What is Infertility?

Infertility occurs when a couple is unable to conceive (get pregnant) after trying for at least a year. Keep in mind that female fertility declines as a woman ages, so obstetrician-gynecologists typically monitor women, 35-years-old and older, who have been trying to have a baby for at least 6 months without contraception more intensely. Although women are often associated with infertility, in some situations, it is the man who is infertile. And, in other cases, both partners suffer from infertility. So, it is not just a “female problem.” Infertility can also be primary or secondary.

What is the Difference Between Primary and Secondary Infertility?

Contrary to popular belief, there are actually two types of infertility – primary infertility and secondary infertility. While they differ to some degree, when it comes right down to it, both types have the same effects and are typically addressed the same ways. The most significant difference between primary and secondary infertility is when it arises.

• Primary Infertility is the most common type of infertility. Couples, who are unable to get pregnant at all and those who are unable to carry a child to term (delivery), are diagnosed with primary infertility.
• Secondary Infertility, is not as common as primary infertility, but no less devastating to couples, who want to add to their families. Couples who were able to conceive and birth one or more children, but who cannot become pregnant or carry a child to term later, are diagnosed with secondary infertility. Couples with this type of infertility have a child or children but are unable to continue adding to their family.

What types of Doctors Specialize in Infertility?

• Obstetrician-gynecologists (OB-GYNS) specialize in women’s health – i.e. menstruation, birth control, sexually transmitted diseases, uterine fibroids, ovarian cysts, breast health, infertility, reproductive cancers, pregnancy, childbirth, and even menopause.
• Reproductive Endocrinologists specialize in repeated (two or more) miscarriages.
• Reproductive Psychiatrists specialize in women’s mental health issues. More specifically, this doctor helps women deal with reproductive stress – i.e. emotional issues that appear to be linked to a woman’s menstrual cycle, postpartum depression (following the birth of a child), anxiety stemming from infertility or pregnancy, heavy menstrual cycles, and perimenopause and menopause issues. These doctors may prescribe medications designed to improve mood and reduce anxiety.
• Fertility Psychologists also specialize in women’s mental health issues – but without prescription medications. More specifically, these doctors treat couples, who are suffering from reproductive issues with therapy. They help couples who, are dealing with the trauma and loss of fertility, pregnancies, premature birth, multiple miscarriages, stillbirths, postpartum depression, and overall poor reproductive health, cope with it in a healthier way.

How Common is Infertility?

According to the CDC, approximately 6% of married American women, between the ages of 15 and 44, are unable to conceive (become pregnant) after one year of trying. Moreover, approximately 12% of American women, between the ages of 15 and 44, have a hard time conceiving (getting pregnant) or carrying a pregnancy to term (delivering a baby).

Can Men Experience Infertility?

Yes, although the exact cause of male infertility depends on the individual. However, testicular or ejaculatory dysfunction, trauma to the testes, varicoceles (a condition that occurs when large or oversized testicular veins overheat, altering the number or shape of a man’s sperm), radiation, chemotherapy, testicular surgery, supplements, high blood pressure, hypertension medications, alcohol abuse or alcoholism, smoking, cancer, illegal steroid use, illegal substance abuse or addiction, a sedentary lifestyle, an unhealthy diet, not enough sleep, obesity, health conditions, like diabetes, cystic fibrosis, autoimmune disorders like lupus, infections, hot tubs/saunas, too tight underwear and pants, genetics, and hormonal imbalances can heighten the risk of male infertility.

What are the Possible Causes of Infertility in Women?

Similar to the causes of infertility in men, female infertility is usually dependent on the individual. However, some possible causes of infertility in women include the following: anovulation (not ovulating), ovarian dysfunction, polycystic ovary syndrome (PCOS), cancer, reduced ovarian reserve, functional hypothalamic amenorrhea (FHA), hypothalamus and pituitary glands dysfunction, premature ovarian insufficiency, anorexia, early menopause, fallopian tube obstruction (i.e. blocked fallopian tube(s)), and uterine fibroids and cysts.

