Intimacy, Connection, and Sex in the Face of Infertility
7 minutes
When Sex becomes a Chore
The experience of sex feeling like a chore is common among couples trying to conceive, though it varies depending on where they are in their fertility journey. In the beginning, when both partners are enthusiastic, the excitement and hope can enhance their mood and closeness. At this stage, there may be no interventions beyond simply stopping the use of contraception. However, as time passes without success, couples often turn to tools like ovulation kits, adding a layer of complexity to the experience. Once sex becomes more structured with set parameters, spontaneity often diminishes. However, some fun and excitement can still be preserved with intentional effort—such as planning date nights, keeping foreplay engaging, or experimenting with role play. But this requires effort. If pregnancy still doesn’t happen after a while, that effort can wane, resulting in a significant shift in sexual intimacy. Intimate moments may start to feel burdensome and obligatory, coinciding with the early stages of seeking external help. At this point, what was once an act filled with joy, connection, and desire becomes managed by doctors and medical professionals. The introduction of clinical procedures and tests strips away the spontaneity and intimacy that couples once experienced organically.
Psychological and Emotional Factors Behind This Shift
Imagine a scenario where one partner has been "shooting up" (taking meds), leading to uncomfortable hormonal shifts, undergoing ultrasounds every couple of days at the crack of dawn, and culminating in a trigger (ovulation) shot—only for the other partner to be unable to perform ("get it up") when the moment arrives. This is a true story, and thankfully, the couple I was working with managed to call in for an emergency blue pill; not all similar stories end that way.
Performance anxiety is one of the most common psychological challenges couples face when trying to conceive. This pressure can lead to performance difficulties, disappointment, guilt, and a very disgruntled partner. The strict schedules required for timed intercourse—whether based on natural ovulation cycles or fertility treatment protocols—exacerbate an already frustrating situation, contributing to feelings of losing control and disconnecting from one’s body or partner.
Feelings of inadequacy often emerge on both sides with each unsuccessful attempt at conception. Hopelessness, frustration, self-blame, and even blaming one's partner can erode emotional closeness. As a result, sex outside of trying to conceive may be pushed to the backburner or become fraught with disconnection and resentment. In some cases, one partner may feel like they’re "taking one for the team," while the other experiences guilt for wanting their natural desires to be met, which can lead to additional emotional strain.
Furthermore, many people become so focused on the goal of conception that they feel pressured to "do everything right," whether it involves following specific diets, sticking to specific exercise routines, or seeking unproven fertility advice that helps maintain their sense of control. This often includes spending significant time on social media forums, reading books, listening to podcasts, and tracking down supplements and herbs. When someone’s world narrows to all things related to conception, it leaves little room for anything else, including their relationship.
Moreover, when multiple attempts to conceive are unsuccessful, it can lead to feelings of depression, anxiety, and isolation. These emotional struggles often diminish overall joy in life, making sex one of the first areas affected by a lack of desire. Even if there’s no obvious disconnection between the couple, individual emotional turmoil can significantly reduce interest in intimacy.
Common Myths About Sex and Fertility
There are many myths surrounding sex and fertility that can complicate matters further, and understanding what they are can also relieve some pressure:
Specific sex positions: There's no scientific evidence to suggest that certain positions increase the chances of conception.
Orgasm is required for conception: While orgasm can enhance the experience, it isn't necessary for pregnancy, and even pre-ejaculation can lead to conception in rare cases.
Daily sex is better: Engaging in sex every day might lower sperm count, making conception less likely.
Infertility is a woman's issue: Male infertility has been shown to be anywhere from 30 to 50% of all infertility.
Lubricants harm sperm: While that is true of some lubricants, there are sperm-friendly ones, so it's essential to check the label.
The Consequences of Overlooking Changing Intimacy
It's important to acknowledge that stepping back from sexual intimacy during fertility challenges is perfectly normal. When faced with physical and emotional hurdles, intimacy may naturally become a lower priority. To provide a different perspective, during cancer treatment, it’s easy to see how sex would take a backseat, and there are typically no qualms about it. Fertility treatments often involve hormonal medications, frequent appointments, surgical procedures for both men and women, strict protocols, uncertainty, and feelings of defeat—all of which can diminish sexual desire. However, ignoring the deprioritization of sexual intimacy can exacerbate both individual and relational dissatisfaction.
