“Ok, well what do we do next?” That is the most common response I receive when calling men to inform them of an abnormal semen analysis. I have been working in reproductive medicine for twelve years, and in that time I have never had a man cry as an initial first response to bad news. Typically we briefly discuss the next steps in testing, I am thanked for my time and we hang up. And then I await either a phone call or email hours later from their partner with follow up questions, typically far more emotional. I don’t mean to stereotype, but in my personal experience men and women do process infertility differently, and it is common for this to challenge even the strongest relationship.
Men and women facing infertility each have a unique loss. For women infertility is a visible wound. They are asked often about their childbearing plans in casual conversation and pressured by family, friends, and co-workers for more details. I wish men were asked “So, do you have children?” as an initial ice-breaking question at business meetings or by the grocery store clerk, but this is not the world we live in. Not yet. Women face a medicalized process to achieve what they have been warned all their lives will happen accidentally if they are not vigilant with contraception. This is unfair, and it is natural to feel resentment, especially so when the cause is male factor. Many women have mentioned to me that there is “nothing wrong with them” at an IVF consult for male factor. While in treatment, women also face daily reminders of the societal expectations of childbearing. From the grocery store clerk banter, tabloids full of stories about pregnant celebrities, or having all the mothers stand at church on Mother’s Day, a woman aching to be a mother is not able to ignore her loss.
Men’s losses may be hidden, but no less real. Male factor infertility used to literally be hidden, with couples advised to use donor sperm and just never tell anyone. Advances in genetics and the current model of open disclosure now encourage honestly about genetic origin and allow men to grieve the loss of a genetic connection. But many men keep their diagnosis private due to stigmas about sperm count as a marker for masculinity. A friend’s husband was once asked awkwardly at a party if he needed any tips on “how to do it” after mentioning they were struggling to have children. I also see men who feel guilt and anger about the painful tests and treatment women may complete as part of treatment for male infertility. How you process these losses can push you together, or apart. There is a classic article from 1991, one of the first large studies to look at how men and women experience infertility stress differently. Their findings feel equally relevant today. “She is surprised and disappointed that he is not more concerned, affected, touched by the problem. He is disappointed that she is so distressed, preoccupied, or affected by the experience. In short, each wishes the other would adopt his/her coping strategies.”
A different coping style does not mean that men do not experience loss and anger from infertility. Stress does come out, perhaps in arguments with their partner, or perhaps in a man berating the front desk of a fertility clinic when the doctor is running 15 minutes behind. This may be his only way of expressing the need to protect his partner. I spoke with a man recently about his diagnosis of azoospermia, and mentioned I would send an email with next steps. However, the email in our system was for his partner (as it typical, the women often complete all the paperwork). He asked me to wait to send anything so he could tell his partner himself, as “she is going to take this really hard.” This is a man who previously survived cancer, and just was told his past treatments may mean he cannot have genetic children. His first thoughts were still how to help his wife.
I have seen relationships end with the stress of infertility. Sometimes this is dramatic, such as a man not showing up to the clinic on egg retrieval day because he has decided to end both the IVF cycle and the relationship. More commonly it is a slow fade. The couple becomes less a couple and more like coworkers on an expensive project where the goals and deadlines keep changing. But most of all, I have seen relationships grow stronger. Together couples are facing an unpredictable challenge that will require time, money, and physical and emotional highs and lows. This may sound like a description of IVF, but it’s also a good summary of parenting. Working so long in fertility I often forget that most pregnancies are unplanned. How can you be ready to be a parent without years talking about options, supporting each other and remaining committed to the goal despite great difficulty? As crazy as it sounds, I now see my infertility as a gift. After eighteen years of marriage, during any challenge I remember how we faced infertility together. Only the two of us knows who we were in our darkest, saddest moments. When we smile at each other over the heads of our children in a cute moment (usually about a second before they then start fighting) somehow it means a bit more.
I suggest you give each other space to grieve in your own way, and at your own pace. Recognize each other’s losses. Don’t force your coping style on someone else. One person may find comfort in talking again and again about treatment options or the upcoming IVF cycle. Another may find thinking about this a lot physically painful and prefer distraction.
Go on that long run or play video games if that is what makes you feel more like your pre-infertility self. Therapy can be invaluable, either as a couple, group or individual. Infertility can be isolating and being around others who “get it” provides shelter from the expectations of the fertile world. Remember your ultimate goal, because it is not just a baby. The goal is completing your family. Parenting is something you do together, in the context of a relationship you want to continue after your children have grown up. Keeping your relationship strong during infertility will make you better parents, and better people after your eighteen years of hands-on parenting. Eventually, your children will leave home and you will be back to the relationship you have now, as a couple. Infertility is often the first major stressor that couple’s face together. Your infertility will end, but the strategies you use now will be needed again for health scares, elderly parents, job losses and all the other trials of adulthood. To be physically strong you exercise, breaking down muscle to allow it to heal stronger. To be emotionally strong through infertility also involves a breakdown, but you can heal as a stronger couple.