Although infertility is widely acknowledged as a crisis for individuals and couples, it is less recognized as a trauma that impacts their families. Yet, involuntary childlessness is an intergenerational crisis that has the ability to strain, even damage, family relationships over time by impairing communications and interactions. Invisible losses, such as miscarriages, failed medical treatments, or adoptions gone awry, may highlight a family’s inadequate means of dealing with problems. Old family issues, jealousies and resentments may resurface or other family struggles, such as parental illness or the pregnancy of a sibling, may take priority over reproductive difficulties, leaving the infertile couple feeling isolated and abandoned. The lack of acknowledgment of the losses associated with infertility may damage family interactions, particularly if family members use negative coping techniques such as blaming, side-taking, denial or avoidance. However, the family experience of infertility also has the potential to bring out the best in the family system, promoting growth and well-being for the members.

This section will examine family dynamics impacting infertility and discuss ways to help deal with the demands infertility places on the family system.

Infertility Etiquette

Chances are, you know someone who is struggling with infertility. More than seven million people of childbearing age in the United States experience infertility. Yet, as a society, we are woefully uninformed about how to best provide emotional support for our loved ones during this painful time.

Infertility is, indeed, a very painful struggle. The pain is similar to the grief over losing a loved one, but it is unique because it is a recurring grief. Infertile people grieve the loss of the baby that they may never know. They grieve the loss of that baby who would have had mommy’s nose and daddy’s eyes. But, each month, there is the hope that maybe that baby will be conceived after all. No matter how hard they try to prepare themselves for bad news, they still hope that this month will be different. Then, the bad news comes again, and the grief washes over the infertile couple anew. This process happens month after month, year after year. It is like having a deep cut that keeps getting opened right when it starts to heal.

As the couple moves into infertility treatments, the pain increases while the bank account depletes. The tests are invasive and embarrassing to both parties, and you feel like the doctor has taken over your bedroom. And for all of this discomfort, you pay a lot of money.

A couple will eventually resolve the infertility problem in one of three ways:

  • They will eventually conceive a baby.
  • They will stop the infertility treatments and choose to live without children.
  • They will find an alternative way to parent, such as by adopting a child or becoming a foster parent.

Reaching a resolution can take years, so your infertile loved ones need your emotional support during this journey. Most people don’t know what to say, so they wind up saying the wrong thing, which only makes the journey so much harder for their loved ones. Knowing what not to say is half of the battle to providing support.

Don’t Tell Them to Relax

Everyone knows someone who had trouble conceiving but then finally became pregnant once she “relaxed.” Couples who are able to conceive after a few months of “relaxing” are not infertile. By definition, a couple is not diagnosed as “infertile” until they have tried unsuccessfully to become pregnant for a full year. In fact, most infertility specialists will not treat a couple for infertility until they have tried to become pregnant for a year. This year weeds out the people who aren’t infertile but just need to “relax.” Those that remain are truly infertile.

Comments such as “just relax” or “try going on a cruise” create even more stress for the infertile couple, particularly the woman. The woman feels like she is doing something wrong when, in fact, there is a good chance that there is a physical problem preventing her from becoming pregnant.

These comments can also reach the point of absurdity. As a couple, my husband and I underwent two surgeries, numerous inseminations, hormone treatments, and four years of poking and prodding by doctors. Yet, people still continued to say things like, “If you just relaxed on a cruise . . .” Infertility is a diagnosable medical problem that must be treated by a doctor, and even with treatment, many couples will NEVER successfully conceive a child. Relaxation itself does not cure medical infertility.

Don’t Minimize the Problem

Failure to conceive a baby is a very painful journey. Infertile couples are surrounded by families with children. These couples watch their friends give birth to two or three children, and they watch those children grow while the couple goes home to the silence of an empty house. These couples see all of the joy that a child brings into someone’s life, and they feel the emptiness of not being able to experience the same joy.

