Many couples expect to enter into parenthood without a care in the world, easy as 1-2-3. But if your baby-making dreams have become a nightmare, you aren’t alone. Infertility affects 7.3 million American women, and more than half of them have already successfully given birth to one or more children; secondary infertility happens when a couple cannot conceive a second (or third) child despite previous pregnancy. What can couples do to increase the odds of expanding their families?

Conception concerns

There are many reasons for infertility, and it isn’t only a woman’s issue. The American Society of Reproductive Medicine attributes one third of cases to male factors, including sperm count or quality and one third to female factors, including ovulation disorders and endometriosis. Age, smoking, stress and obesity can increase infertility risks. And one third of cases are due to a combination of factors or to unknown causes.

Melissa Ford, author of “Navigating the Land of If: Understanding Infertility and Exploring Your Options,” likens infertility to the Bermuda Triangle.


“The physical, emotional and financial stressors of infertility are intense,” Ford shares, “and it’s easy to get lost.” Most couples take one step at a time, venturing deeper into the unknown as they go. Each couple has to find their own way out.


Pathways out of infertility

Infertility might be simpler if there was only one solution. But there are many options, Ford explains, and it’s helpful to explore them with your physician as your journey unfolds. Many couples start with the “simplest” options – fertility medications and intra-uterine insemination – before moving to more invasive (and more costly) procedures like in-vitro fertilization.


Depending on the causes of infertility, the use of donor eggs, sperm or embryos or a surrogate may be warranted. Some couples opt for adoption from the beginning, and others choose adoption only after other treatments fail. If you’re considering donors, surrogacy or adoption, you’ll want to consult a reproductive attorney for advice.


Some infertile couples choose to live child-free says Constance Shapiro, Ph.D., therapist and author of “When You’re Not Expecting: An Infertility Survival Guide.” They move past the grief they feel and commit to a life that doesn’t include kids. The emotional journey from feeling childless to being child-free opens the door to other possibilities, but it isn’t easy.


Stresses of infertility

Not long after blissfully declaring, “I Do,” newlyweds begin to hear, “When are you going to start a family?” Our society reinforces the idea that a family consists of two parents and their children and people internalize that model, Shapiro says. When infertility threatens that ideal, it hurts.


Treatment is stressful, too. Doctor appointments are inconvenient and fertility drugs can cause mood swings and weight gain. Fertility procedures are expensive, and many couples are forced to take out loans to finance baby-making, according to Ford. Feedback throughout the process – about hormone levels, follicle development and (you hope) pregnancy – is a double-edged sword. Each bit of bad news crushes you a little more.


Seeing others have babies can magnify the disappointment couples feel. When friends show off their sonograms and ask for baby-naming advice, you may feel angry and jealous. Infertility can be isolating, especially if it’s a secret.


To top it off, when you’re struggling to get pregnant, sex isn’t so sexy, Shapiro cautions. Treatments may require intercourse at specific times in the menstrual cycle and forbid it at other times. Couples may miss the intimate physical connection they once experienced. At a time when people long to feel close and connected, a great divide can form.


How to cope

So, where do couples begin to deal with the many emotions and challenges that come with infertility and the road to being parents?


1 The first step is to acknowledge your sadness. Share your feelings with each other, but don’t be consumed by negativity, Shapiro warns. Put limits on when and where you will discuss emotions. “And don’t do it in the bedroom!” she insists.


2 Ration your energy. If baby showers and kid-focused conversations are weighing you down, it’s okay to opt out sometimes, encourages Ford.  Friends and family will understand. Participate in social events when you can, and acknowledge when you need a break.


3  Be united. “For most couples, infertility is too heavy an emotional load to shoulder between just the two of them,” says Shapiro. “Working through who to tell and how much to share can increase your emotional intimacy.” Treat infertility as a couple’s issue and stay connected.


4 Seek support. Don’t let infertility tear you down. Join an online community or attend counseling. Many clinics have psychologists on staff and most use sliding fee scales, Shapiro reassures. Reach past the isolation and get help.


There is no easy way out of infertility. It’s normal to feel an enormous loss when your dreams for the future aren’t coming true in a snap.


“Before infertility, I had never encountered a ‘no’ from the universe,” reveals Ford. “All the big life events came easy. Infertility made me realize how much is out of my control.” Now a mother of twins, Ford says she’s learning that lesson over and over in parenting.


Resources for couples


Read “Navigating the Land of If: Understanding Infertility and Exploring Your  Options” (2009; Seal Press) by Melissa Ford

Find infertility coping tips and tools

Reach out to others for support and

Read up on budgeting for infertility treatment and get referrals to treatment providers, counselors, support groups and reproductive attorneys

Learn about topics from artificial insemination to vasectomy at


Heidi Smith Luedtke is a personality psychologist and other of two. She is the author of “Detachment Parenting”.

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