Scism_3930final_Fall2015

Running Head: INFERTILITY IN COUPLES
Infertility and Gender, Sexual Relationships, and Overall Well-Being in Couples
Margaret Scism
The University of Georgia

INFERTILITY IN COUPLES 2
Infertility and Gender, Sexual Relationships, and Overall Well-Being in Couples
Introduction
Infertility is defined as the inability to conceive at least twelve months after regular
and unprotected sexual intercourse (Jafarzadeh-Kenarsari, Ataollah, Ali, & Mojtaba, 2015).
About eight to twelve percent of couples around the world face trouble conceiving a child
(Tao, Coates, & Bruce, 2012). Infertility may cause couples to question many things about
themselves and the overall quality of their life, considering that it will dramatically affect
the way their relationship progresses. In today’s society, there are many reasons to have a
child. There is pressure to add children into a family after a certain amount of time
together, and there are also couples that truly want nothing more than to have a child
together. Whatever the reason is, when a couple finds out that they will have difficulty
conceiving, their relationship may be affected in many different ways. The stress of dealing
with infertility and attempting to solve it can ultimately vary depending on the couple. It
differs depending on many variables, including the current relationship, social support, and
their gender, while also affecting their sexual relationship and overall well-being.
Most studies that are conducted focus on the effect of infertility on individuals
(mostly females); however, it is equally as important to conduct research that examines the
effect of infertility on the couple, taking a dyadic view (Onat & Beji, 2011). Couples who face
infertility are likely to experience a difference depending on their gender. Their sexual
relationship might decline. The confusion of handling infertility along with depression,
anxiety, and fear may lower an individual’s overall well-being. This will ultimately lead to
an unsatisfactory marriage with increasing conflict. In some couples, the stress of all the
stated factors may be too much for them to handle. Infertility may ultimately lead to the

dissolution of the relationship (or divorce). No matter who or what is the reason for the
infertility, there is no question that it will affect the couple as a whole.
Infertility and Gender
The majority of those who are infertile are women (Ying, Wu, Loke, 2014). This is
psychologically demanding for women, causing depression, distress, anxiety, sadness,
anger, and the loss of self esteem; however, studies show that men for the most part have
the same emotional response to infertility that women do (Ying, Wu, & Loke, 2014).
Because of socialization and biological differences, it is inevitable that men and women in
relationships have different reactions to their infertility. Men differ in that they view
infertility just as they view any other problem; they handle it with an increase of
masculinity, which has been associated with lesser levels of poor emotional response. Men
feel the need to uphold their traditional stoic role. They feel that they must control their
anger and uphold their manliness (Dhillon, Cumming, & Cumming, 2000). Women view it
as something they have never had to experience before (Andrews et al., 1992), putting it on
the same level as cancer and heart disease (Domar et al., 1993). This could cause friction in
a relationship because the male may not view the issue as important as the female does,
and in the case that he does, he is too embarrassed to show his true feelings, causing her to
feel as if her mindset is not appreciated and justified.
Previous studies show that women with infertility feel less feminine (Cserepes,
Kollar, Sapy, Wischmann, & Bugan, 2012) because they are not able to fulfill their main
calling in life, having a child. Cserepes, Kollar, Sapy, Wischmann, and Bugan (2012) found
that when women who faced infertility showed more femininity; they wanted to prove that
they were still womanly, despite the fact that they have not been able to get pregnant. This

could lead to personality changes for the woman in the relationship; triggering her to
suddenly care about things she did not care about before, confusing her partner and
ultimately causing him to feel as if he is now with somebody different.
Infertile women have been found to have a higher level of emotional distress, while
men have been known to have a more positive outlook. Despite the fact that men are not as
emotive, it is still important to incorporate their masculinity as an invaluable resource to
the couple as a whole. The role of the husband (or partner) is to be a support system that
the woman will not be able to find elsewhere (Ramirez-Ucles, Castillo-Aparicio, & Moreno-
Rosset, 2014). Couples facing involuntary childlessness may view this as a chance to
reclaim their roles in the relationship. Some men may view this as an opportunity to
strengthen their masculinity and help face the stress of infertility by protecting their
partner. If the men are excited and engaged in having a child and view the infertility as less
of a problem and more as a way to explore other options, the problems in the marital
relationship greatly decrease (Cserepes, Kollar, Sapy, Wischmann, & Bugan, 2012).
Infertility does not always tear relationships apart, but rather allows the couple to work
through it together, claim specific roles, and keep moving forward.
Infertility and a Couple’s Sexual Relationship
One characteristic of an intimate relationship is having some sort of sexual, physical
relationship. Obviously if a couple is attempting to conceive a child, they are involved in
sexual interaction, one that is physical as well as emotional. Infertility can have a large
impact on that interaction. When infertile and attempting to solve that problem, sexual
intercourse is occasionally forced around the timing of the women’s ovulatory cycle,
resulting in anxiety, depression, and a decrease in masculinity for men. Long-term,

