need to understand they are leaving, at the very least, a scar and sometimes an open wound. She also mentioned psychological support should continue after the pregnancy as “it is not over when you get the double line “

Stages of acceptance of infertility

  • Surprise
    • Been trying to avoid pregnancy all my sexual life.
    • Still, the belief that fertility can be controlled and is due to circumstances
  • Action
    • Action & bargaining
    • Couples scrutinize their behaviour & habits to do everything to improve fertility
  • Irritation
    • Well-intentioned advice met with irritation
    • Fertility triggers start emerging
  • Anger
    • Life has treated me unfairly
    • Guilt, shame, and blame might start emerging
  • Acceptance
    • Acceptance of infertility
    • Seeking actions to remedy this

After going through 1 cycle of acceptance, many times another cycle of acceptance is started.  That is because some couples believe that everything is done correctly, they are not ready to look beyond the next step, their disillusionment sets in, and fertility triggers start emerging, after this blame, guilt, and helplessness start emerging. Although it might look organized and structured, the cycle is nothing but that. In real life, going through the cycle is characterized by ups and downs.

Marriage and infertility

Although it is proven that men and women communicate differently. If you are married, approach and continue approaching this together. It’s not the fertility treatment that causes the marriage problem, but how we manage the journey as a couple. Men are often optimistic and want scientific explanations of the process. Men are distressed more about the fact that their wives are struggling. They tend to battle more with the impact of infertility on their wives. Spouse begin to cope independently a they try to keep their own distress from each other. This just isolates each party more.

Relationship changes in infertility

A study was done on couples who could not conceive a baby and couples undergoing IVF. The results have shown that over the years, the risk of marriage has increased with the time passing when unable to conceive.

  • Coping as a team (first year)
  • Disillusioned but coping (2- 3 years)
  • Independent coping (4- 5 years)
  • Risk in marriage (beyond)

Another thing that is important to look at is shame, which is self-doubt – internalized, personalized, inability to share while guilt is feeling bad and blaming yourself/ others verbally, often emerging in conflict. It involves another person.

Educate yourself and implement action

  • Learn about your diagnosis
  • Make it predictable
  • It can relieve self-blame
  • Throw yourself back into your daily life, so infertility is not all-consuming
  • Remember, blaming yourself gives others the same narrative
  • It is what it is rather than“ it is my fault “
  • Take action

Further coping strategies

  • Use the action phase
  • Only good can come from you stopping smoking, managing diet, and managing stress
  • These lifestyle changes will help you with your fertility journey
  • Eating healthy can improve your time to pregnancy
- Questions and Answers

How many couples end up getting divorced after repeated failed IVFs and miscarriages?

I can’t give you statistics. If I look at my experience of over 27 years, there are not a lot of couples who end up getting divorced due to miscarriage or repeated failed IVF attempts, but it is how they cope with it afterwards. I guess it also depends on whether they are successful in the long run or not because it is often the failed IVF and the willingness of one partner to go then to the Knicks. That creates the marriage plot problem. It is dealing with the miscarriage differently that creates, the marriage problem. In the clinic that I work for, when there is a failed IVF or a miscarriage, the couple is immediately given a psychological session so we can debrief them, and say, okay what do we do as a couple now? What are the next steps of going forward in terms of the miscarriage? And you know, what, at the end of the day in my heart I’m saying if someone is going to leave you because of repeated failed IVF, or miscarriages I am not sure if they would have hung around with a person with depression or with challenges that happen once you’ve got a child. So I think it’s something we can avert by following up if there is something like a negative IVF or a miscarriage and have a look at it and ask: What are the next steps? What do we do as a couple? I think that’s important.

How would you go about helping a couple who are on different pages? For instance, the wife would like to continue treatment, and the husband doesn’t want to.

So like I said before, I see husbands initially before they embark on their fertility treatments., They often say, I am not having a baby via IUI, I am not doing IVF, I am not doing any of this invasive treatments, but down the line, they do it. The men tend to be a little more optimistic. I guess they think y when the next step happens, then I’ll address that. What I always tend to do is try to get them on the same page with me as your therapist, go through the different stages. If this step doesn’t work what is the next step. Let’s see how you both feel about it. You might come to terms with it sooner than your husband, but you need to also ask your husband: What is it that he’s worried about? I can promise you the largest percentage of husbands are worried about what continuing treatment is going to do to their wives. Not as much the costs, but they move towards another wife when they’re not going to feel supported. I sometimes get the wives to write on their fertility triggers, in fact, we have this card game, and we get the wives to take out the concept unfamiliar to them and the husbands to check out the concept, that is familiar to them, and then we see the two of you feel the same way there, or there, this is possibly how you can manage it, this is how your wife feels, and this is how you don’t. And definitely, we are able to get you on the same page.

Don’t you feel debriefing should be a part of every single treatment session, whether it had a positive or negative outcome?

Absolutely. I really do.

According to the stages, what do you recommend to move toward acceptance of the diagnosis?