How is Infertility Usually Treated?

Infertility is usually treated with supplements, prescription medications (i.e. clomiphene or clomid, femara, letrozole, metformin, etc.), surgery, in vitro fertilization (IVF) (a process that involves removing a woman’s eggs and a man’s sperm and combining them in a petri dish. Once an embryo has form, it is re-inserted into the woman’s uterus), intrauterine insemination (IUI) (a procedure that involves placing a man’s sperm inside a woman’s uterus, so they can travel through her fallopian tubes and become fertilized (joined with the woman’s egg)), and infertility counseling.

What is the Main Difference Between IVF and IUI?

The main difference between IVF and IUI is that with IUI sperm is removed and placed in a woman’s uterus, so they can travel through her fallopian tubes towards fertilization. The woman’s eggs are not removed from her body. IUI is a less expensive procedure, but also considered riskier because the sperm has to do more work (steps) to fertilize the egg.

But, with IVF both the sperm and the egg are individually removed from their owner’s bodies and combined in a petri dish. Once an embryo is formed, it is repositioned in the woman’s body. The procedure bypasses the fallopian tubes and fertilization process. It is a little less risky than IUI because some of the work is completed outside of the body. However, because most of the work is completed before the embryo is implanted in the woman, it’s also more expensive. It’s important to understand that even with bypassing many of the fertilization steps, it still may not work. Why not? Because the woman’s body still has to accept the embryo and carry the baby to term.

What is Infertility Counseling?

Infertility is always devastating to couples suffering from it. It is psychologically distressing to get one’s mind and heart set on adding a child to the family only to learn that it will be harder than expected. In some cases, all avenues to being a parent appear to be blocked – adding to the heartbreak, frustration, depression, anger, and anxiety. The truth is, it is expected for couples, especially married ones, to have children.

When this takes longer than expected or when it does not happen at all, people tend to look upon the couple with sadness and pity. This only makes the couple feel worse, increasing the worry and sadness they feel. This is especially true when others, unaware of the couple’s struggles, continually ask them when they are going to have children and/or if they are pregnant yet. Loved ones and friends don’t mean to be hurtful or nosey, but many times that is exactly what they are.

Therefore, the purpose of infertility counseling is to help couples emotionally deal with their reproductive problems. More specifically, infertility counselors aim to help couples process the loss of fertility, identify and understand what they are feeling, work through the trauma and emotional pain, strengthen their relationship, and explore other options for starting or adding to one’s family. Most infertility counselors recommend a combination of individual and couple counseling sessions, while others treat solely couples or provide counseling in group atmospheres.

What is the Ultimate Goal of Infertility Counselors?

The ultimate goal of infertility counselors is to assess the individual and/or the couple and teach him/her or “them” healthy coping skills. The aim is to help the couple navigate their infertility challenges in a healthy and productive way. It is common for individuals to blame themselves for infertility, however, there are often many factors involved in the inability to conceive or carry a baby to term. Rarely is it solely one partner’s “fault.” So, infertility counselors address these concerns by focusing on both partners. More specifically, they look at infertility from a “systems” (couple or relationship problem) perspective, rather than as an “individual problem.”

What Approaches are Typically Used During Infertility Counseling?

Infertility counselors use a variety of methods to address the issues (and emotions) associated with infertility. A common approach used in infertility counseling is emotionally-focused therapy (focusing on the emotions involved with this “new reality,” when it comes to having a child). Another approach typically used at the same time, as emotionally-focused therapy, is solutions-based therapy (focusing on finding solutions for the couple’s issues and helping them explore other ways to have children).

Most infertility counselors also use a cognitive-behavioral therapy approach to help infertile couples. This approach typically focuses on changing the mindset of the couple. More specifically, changing negative thoughts to more positive ones. So, instead of looking at the cup (situation/an inability to have children) as half-empty, it teaches couples to look at it as half-full (other ways to add to the family). The other purpose of cognitive-behavioral therapy is to alter the behavior of the individuals, so they don’t blame themselves for infertility.

