When Baby Plans Meet Medical Reality
While the transition to parenthood presents its own marital challenges, research shows that infertility creates particularly intense relationship stress. Couples facing infertility often deal with communication breakdowns, difficult decision-making processes, and complex issues with intimacy and sexuality.
When Medical Treatment Meets Relationship Challenges
Couples who pursue medical treatments to address infertility sometimes find themselves needing therapy to address emerging relationship issues. Common challenges include struggling to understand each other, power struggles, conflicting opinions on treatment decisions, differences in how men and women cope strategies, secrecy, and patterns of overprotection that harm rather than help.
Infertility treatment can become a breeding ground for guilt and resentment. Partners may gradually close off, becoming less willing to share their deepest fears, anger, and anxieties. In attempting to shield each other from shame while masking their own depression and frustration, couples often “slip out of intimacy” right when they need connection most.
The Five Stages of the Infertility Journey
Therapists have identified five predictable stages that couples typically go through:
1. Awareness
The couple recognizes their difficulty conceiving and becomes activated to seek medical assistance.
Anna and David’s Story: After eight years of marriage, Anna and David expected pregnancy would come easily. When months turned into years, their playful jokes — “we just need a vacation baby” — started to feel hollow. The awareness crept in: something might be wrong.
2. Activation
Medical confirmation of infertility often arrives as a profound shock, adding new layers of stress to an already difficult situation.
Their Diagnosis: The fertility tests delivered a clinical phrase: “diminished ovarian reserve.” Anna heard it as “my body is broken.” David’s instinct was to go into problem-solving mode — lining up doctors, insurance, and treatment options. They absorbed the shock differently, and that difference started to affect all their conversations.
3. Acclimation
The couple enters the medical system, stuck in the uncertainty of “not yet pregnant” while undergoing various treatments and procedures.
Living in Limbo: They began IVF. Their calendar filled with appointments and injections. Sex became scheduled and mechanical, losing all spontaneity. Anna avoided talking about her despair, afraid of burdening David. David kept his fears private, believing his role was to “stay strong.” The silence between them grew heavier than the treatments themselves.
4. Acceptance
When medical treatments are unsuccessful, acceptance unfolds in three phases:
• Ending fertility treatments
• Grieving the loss of biological parenthood
• Considering on alternative paths to family life
After several failed cycles, Anna and David sat across from each other in therapy, exhausted. The conversation shifted from “one more try” to “how much can we bear?” They began mourning not just failed cycles but the dream of biological parenthood. Therapy invited them to name this grief aloud, and to imagine new possibilities: adoption, a childfree life, a family built through mentoring and close friendships.
5. Aftermath
When couples don’t fully process their grief it can lead to lasting sadness. While some couples experience ongoing marital difficulties and communication problems, those who actively work on their relationship often develop remarkable resilience and experience growth after infertility.
Finding Their Way Forward: They started having “no baby talk” date nights, reconnecting with who they were before infertility. Over time, they found themselves laughing again, planning trips, and speaking openly about their future options. Infertility wasn’t a test they passed; it was a fire that transformed their marriage. What they carried forward was not just sorrow, but a deeper knowledge of their ability to survive together.
The Power of Externalization in Therapy
Learning to see infertility as something you’re facing, not something you ARE, serves as a valuable therapeutic tool. The crucial shift from “Am I infertile?” or “Is one of us defective?” to “We are facing infertility together” can transform a couple’s experience. The term “involuntary childlessness” g—shows how changing how we speak about challenges can change how we experience them.
The Many Ways Infertility Impacts Couples
Infertility creates many different stressors that change over time:
• Identity crisis: Partners may feel broken, cursed, or fundamentally flawed
• Loss of control: The inability to plan their family leaves couples in reproductive limbo
• Complex family dynamics: Using donor and surrogate can create complicated relationships
• Life depletion: The emotional, financial, and time demands can drain joy from everyday life
• Exposed foundations: Infertility brings up deep-seated assumptions, expectations, and dreams about family life
Gender Differences in Coping
Research shows men and women respond differently to infertility:
Women’s Experience
• About 50% of women (compared to only 15% of men) describe infertility as their life’s greatest disappointment
• Women report higher distress levels, reduced life and sexual satisfaction, and increased depression and anxiety
• Many women link their self-worth directly to their ability to conceive and raise children
Men’s Experience
• Men often begin with goal-oriented optimism while their female partners experience despair
• As treatments continue unsuccessfully, men may distance themselves emotionally to protect their sense of masculinity
• Men frequently become hypervigilant to their wives’ emotional states, often more aware of their partners’ feelings than their own
• Financial pressures from treatment costs can trigger additional stress about their provider role
• One researcher that men’s apparent stoicism may mask stress levels equal to their partners’
Finding Common Ground
Despite different coping styles, both partners share the fundamental experience of failure and loss. As couples continue their journey, the emotional gap between partners often narrows. Shared sadness, when expressed openly, can deepen intimacy.
