Chapter 5
The Relationship

Everything was perfect. We had this enchanted life. We met and fell in love, bought the house. His business was going well. I got a raise. We had practically bought the baby stroller. We were looking for it.

Then our terrier died. It was really rough. I stayed in a cage with her for a week. I was so attached to her. I loved her. This was a real set-back.

It was the first inkling I had that things weren't going to be so charmed. I'd always had the suspicion that everything I touched kind of turned to poop. It seems like everything I get involved with gets to be a failure. I thought I had paid my dues. I was thinking, 'No, no, don't let this start happening again.'

Things were all of a sudden not going so well. The doctor is telling me the same speech every month: 'Seventeen percent of all women get pregnant every month.' But it was never me.
—Marsha

Strain on the relationship often begins quietly, as problems with fertility eat away at the carefully constructed moorings that anchor relationships. Initially, a man reassures his partner. She's imagining things, jumping to conclusions. He's sure it will work out. But when time passes without a pregnancy, she becomes more preoccupied. And he starts feeling left out. He's resentful

about it. He feels abandoned because she has turned inward, in communion with herself. She has become self-absorbed, enveloped by the fertility problem.

Women complain that men are not taking their fertility issues seriously. What about men? They say that women are taking things too seriously. They see a woman's emotional immersion in the problem as a threat. Polarization in the relationship begins here.

Loss of fertility is a threat to the relationship. As partners question themselves and each other, the threat seems to grow. As they become increasingly engulfed by the problem, they forget their similarities and shared concerns. They focus on their differences.

Men and women can counteract the effects of a fertility problem on their relationship. The question is, how can they do this? By understanding the dynamics that are involved. And by taking action that will defuse instead of load the marital encounter.

Part of this potential dilemma arises because women receive most of the medical treatment. They become engulfed by it, while their partner feels left out. These dynamics sow seeds for the development of mistrust. When a woman feels she is not being taken seriously, she becomes aggravated, then angry. A man, in response, becomes defensive. Carrie and Russ experienced this problem when she had side effects while taking clomiphene:

The doctor writes out this prescription for Clomid and he doubles the dose and I start taking it and start flipping out. I thought, 'This is too much.' I blanked out, saw little white lights, had hot flashes. Now I know they are the usual side effects that you get.^[*]

Russ interjected:

[*] Although they are often ignored medically, emotional side effects of clomiphene are common.

I used to think this was a joke. I really did because …

Angrily, Carrie said:

He was horrible about it—he thought I was hallucinating.

Russ responded lamely:

I just thought it was a joke.

Carrie, remembering indignantly, said:

I had high-blown personality changes. I mean, Sybil was my name!

Russ, still sounding doubtful, said:

Then we got in Resolve and the other women started reporting similar things so I had to accept that it's a real situation.

A man wants to be part of what his partner is going through, but usually he doesn't know how. Because she has suddenly become an inscrutable woman. Hard to understand. He never thought of her as remote or hard to reach before. He never thought of her as temperamental. He never noticed she was so emotional, either. What has happened to her?

When he's mad at her, he sees her as a stereotype of women—what men talk about when they say a woman is being "a typical woman." Suddenly she's demanding, unpredictable, hysterical, and untouchable. All at the same time. What did he do to deserve this? He doesn't know what to do about it. For many couples, this—a man's bewilderment in the face of his partner's absorption in the problem—is the heart of the problem.

Stan doesn't know what to do. He wants to do the right thing and sometimes when I'm really upset or depressed I get angry. I'm just irrational, and what I really want is someone

to say, 'Hey, honey, it's going to be okay. Come here and let me hold you.' And that's not his style.

I just can't let my grief out. I think it's because Stan has always been uncomfortable with that.

A couple's sense of connectedness with each other may seem to fade. Each partner feels unsupported, and in turn becomes less supportive of the other one. Rachel and Bill were overwhelmed by the tension and frustration that was suddenly ever-present in their relationship.

RACHEL : We didn't handle the infertility well for a while. I was yelling at him and he was depressed. I think it put a lot of stress on our relationship.

There was a period of time when nothing was right. I was all upset, just devastated. It was horrible. Bill was off the wall. It was all wrong and everything. I felt a lot worse then than I do now, don't you think, Bill?

Bill responded:

It was just indicative of the frustration she was going through. We finally decided that we would go on a trip and get away from all this. We just picked up and went. We had a great time. But everything leading up to it was just too much.

