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Infertility: Interventions for Shame, Mourning, and Feelings of Inferiority
Infertility continuing education psychology CEUs

Section 5
Couples’ Resolution of an Infertility Diagnosis

CEU Question 5 | CEU Test | Table of Contents
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

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On the last track, we discussed couple issues in the dawning phase.  These included the crisis and trauma of infertility, the impact on the couple’s relationship, bringing up infertility, helpful questions and attitudes about parenting.

On this track, we will discuss couple issues in the mobilization phase.  These will include shock and disbelief, losses, communication gaps and problem solving versus expression of emotion.  On the next track, we will discuss a therapeutic approach to the mobilization phase.  As you listen, think of your client.  Is he or she in the mobilization phase of coping with infertility?

During mobilization, couples shift into active gear and start to investigate medical assessment and treatment.  Whether they start with a gynecologist or an infertility specialist, couples may investigate several clinics or doctors in their search for competence and comfort.  A lot of medical tests may be initiated. 

Although the diagnostic phase may be brief if the condition can be diagnosed quickly, as you are aware, it is sometimes drawn out for years.  Often, as you have experienced with your clients, idiopathic infertility, or infertility in which no problem areas are found but there are repeated failures to conceive, is very distressing to couples.

During mobilization, partners may form enduring patterns of communication with the medical system, family and friends, and each other.  These patterns will affect the couple’s experience in later phases.  For some, this marks the beginning of ongoing distress, both individually, as with the onset of the infertile identity, and as a couple, with communication gaps and different coping styles.

4 Patterns of Communication

#1 Shock and Disbelief
First, let’s discuss the couple’s shock and disbelief.  When couples enter the mobilization phase and decide to go to the doctor, often they do not expect that any indication of infertility will be found.  If a diagnosis of infertility is confirmed, the couple may react with shock and disbelief.  Couples may doubt the diagnosis and seek a second opinion, assuming that this will refute the first. 

As with the diagnosis of cancer or some other life-threatening disease, couples may balk at the truth, denying the possibility and hoping to find out that it was all a dreadful mistake.  For couples experiencing secondary infertility, the shock may be particularly severe.  Having already borne a child, they are completely taken by surprise at finding that they are no longer fertile.

#2 Losses
Second, let’s discuss different losses that couples become aware of during the mobilization phase of infertility.  When diagnosed with infertility, couples may initially experience feelings of disappointment, sadness, and anger, which generally become more intense as time goes on.  As with other crises, partners may blame themselves for bad choices, such as delaying childbearing, or of imagined transgressions, such as having had an abortion. 

They may also blame their physicians for not warning them about the risks of infertility.  But once couples realize that the process of having a child will be different than they had expected, they are faced with the first losses of infertility.  These losses may be traumatic, and you may need to be alert for the significance of these losses with your client.

Four Kinds of Loss
Four kinds of loss that a couple may experience include loss of control over sex life and problem-free conception, loss of faith in one’s body, loss of privacy and intimacy and a barrier to achievement of full adult status. 

Loss One - Control over Sex Life & Problem-Free Conception
First, when infertility becomes an issue for a couple, the imperative of making a baby often changes the purpose of having sex.  Couples are typically required to schedule their intercourse during the fertile days of the woman’s menstrual cycle, and sex becomes mechanical.  The loss of spontaneity in the couple’s sexual relationship can be upsetting. 

In addition to anxiety and uncertainty undermining the couple’s sex life, their expectation of having a problem-free conception is thwarted.  Perhaps their imagined conception, a private occasion, joyously undertaken with no worries, has been lost and replaced by a lot of medical exams, office procedures and unwelcome intrusions.  This may precipitate feelings of sadness for the couple, although in the face of the hope that accompanies the mobilization stage, this loss may not be acknowledged.

Loss Two - Confidence in One's Body
Second, the diagnosis of infertility may trigger a loss of confidence in one’s own body, a feeling that one’s accustomed trust in one’s body has been disrupted. 

Loss Three - Loss of Privacy & Intimacy
Third, the infertility work up requires medical examinations, questions about sexual behavior, and a technical approach to reproduction, all of which can seriously compromise a couple’s privacy and intimacy. 