Are There Alternative Approaches to Coping with Infertility?

Yes, although not as popular as medication (anti-anxiety or depression meds) and counseling, hypnotherapy is an alternative approach sometimes used to help couples cope with the stress of infertility.

Should I Hire an Infertility Counselor?

Well, it depends. Being infertile isn’t a reason in itself to seek infertility counseling, however, if you or your partner begin to experience depression, anxiety, impulse control, or other negative emotions, infertility counseling could be very beneficial by helping you navigate your conflicting and distressing emotions.

Moreover, if you or your partner begin exhibiting unhealthy and destructive behaviors, along with experiencing depression, anxiety, panic attacks, etc., it is important that you seek counseling to help you process infertility and cope with it in a healthy way.

What Should I Look for in an Infertility Counselor?

An infertility counselor should be a marriage and family therapist or family therapist or psychologist, who specializes in infertility. Moreover, this infertility specialist must be empathetic, open, relatable, and patient. If one of these key factors is absent, it could cause more harm than good. Also, look for references from previous couples, who have used the services of the counselor.

If you are a woman, you may want to select a female counselor for comfort. According to the researchers, women are more likely to suffer from infertility-based psychological distress, so a female counselor is often a better choice, especially if she has also experienced infertility. Remember, you want a counselor that both you and your partner feel comfortable with and trust. The good news is that our TherapyTribe Directory can help you find an infertility counselor that is right for you.

Post-Pandemic Impact on Infertility

As the coronavirus wrecked havoc throughout the world, doubt, uncertainty, fear, anxiety, stress, and depression became a reality of massive amounts of people. And, while many couples relished the opportunity to have more “baby-making” time, due to the lockdowns, layoffs, and social distancing, the extra time and effort was not always fruitful for some of them. Although infertility has always been a problem since the beginning of time, COVID appeared to magnify the stress of being unable to create a baby or carry it to term. 

Couples were “forced” to stay home most of the time, especially during the early stages of COVID, this provided these individuals with more “bonding time.” Although the pandemic brought high levels of stress and anxiety, couples, who were desperate to have another baby or start a family, took this time to “start or resume trying for a baby.” This was especially true for couples, who suddenly found themselves, at least temporarily, out of a job. These couples increased their “love-making” in the hope that they would finally get lucky and become pregnant.  

When this did not occur, it caused unbearably high levels of stress and angst. It was another slap in the face that many infertile couples tend to get regularly. Infertile couples around the globe simply could not understand why they were not “getting pregnant ” with all of this extra time and effort. Many of these individuals felt “defeated” because they could not “make it happen” in the most opportune time in their lives. Checking month to month for the “plus” sign or the words “you are pregnant” only to receive no “plus” sign or words saying “you are pregnant” was a knife to the stomach during the pandemic.  

The added stress and anxiety from being in a pandemic, being “stuck” at home, and having plenty of time to create a baby, only made things worse. In other words, being together nearly all day long with nothing to do, but “be together,” and still being unable to “get pregant” only increased their stress and anxiety, and as a result, their fertility issues. Thus, according to researchers, infertility did not improve during the coronavirus (COVID-19) pandemic. The pandemic also negatively affected couples in the midst of fertility treatments, like IUI and IVF.  Because many businesses were “locked down” during the pandemic, couples, who were on the cusp of having fertility treatments, retrieval, or insemination, were unable to start their “baby-making” journeys or have their procedures.  

What did this mean for infertile couples – they had to wait. In other words, their dream of having a baby and starting their families were delayed for an undetermined time. No one, including people wanting to work on their fertility or have a baby, were faced with a high level of stress, anxiety, depression, doubts, fears, and uncertainties. They were no longer able to enter their fertility treatment centers, have elective procedures or surgeries, which made their fertility problems even more pronounced – and heartbreaking.  