Rachel described how the stress of infertility affected her:

I would just get frustrated. There were some days that I would just explode. I couldn't stand it anymore. All the pressure of not knowing. I was a wreck.

Bill concluded:

It's been really hard on our relationship. Nonetheless, I think we both feel much stronger at this point. There were times

when it was pretty rough. In the beginning it was compounded by the job situation, living 2,000 miles from where we grew up, meeting new friends, dealing with the real estate, dealing with the weather. All these things. At first, infertility was just another issue. It became the last straw.

What is really happening in their relationship? This is the point at which their identities as man and woman diverge. As attuned as Bill is to Rachel's feelings, it's hard for him to relate totally to what Rachel is going through. Like most men, fertility, unless it is linked to his sexuality, is just not that central to who he is.

But it is central to who she is. Rachel, completely self-absorbed, is focused only on herself. She can't get outside herself long enough to relate to Bill. Her life revolves around her fertility right now.

Polarization of the Relationship

Differences between men and women are polarized when fertility is the issue. Huge crevasses appear from nowhere to open up underneath a couple's feet, creating one chasm after another. How could that person sitting across the dinner table, so well known and predictable, suddenly become a stranger? Celia described how this shift came about:

Ron wasn't in favor of a work-up at all because he had a much more romantic notion of getting pregnant and he didn't want science to have very much to do with it. I was fairly impatient at that point, I think partly because I had this hunch all along.

So that is when the tension began. We started to go down different roads. I wanted to know why we were not getting pregnant, and I was sure there was a problem. And he thought it was just a problem of time and romance. At that point we were on very separate paths.

Fertility issues highlight differences between men's and women's views of the world. As I discussed in Chapter 1, the different roles for which we are prepared early in life may have seemed insignificant before the effort to have children began. But once those efforts fail, subtle differences between women and men suddenly take on huge proportions. Each partner begins to focus on these differences. Although they have no way of knowing it, the differences they experience result from the conflict inherent within each person's gender role. These inconsistencies greatly complicate communication. They are almost impossible to tease out because they reflect cultural attitudes that are embedded in how we think.

The complexity of gender roles, combined with the need we experience in middle adulthood to finally evolve a separate self, results in an explosion, however quietly it may occur. That vision of a shared reality, once so mutually held, bites the dust. Before each partner's eyes, that single reality evolves into two separate views, as women and men begin to differentiate themselves from each other.

The catalyst is their fertility.

Whose Problem is It?

When a man doesn't have a fertility problem, he feels as though he is the supporting cast for the central drama of his partner's life. He doesn't like this role. He feels as if he has suddenly been discarded in favor of a mythical child. The child they are to have becomes the competition, even before it is conceived.

The ambivalence men often feel about sharing their partner with a newcomer after the baby's arrival is first experienced now. Except, in this case, the child is not yet a reality. This makes it worse. The competition is still in the image stage.

He feels hurt. Angry. As a result, he gets detached. The intangible nature of the child makes it easier, though, to hide his feelings from his partner and himself.

A man often belittles his partner's preoccupation with her

fertility, hoping it will go away. Why does he do this? He is reacting to his own hurt feelings, and is at a loss about the best way to deal with this threat. Greg explained how he made the problem worse:

I thought I was right in what was the matter with Gina and what was the matter with all the rest of the things. You have a problem? Let's deal with it and go on to the next thing.

And, of course, the more problems Gina and I had between us, due to our infertility, due to our lack of communication, due to the perception of power imbalance in our relationship, the more blockheaded I became. You know, if it's right, then it's logical and you can see it. We clear this up and move on. Instead, it just got worse and worse and worse.

Under stress, we become stereotypes of ourselves. We cling to our basic coping style in an effort to weather the crisis. Greg got locked into stereotypic behavior in an effort to cope:

Coming from a family like mine, you take on the aura of not righteousness but just being right. The element that contributed to how I felt and how I dealt with things was basically, 'Everything is logical. If it's logical, it's right, and if it's illogical, it's unclean, it's untidy.' And we don't deal with it. Because it's not logical and emotions are—you know—so illogical.

Gina interjected:

Everything was black and white, and infertility is one big, fat gray area.

A man feels inadequate to handle his partner's pain. And he gets defensive about it. Could it somehow be his fault? Sometimes it sounds as if she thinks so.