Comments like, “Just enjoy being able to sleep late . . . .travel . . etc.,” do not offer comfort. Instead, these comments make infertile people feel like you are minimizing their pain. You wouldn’t tell somebody whose parent just died to be thankful that he no longer has to buy Father’s Day or Mother’s Day cards. Losing that one obligation doesn’t even begin to compensate for the incredible loss of losing a parent. In the same vein, being able to sleep late or travel does not provide comfort to somebody who desperately wants a child.

Don’t Say There Are Worse Things That Could Happen

Along the same lines, don’t tell your friend that there are worse things that she could be going through. Who is the final authority on what is the “worst” thing that could happen to someone? Is it going through a divorce? Watching a loved one die? Getting raped? Losing a job?

Different people react to different life experiences in different ways. To someone who has trained his whole life for the Olympics, the “worst” thing might be experiencing an injury the week before the event. To someone who has walked away from her career to become a stay-at-home wife for 40 years, watching her husband leave her for a younger woman might be the “worst” thing. And, to a woman whose sole goal in life has been to love and nurture a child, infertility may indeed be the “worst” thing that could happen.

People wouldn’t dream of telling someone whose parent just died, “It could be worse: both of your parents could be dead.” Such a comment would be considered cruel rather than comforting. In the same vein, don’t tell your friend that she could be going through worse things than infertility.

Don’t Say They Aren’t Meant to Be Parents

One of the cruelest things anyone ever said to me is, “Maybe God doesn’t intend for you to be a mother.” How incredibly insensitive to imply that I would be such a bad mother that God felt the need to divinely sterilize me. If God were in the business of divinely sterilizing women, don’t you think he would prevent the pregnancies that end in abortions? Or wouldn’t he sterilize the women who wind up neglecting and abusing their children? Even if you aren’t religious, the “maybe it’s not meant to be” comments are not comforting. Infertility is a medical condition, not a punishment from God or Mother Nature.

Don’t Ask Why They Aren’t Trying IVF

In vitro fertilization (IVF) is a method in which the woman harvests multiple eggs, which are then combined with the man’s sperm in a petri dish. This is a method that can produce multiple births. People frequently ask, “Why don’t you just try IVF?” in the same casual tone they would use to ask, “Why don’t you try shopping at another store?”

Don’t Be Crude

It is appalling that I even have to include this paragraph, but some of you need to hear this-Don’t make crude jokes about your friend’s vulnerable position. Crude comments like “I’ll donate the sperm” or “Make sure the doctor uses your sperm for the insemination” are not funny, and they only irritate your friends.

Don’t Complain About Your Pregnancy

This message is for pregnant women-Just being around you is painful for your infertile friends. Seeing your belly grow is a constant reminder of what your infertile friend cannot have. Unless an infertile women plans to spend her life in a cave, she has to find a way to interact with pregnant women. However, there are things you can do as her friend to make it easier.

The number one rule is DON’T COMPLAIN ABOUT YOUR PREGNANCY. I understand from my friends that, when you are pregnant, your hormones are going crazy and you experience a lot of discomfort, such as queasiness, stretch marks, and fatigue. You have every right to vent about the discomforts to any one else in your life, but don’t put your infertile friend in the position of comforting you.

Your infertile friend would give anything to experience the discomforts you are enduring because those discomforts come from a baby growing inside of you. When I heard a pregnant woman complain about morning sickness, I would think, “I’d gladly throw up for nine straight months if it meant I could have a baby.” When a pregnant woman would complain about her weight gain, I would think, “I would cut off my arm if I could be in your shoes.”

I managed to go to baby showers and hospitals to welcome my friends’ new babies, but it was hard. Without exception, it was hard. Stay sensitive to your infertile friend’s emotions, and give her the leeway that she needs to be happy for you while she cries for herself. If she can’t bring herself to hold your new baby, give her time. She isn’t rejecting you or your new baby; she is just trying to work her way through her pain to show sincere joy for you. The fact that she is willing to endure such pain in order to celebrate your new baby with you speaks volumes about how much your friendship means to her.

