Infertility as a test for a couple: what happens to the relationship

“Not this time either.”

She says it through the half-open bathroom door, quietly, almost without a voice. He is standing in the kitchen with his hands in the sink, and he answers what he has already answered seven times: “Next time, then.” He means well. He wants it to be easier for her. But in that sentence she does not hear comfort; she hears a door closing. Next time. As if this month were just a delay on the schedule, and not one more small loss she carries in her body.

In the evening they lie on their own sides of the bed. Nobody said anything wrong. And yet they are more alone than they were in the morning.

Infertility is mostly talked about as a medical question: hormones, test results, procedures. That is right — medical questions belong with a gynaecologist and a fertility clinic. But infertility does not only happen to a body. It happens to two people who once imagined a shared future, and who now, in the same flat, each wait, hope and lose in their own way. In this post I write about what happens between them.

A crisis nobody sees from the outside

Difficulty conceiving is more common than the silence around it suggests. An international review of studies by Jacky Boivin and colleagues estimated that in more developed countries roughly one couple in ten has difficulty conceiving — the median estimate was 9%. That means almost every one of us knows a couple going through this, even if we do not know it.

And we do not know, because infertility is invisible. There is no plaster cast, no scar, no funeral. The couple goes to work, to Sunday lunches and to friends’ birthday parties, while living by a rhythm those around them know nothing about: the days before ovulation, two weeks of waiting, a test, bleeding, a new beginning. As early as 1993, Alice Domar and colleagues compared women with infertility to patients with other serious medical conditions and found that their levels of anxiety and depression were comparable to those of women with cancer or heart disease. The comparison does not mean infertility is “as bad” as cancer. It does show that the distress it brings is not an overreaction or a whim.

When that kind of distress settles into a couple, it does not just affect each of them separately. It changes the space between them — how they talk, how they touch, what they keep quiet about and who carries which part of the load. What the first stretch of waiting looks like month by month is described in the post When it doesn’t happen: the first year of trying to conceive. Here I am mainly interested in the relationship.

The same loss, two different ways

One of the most common misconceptions couples carry is the belief that they should feel the same about the same loss. If you don’t cry with me, it doesn’t hurt you. If you don’t talk about it, you don’t care.

In reality, partners often experience infertility differently — in intensity, in timing and in style. In his review of the research, the sociologist Arthur Greil found that, on average, women experience infertility as more stressful than men do. That matches the experience of many couples: she feels her whole life has shrunk to a single goal, while he still has work, training and friends — and so finds it hard to keep up with her. But averages hide a great deal. Many men feel the pain very strongly; they just show it differently, or not at all, because they believe that at least one of the two has to be “the strong one”.

Brian Peterson and colleagues looked at what happens when partners perceive infertility-related stress differently. Couples in which both partners rated it similarly reported better marital adjustment; where the gap was larger, the relationship had a harder time. So it is not about feeling the same. It is about knowing how the other is doing — about the gap between you not being a secret.

From relational family therapy, in which I am training, I bring one more perspective: each partner also brings their own story into this experience. How their family dealt with loss. Whether pain was spoken about or you gritted your teeth. What it meant to be a mother or a father. Someone who grew up with a mother who carried everything difficult in silence may fall silent too — and may not notice that his partner reads his silence as absence.

The loop you get caught in

When the differences in how you experience this go unspoken, it is easy to get caught in a loop we know very well in couples therapy. One partner seeks closeness and conversation, the other withdraws and fixes things. The more the first one pushes, the more the second withdraws. The more the second withdraws, the more the first one pushes. Both are convinced they are doing the right thing — and both feel alone.

An evening like that might sound something like this (a composite dialogue, not a real person):

“Do you even care? I got my period again today. And you’re watching the match.”
“Of course I care. What am I supposed to do? We talk about it every day.”
“We don’t. I talk. You just say it’ll be fine.”
“Because I don’t know what else to say. If I tell you I’m scared, it’ll be even harder for you.”
Silence. “You’re scared?”