Loss Four - Loss of Full Adult Status
Fourth, because the role of parent is central to many couples’ identities, the inability to have a child may mean a failure to fulfill that role.  One’s identity, one’s sense of "who I am and who I planned to be" may be threatened.

Anita, age 30, described to me a family wedding at which she and her husband were put at a table with the teenagers.  Anita stated, "We’re older than many of my cousins who have children!  Until we produce a kid, I doubt they will see me as an adult…Will they be putting us at the young adult table until we’re 60!?  And then what?!  At the old people’s table!"

#3 Communication Gaps
Third, in addition to shock and disbelief and losses, let’s discuss communication gaps within the couple.  I have found that women who talk to their partners may experience less distress, though men often feel worse after talking about the crisis.  Have you found, as I have, that men may remain silent about infertility, hoping that this silence will protect their partners from further distress? 

Because men may communicate less distress about being childless, women often conclude that men do not share the desire for a child.  Unfortunately, when men appear calm about treatment failures, women may feel rejected, unsupported or weaker than their partners.  For their part, men may be confused about how best to relate to and support their partners.  Men may even accept their partner’s perception of them as unfeeling or less devoted to the idea of having a child.

Because men are socialized to regard menstruation, reproduction and infertility as "women’s problems," men may find it difficult to talk about the infertility.  The degree of intimacy required for adequate discussions regarding medical plans necessitates an alteration in the couple’s relationship, one that both partners may at first find difficult.

#4 Problem-Solving vs. Expression of Emotion
Fourth, in addition to the impact of infertility on a couple’s relationship and communication gaps, let’s discuss problem-solving versus expression of emotion as coping styles.  Conflict often arises over differences in coping styles.  A more action-oriented partner may try to push ahead with treatment or, conversely, may want to avoid treatment failures by moving straight to adoption. 

The other partner may prefer a slower process, with ample time and opportunity to express him- or herself.  Action-oriented partners may think that talking about feelings and expressing sadness is a waste of time an, indeed, may feel worse when they talk about their pain.  On a practical level, this may become problematic if the action-oriented partner rushes into a precipitous decision that has long-term effects, not only for the other partner, but for the couple and any possible offspring as well.  On an emotional level, the different coping styles can lead to feelings of isolation and disconnection between the partners.

Do you have a client like Anita?  Might he or she benefit from hearing this track? 

On this track, we have discussed couple issues in the mobilization phase.  These have included shock and disbelief, losses, communication gaps and problem solving versus expression of emotion. 

On the next track, we will discuss a therapeutic approach to mobilization.  This will include externalizing the infertility, eliciting the story, evoking the future and curtailing the shame.

Peer-Reviewed Journal Article References:
Barbaro, N., Shackelford, T. K., Holub, A. M., Jeffery, A. J., Lopes, G. S., & Zeigler-Hill, V. (2019). Life history correlates of human (Homo sapiens) ejaculate quality. Journal of Comparative Psychology, 133(3), 294–300.

Casu, G., Zaia, V., Fernandes Martins, M. d. C., Parente Barbosa, C., & Gremigni, P. (2019). A dyadic mediation study on social support, coping, and stress among couples starting fertility treatment. Journal of Family Psychology, 33(3), 315–326. 

Chazan, L., & Kushnir, T. (2019). Losses and gains of psychosocial resources: Effects on stress among women undergoing infertility treatments and participating in social network systems. Psychiatric Quarterly, 90(4), 717–732.

Darwiche, J., Favez, N., Maillard, F., Germond, M., Guex, P., Despland, J.-N., & de Roten, Y. (2013). Couples’ resolution of an infertility diagnosis before undergoing in vitro fertilization. Swiss Journal of Psychology, 72(2), 91–102. 

Galst, J. P. (2018). The elusive connection between stress and infertility: A research review with clinical implications. Journal of Psychotherapy Integration, 28(1), 1–13.

Jaffe, J. (2017). Reproductive trauma: Psychotherapy for pregnancy loss and infertility clients from a reproductive story perspective. Psychotherapy, 54(4), 380–385. 

Online Continuing Education QUESTION 5
What are four issues that couples face during the mobilization phase? To select and enter your answer go to CEU Test.

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