Don’t Treat Them Like They Are Ignorant

For some reason, some people seem to think that infertility causes a person to become unrealistic about the responsibilities of parenthood. I don’t follow the logic, but several people told me that I wouldn’t ache for a baby so much if I appreciated how much responsibility was involved in parenting.

Let’s face it-no one can fully appreciate the responsibilities involved in parenting until they are, themselves, parents. That is true whether you successfully conceived after one month or after 10 years. The length of time you spend waiting for that baby does not factor in to your appreciation of responsibility. If anything, people who have been trying to become pregnant longer have had more time to think about those responsibilities. They have also probably been around lots of babies as their friends started their families.

Perhaps part of what fuels this perception is that infertile couples have a longer time to “dream” about what being a parent will be like. Like every other couple, we have our fantasies-my child will sleep through the night, would never have a tantrum in public, and will always eat his vegetables. Let us have our fantasies. Those fantasies are some of the few parent-to-be perks that we have-let us have them. You can give us your knowing looks when we discover the truth later.

Don’t Gossip About Your Friend’s Condition

Infertility treatments are very private and embarrassing, which is why many couples choose to undergo these treatments in secret. Men especially are very sensitive to letting people know about infertility testing, such as sperm counts. Gossiping about infertility is not usually done in a malicious manner. The gossipers are usually well-meaning people who are only trying to find out more about infertility so they can help their loved ones.

Regardless of why you are sharing this information with someone else, it hurts and embarrasses your friend to find out that Madge the bank teller knows what your husband’s sperm count is and when your next period is expected. Infertility is something that should be kept as private as your friend wants to keep it. Respect your friend’s privacy, and don’t share any information that your friend hasn’t authorized.

Don’t Push Adoption (Yet)

Adoption is a wonderful way for infertile people to become parents. (As an adoptive parent, I can fully vouch for this!!) However, the couple needs to work through many issues before they will be ready to make an adoption decision. Before they can make the decision to love a “stranger’s baby,” they must first grieve the loss of that baby with Daddy’s eyes and Mommy’s nose. Adoption social workers recognize the importance of the grieving process. When my husband and I went for our initial adoption interview, we expected the first question to be, “Why do you want to adopt a baby?” Instead, the question was, “Have you grieved the loss of your biological child yet?” Our social worker emphasized how important it is to shut one door before you open another.

You do, indeed, need to grieve this loss before you are ready to start the adoption process. The adoption process is very long and expensive, and it is not an easy road. So, the couple needs to be very sure that they can let go of the hope of a biological child and that they can love an adopted baby. This takes time, and some couples are never able to reach this point. If your friend cannot love a baby that isn’t her “own,” then adoption isn’t the right decision for her, and it is certainly not what is best for the baby.

Mentioning adoption in passing can be a comfort to some couples. (The only words that ever offered me comfort were from my sister, who said, “Whether through pregnancy or adoption, you will be a mother one day.”) However, “pushing” the issue can frustrate your friend. So, mention the idea in passing if it seems appropriate, and then drop it. When your friend is ready to talk about adoption, she will raise the issue herself.

So, what can you say to your infertile friends? Unless you say “I am giving you this baby,” there is nothing you can say that will erase their pain. So, take that pressure off of yourself. It isn’t your job to erase their pain, but there is a lot you can do to lessen the load. Here are a few ideas.

Let Them Know That You Care

The best thing you can do is let your infertile friends know that you care. Send them cards. Let them cry on your shoulder. If they are religious, let them know you are praying for them. Offer the same support you would offer a friend who has lost a loved one. Just knowing they can count on you to be there for them lightens the load and lets them know that they aren’t going through this alone.

Remember Them on Mother’s Day

With all of the activity on Mother’s Day, people tend to forget about women who cannot become mothers. Mother’s Day is an incredibly painful time for infertile women. You cannot get away from it-There are ads on the TV, posters at the stores, church sermons devoted to celebrating motherhood, and all of the plans for celebrating with your own mother and mother-in-law.