That last question holds the key. His silence was not indifference but an attempt not to burden her further. Her pushing was not an accusation but a need not to be alone in this. When a couple sees that, the loop can stop. This dynamic is not unique to infertility — it is described in more detail in the post The anxious and the avoidant partner: why these two find each other.

When the body becomes a project

Infertility also changes a couple’s everyday rhythm. Appointments, test results, apps, charts, tests. Dinner conversations revolve around which day of the cycle it is, what the doctor said and what still needs sorting out. Even sex, which was once a space for play and closeness, acquires a date and a purpose.

None of this is wrong. Many couples need structure to keep at least some sense of control over something that keeps slipping away from them. But along the way the relationship slowly loses everything that is not connected to conceiving. The partners become colleagues on a shared project that is not working. And colleagues do not hold each other when things are hard — colleagues analyse what went wrong.

What happens to intimacy when it becomes part of the plan is described in the post Infertility and sex: when closeness becomes a task. Here I will stress just one thing: if you notice that you no longer meet as partners but only as a conception team, that is not a failure. It is a signal that the relationship also needs space that serves nothing but the two of you.

Whose “fault” is it?

When doctors find the cause in one of the partners, something hard to talk about often settles into the couple: guilt. The partner with the “problem” may feel as though they have taken something away from the other. At such moments some people say things like “You could have children with someone else” or “I’ll understand if you leave.” These are not threats; they are shame looking for a way out.

The other partner may feel anger — at the body, at fate, sometimes at their partner too — and then feel guilty about that anger. So both hide something they do not dare say, and the distance between them grows. How shame works and why it is so good at silencing us is explained in the knowledge base under shame.

For many couples no cause is found at all. At first glance that might seem a relief, since there is no one to blame. In reality it is often even harder: without an explanation there is nothing to hold on to, and each partner starts looking for the cause in themselves. One sentence I often repeat to couples helps here: infertility is a problem of the couple, not a fault of one body. You made the decision to have a child together — and the path that was never part of the plan is now shared too.

Family, friends and the question “so when are you two…?”

At Sunday lunch the question is almost obligatory. “So when’s it happening?” “You’re not getting any younger.” “I’d love to live to see grandchildren.” Relatives rarely know that behind the polite smile the couple has been carrying something corrosive for months or years. And when the question comes for the third time in one afternoon, the smile can no longer be held.

Relational family therapy stresses that a couple never lives in empty space. Behind them stand two families of origin, each with its own expectations, stories and unwritten rules. In one family problems are discussed openly; in the other “you don’t broadcast that sort of thing”. She may need to tell her sister everything, while he cannot bear the thought of his mother knowing about his test results. Neither of them is wrong. But they have two different needs that have to be reconciled.

So it helps for a couple to agree what to tell, to whom and when — and how they will answer the questions they cannot prevent. A short sentence they both know (“We’d rather not talk about that, thanks for understanding”) can save a lot at the next family lunch. It also matters that neither partner shares anything about the other without their permission. When and how to set boundaries with families of origin is covered in the post In-laws and boundaries: families of origin in a relationship.

Grief without a name

Every month it doesn’t happen is a small loss. Not the loss of a child who existed, but of a child who could have been, of the future you imagined together, and of the picture of yourself as a mother or father. For some couples a pregnancy loss is added to this — a subject that deserves its own space and is briefly described in the knowledge base entry pregnancy loss.

Losses like these are rarely recognised by those around us. There is no ritual, no condolences, no time off. In the professional literature this is called disenfranchised grief — grief that others do not see or do not grant the right to exist. More on this in the post The grief nobody acknowledges: miscarriage, divorce, losing a job.

When not even the people around you acknowledge the grief, it becomes all the more important to acknowledge it between yourselves. And here we come back to differences: one grieves with words and tears, the other with work, with planning, with retreating to the garage. Both are grieving. Why this happens, and how the difference need not break a relationship, is described in the post Grieving as a couple: why you grieve differently and how it need not break you.

What research says about couples who stay close

Infertility is not necessarily a road to drifting apart. Lone Schmidt and colleagues in Denmark followed more than two thousand women and men in fertility treatment and asked them, among other things, whether the experience had given their relationship anything. A notable share said yes: that they had grown closer to their partner and that the relationship had become stronger. How a couple came out of this test was also linked to the way they coped with it and talked about it.

