Infertility and sex: when closeness becomes a task

“Today’s the day.”

The message arrives at two in the afternoon, in the middle of a meeting. No heart, no joke, like a reminder for the dentist. He reads it and feels something in his stomach he wouldn’t admit even to himself: not excitement, but a faint unease. In the evening they will both be tired, both will know why they are in bed, and both will try hard to make sure the other doesn’t notice. Afterwards she will lie with her legs up against the wall, and he will stare at the ceiling wondering whether it was “good enough”.

When a couple has been trying to conceive for a long time, their sex life almost always changes too. People talk about this far less than about hormones, test results and waiting lists. Perhaps because it feels shameful to complain about sex when something as big as a child is at stake. But sex is not a side issue. For many couples it was exactly the place where they could be with each other without any purpose. And when that place becomes a task, something is lost — quietly, and often unnoticed.

When closeness gets a timetable

In 2023 the World Health Organization published an estimate that roughly one in six adults worldwide experiences infertility at some point in their lives. It is not a rare experience, even though most people carry it as if they were alone in it.

For many couples the road starts simply. They stop using contraception, sex is relaxed, perhaps even more than before, because there is a new possibility in it. Then the months go by. Cycle-tracking apps appear, ovulation tests, a thermometer on the bedside table. Sex starts to cluster around a few days a month, and in the rest it often almost disappears — because “there’s no point now anyway”, or because both are worn out by waiting.

Research on this is fairly consistent. A review published by Luk and Loke in 2015 gathered studies on how infertility affects couples and found that sex is one of the areas where the distress shows most clearly: less satisfaction, less spontaneity, more anxiety around sex and a stronger sense that it has become an obligation. That doesn’t mean it happens to every couple. But it does mean that if it is happening to the two of you, it is not a sign that something is wrong with your relationship. It is a sign that you are under a pressure that would bend a great deal of closeness out of shape.

What happens to desire when sex has a goal

For a long time we believed that sex begins with lust: first you want something, then you do it. Rosemary Basson, a physician working in sexual medicine, described a different model in 2000, which we now know as responsive desire. For many people — and in long relationships, for most — desire doesn’t come first. It comes during touch, when the body relaxes and when there is enough safety and play in the closeness.

And this is exactly what infertility often takes away. If sex happens because “today’s the day”, there is no longer room for a slow warm-up, for a joke, for changing your mind and simply curling up under the duvet instead. Responsive desire needs an open ending. A timetable closes it.

A loop forms that feeds itself. The more pressure there is, the less desire. The less desire, the more sex feels like work. The more it feels like work, the more both of you avoid it on the days when “you don’t have to”. And when the next “right” day comes, the distance between you is even greater.

A body that is supposed to obey

People who have been trying to conceive for a long time often describe a new, uncomfortable relationship with their own body. The body is no longer something that carries you and enjoys things, but a device that doesn’t work the way it should. Women talk about feeling betrayed by it. Men talk about starting to wonder whether they are “real men”, especially if the difficulty is on their side. Because male infertility is talked about even less than female infertility, this doubt often stays completely unspoken.

This relationship with the body doesn’t stop at the bedroom door. When sex is also a test, attention shifts from your partner to your own body: will it work, will I be aroused enough, will the erection last, will it hurt. Researchers call this self-monitoring, and it is exactly the mechanism I describe in detail in the post Sexual anxiety: the fear of failing. With infertility the pressure is even greater, because “failing” doesn’t just mean an awkward evening, but a lost month.

Underneath there is often shame. Not guilt that you have done something wrong, but a deeper sense that something is wrong with you. I explain the difference between the two in the post Guilt and shame are not the same, and with infertility it matters: shame doesn’t lead to conversation, it leads to withdrawal. Someone who is ashamed of their body will not gladly offer it to another person in bed.

A small loss every month

What is often overlooked with infertility is the rhythm. Every cycle has its hope and every cycle has its ending. When a period arrives or a test is negative, it isn’t only disappointment. It is a small loss — of something that didn’t yet exist, but that you had already imagined. And that loss repeats month after month, sometimes for years.

Those around you don’t see this kind of grief. There is no funeral, no leave, no condolences. I have written about how much a loss nobody acknowledges can hurt in the post The grief nobody acknowledges. With infertility, though, this grief has one more peculiarity: it happens in the same space as sex. The bed that was once a place of closeness becomes the place where every new attempt begins — and somehow also the place where it ends.

If you have also been through a pregnancy loss, this link can be even stronger. Some couples describe how, after a miscarriage, touch reminded them of what had happened, so they found themselves avoiding it without meaning to. That isn’t coldness. It is sadness that hasn’t yet found anywhere else to go. You will find a short explanation of how the distress of infertility shows up in different areas of life in the knowledge base under infertility and distress.

Two people, two ways

It is rare for both partners to experience infertility in the same way. Often one wants to talk, read and plan, while the other needs distance, humour and a part of life that isn’t about this. Counsellors who work with couples in treatment — among them Sharon Covington, who edited a handbook on infertility counselling — describe how easily these differences are read as a lack of love: “You don’t care as much as I do.”

The same happens with sex. One of you may still want closeness while the other has started to dread it. One would like a break from planning, the other is afraid of losing a month. So the difference in desire that many couples know from long relationships becomes sharper with infertility. I write about what happens when sexual desires don’t match in the post When your desires don’t match, and there is a short explanation in the knowledge base under differences in sexual desire.

