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

Section 13
Expectations in Infertility Transition

CEU Question 13 | CEU Test | Table of Contents
Psychologist CEUs, Social Worker CEUs, Counselor CEUs, MFT CEUs

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On the last track, we discussed a therapeutic approach to resolution.  This included restructuring the couple’s relationship, facing denial of loss and choosing a life without children.

On this track, we will discuss couple issues in the legacy phase.  These will include lingering loss, patterns of protection, a changed sexual relationship and infertility as an identity.  On the next track, we will discuss a therapeutic approach to the legacy phase.

Legacy, the aftermath of infertility, is the phase in which couples have moved on to the next chapter in their lives and any long-term effects of infertility are seen.  Many couples report that, no matter what the eventual outcome may be regarding children, infertility is a watershed event. Life is never quite the same afterward.  For some couples, the repercussions can be so powerful that they are still felt decades later.

Regardless of how well partners may have dealt with infertility, many experience recurring sadness either at key points in the life cycle, or simply out of the blue when some memory is evoked.  It may be important to remember that a baby, even one born biologically, is rarely the antidote or cure for infertility.  I have found that some remnant of the infertile identity usually remains with couples who have faced it at one time or other.

The more problematic aspects of legacy are present in couples who have not come to terms with infertility and continue to be angry at and victimized by the experience.  Left unaddressed to fester in silence, these legacies can affect the couple’s behavior in such ways as ongoing sexual problems, communication difficulties, and parenting insecurities.

4 Issues in the Legacy Phase

#1 Lingering Loss
First, although the crisis and trauma of infertility may fade as time passes, the sense of loss may linger for years.  Whereas shared loss can create a profound bond, when partners are unable to share their grief, they may live for years feeling estranged.  Couples without children, and the bonds crated by co-parenting, need to restructure their relationship in order to avoid exacerbating their feelings of disconnection.

Any of the losses of infertility, such as a normal conception and pregnancy, sharing the creation of a genetically-related child, and genetic continuity along family lines, may revisit the couple at any time.  For example, when a woman who was unable to have children hears that her best friend’s daughter is pregnant, she may feel a flood of sadness that she will not have grandchildren or experience the intimacy of sharing pregnancy stories with her daughter.  Even decades later, unexpected circumstances can trigger painful feelings.

Ginger had an extreme reaction when her stepchildren’s offspring called her "grandma," and she angrily demanded that they stop using the word.  I wondered whether this signified an awakening of Ginger’s own grief and anger over her infertility.  In exploring her reaction within the context of her infertility, Ginger stated, "I guess…I was just protecting myself…there is still an old pain in not being able to conceive, and I think I still have some jealousy because my stepchildren were able to conceive."

#2 Patterns of Protection
Second, if patterns of a partner protectively hiding his or her innermost thoughts and feelings from the other partner takes hold and persists, potential problems in the relationship are likely to increase.  Couples may hide their sadness, such as crying silently during baby commercials, their resentment and their sense of guilt.  Each partner may even suspect what the other is thinking or feeling, but they may say nothing.  Unable to express themselves during legacy, communication gaps that developed during the acute phases of infertility may widen. 

Partners who sought to protect each other from guilt and resentment often continue the same patterns of silence and avoidance years after the immediate crisis of infertility has passed.  Some may have turned to friends or individual therapists for solace and understanding during the ordeal, never resuming intimate communication with their partners.  These rifts, whether angry or silent, can be hard to bridge.

Without some essential refocusing of their marriages, couples without children may find themselves, years later, less satisfied with their choices than they had hoped.  They may feel an emptiness along with a sense that their relationships are not enough to sustain them.  Each partner may have found different ways to replace the void, which have moved them in different directions. 

One partner may be wanting more connection and self-fulfillment within the relationship, while the other is content with less intimacy and more involvement in outer-directed activities.  Partners may not talk about their remorse over the decisions that they have made.

#3 A Changed Sexual Relationship
Third, in addition to lingering loss and patterns of protection, let’s discuss addressing the couple’s changed sexual relationship as a result of infertility.  During immersion, couples often find that trying to get pregnant and sustain a passionate sexual relationship are mutually incompatible.  In the legacy phase, when couples are asked about their sex lives, they often report problems. 

These sexual difficulties can be manageable or catastrophic for the couple, depending on the importance of sex in their relationship and the meaning they attach to its absence.  For some couples, sex is such a fundamental way of achieving intimacy that its absence can have significant and negative consequences on the couple’s relationship.  As their enjoyment of sex diminishes, the ability to use physical intimacy as a means of achieving and reinforcing their emotional connection is severely compromised.  If they cannot establish other ways of achieving intimacy, they may drift apart.

#4 Infertility as an Identity
Fourth, in addition to a changed sexual relationship, let’s talk about infertile couples facing infertility as an identity.  I have found that it is common for couples who had once considered themselves infertile and who later have children to retain scars from the infertile experience, even if the encounter with infertility was a brief one.
Sean and Rosemary took six months to get pregnant with their first child.  Sean stated, however, that "things were never quite the same afterward.  When I got the results of the tests that showed a low sperm count, it shook me up…it probably changed how I saw and see myself today." 

Rosemary stated, "I think we were both shaken by it.  They didn’t treat it in any way, no inseminations and no hormones, just the diagnosis…but it’s one of those things in life that you only need to be close to for a very short time to feel changed.  When I hear infertility mentioned on TV or the radio, I get a pang….it feels like something’s still wrong with me."

Couples without children may face the greatest burden in legacy.  Having a different status than siblings with children, families may never regard them as being truly adult.  Even if a couples feels good about their decision, the culture reacts to them as a "childless couple" and they may be angry if people assume they could not have children rather than this being their choice.

On this track, we have discussed couple issues in the legacy phase.  These have included lingering loss, patterns of protection, a changed sexual relationship and infertility as an identity.

National Public Health Action Plan for the Detection, Prevention, and Management of Infertility

- Centers for Disease Control and Prevention. National Public Health Action Plan for the Detection, Prevention, and Management of
Infertility, Atlanta, Georgia: Centers for Disease Control and Prevention; June 2014

On the next track, we will discuss a therapeutic approach to the legacy phase.  This will include latent feelings about infertility, a history of infertility, different legacies, revisiting belief systems and belated mourning.

Peer-Reviewed Journal Article References:
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. 

Flykt, M., Lindblom, J., Punamäki, R.-L., Poikkeus, P., Repokari, L., Unkila-Kallio, L., Vilska, S., Sinkkonen, J., Tiitinen, A., Almqvist, F., & Tulppala, M. (2011). Prenatal expectations in transition to parenthood: Former infertility and family dynamic considerations. Couple and Family Psychology: Research and Practice, 1(S), 31–44. 

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. 

Hudson, J., Nahata, L., Dietz, E., & Quinn, G. P. (2018). Fertility counseling for transgender AYAs. Clinical Practice in Pediatric Psychology, 6(1), 84–92.

Kang, X., Fang, M., Li, G., Huang, Y., Li, Y., Li, P., & Wang, H. (2021). Family resilience is a protective buffer in the relationship between infertility-related stress and psychological distress among females preparing for their first in vitro fertilization–embryo transfer. Psychology, Health & Medicine.

Online Continuing Education QUESTION 13
What are four issues that couples must face in the legacy phase? To select and enter your answer go to CEU Test.

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