Mother’s Day is an important celebration and one that I relish now that I am a mother. However, it was very painful while I was waiting for my baby. Remember your infertile friends on Mother’s Day, and send them a card to let them know you are thinking of them. They will appreciate knowing that you haven’t “forgotten” them.

Support Their Decision to Stop Treatments

No couple can endure infertility treatments forever. At some point, they will stop. This is an agonizing decision to make, and it involves even more grief. Even if the couple chooses to adopt a baby, they must still first grieve the loss of that baby who would have had mommy’s nose and daddy’s eyes.

Once the couple has made the decision to stop treatments, support their decision. Don’t encourage them to try again, and don’t discourage them from adopting, if that is their choice. Once the couple has reached resolution (whether to live without children, adopt a child, or become foster parents), they can finally put that chapter of their lives behind them. Don’t try to open that chapter again.

Myths and Facts About Infertility

Myth: Infertility is a women’s problem.

Busted: This is untrue. It surprises most people to learn that infertility is a female problem in 35% of the cases, a male problem in 35% of the cases, a combined problem of the couple in 20% of cases, and unexplained in 10% of cases. It is essential that both the man and the woman be evaluated during an infertility work-up.

Myth: Everyone seems to get pregnant at the drop of a hat.

Busted: More than five million people of childbearing age in the United States experience infertility. When you seek support, you will find that you are not alone. Join RESOLVE, a support group, or talk with others who are struggling to build a family, so that you won’t feel isolated.

Myth: It’s all in your head! Why don’t you relax or take a vacation. Then you’ll get pregnant!

Busted: Infertility is a disease or condition of the reproductive system. While relaxing may help you with your overall quality of life, the stress and deep emotions you feel are the result of infertility, not the cause of it. Improved medical techniques have made it easier to diagnose infertility problems.

Myth: Don’t worry so much — it just takes time. You’ll get pregnant if you’re just patient.

Busted: Infertility is a medical problem that may be treated. At least 50% of those who complete an infertility evaluation will respond to treatment with a successful pregnancy. Some infertility problems respond with higher or lower success rates. Those who do not seek help have a “spontaneous cure rate” of about 5% after a year of infertility.

Myth: If you adopt a baby you’ll get pregnant!

Busted: This is one of the most painful myths for couples to hear. First it suggests that adoption is only a means to an end, not an happy and successful end in itself. Second, it is simply not true. Studies reveal that the rate for achieving pregnancy after adopting is the same as for those who do not adopt.

Myth: Why don’t you just forget it and adopt? After all, there are so many babies out there who need homes!

Busted: For many, adoption is a happy resolution to infertility. However, most people explore medical treatment for infertility prior to considering adoption. In addition, traditional adoption options have changed, and adoption can be more costly and time-consuming than expected. It is, however, still possible to adopt the healthy baby of your dreams. There are also many older children and children with special needs available for adoption.

Myth: Maybe you two are doing something wrong!

Busted: Infertility is a medical condition, not a sexual disorder.

Myth: My partner might leave me because of our infertility.

Busted: The majority of couples do survive the infertility crisis, learning in the process new ways of relating to each other, which deepens their relationship in years to follow.

Myth: Perhaps this is God’s way of telling you that you two aren’t meant to be parents!

Busted: It is particularly difficult to hear this when you are struggling with infertility. You know what loving parents you would be, and it is painful to have to explain to others that you have a medical problem.

Myth: Infertility is nature’s way of controlling population.

Busted: Zero population growth is a goal pursued in a time of world overpopulation, but it still allows for couples to replace themselves with two children. Individuals or couples can certainly elect the option to be childfree or to raise a single child. Infertility, for those who desire children, denies them the opportunity to choose.

Myth: I shouldn’t take a month off from infertility treatment for any reason… I just know that this next month will be THE one!