For me to be talking with him is … it's okay if I talk to him while he is reading the paper or watching TV—that's okay—but to talk to him with undivided attention is a real struggle. We just had a big fight over that. I told him I need one half hour a day, I didn't think it was unreasonable. He sort of agreed, so maybe we are making some sort of improvement.
—Laurel

In contrast, a man who has a fertility problem suddenly finds himself in a crisis that revolves around the threat to his masculinity. But he may feel as though he has to compete with his partner for attention. Who has the biggest problem? Each of them thinks he or she does. And they both feel as if they are not getting everything they need from the other one. Both of them may feel so needy, initially, that there isn't enough sympathy to go around.

There were times in frustration when she would say, 'Look, you're just going to have to handle your own problem yourself because I have enough to worry about of my own … this business with your semen. I don't know what to say, that's up to you.' Whereas before, going through all her problems with her, I would have to support her. That made me mad.
—Billy

When both partners see themselves as infertile, they alternate between feeling at odds with each other and feeling united. Because it is their problem, and they both know it. There is a lot of stress, especially initially, but once they have both identified a problem, partners usually feel as if they are in this together. They are a team.

There was a lot of guilt and blame for a while. It happened. Until we realized that it was nobody's actual fault. When you say it's somebody's fault, that means that they did something to deserve it. You may be able to say, 'Well, it's

your condition,' but there's nothing you did to cause it. So you can't blame somebody for it.
—Bill

What happens when a man is infertile and his partner isn't? A woman still sees herself as having a problem—she sees the fertility problem as their problem. But he doesn't. He thinks, "If it weren't for me, she could get pregnant. She could have the child she wants. I'm in the way." His sense of failure is profound, and so is his sense of guilt.

We went through a heavy discussion, considering—not considering divorce, but we discussed it. The fact that we'd even discussed it was, to us, pretty far gone. He said to me, 'If you want to get somebody else to do it. … If you want to get somebody else …'

I have never seen him so depressed in my life. This really killed him. He … it was like up till then … I don't know. Anyway, it was awful.

But you know what? It's my thing, too. As far as I'm concerned, I'm as guilty as he is.
—Angie

The relationship is affected somewhat differently, depending on where the problem lies. But the basic issues don't change.

Feeling Isolated

Men and women learn sooner or later that their view of the world is not identical. This discovery is part of the process of personal growth in adulthood. But when it occurs in tandem with the discovery of infertility, it may polarize the relationship. Shocked by their infertility and flooded by feelings of failure and guilt, women and men experience isolation from each other—one of the most difficult things for them to bear at this time.

The sense of isolation a woman feels is related to her identity

and her feelings of failure to live up to her own lifelong expectations. She is extremely disturbed by feelings of isolation from her partner part of the time, and unaware of how she contributes to the problem at other times. Because of the identity issues infertility raises, she may become engulfed by the problem and view her fertility as a burden she must carry alone.

Laura's sense of isolation from Stan manifested itself in a recurring dream:

For the first time in my life about eight or nine months ago, I started having a dream over and over again. That's never happened to me before. It was really strange. Not only that but the dream just seemed completely inappropriate. It didn't make any sense.

Every single time in the dream, Stan would say very matter-of-factly, 'Listen, I just realized that I don't love you anymore and I think I'm going to be leaving. It's been real nice.' And he walks out and I'm going, 'Oh, no, please stop, I'll do anything, I'm going to kill myself, I can't survive, you've got to stay. …' Total hysterics.

And I've woken up a few times with tears coming out of my eyes in the middle of the night. Then unable to get back to sleep again and spending the whole next day with a knot in my stomach, saying to myself, 'Hey, it was just a dream and the guy is not going to do that at all.' It's completely out of the question.

I brought this up to a very perceptive friend of mine. I was just sort of joking and talking about it and she said, 'Don't you see what this is about?' And I said, 'I guess it's about my not feeling I'm a wonderful person.' And she said, 'No, what it's about is your infertility problem. What I hear in that dream is that you're being just tremendously emotional and you're so involved in what's going on. And he's not there for you. You really feel like you're alone.'

Men also experience isolation from their partner. Men tend to rely on their partner to meet many of their emotional needs. They

have fewer approved outlets for social exchange and intimacy than women do. That cultural expectation about being a real man—fitting the stereotype—prevents many men from exploring the expressive side of themselves with other men. Before he can go beyond the boundaries that rigidly define who men are and what is possible in other relationships, a man has to work his way through a tangle of men's issues, such as to whom men talk and what they talk about.