unsuccessful treatment leads to increased anxiety and depression in women (Shakeri,
Parandavar, & Majahedi, 2013). These effects on both members of the relationship lead to a
decrease in sexual desire and sexual arousal, and the interactions become much less about
pleasure and much more about “duty”.
In a study of infertile women, by Kohan, Ghasemi, and Beigi, it was found that
women felt as if they no longer could have the pleasure of sexual relation and felt as if they
could not provide sexual satisfaction to their spouses, feeling almost disabled (2015). In
multiple studies it has been found that sexual desire is extremely interdependent between
partners. In a specific study by Yeoh et al., it was found that female sexual satisfaction was
heavily related to good sexual functioning in men (2014). Therefore, because it is most
often the woman who is having trouble with her fertility, she can heavily affect the way her
partner performs. When her partner in turn does not perform (because she is not satisfied),
this leads back again to a sense of failure for the woman, indicating that she did not make
her spouse happy. Some women avoided sexual relations in total, feeling as if they could no
longer perform the ultimate goal – pregnancy. When they did take part in sexual relations
with their spouse, they were thinking about pregnancy the whole time, which lead them to
have no good feelings or interest in what was actually taking place (Kohan, Ghasemi, &
Beigi, 2015). This decrease in the woman’s satisfaction could therefore lead to self-esteem
issues for her partner, making him feel less than or inadequate. The feeling of low self
esteem, along with all the other pileup stressors that already exist, lead to depression and
anxiety. This then causes more internal problems for the couple.
Many causes of infertility, such as polycystic ovary syndrome, are accompanied by
changes in women’s physical appearance (i.e. obesity and acne), which could affect the way

the woman feels about herself as well as the way her partner feels about her. However, it
should be noted that the woman’s sexual satisfaction was much lower compared to her
partner’s, indicating that a supportive partner is understanding even when the individual is
not 100 percent themselves; it is more the woman who feels negative about herself (De
Frene et al., 2014).
Although infertility and its treatment can be extremely stressful and unfortunate, it
does not automatically mean there will be a decrease in sexual desire and function. In the
study by Ezabadi, Mollaahamadi, and Shabani, they found that increased education and
counseling increase sexual function in infertile women (2014). In order to continue to have
a healthy sexual relationship, positive feedback from one partner to the other is
particularly fundamental (Riley, 2002). Couples who communicate effectively, work
together through conflict, and support each other tend to have more positive relationships,
and in turn have more positive sexual relationships. When couples have an increased
awareness of each other’s feelings and learn how to understand what each partner expects
from the relationship, emotionally and sexually, their relationship is much more likely to
succeed (Clarke, 1970).
Infertility and a Couple’s Overall Well-being
A couple’s overall well-being consists of their psychological health, general health
and their life meaning. A couple’s overall well-being when facing infertility will, in some
way, alter. Both males and females in infertile relationships report symptoms of
depression, anxiety, and fear, however men are able to search deeper for another meaning
of life, whereas women are not as optimistic (Cserepes, Kollar, Sapy, Wischmann, & Bugan,
2012). Women substantially view infertility as more of a problem than men do, possibly

because the treatments tend to be geared more towards women more than men (Andrews,
Abbey, & Halman, 1991). Because women tend to have a more negative outlook on their
infertility, it is proven in many different studies that they generally have a more negative
outlook on their marital relationship and overall life (Tao, Coates, & Bruce, 2012).
When most couples decide to go through with infertility treatments, it is because
they have a strong relationship. They have decided that building a family is extremely
important; therefore, a lot of these couples are satisfied within their relationship and have
an overall positive well-being. The idea is that those having marital problems would decide
to not go through treatment together and ultimately get divorced (Onat & Beji, 2011).
Because couples will have to go through this together, it is possible that it could end up
bringing them closer together, thereby improve the future of their life together. According
to the model by Andrews, Abbey, and Halman, there are steps couples who are faced with
infertility can take in order to mend their relationship and decrease stress. The first is that
when the couples understand their situation, they are much more likely to see a reduction
in their stress level. The second is, even in times of fertility stress, to attempt to maintain
their marital norm – reduce conflict, sustain a sexual relationship similar to what it was
previously, and promise to build each other up instead of placing blame (1991).
Low interpersonal relationships predict higher levels of emotional distress,
therefore, married (or long-term, sustaining) couples with a positive marital relationship
have a greater chance of gaining something from their infertility (Ramirez-Ucles, Castillo-
Aparicio, & Moreno-Rosset, 2014). A social support system, especially from somebody who
understands the struggle (a partner), gives space to get in touch with positive emotions and
higher the level of overall well-being. In a study done by Steuber and High, there is a known