Busted: It is important periodically to reassess your treatment and your parenting goal. Continuity in treatment is important, but sometimes a break can provide needed rest and renewal for the next steps.

Myth: I’ll be labeled a ‘trouble maker’ if I ask too many questions.

Busted: The physician/patient team is important. You need to be informed about what treatments are available. What is right for one couple may not be right for another, either physically, financially, or emotionally. Don’t be afraid to ask questions of your doctor.

A second opinion can be helpful. If needed, discuss this option with your physician.

Myth: I know I’ll never be able to stop treatment until I have a pregnancy.

Busted: Pregnancy is not the only pathway to parenthood. You may begin to think more about parenthood than about pregnancy. You may long for your life to get back to normal. You may consider childfree living or begin to think of other ways to build a family.

Myth: I’ve lost interest in my job, hobbies, and my friends because of infertility. No one understands! My life will never be the same!

Busted: Infertility is a life crisis — it has a rippling effect on all areas of your life. It is normal to feel a sense of failure that can affect your self-esteem and self-image. You will move through this crisis. It is a process, and it may mean letting go of initial dreams. Throughout this process, stay informed about the wide range of options and connect with others facing similar experiences.

When Infertility Strikes

Although infertility is widely acknowledged as a crisis for individuals and couples, it is less recognized as a trauma that impacts their families. Yet, involuntary childlessness is an intergenerational crisis that has the ability to strain, even damage, family relationships over time by impairing communications and interactions. Invisible losses, such as miscarriages, failed medical treatments, or adoptions gone awry, may highlight a family’s inadequate means of dealing with problems. Old family issues, jealousies and resentments may resurface or other family struggles, such as parental illness or the pregnancy of a sibling, may take priority over reproductive difficulties, leaving the infertile couple feeling isolated and abandoned. The lack of acknowledgment of the losses associated with infertility may damage family interactions, particularly if family members use negative coping techniques such as blaming, side-taking, denial or avoidance. However, the family experience of infertility also has the potential to bring out the best in the family system, promoting growth and well-being for the members. This article will examine family dynamics impacting infertility and discuss ways to help deal with the demands infertility places on the family system.

Family Systems

Some families faced with infertility grow closer and find ways to provide support, compassion, and understanding in the midst of the maelstrom of profound loss and despair. These families are able to handle the myriad of negative emotions of infertility, and weather the pain of its many losses. They acknowledge the despair of this unique loss and its impact on the family as a whole, not simply on the individual or couple. Family members listen, openly communicate warmth and compassion, and ask for what the couple wants or needs during the infertility journey. And, they are willing to provide support in a variety of ways, including participation in rituals for commemorating losses as a family (e. g., attendance of service after a miscarriage) and a willingness to adjust family life to accommodate the realities of the infertile couple’s situation (e.g., adapt gatherings to meet treatment plans or emotional needs). However, even strong, healthy families can find the challenges of infertility daunting and draining, particularly the pain of being an observer in a drama in which your loved one is suffering and there is little one can do to relieve that suffering.

Involuntary childlessness is an interruption of the family life cycle. Family building is a developmental stage that represents generativity or fostering the next generation. It is a life cycle stage in which each and every member of the family transitions from one developmental stage to another, and in the process assumes new roles and new role responsibilities: couples move from being spouses to parents; their parents become grandparents; their siblings become aunts or uncles; nieces and nephews become cousins, and so on. Infertility is the obstacle blocking these normal transitions and preventing family members from assuming new developmental roles.

Interruption of normal life cycle transitions can highlight a family’s unique flaws, precipitating negative behaviors such as; parental favoritism; poor communication; and/or unhealthy coping strategies. Infertility may also require family members to re-examine some long-held family beliefs if they cause increased distress. For example, the belief that an offspring is not an adult until he/she is also a parent, or children owe parents grandchildren. In short, infertility has the ability to distress not only infertile couples but also, also, their families, resulting in ‘collateral damage’ that lingers long after the problem of childlessness has been resolved.