During our session with my patients, I always ask them: What is the worst-case scenario? This is your diagnosis, these are your options. There are like 2 test tubes, one of them is like the sadness about the fact that because of your diagnosis, it’s not going to happen like you thought it’s going to happen. People think I’ve got to deal with that sadness and then possibly my excitement will slowly buildup for the next stage. No, the way to go towards acceptance is to have that long-term goal in mind and say: let’s start preparing you for the worst-case scenario and let’s see that the excitement slowly grows as the sadness gets less. That’s how I do it, I start trying to create a peace of mind about the next step forward and have a plan in mind and at the same time look at your goals and look at saying okay: what is the next step in terms of let’s get other goals in place and I know that’s hard, and I know nobody wants to hear: relax and it’ll happen, nobody wants to hear any of that, but if we can get other goals that are to fall back on that run concurrently to your fertility goals, to that worst-case scenario, people cope better. I wrote a chapter, I think it was three years ago for a textbook in Europe on why do people who adopt fall pregnant, and it was a similar thing. They had accepted their worst-case scenario, they were working towards that, and in between the adoption or before they got there, they fall pregnant because there was something else they were focused on, it’s not something I can say to you: just relax and it’ll happen but there are techniques we can get you to focus on, a plan for a year of your fertility goals and a plan of your other goals and merge the two together.

How do you help couples if one partner is more comfortable with the prospect of egg donation and the other isn’t?

I can promise you, this takes me 2 sessions to get them on the same page. I inform them with literature, I look at the various options, so what are our options, are those donor gametes, our options are adoption, and another option is no children, and I look at the values associated with those. Then, we start looking at what are you actually afraid of. I’ve typed a list over the years of things people are afraid of and I give each couple the list, and I say go home read this independently, start doing a bit of research for me and come back to me. I promise you the majority have come back to me, and they’ve addressed those issues by the next session by themselves, and we left with the issues, that they haven’t. We do get them on the same page, because there is always one and it’s often the woman who can’t even say the word egg donation, and the men don’t want to agree to it because they don’t want to feel like they’re betraying their wives in some way. So, yes I would have a look at it, and I’ve got literature, I have a look at what are your various options and trying to pursue the option of a donation, you don’t need to put any money down, you can look at the agencies, you can look at what’s available, and if you are not ready, you will very quickly close down those sites. The next time it’ll be a little bit easier, and slowly those tubes like the sadness get less, the tube for excitement gets a bit more.

How do you manage the added stress of financial aspect on top of infertility stress?

I know it’s such a big thing, and I know specifically here in South Africa other than one medical aid that pays once a year, it is not covered by the health system. The majority of the people unfortunately in our country cannot even afford to have a look at that option. I often say to people, okay we’ve got to say what would a holiday cost us, what would a year of education cost us, look at the statistics and say I am willing to put this aside if the stats are two out of three that it should work at my age. Try and put that aside and to have that goal aside, so that they can manage it. It is a very difficult one, and we are personally busy trying to put this message across, that medical aids should recognize like the WHO that infertility is a disease. The financial aspect is definitely a big one on top of the fertility stress.

What is the impact of social pressure on the couple that is trying?

There are just tons of feelings, you don’t fit in anywhere, so there could be cultural pressure, there could be this pressure from friends, there could be extended family pressure, and a pressure that we often ignore is that the woman possibly hates her job to death but because of was said earlier, some women are trying very hard to actually keep a job in case, they fall pregnant to get the maternity leave, but unfortunately, we feel marginalized in all those categories, and sometimes it isolates us from sharing.

We are struggling to decide on the same treatment between me and my husband. What would you recommend?

The best way is to go to a fertility specialist that you trust, and you need to believe what they’re saying. I guess it’s also hard because a lot of the time with infertility, you kind of have a choice, I’ve also had cancer before and there I didn’t have a choice, it was you go in, you have your chemo, and this is what you do, and you got a 95% success rate. IVF I found worse, I must be honest because a lot of it was about first of all medical aid didn’t pay, secondly, it was a struggle if I am ready to start now, what are the finances, what are the implications for work, so when people are struggling I strongly recommend that they get together and possibly go and speak to someone if possible and say what are our options, and why possibly your husband does not want to deal with this or why don’t you want to do this, and usually, it’s because I don’t know how she will cope. We need to bring that up and say your wife is not going to have a nervous breakdown, she’s going to cry, she’s going to need you, they’re often worried about how they’re going to support you through this journey. I think we need to then say there are different treatments, but let’s have a look specifically if it’s IVF maybe as a very expensive investigative procedure and then you can both decide. I think again speaking to someone, even if it’s a fertility sister that’s available at a clinic.

How did you overcome the loss of your two miscarriages? What practical advice can you give to grief the loss?