Talking about this is hard, because every word carries double weight. It might sound like this (composite example, not a real person):

“You turned away last night.”
“I was tired.”
“You’re always tired when we don’t have to.”
“Because when we do have to, I feel like a donor. I miss you wanting me just because I’m me.”
“I thought you didn’t want me any more. That I’m just a plan to you now.”

In this short exchange both of them said the same thing: I miss being a person to you, not a function. But to get there they had to go through an accusation. Many couples never make that part of the journey, because they stop at the first sentence.

During treatment: sex that is no longer needed

When a couple decides on medically assisted reproduction, something paradoxical happens. Sex is no longer the route to a child. Conception moves to the clinic, to waiting rooms, to a schedule of scans and injections. Some couples experience this as a relief: at last the bed belongs to them again. Others find that once sex is no longer needed, it doesn’t come back at all. It had become so tightly bound up with conception that without that purpose they no longer know what it is for.

Treatment brings something else too: the body becomes public. Examinations, ultrasounds, procedures, conversations about sperm and eggs with people you barely know. For some it feels as if the privacy of the body has dissolved, and they need time before their body feels like their own again.

Importantly: all medical questions — whether sex is advised against at certain stages of treatment, what the medication means for your mood and desire, whether pain during sex is linked to a diagnosis — belong with your gynaecologist or the doctor at your fertility clinic. My role is elsewhere: with what happens between the two of you in the meantime.

Couples who have been through treatment often say that the hardest part was finding their way back to themselves afterwards — whatever the outcome. A body that has been measured for months doesn’t come back on its own. It needs touch that doesn’t measure anything.

Exercise: two purposes, two names

One thing that helps couples is to separate sex for conception from closeness for the two of you — in words as well. It isn’t a solution, but it is a way of giving closeness its own space again. You can do this exercise this week.

1. Name both. Agree on two different names: one for “those days” (it can be dry, such as “the project”), and another for closeness without a goal. Simply giving each its own name takes some of the weight off.
2. Each of you writes one sentence. What do I miss from the time when sex didn’t have a timetable? Not what you want from the other person, but what you miss. Read your sentences to each other without commenting.
3. Choose one evening outside the “right” days. On that evening the agreement is clear: you won’t have intercourse. Touch, massage, lying together, talking — everything is allowed, but nothing leads anywhere. This approach comes from exercises developed by Masters and Johnson, known as sensate focus.
4. After the evening, each of you names one thing that felt good. Just one, briefly.
5. For “those days”, agree on kindness. How can you ease the pressure for each other? Perhaps by not talking about the cycle in bed, by having a laugh together first, or by agreeing that a “bad” evening is nobody’s fault.

If touch without a goal feels too strange, or if a lot of sadness surfaces with it, that isn’t the exercise failing. It tells you how much has built up between you.

Where this doesn’t apply, and where the answer lies elsewhere

I wouldn’t want to give the impression that infertility necessarily destroys a couple’s sex life, or that every difficulty in bed is psychological. A few limits need to be stated clearly.

For some couples, sex doesn’t get worse. For some, the shared distress even brings them closer. If that is true of you, there is no need to go looking for a problem that isn’t there.

Physical difficulties need a doctor. Pain during intercourse, problems with erection or ejaculation, bleeding, or changes after medication are not something couples therapy should be solving. They first need to be seen by a gynaecologist, a urologist or the doctor overseeing your treatment. The psychological side comes alongside that, not instead of it.

Infertility isn’t always the cause. Sometimes sex in the relationship was already carrying a tension nobody had named, and infertility simply exposed it. In that case the two-names exercise won’t be enough, and it is worth taking a wider look — including at what was there in the relationship before.

If hopelessness or deep low mood sets in and lasts for weeks, not just at the end of a cycle, that is a reason to see your GP. If you have thoughts of not wanting to live, call the crisis line Klic v duševni stiski on 01 520 99 00 in Slovenia (every day from 7 pm to 7 am) or the Samaritans helpline Zaupni telefon Samarijan on 116 123 in Slovenia (24 hours a day), and in an emergency 112.

What talking to a third person can bring

In relational family therapy, in which I am training, we look at a couple’s difficulty as something happening between them, not inside one of them. Christian Gostečnik describes how people in distress unwittingly repeat the ways they learned in their families of origin: one withdraws in the face of pain, because at home that meant safety; the other pushes, because at home they knew nobody would hear you unless you were loud. With infertility these patterns often show up precisely in sex, because that is where vulnerability is greatest.

Couples therapy at this stage isn’t there to tell you how often and how. It is there so that you can be in the same room with everything you are carrying — disappointment, anger, shame, sadness, and the desire that has gone into hiding too — and talk about it in a way that doesn’t lose you each other. Sometimes a few sessions are enough for a conversation that always stopped at an accusation to move forward. I also work with English-speaking clients.

And if sex in your relationship faded some time ago, regardless of infertility, you may also find the post on sex in a long relationship useful — it describes patterns that infertility only sharpens.

What to remember

• When sex gets a timetable and a goal, desire and spontaneity drop for many couples — that is a response to pressure, not proof of a bad relationship.
• For many people desire only wakes during touch; a timetable takes away its room, so closeness also needs time with no purpose.
• Every unsuccessful cycle is a small loss that deserves to be taken seriously — in bed as well.
• Partners often experience infertility differently; the difference isn’t a lack of love.
• Show physical difficulties with sex to a doctor first; what is happening between you is worth talking through with a therapist too.