Later in the pandemic when some facilities opened – with social distancing and masks, oftentimes only one person would be allowed in the doctor’s office. The man would usually have to obtain the sperm sample at home, quickly return it to the doctor’s office, and wait in the car while his partner had the procedure. This not only worsened the couple’s stress and anxiety, but also triggered a heavy loneliness. Researchers found that what should have been an exciting time ended up being scary, nerve-wrecking, and incredibly isolating. Even though many doctors were available for telehealth services, and encouraged female partners to use video calls (i.e., Zoom, Facetime, etc.) to keep their male partners “in the loop” before and after the procedure, there was still something missing – the closeness of being with your partner as you create a baby.  

References

1. Stringer, H. (2017). No insurance required: Psychologists who treat the trauma of infertility. APA Monitor, 48(7). Retrieved from https://www.apa.org/monitor/2017/07-08/trauma-infertility
2. Center for Disease Control and Prevention (CDC). (2019). Infertility FAQs. Retrieved from https://www.cdc.gov/reproductivehealth/infertility/index.htm
3. Drugs.com. (2019). Medications for female infertility. Retrieved from https://www.drugs.com/condition/female-infertility.html
4. WebMD. (2019). Infertility and in vitro fertilization. Retrieved from https://www.webmd.com/infertility-and-reproduction/guide/in-vitro-fertilization#1
5. American Pregnancy Association. (2019). Intrauterine insemination (IUI). Retrieved from https://americanpregnancy.org/infertility/intrauterine-insemination/
6. Burnett, J. A. (2009). Cultural considerations in counseling couples who experience infertility. Journal of Multicultural Counseling & Development, 37(3), 166–177. Retrieved from https://doi.org/10.1002/j.2161-1912.2009.tb00100.x
7. Gibson, D. M., & Myers, J. E. (2000). Gender and infertility: A relational approach to counseling women. Journal of Counseling & Development, 78(4), 400–410. Retrieved from https://doi.org/10.1002/j.1556-6676.2000.tb01923.x
8. Burnett, J. A., & Panchal, K. (2008). Incorporating ideological context in counseling couples experiencing infertility. Journal of Humanistic Counseling, Education & Development, 47(2), 187–211. Retrieved from https://doi.org/10.1002/j.2161-1939.2008.tb00057.x
9. Hasanpoor-Azghdy, S. B., Simbar, M., & Vedadhir, A. (2014). The emotional-psychological consequences of infertility among infertile women seeking treatment: Results of a qualitative study. Iranian Journal of Reproductive Medicine, 12(2), 131–138. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4009564/
10. Vaughan, D. A., Shah, J. S., Penzias, A. S., Domar, A. D., & Toth, T. L. (2020). Infertility remains a top stressor despite the COVID-19 pandemic. Reproductive Biomedicine Online, 41(3), 425–427. Retrieved from https://doi.org/10.1016/j.rbmo.2020.05.015 
11. Muhaidat, N., Alshrouf, M. A., Karam, A. M., & Elfalah, M. (2021). Infertility management disruption during the COVID-19 outbreak in a middle-income country: Patients’ choices, attitudes, and concerns. Patient Preference and Adherence, 15, 2279–2288. Retrieved from https://doi.org/10.2147/PPA.S327055 
12. Rosielle, K., Bergwerff, J., Schreurs, A. M. F., Knijnenburg, J., De Bie, B., Maas, J. W. M., Nap, A. W., van Wely, M., Lambalk, C. B., Goddijn, M., Custers, I. M., van Loendersloot, L. L., & Mijatovic, V. (2021). The impact of the COVID-19 pandemic on infertility patients and endometriosis patients in the Netherlands. Reproductive Biomedicine Online, 43(4), 747–755. Retrieved from https://doi.org/10.1016/j.rbmo.2021.06.001