In a way, I was fortunate. I deal a lot with stillbirth, and I deal a lot of babies in the NICU time, so mine were early miscarriages meaning they were both blighted ovum, that was established pretty early on at the six-week scan. Regardless of that, it’s still a miscarriage and a loss. You need to understand when you have a miscarriage even a negative IVF result because that’s a baby, you grieve into the future. All significant anniversaries, as soon as you find out you’re pregnant you’re grieving into the future. You’re thinking, I would have been three months in, I would have had my baby by Christmas, I would have had it by Easter, so to understand you go through that same grief cycle I spoke about in terms of the Kübler-Ross model of the grief of bargaining and understanding and allowing yourself to go through all those stages. The complication with grief and miscarriage and loss is when you don’t allow yourself to go through those stages because then you can get a complicated grief cycle, and it can all come back later. My practical advice is that the first two weeks are usually the worst, and then the next four weeks a little bit easier, six weeks of acute loss and then it settles into some sort of acceptance, but again, that’s when people get assistance, and that’s why I always say it’s important to go to the right people and if you can’t afford a therapist, go to people, those kinds of groups where online you’re going to get professionals speaking, you are not alone in this.

I am struggling to believe that I deserve to be with my partner. I have a constant fear that he might want to find someone else. What is your advice? My partner is 5 years younger than me.

I’m not quite sure what is going on. If it’s an egg or sperm problem or what is happening. I also need you to understand that there are some exceptions to the rule. However, the majority of the men I have seen, 98% of the men I’ve seen, they often say to me, I married my wife to be with my wife, not to have kids. Women are more likely to get married to the kind of partner, and it’s shown in biology that they want to have kids. Often the men will choose, give me my wife back, and we can establish some sort of life together, the women are the ones that fear that insecurity most of all. My advice would be, look you’re 39, he is 5 years younger than you, I don’t know what your FSH is or what your AMH, but he can still have his own baby with you, with you carrying it. If your AMH is a problem, or if your FSH is a problem always remember that even if you feel it’s your responsibility as a couple of problems, at the end of the day, I have seen so many people who might have an egg problem and 2 years down the line, they meet someone else for whatever reason, and they fall pregnant, so it’s not to say it’s just one partner it’s the two together, and I suggest you talk about it to someone. You’re feeling ashamed, and you’re feeling guilty, and shame and guilt brings you nothing but depression and internalizes, it makes you more insecure whereas if we can have you realize this is a reality, let’s have a plan in mind, are you willing to be on board, why aren’t you, what are your different options and I can tell you, he would be willing to be on board, it’s his sperm, and getting him over donor eggs and informing him about donor eggs can take 1 to 2 sessions, and it does make sense in that cognitive mind of the men I’ve seen.

Is it possible to be genetically mismatched with someone which results in infertility?

I am not a fertility specialist, I’m a clinical psychologist who specializes in infertility, I think that is pretty rare. We know that if siblings are trying to have babies, there are those kinds of problems, but very different. I must be honest. I cannot answer that, I know that it does happen, but I know that it is also quite rare, and I’m the wrong person to ask.

My husband wanted to wait a few years in between having children. Now I’m 42 and are needing an egg donor. I’m feeling angry and resentful. Any ideas on working through those feelings?

The anger and resentment, I can understand. He wanted to wait a few years, so I can imagine that there is some feeling of blame towards him, possibly. The problem is, it is what it is at this point, feeling guilty about it or feeling angry or resentful is not going to fix it. What needs to be fixe is some action now, and yes, my ideas on working through those feelings are I think you need to explore the next step of using an egg donor. It is less daunting as one looks at the research a little bit more including the research on epigenetics. I know it is a very sad place to be because you’re grieving the loss of your own DNA, but if you look at the field of epigenetics, your own DNA does have something to play in the outcome of the baby. In terms of feeling angry and resentful towards your husband, I think the two of you should go and see someone and sort that out and come up with what is the next step, have a plan in mind because anger and resentment are not going to get you anywhere. We can still be angry and resentful, but let’s have a plan in mind in terms of what are we going to do about it. I hope that helps you, but I know that we need to actually do some more research on it and get that sadness less, get that excitement more about the next step and look at what the other option is like adoption or childlessness, or surrogacy etc. I would then take which of these options are we willing to approach because either way even if you meet someone else you’re going to need an egg donor, so walking out on your husband would not be an option, it’s not going to help your fertility.
IVF & fertility treatment with own eggs for women over 40 – what are your chances?
Exploring Male Fertility – all you need to know about semen analysis
IVF for women over 40 – options and insights
Creating Fertility Awareness: Navigating Your Journey with Holistic Insights and Medical Know-How
Choosing the right clinic for your treatment: One of the most important decisions you’ll ever make
How will this affect my future child? 40+ intended parents’ concerns (age, donor conception, single motherhood)
Mandy Rodrigues, MA

Mandy Rodrigues, MA

Mandy Rodrigues is a Clinical Psychologist registered with the Health Professions Council of South Africa. She holds the degree BA (Honours) (SA), MA (Research) (Cum Laude) (SA), MA (Clin. Psych) (Cum Laude) (SA). Mandy has written numerous articles for popular magazines and newspapers; and have been guest speaker at numerous lectures, motivational talks and conferences. She also has made numerous television appearances in relation to the field of infertility, couples and families, and stress. Mandy consults to Medfem Fertility Clinic, working with a multidisciplinary team in relation to women’s health and infertility.
Event Moderator
Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.