Shraddha was in tears. She had got her period again. Unable to hold herself anymore she closed the lid of the toilet seat, sat down on it and wept. Voices and images raced in her head, her mother’s “I can’t wait from my grandchild!”, her husband’s “Don’t think about it, it will happen”, her friends’ uncomfortable silences and her own dismal truth experienced every day had become painful. She tested her body temperature each morning, noting for daily changes. She was diligently noting events such as sexual intercourse, sleepless nights, and sickness. She peed every other week in a cup to test for ovulation. “Prolactin testing, serum testing, thyroid testing”, the voices wouldn’t cease and worse still she knew “testing” was set to become more and more invasive with “post-coital testing”, laparoscopy and every other thing in the loom. A cloud of confusion sat on Sraddha’s head as she began to wipe her tears away. She was at once angry, frustrated, sad, dejected, annoyed, worried, powerless, and cheated. A wave of fatigue swept through her and she felt numb again.

Shraddha is just one among many women and men struggling to make sense of infertility. The text book definition of infertility is “the inability to achieve a viable pregnancy after 12 months of regular, unprotected sexual intercourse”. According to WHO estimates 8-10% of couples experience the frustration of infertility at some point in their relationship. They also indicate that the incidence is equal among both men and women, which means it’s never just the woman’s or man’s fault, like our society often makes it out to be.

Infertility and our Society

India is possibly the most difficult country to live in with infertility. Well, it may seem like that at least. With families trying to hide the fact that their son or daughter is infertile to marriages ending on the grounds of infertility, we are a culture where one might give up their lives sooner than acknowledge that infertility is in question.

We begin our marriages with blessings from our elders to beget many children; we are often reminded of the same every time we pay our respects to them. “May you be blessed with a son, just like mine” says the mother-in-law. Relatives seem to insist “Your biological clock is ticking”, friends ask “are you family planning?” Parents seem to wonder “when am I going to be a grandparent?” Why, one of the many standard job interview questions seems to be “do you have children?” At this rate, I’ll bet you (obviously because research, work and experience shows) that no couple is comfortable making love with questions like this circling their head.

Unfortunately, in a country like ours, where a high premium is placed on family, the stigma that comes with infertility weighs heavily upon women like Shraddha. Moreover, our own thoughts, fuelled by myths, plague us “I shouldn’t have taken birth control for so long”, “its Gods punishment for my abortion”, “that’s just how my fate is”, and “this is because I didn’t want to have children when I was younger” comes back to us in our most vulnerable states.

“I am all tied up in knots and can’t think straight”: Infertility and the Biopsychosocial Impact

Research has reported high incidence of anxiety and depression among couples who are infertile and/or trying fertility treatments to get pregnant. “Finding out the problem” can cause immense emotional upheaval in itself. Like Shraddha, just beginning the process of finding out why a couple can’t get pregnant can be more that just frustrating. Couples often experience a roller coaster of emotions, ranging from anger, frustration, and sadness to guilt, shame, stigmatization, loneliness, jealously, loss, grief and helplessness. Couples report feeling exploited by their doctors who initiate new procedures on them, worse still is the experience of many couples who feel rushed or discouraged to ask their doctor questions about different tests, what is to come and what needs to be done. Frustration and anger toward professionals is also a common experience of couples whose treatment fails at one phase or another.

From focusing on life in general with responsibilities of work, love and leisure couples suddenly find themselves overloaded by the” role of an infertile adult”. With weekly visits to the hospital, to noting daily changes of body temperature, time of sex and so forth couples are often reminded of their inadequacy as an adult. The stress of figuring out time and money for fertility treatments weigh heavily on couples.

The marital effects that the infertility experience brings with it are immense. Coping with stress is unique to individuals and often times, when one couple focuses on issues in a solution-focused way the other couple is emotionally focused on the issue. Like Shraddha, many woman choose to get scrutinized first (medical tests and the like) than going at it together as a couple. Often times, one partner may be more ready than the other to name the elephant in the room. Moreover, at some point, what once was perceived an enjoyable sexual experience becomes more and more uncomfortable because what was once making love, is now a goal oriented exercise. The dynamics that couples create between one another either make it extremely easy to deal with the pain or extremely hard to deal with the pain that comes with getting pregnant. Many times it is the latter that happens. Studies show that couples who are able to name the elephant in the room and work together towards a personal goal, they become more intimate in their marriage than before.

Because of the role overload and the immense stress, couples find themselves slowly withdrawing from social support the once enjoyed. While friends don’t know what to say, relatives say too much. Studies have shown that often couples perceive that the support that they get from their friends and family as limited.

From being a biological upheaval to an emotional one there is much to be considered when couples come to this place of getting pregnant. Appraising the situation as a biological issue does not mean it is not an emotional process. The experience of infertility is a very private and emotional one. From starting on getting tested to deciding on IUIs, IVFs, adoption or donor programs-stress only gets built more and more. Hence, acknowledging the biopsychosocial impact of infertility is key to a healthy coping process, what that simply means in the words of one of my clients is “it’s ok to feel like you are a mess right now”. Seeking a counselor who is able to support the couple with the emotional upheaval experienced due to infertility can be extremely beneficial while one is on the road to becoming a parent.