On a personal level, feeling undesired can lead to feelings of inadequacy or shame, affecting self-esteem and making discussions about intimacy more difficult. For a partner who is uninterested, this can also breed resentment, feelings of obligation, and guilt when sexual intimacy is the furthest thing from their mind. On a relational level, a lack of communication about these challenges can create misunderstandings and resentment.
The shift from pleasurable intimacy to task-oriented sex or no sex can leave one or both partners feeling disconnected, particularly if physical intimacy was a primary way the couple bonded before trying to conceive. Consequently, increased arguments, withdrawal, and frustration may arise. Combined with the emotional toll of infertility, this can leave partners who once sought to expand their family through love and connection feeling trapped in a difficult, unwanted "job" neither of them signed up for.
Communication Comes First
The first step in addressing these challenges is to open up communication. Each partner should have the opportunity to express their feelings about the changes in their relationship. If enough time has passed without a meaningful discussion, one way to bring it up could be to say, “I’ve noticed that since we started trying to conceive, our connection has shifted, especially regarding physical intimacy. I’d like to set aside some time to talk about how we’re both feeling and find ways to reconnect in a way that feels comfortable for both of us.” This approach not only opens the door for discussion but also gives the other person space to reflect on their own feelings before engaging in a potentially emotionally charged conversation. This helps to prevent impulsive responses driven by frustration or lack of preparation.
Once this initial conversation occurs, couples should aim for regular check-ins—ideally at least once per fertility cycle—to discuss any emotional or physical changes in their relationship. While it’s impossible to fully separate the topic of fertility from these discussions, the focus should remain on how both partners feel connected (or not) and how to move forward. Each cycle may present new challenges, making it important to revisit these feelings. This practice should continue even if pregnancy occurs, as pregnancy can bring its own stress and anxiety, as well as potential impacts on intimacy, even if medically cleared for sexual activity.
Finally, it’s important to acknowledge that outside stressors unrelated to fertility can also affect the relationship. While fertility may be the primary focus for one partner, the other might be dealing with job stress, financial concerns, or caregiving for aging parents. The situation can become even more complex if secondary infertility is the issue and the couple already has one or more children. Recognizing these factors outside the fertility protocol helps maintain a balanced approach to the overwhelm each person is trying to manage.
Strategies to Maintain Healthy Intimacy
Couples can explore various strategies to maintain healthy intimacy, whether that includes sex or not. These strategies can focus on physical, emotional, or both types of intimacy. To work on physical intimacy, one approach is to start small with simple gestures like hand-holding, hugging, and cuddling to rebuild the physical connection alongside the emotional one. It’s also beneficial to focus on pleasure rather than solely on conception. This might involve scheduling intentional breaks from actively trying to conceive or from treatment protocols, allowing time for intimate connection outside the fertility window.
Date nights or weekend getaways can be particularly helpful, as they provide an opportunity to separate your fertility journey from your identity as a couple. These efforts can remind you why you are together and what you enjoy about each other, creating a more relaxed environment where physical intimacy may feel more appealing, rather than awkward or laden with emotions tied to your imagined child.
Additionally, engaging in activities together that enhance intimacy without being physical can be effective. Consider taking a class together—such as yoga or running (as long as it aligns with your protocol), or taking a cooking, dance, or painting class. While these activities may not replicate the same form of intimacy you had before, they provide a welcome break from the constant fertility focus that may exist between you.
The Role of Therapy in Addressing These Challenges
Couples therapy can offer a safe space for each partner to express their feelings of grief, disappointment, and fear regarding fertility struggles, which can help both partners understand each other's perspectives and cope more effectively. This understanding can foster a sense of closeness and enable the couple to begin working toward ways to be intimate again.
After a period of restrained intimacy, it can be challenging to reinitiate due to fears of rejection, uncertainty about whether the partner will reciprocate, or questions about the level of intimacy—whether it will involve simple physical touch or lead to sexual connection. A therapist can address these tough topics and facilitate the conversation, including assigning homework to take the pressure off either partner having to initiate. Additionally, a therapist can guide a couple in developing communication skills that they can build upon independently.
In conclusion, we know that sexual intimacy is an important part of romantic relationships; however, we must also be mindful that in a long-term partnership, life can interfere with physical intimacy as it once was. The key to making that okay is to discuss these issues openly, with the intention of either finding ways to reconnect sexually or exploring other ways to connect for a period of time. When the tide of heaviness lifts, if open communication has been maintained throughout, it shouldn’t be an issue to return to sexual intimacy, even if it looks different—hopefully because there is a pregnancy or baby in the picture. It is when communication has been lacking that it becomes much more difficult to get back into a good groove.