Peterson and colleagues showed something else in couples that I find very useful in everyday life: the way one partner copes with infertility is linked to the other partner’s distress. So nobody grieves entirely alone, even if it feels that way. What one does echoes in the other.

That may sound like bad news, but it is actually good news. It means a couple can also help each other — not with solutions, but with presence. In the knowledge base we call this co-regulation: one person’s nervous system calms down next to a calm, present other. A partner who does not know what to say, but sits down beside you anyway and stays, can do more than a partner with perfect advice.

If accusations are turning up more and more in your conversations, the post From blame to needs: how a couple learns a new language may help. Behind every “you never” there is a need that can be expressed differently.

Exercise: twenty minutes that aren’t about the plan

This exercise is simple, but couples often skip it because they feel “we talk all the time anyway”. And you do — about appointments, results and the next step. This conversation is different.

1. Agree on a time once a week, twenty minutes, phones in another room. During this time no decisions about treatment are made and no results are reviewed.
2. Each of you gets five minutes to say how this week was for you — not about the plan, but about yourself. What was hard, when you felt alone, what you are afraid of. The other only listens, without correcting or comforting.
3. The listener sums up in one or two sentences what they heard and asks: “Did I get that right?” The speaker can add to it.
4. Each of you names one concrete thing that would help you from the other this week. Not “more support”, but “that you call me on Thursday after the appointment”.
5. Finish with something that has nothing to do with conceiving — a walk, a film, coffee at a place you used to go to before all this became your everyday life.

If the conversation still turns into an argument, it is perfectly fine to stop and pick it up later. How to step away without the other experiencing it as abandonment is described in the post Taking a break during an argument: how to step away without walking out.

Where this view falls short — and when to seek help

I want to be honest about what this post does not cover.

Not every couple is in crisis. Some couples go through infertility with a great deal of pain but without cracks in the relationship. If you don’t recognise yourselves in this post, it does not mean you are hiding something. You may simply have found your own way.

Sometimes infertility opens an older question. During treatment, some couples discover that one partner never really wanted a child as much as the other — or that they only half talked it through years ago. Then it is no longer about a communication technique, but about a question that needs its own time and often help from outside.

Psychological support does not replace medicine. Questions about causes, tests and treatment options belong with a gynaecologist or a fertility clinic. Talking as a couple, or therapy, also cannot guarantee a pregnancy — and nobody should promise you that.

When distress grows into something more. If one of you has not slept properly for weeks or months, has no energy for anything, withdraws from everyone or feels there is no point in going on living, it is right to turn to a GP or a psychiatrist. If you have thoughts of suicide, call the mental health crisis line in Slovenia on 01 520 99 00 (daily, 7 pm to 7 am) or the Samaritans helpline in Slovenia on 116 123 (24 hours a day), and in an emergency 112.

Couples therapy is not reserved for relationships that are falling apart. Around infertility, it can above all be a space where both of you are heard — including the one who has mostly kept quiet so far. It is worth considering if the same argument keeps repeating for weeks, if one of you has felt alone for a long time, if you can no longer talk about anything but the plan, or if you cannot make a decision about the next step together.

One approach with good research support for couples in distress is emotionally focused therapy; it is described in the post Emotionally focused couples therapy (EFT): what it is and how it works. I work from relational family therapy, which, besides what happens between you, also looks at what each of you brings from your own family. As a therapist in training under supervision in marriage and family therapy, I see couples in person in Ljubljana, and I also work in English — more on the couples therapy page.

What to remember

• Infertility is not only a medical question — it also changes the relationship, conversations, closeness and the roles of both partners.
• Partners often experience it differently; what matters is not feeling the same, but knowing how the other is doing.
• The loop of pushing and withdrawing is common: one seeks to talk, the other withdraws, both feel alone.
• Infertility is a problem of the couple, not a fault of one body — even when the cause is found in one partner.
• Many couples say the experience brought them closer; regular conversation that is not only about the plan helps.