Effective couples therapy creates space for profound conversations about the meaning of parenthood, the value of children in their lives, and their vision for their future together.
Common Relationship Patterns
A prevalent dynamic involves wives feeling their partners aren’t equally invested in addressing infertility. This often manifests as emotional isolation for women while men experience internal pressure to contain their own emotions while managing their partner’s “intense emotionality.”
The physical and emotional demands of fertility treatments rival those experienced by women facing cancer, cardiac rehabilitation, or hypertension—requiring similar levels of psychosocial support and intervention.
Parallels with Other Relationship Crises
While the comparison may seem unusual, couples therapy for infertility shares structural similarities with therapy for other major relationship disruptions like infidelity. Both experiences involve:
• Unexpectedly thwarted reasonable expectations
• Feelings of invasion and self-doubt
• Mismatched coping styles between partners
• The need to balance problem-focused discussions with ordinary couple connections
Strategies for Maintaining Connection
Creating Breaks
Couples benefit from scheduled breaks from fertility-focused conversations. Regular date nights with agreed-upon “no baby talk” rules provide essential breathing room and help partners reconnect with their pre-infertility relationship.
Post-Treatment Growth
Couples who successfully navigate the end of unsuccessful fertility treatments often report unexpected benefits. United in shared grief, many experience improved marital satisfaction and enhanced communication skills (Greil, 1999). These couples have confronted fundamental questions about meaning, purpose, and partnership that other couples may never face directly.
Moving Forward
The question “Why did nature not keep faith with us?” represents an agonizing uncertainty best addressed through mutual support and shared grieving. Countries like Canada have developed research-based approaches that serve as models for comprehensive infertility support.
While this journey tests relationships deeply, it also offers opportunities for growth, intimacy, and resilience. By understanding the predictable stages and challenges, couples can navigate this difficult path while protecting and even strengthening their bond.
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*Note: This article focuses on heterosexual couples’ experiences as reflected in the cited research. Different dynamics may emerge for LGBTQ+ couples and other family structures facing fertility challenges.*
More Reading
Ammari, T., Khondoker, Z., Wang, Y., & Roda, N. (2025). Beyond the Silence: How Men Navigate Infertility Through Digital Communities and Data Sharing. (preprint) arXiv. https://arxiv.org/abs/2509.10003
• This exploratory, data-driven study examines how men use online platforms (especially Reddit’s r/maleinfertility) to articulate infertility emotional work, share medical info, and find peer support. It resonates with your interest in male experience, emotional invisibility, and externalization.
Ciacchini, R., Piarulli, A., Bottai, B., OrrĂą, G., Gemignani, A., & Conversano, C. (2025). Initial Psychological Evaluation in Couples with Unexplained Infertility: Focusing on Gender Differences. Psychology International, 7(3), 63. https://doi.org/10.3390/psycholint7030063
• This study examines psychological distress and gender differences in couples dealing with unexplained infertility. It reports on stress, anxiety, depression, and how the partners differ in their experience during the initial clinical evaluation.
Sunil, S., et al. (2024). Psychosocial Interventions for Infertile Couples: A Scoping Review. Asia Pacific Journal of Reproductive, 13(3), 97-106.
• This review surveys the landscape of psychosocial interventions (couple therapy, support groups, counseling, etc.) and their efficacy in improving emotional, relational, and sometimes even fertility outcomes.
Reisi, M., Kazemi, A., Maleki, S., Sohrabi, Z., et al. (2024). Relationships Between Couple Collaboration, Well-Being, and Psychological Health of Infertile Couples Undergoing ART. Reproductive Health, 21, Article 119. https://doi.org/10.1186/s12978-024-01857-3
• This article explores how couple collaboration (i.e. how partners work together) is associated with depression, anxiety, stress, and overall well-being during assisted reproductive treatments (ART). Helps ground your “relational tasks” framing.