I can sit here and discuss it now. It's not something to stand around and talk about while you're putting at the last tee. I really didn't have anybody intimate to discuss it with.
—Kenny

These limits on a man's social self means that he relies heavily on his relationship with his partner to meet his emotional needs. Since a woman is expected to be emotionally expressive and have a variety of social relationships, he may rely more on her than she relies on him to get emotional needs met.

The recognition that goals are different reinforces feelings of isolation. Theresa, describing the first Resolve meeting she went to, said,

The guy that came the first night was there because his wife asked him to come. He felt that he could live without having children, it wasn't that big—I mean, he wants them but he would survive. 'I have my work and my fulfillments.'

That was what Paul was saying, too, before he found out he had a problem: 'I think I can do okay without it. It would be nice but it's not going to ruin my life.'

A sense of isolation arises not only because of attitudes or emotional differences between partners, it emanates from within the individual.

There are times I feel more distant because I get things walled up inside of me. And I don't know how to get them out without blowing up.
—Paula

What can a couple do about it? They can start by talking with each other. When communication is ongoing, isolation fades.

Feeling Like a Failure

The pervasive sense of failure that both men and women express contributes to feelings of isolation. They feel humiliated by their failure to live up to their own lifelong expectations. Marsha felt guilty over her failure to meet Hal's expectations.

Hal, his whole life, has expected to get married, marry a Jewish woman, and have children. So he got it half right.

His aunt was right. She said, 'Hal, she has been married and has no children,' and she was right. I feel terrible about that but what can you do?

Carolyn, to her husband's amazement, offered him a divorce. Talking about it later, she said,

He's the kind of guy who is just cut out for a family. It didn't seem fair to him. He always expected to have a family, and he could do that with someone else.

He was amazed when I brought it up. We talked about it, and after a while I thought, 'What's the matter with me? This is ridiculous. We have a great relationship.'

Not only does a man who has a fertility problem feel like a failure, men who are not themselves infertile experience a sense of failure. Why is this? The myth says real men don't have failures. When problems begin to surface in the relationship, a man asks himself, "What is my part in this?" Greg felt forced to examine the way that infertility meshed with his general fear of failure:

Failure is not pleasant for me and so affects how I feel about success. My upbringing was not such that I am very good at

failure. I wasn't prepared for failure. Failure wasn't really acceptable. It wasn't something you did or allowed to happen. So my coping mechanisms aren't very good for failure.

I've never experienced failure, been around failure, been in an environment of failure. It seems like a bottomless pit, a hole in hell. There are no stopping points in between, and there is certainly no recovery point. That same fear of failure is in the infertility stuff.

I know for a fact that I don't have any of the classic macho, 'I must bear fruit' type stuff—'my loins must produce the next generation.' I don't believe I have any of that, and I don't have any fear of sexual failure or impotence or failure to have offspring. I don't think I have that, either. So I don't think I'm driven. It seems to be pretty well contained in sports and business, classic male areas.

I can't cope with the failure stuff. When business goes bad, I trot that over and dump it on Gina and the can of gasoline called infertility is lying around and that goes off. I don't know if it is a detonator or the detonee or whatever. I refuse to say anymore what is infertility-related and what isn't, having learned that it is all mixed together like a fruit salad.

Rational Versus Emotional

The idea that men are rational and women are emotional is another cultural stereotype that crops up when fertility becomes a problem. This stereotype plagues a couple once it gets an upper hand in the relationship. Its destructive potential is huge. It may become one of the most volatile issues a woman and man face as they deal with their fertility.

Why is this?

The rational versus emotional stereotype puts men and women in boxes. When partners are mad at each other, they may resort to this kind of labeling. It makes them feel better. It justifies their stand, and invalidates the other person. They may say it out loud,

or communicate it silently with a more subtle series of cues—body language or emotionally shutting down. Here is a typical interchange that is sure to polarize the subject:

HE: Why do you always get so hysterical?

SHE: I'm not hysterical, I'm just mad. How can you be so rational about something that involves our entire life?

Either way, partners know a label has just been assigned, and consequently, anger grows. The battle lines are drawn. This argument isn't between two people who are in a lot of pain, anymore. It has become Men versus Women.

When this happens—and it does happen all the time when the issue is fertility—watch out! This is combustible material that's being handled.