positive correlation between quality of life and positive social support from family, friends,
and their significant other (2013).
Infertility and Divorce
In any marital relationships, there are stressors that could ultimately lead to
divorce, but infertility brings many stressors that a couple may have thought they would
never have to experience. Lack of a parental role and a decrease in overall life satisfaction
may lead individuals to undergo personality changes from depression and stress (Kahaki,
Nazari, & Khosravi, 2014), ultimately leading to the dissolution of their marital
relationships. Unsuccessful infertility treatments come with higher levels of stress, anxiety,
and depression than when the treatment first started. This causes marital distress and
increased rates of divorce (Kjaer et al., 2013). In the study by Kjaer et al., it was found that
women who did not end up having a child were up to three times more likely to get a
divorce or end cohabitation during the twelve years after the evaluation than those who
did end up having a child (2013).
Couples who do not end up having a child together may no longer be able to see
their partner as their confidant, friend, and lover, but rather only as a reminder of what
they wanted but never had the chance to have. This could in turn lead to more negative
feelings than were there initially. Not having a child after fertility seems to be an important
part of whether couples decide to stay together after a long period of time trying (Kjaer et
al., 2013). Although it cannot be proven as a cause for divorce, there is a positive
correlation between unsuccessful fertility treatments and the dissolution of a relationship.
It also cannot be said that all couples that stay together have a positive marital relationship.
Practical Implications

As stated previously, infertility can be extremely detrimental to a relationship. It can
change personality traits, the way partners see each other, the way individuals see
themselves, and the way the world sees a couple. This can have a large impact on the stress
that is put on a couple, possibly leading to their relationship’s demise.
The research given by Andrews, Abbey, and Halman can be practically connected to
couples’ relationship outcomes. It can possibly prevent the ending of a relationship because
of infertility. It is possible that a couple comes out stronger in their long-term relationship
than when they entered this journey. If they follow the steps listed in their study, they will
perhaps gain a closer relationship with their partner. This relationship will help them deal
with their current fertility stress; it will give them a safe haven, somebody they feel
completely comfortable with – which is what they should have during such a difficult time.
A closer relationship will help them as they work through the infertility process. It
will allow them to move forward and take things as they come. A positive marital
relationship will more than likely lead to an overall positive well-being for each of the
individuals, and an overall happier life now and in the future.
Reliability of the Studies
A negative about many of the studies mentioned is that most focus on the woman
being infertile. There are not many studies that mention the male in the relationship being
the one who is going through the infertility treatments. This could be because women view
infertility as a much larger problem; therefore they have many more “conditions” to
observe than men. Socially, being infertile may be viewed as less masculine, which could
inhibit some men from wanting to publically state that they are infertile. The studies are
volunteer based, meaning that there are more than likely many couples experiencing this

who may have completely different reactions, yet because they are not willing to
participate, researchers are not able to identify different results.
Most of the studies mentioned are also short-term studies. Only one study
mentioned was a longitudinal study that focused on the outcome of marital relationships
(Kjaer et al., 2013). Short-term studies only allow researchers to study data that may
change after years of continued infertility and its treatments. Longitudinal research is able
to look at change over time and can compare things in the past to essentially predict future
occurrences
These studies also cannot say 100 percent that infertility is the definite reason for
the way it affects its sufferers. There is no way to “cause” infertility and watch the reactions
from only that single variable. In real life there are outside factors that play a large part in
peoples’ day to day lives that could have a significant role in the way they are feeling,
acting, and responding to their circumstances (Tao, Coates, & Bruce, 2012).
Many of the studies are focused on different societies, like the Cserepes, Kollar, Sapy,
Wischmann, and Bugan study that focused on involuntary childless couples in Hungary
(2012). These societies all view infertility differently. For example, some cultures view
infertility as being weak (unable to perform) while others view it as a religious sign. Most
of the studies focused on middle- and upper-class couples (Dhillon, Cumming, & Cumming,
2000). This is probably because fertility treatments are extremely expensive and time
consuming, something that lower-class couples probably cannot afford to take on.
Conclusion
In conclusion, most of the research shows that women in the relationship have a
harder, more emotional time dealing with infertility versus men in the relationship;

however, it helps to understand both the male and females role within that dyadic
interaction. Most couples experience a different, more emotional and confusing sexual life
versus the one they had before knowledge of their infertility. Lastly, well-being can be
negatively affected if couples handle infertility as a hindrance versus an opportunity to
grow together and work through the problem together. Infertility becomes a mentality, a
way of life, and an all consuming-state of mind, and it can affect almost any part of your life.
Infertility affects many people in different societies, and the couple is an extremely
important factor in how infertility is handled; therefore, it is necessary that its research be
continued thoroughly and consistently.