Like all stereotypes, this one carries a grain of truth. According to our stereotypes about who does what, men are supposed to be in charge of objective thinking, while women are supposed to be experts in feelings and relationships. It is true that men and women are socialized in these different directions. We are participants in—and sometimes victims of—culture. It's a cultural setup for conflict.

Looked at another way, it's a statement about women's and men's roles. Which is the better way to be? "Why, the way I am, of course." It's human nature for people to think that what they're comfortable with is the best way. Of course, the other person, who does things differently, feels irate and misunderstood. Suddenly, fertility isn't the issue at all. It has become an identity struggle—a personal issue—"Are you suggesting there is something wrong with me?" In other words, who is better than whom?

A rational approach to infertility makes a woman wild. She feels angry and hurt. She feels isolated from her partner. Greg's rational approach triggered a storm of reactions in Gina:

In my family we were encouraged to debate, criticize, challenge. Gina's favorite word for me during our therapy was to call me the 'DA'—district attorney.

When men and women feel their relationship is threatened, their behavior often becomes a more extreme version of their usual coping style. For example, if he likes life to be calm and predictable, he may become more controlling. If, on the other hand, she is accustomed to expressing her feelings spontaneously, she may send her partner on a continual roller-coaster ride if she escalates her expressiveness.

This is what Stan and Laura did. They characterized themselves, respectively, as rational and emotional. When infertility began to take over their lives, they each took refuge in the coping patterns that had helped them to survive other problems in life. These survival tools, developed in childhood and adolescence, didn't work for this particular problem. Instead, the sense of threat that hung over the relationship was heightened. Laura became emotionally overwhelmed. In contrast, Stan clung rigidly to a rational, detached stance. As medical treatment moved into its final stage, he was still saying:

The first thing to remember is that it's not my problem. I know I'm involved in it but I can't see myself as infertile. So there's that right there. I have no need to have a child.

When the relationship becomes polarized, alienation occurs. Personalities interact. Emotions escalate. One-upmanship takes over. Disagreeing over whether to explore adoption, Stan, frustrated because Laura was not ready to adopt, interjected a dig into their discussion:

You haven't quite psyched to the fact that you could do this with some other children.

Laura, offended, became sarcastic and escalated the argument:

Yeah, that is true. I have all the problems.

Stan, defending his point of view, responded by calling attention to their dissimilar goals:

I have other problems. I had a horrible job search a few years back. So far this has been trivial compared to the job search.

Laura, recognizing that they have worked themselves into a corner they have been in before, but still angry, said sarcastically:

Ah, the analytic man. The emotional woman. Strikes again.

Stan, stiffly, but wanting this argument to end before it got worse, responded:

Yeah, right.

They sat quietly for a few minutes, then Stan, in a conciliatory tone, said:

Yeah, it's stressful, infertility.

Laura, now trying to smooth over muddy waters, restated one of their basic differences that continuously got them into trouble:

You go about things in a linear fashion, and I do things in this explosive way.

Fighting

I am angry with Rick a lot, and I know it's because of the infertility. And Rick says it right out. He says, 'I can't give you the thing you want.' And it may not be his fault. It's nobody's fault, anyway. I have to remind myself it's nobody's fault.
—Angie

Infertility fuels anger. A couple may start to have a lot of difficult, painful discussions. They may make strained efforts to talk to each other. Sometimes they feel isolated from each other when they try to talk because neither one can see the other's viewpoint.

Or a man may not want to talk about it. He feels so inadequate. What can he say? "Don't worry. It will be all right. It won't take much longer, you'll see." He's already said that many times, and now she gets mad if he says it.

When they fight, she often cries and says he is insensitive. And he has been trying so hard to support her. And not getting any attention himself.

She makes me feel like a creep! It's not my fault. I was just trying to be logical.

Sometimes anger seems to come out of nowhere. It becomes displaced and flies around like a poltergeist, causing unexpected havoc in daily life. Angie found that the simplest encounters with Rick became complex:

It just gets tiresome. He came home for lunch today, and he was not even coming home for lunch, he was just coming home for something. And I should be glad to see him, and I wasn't glad to see him. He could tell, and it pissed him off. I said, 'When are you going to come back?' And he said, 'I don't know.' He was real mad, and finally I apologized. I said, 'I'm sorry, I just feel crabby.' And he knew it. I don't know … little things set me off. I don't even know if today was fertility-related. Some stupid thing sets me off and then I blame him. And he does the same thing to me.