References
Andrews, F.M., Abbey, A., Halman, L.J., 1992. Is fertility-problem stress different? The
dynamics of stress in fertile and infertile couples. Fertil. Steril. 57 (6), 1247–1253.
Clarke, C. (1970). Group Orcedures for Increasing Positive Feedback Between Married Partners.
Family Coordinator, 19(4), 324-328.
Cserepes, R., Kollar, J., Sapy, T., Wischmann, T., & Bugan, A. (2012). Effects of gender roles,
child wish motives, subjective well-being, and marital adjustment on infertility-related
stress: a preliminary study with a Hungarian sample of imvoluntary childless men and
women. Archives of Gynecology and Obstetrics, 288(4), 925-932.
De Frene, V., Verhofstadt, L., Loeys, T., Stuyver, I., Buysse, A., & De Sutter, P. (2015). Sexual
and relational satisfaction in couples where the woman has polycystic ovary syndrome: a
dyadic analysis. Human Reproduction, 30(3), 625-631.
Dhillon, R., Cumming, C., & Cumming, D. (2000). Psychological well-being and coping
patterns in infertile men. Fertility and Sterility, 74(4), 702-706.
Domar, A.D., Zuttermeister, P.C., Friedman, R., 1993. The psychological impact of infertility – a
comparison with patients with other medical conditions. J. Psychosom. Obstet. Gynecol.
14, 45–52.
Ezabadi, Z., Mollaahmadi, F., & Shabani, F. (2014). Assessment of infertile patient’s attitude
toward educational effectiveness (A descriptive study). Iranian Journal Of Reproductive
Medicine, 12, 50.

Jafarzadeh-Kenarsari, F., Ghahiri, A., Zargham-Boroujeni, A., & Habibi, M. (2015). Exploration
of the counseling needs of infertile couples: A qualitative study. Iranian Journal of
Nursing & Midwifery Research, 20(5), 552-559.
Kahaki, F., Nazari, M., & Khosravi, M. (2014). A survey of the relationship between anxiety,
stress, depression and life satisfaction in fertile and infertile women. Journal of Jahrom
University of Medical Sciences, 11(160).
Kjaer, T., Albieri, V., Jensen, A., Kjaer, S. K., Johansen, C., & Dalton, S.O. (2014) Divorce of
end of cohabitation among Danish women evaluated for fertility problems. Acta
Obstetricia Et Gynecologica Scandinavica, 93(3), 269-276.
Kohan, S., Ghasemi, Z., & Beigi, M. (2015). Exploring infertile women’s experiences about
sexual life: A qualitative study. Iranian Journal of Nursing & Midwifery Research, 20(1),
34-39.
Onat, G., & Beji, N. (2011). Marital Relationship and Quality of Life Among Couples with
Infertility. Sexuality and Disability, 30(1), 39-52.
Ramirez-Ucles, I.M., Del Castillo-Aparicio, M., & Moreno-Rosset, C. (2015). Psychological
predictor variables of emotional maladjustment in infertility: Analysis of the moderating
role of gender. Clinica Y Salud, 26(1), 57-63.
Riley, A. (2002). The role of the partner in erectle dysfunction and its treatment. International
Journal Of Impotence Research. 14(1), 105.
Shakeri, N., Parandavar, N., & Mojahedi, L. (2014). Factors affecting sexual function in infertile
couples. Journal Of Jahrom University of Medical Sciences, 11, 112.
Steuber, K. R., & High, A. (2015). Disclosure strategies, social support, and quality of life in
infertile women. Human Reproduction, 30(7), 1635-1642.

Tao, P., Coates, R., & Maycock, B. (2012). Investigating Marital Relationship in Infertility: A
Systematic Review of Quantitative Studies. Journal of Reproduction & Infertility, 13(2),
71-80.
Yeoh, S.H., Razali, R., Sidi, H., Razi, Z.M., Midin, M., Jaafar, N.N., & Das, S. (2014). The
relationship between sexual functioning among couples undergoing infertility treatment:
a pair of perfect gloves. Comprehensive Psychiartry, 55(1), S1-S6.
Ying, L. Y., Wu, L. H., & Loke, A.Y. (2015). Review: Gender differences in experiences with
and adjustments to infertility: A literature review. International Journal Of Nursing
Studies, 52, 1640-1652.

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