Feelings that are first raised in infertility treatment are not contained in medical care. They spill over to contaminate other aspects of the relationship. Months after Russ and Carrie had learned about the option of donor insemination (DI), ^[*] it was still

[*] Donor insemination (DI), the use of sperm from someone other than a woman's partner for the purpose of achieving pregnancy.

an emotionally loaded topic. Remembering the shock they had each felt at the discovery of Russ's infertility, their voices rose in anger as they remembered a meeting with their doctor differently:

RUSS : AID came up right from the beginning. He made us aware of what it was and that there was a donor clinic, and we should seriously consider that.

CARRIE : I think you're wrong about that. He has and he hasn't. He hasn't pushed that on anybody. I've been pursuing that.

RUSS : I don't think you're characterizing this very correctly because I was extremely upset by what I felt was a high degree of pressure toward donor insemination.

In a more conciliatory tone, he added:

I'm ready to do it now but I wasn't ready then.

Personality differences between Paula and Lou were magnified and added friction to their daily life:

Lou has one really strong characteristic and that is that he bugs and bugs and bugs until he finds out what is wrong. He never lets a snitty mood go by. I mean, he'll let it go by for a day because everybody can have a bad mood, but he senses when there's something really there. That lingers, then he is just after it until there is a total confrontation and it all comes out.

And I tend to push things down inside like Scarlett O'Hara. 'I'll think about it tomorrow.' Until I get overwhelmed, and then I get totally unglued.

Sometimes people become afraid to fight. They hold things in because they are afraid an argument will escalate too far, and then they will have to live with the consequences.

We fight like crazy sometimes. We are passionate people. We have horrible fights. We can really hurt each other, and yet he knows I love him and I know he loves me.

Actually, we have not fought as much since the infertility thing really started. I would say in the last six months we have not fought as much. We usually have a good fight every month. Like a period.
—Angie

Angie realized that fighting may threaten the relationship when there is a fertility problem:

I think fighting gets dangerous when there's infertility. It gets very ugly. I remember a fight when we were first going through infertility. … I do partly credit him with the fact that we haven't fought as much. I think he is growing up.

Laughing, she added:

I'm already grown up, of course.

In a more thoughtful tone, she continued:

We will probably always have fights but they are not good for us. Sometimes our fights are unhealthy. We are emotionally interdependent. He meets all my needs. If we fight, I can't call up other people. He is the other people.

She reflected on how she thought their relationship would be affected in the long run:

It has definitely affected our relationship. There is no question. I don't think it has made us love each other any less. I know we will resolve things. I am not worried about that. It is just something else we have to work on. I know we will deal with it.

I think I understand it all. It's not something that I am

scared about for our relationship. I'm not scared that the infertility is going to break us up. It has brought us closer. It really has. We both feel the same way about it. But it is a big concern to both of us.

Sex

A couple's sexual relationship is one of the greatest potential sources of intimacy they have together. When life starts to feel as if it is falling apart, men and women want to take refuge in their intimacy. But often they can't retreat into sex together. There is no solace to be found in sex anymore because infertility invariably affects the sexual relationship. Sex, already laden with emotion and symbolic meaning for a couple, now acquires other layers of meaning that revolve around stigma, illness, and the failure to conceive. When a couple's sexual relationship suffers, the threat to the relationship becomes a serious concern.

At first we were dealing with the infertility. But then we stopped taking it in stride. We both got real depressed and we would get angry. It doesn't do a lot for your sex life. You ask yourself, 'Why go to bed? What for?'
—Dierdre

Women and men become resentful when infertility interferes with sex:

Our sex life has gotten really rotten because you can't make love after you ovulate because you might shake loose an egg that is trying to implant. And I don't want to during my period because I feel lousy. So there is just this little bit of time, and you have to do it right now, tonight, and you just don't have a choice.

Sex used to be just perfect for Ned and me. Both of us, we were the most satisfied. He was the most satisfying

partner I've ever been with. So infertility has wrecked that for me and I resent that.
—Donna

Donna, full of angry frustration over infertility wrecking her sex life with Ned, has her facts wrong—important facts that are further damaging their sexual relationship. It's a fallacy that a couple can't make love after ovulation. In fact, it's a fallacy guaranteed to put tremendous stress on the marital relationship. The truth is, couples can make love anytime they want to. Intercourse is not going to interfere with the fertilization process or the budding of a fetus.

The primary deterrent to sex has nothing to do with physiology—it's emotional. Women may lose interest in sex because it has become loaded with feelings of failure and despair. Sex may no longer be for enjoyment in a woman's mind. It isn't lighthearted, it isn't an occasion for happiness or intimacy. Sex has become tinged with sadness. She may feel apathetic. She may fight off tears.

Sex has become work for her—a job—one she feels she is failing at miserably. Because of a woman's lifelong training to seek out continuity in her life, she can't compartmentalize her head and just live in the moment. Sex has become another symbol of her inadequacy as a woman.

We go to bed often because we have to, but lately I'm not interested. When I am interested, I am really interested, but I'm just not very interested in sex right now.
—Angie

The quality of sex is different five years after infertility starts. The problem with sex remains longer than other problems. Women's enjoyment of sex is harder to come by because of all those feelings being there. I'm sure it's not just me.
—Penny

Here lies another difference between women and men. Women's feelings—about themselves and about the situation—

interfere with their ability to separate their sexuality from their fertility. But a man funnels much of his emotional expression through his sexuality. This goes back to the cultural emphasis on sexuality as a symbol of a man's identity. Sex may be more important to him than ever right now.

What happens when a man lives out much of his expressive side in his sexual relationship, and suddenly his partner has lost interest? Sex becomes charged. She may not be enjoying it right now. Maybe she has said so. Maybe she has said it's a reminder of her sense of failure. Even if she hasn't said anything, maybe it's obvious to him, anyway. Sex has turned into a business conference for egg and sperm to meet. It is dead serious. They may both feel performance pressure.

In terms of our sex life, for a week out of the month sex was purely mechanical. Actually, we kept saying this fall, 'If only we had insulated the bedroom before now. Our upstairs is now 20 degrees warmer and Lou said, 'Why didn't we do this last year when we were freezing to death, screwing at one o'clock in the morning?' You know, practically dying because it was 40 degrees in this bedroom. Now that I'm pregnant and we don't need to screw, we have insulated the house!
—Paula

Couples are often at a loss to defuse a situation that is growing more difficult with each passing month. What can they do about it? They can start by talking about their sex life. And if they keep talking about it, they will at least know what their partner is thinking and feeling, instead of guessing.

And, just as important, talking about sex fosters emotional intimacy. Paula and Lou resorted to humor. It helped.

I guess humor got us through that week. There can't be anything terribly passionate about him climbing off an airplane at ten at night and having this very short period of time before he had to fly off to another conference. Neither

of us was very excited about it. I really missed spreading it out and having a nicer time with it all.

Penny and George, who had conceived a child after a lengthy infertility work-up, were working on having a second child.^[*]

There's a time period in which you are supposed to have intercourse. It's like a window. You have to make an appointment for it. I'm going to be home at six-thirty tonight so we can get our son to bed. Tomorrow morning I have to go in late and all that kind of stuff.

It was very depersonalizing—to have to go get ready to make love and do what we have to do—it was just making things worse.
—George

If that time period has lost its sexual appeal, it may help to compartmentalize that week, to have fewer expectations for it than for the rest of the month. Otherwise, the regimentation and the businesslike aura of this appointment may begin to engulf all the other times, the times it doesn't need to be like this.

Both partners may feel a lot is missing in sex—maybe all of the expressions of care and feeling that usually accompany it. A man resents this. It reinforces his feelings of being abandoned, uncared for. He isn't getting his needs met. And he may not be able to put his finger on exactly what is missing. But he knows something is. And the crazy thing is, he feels guilty!

Rick knew Angie had lost interest in sex. She said so. And her orgasms were infrequent, to prove it. To complicate matters, he was the one who had a fertility problem, but he hadn't lost interest in sex. If men who have a fertility problem have any loss of interest in sex, it's probably temporary, during the initial shock of learning they have a problem. But interest in sex usually returns fairly soon. Except now it is loaded—loaded with feelings of

[*] Secondary infertility is the inability to conceive and give birth to another child after one or more successful pregnancies.

inadequacy. Loaded with feelings of "Will she still want me?" Loaded with the need to express intimacy and caring in this traditional masculine way. And loaded with the need to perform—to please her—more than ever.

It's a no-win situation. Because by this time most women have gone too far inside themselves to meet their partner's needs and respond in a way he will find satisfying.

As far as orgasms or anything like that, I'm just not that interested. And Rick feels terrible about it. He wants me to be satisfied for his ego. And he wants to be satisfied, too.

We had a big fight a few months ago that really affected our relationship. It definitely affected our sexuality. There is no question. He feels that now there is a question about his sperm count, it's in bed with us every time we are in bed together. There it is, every time.
—Angie

Sometimes anger becomes explosive. When it does, it endangers the sexual relationship. Laura described what happened to her and Stan:

All the things you read about—that men feel like they are just a tool. You have to have an erection and ejaculate at a certain time whether you want to or not. He has said to me in times out of genuine anger, 'I feel like all you want me for is to make a baby. You don't really want me, you just want me to do it.'

And that was real hard for me to hear because I'm so involved in trying to hold myself together, and Stan keeps everything so much to himself that I hadn't noticed this was happening. We had a couple of real battles about it, and we've had a lot of sexual trouble. We just virtually don't have a sex life anymore.

Because we failed several times, and I do say, 'we.' It was him a couple of times and once I was just so uptight he couldn't enter me. I knew it, I could just feel it. I just

couldn't get relaxed. And I think the first time he failed, I just exploded. I mean a terrible explosion.

I didn't get angry with him, I just showed anger, and I can't even remember the dynamic. It was one of the worst fights we have ever had. I remember I waited until he left the house and then I really exploded. I made sure the people downstairs weren't home and then I just screamed and yelled and ranted and raved at the walls.

Anger expressed during sex can have long-term repercussions.After that he was really angry, really resentful, and he didn't want any sex. He was withholding. He wanted to withhold himself because he felt like he was being used, prostituted. At that point I sat down and had a big, serious talk with myself and said, 'Hey, look, let's pretend you were him for a change.' Yeah, absolutely, it must be just awful. All I have to do is relax. He has to get hard and stay hard and do it.

So I decided I was going to shut up, and I would go along with what he wanted to do in exchange for his willingness to perform when I ovulate. He told me that, frankly, he just didn't like sex right now. He didn't want it. He associated intercourse with failure and stress. I did too, very much.

I thought to myself, 'Okay, this isn't going to go on forever.' I mean, we are either going to get pregnant, or we are going to adopt, or we are not going to have children. But for now I'm just going to go with what he wants.

They altered their sexual relationship in an effort to get through the infertility work-up without more crises:

What we seem to have gotten to on a real low-key and infrequent basis is sex without intercourse, which is a real relief to him. It's a real relief to both of us. I don't have to worry about, 'Am I lubricated?' He doesn't have to worry, 'Am I hard?' and we both enjoy it.

When Laura and Stan's sex life got derailed, it affected their medical treatment.

That time I had to call the doctor's office and say, 'Is there anything that can be done to save the month? This is just so stressful.' She said, 'Well, I think he could send in a sperm sample.' I said, 'You're kidding. Why didn't you tell me that before?' And do insemination, which is actually what we have done since then.^[*] It was a tremendous relief to both of us.

But by then the damage was done.

Her sense of failure was reinforced by the knowledge that another person knew:

Before all this happened, my doctor said to me, 'Don't let me see on your chart what I see on a lot of women's charts, lots of little marks for sex around ovulation time and a total blank the rest of the time. Don't let sex become just for procreation.'

That was before we failed. So I have been putting arrows for nonexistent sex for months, saying to myself maybe I should tell him the truth because maybe it's affecting the sperm's motility.

Once I said to him I was having a hard time relaxing— maybe it was after the time I was just too tight. I had to cancel a postcoital test,^[**] and he said to me he was hearing I was having sexual problems. And I can't talk to him about it—I just start to cry, and I can't stop. Now that he knows, my sense of failure about this is even worse.

There are ways to avoid a catastrophe like this. Part of the answer lies in defusing things before anger gets explosive. Not

[*] Artificial insemination by husband (AIH) is usually done to bypass cervical mucus that is inhospitable to sperm.

[**] The postcoital test observes the quality of midcycle cervical mucus and the sperm's reaction to it.

buying into the men versus women mind-set is one way. Using humor is another. A third way is to talk about it and together explore other ways of expressing the love and caring that was once so much a part of the sexual relationship—before it lies in tatters at a couple's feet.

But there are other ways as well. In subsequent chapters we will explore the various ways couples work to create unity in the relationship. Ways that can transform the relationship for the better.