Interfamily Relationships

Very often parents of an infertile couple feel caught between their infertile child and their ‘fertile’, sometimes pregnant, child(ren). Naturally, both offspring may expect to rely on their parents for emotional support at this significant time in their lives. While this is a realistic expectation, many parents may, for a variety of reasons, end up providing more support to the ‘pregnant’ child than the infertile couple. Sometimes this happens when a parent is more knowledgeable about providing support around pregnancy and parenthood issues than about infertility. Other times, it may be that pregnancy and grandparenthood is a happier, more enjoyable experience, while infertility brings sadness, loss, and a variety of negative emotions. In addition, the infertile offspring may not have asked for parental help, keeping infertility a secret, or may have asked for assistance that is impossible to provide. Many parents become paralyzed by their child’s pain and feel helpless to know what to do. Sometimes they feel trapped in the middle-or worse, their children demand they declare a specific loyalty or that they take sides. It is important to remember that parents still set the tone for family interactions and values, even in adulthood, and must refuse to take sides.

A significant challenge to parents of adult children is knowing when and how to provide feedback-particularly when it may not be wanted or appreciated. How does a parent say, “Telling me to support you by asking that I reject your sibling is inappropriate. I will support you in any way I can, but not by being hurtful to your sibling.” Or “While it is wonderful that you are overjoyed with your new baby, I expect you to be compassionate of your sibling’s feelings while they struggle to have children.” Parents must be aware that watching a sibling move through the stages of pregnancy is typically most difficult for the infertile couple.

Parents faced with their children’s infertility are often baffled by this crisis. It is an ‘invisible’ loss that involves private marital issues, complex medical treatments, and a rollercoaster of emotions. They may know how to support a fertile child, because of their own experience, and may be less clear about their role of support for infertile child. As with other experiences in parenting, they may have difficulty dealing with different children, with different needs, and coming from two very different life experiences.

Families dealing with infertility must find ways to help each member feel respected and acknowledge, despite their differences. It is important to define goals for strengthening the family which help to keep the group intact, communication open, and strengthening the functioning of all members.

The following suggestions are advice for family members and couples struggling with infertility and is based, in part, on Patricia Irwin Johnston’s Understanding Infertility:Insights for Family and Friends:

For Family Members:

  • Acknowledge infertility as a medical and emotional crisis with a wide variety of losses, disappointments and ‘costs’: physical, financial, social, marital. Do not attempt to deny or minimize involuntary childlessness either by avoiding the topic or offering empty platitudes like, “Everything will be fine” or “Just relax”. Avoid offering unsolicited advice and never interfere by taking sides, blaming, or imposing rigid expectations or limitations.
  • Be sensitive to the pain, stress, and emotional pressure of childlessness or the inability to expand one’s family as desired. If it is difficult to know what to say, tell the couple rather than saying nothing. Ask them what you might say or do that would be helpful. Try to frequently convey care and compassion and do not ‘forget’ the couple over time as the months and years of the infertility struggle drag on. Be cognizant that some junctures in the journey may be more difficult than others such as after a miscarriage, failed in vitro fertilization cycle, or surgery that fails to produce the hoped for results. Remembering the couple with a card, phone call, donation in their names, flowers, or some other kind gesture can make the journey less difficult.
  • Be supportive. Do not assume you know what supportive means to your loved one but, instead, ask how you can be supportive: what would they find most helpful and useful? If you are able, consider ways in which you can assist emotionally (listening during a ‘good cry’) and functionally (offering financial assistance). Offer to simply listen and be ready to listen when called upon.
  • Emphasize the importance and value of the couple (and each partner) in the family. Encourage and welcome their involvement as a couple or individually in family events and activities. Once it occurs, infertility becomes a part of the family’s history; how a family adapts and copes with the events and stress will be forever part of the family’s past. Like any stressor, infertility can strain family functioning or improve it. Families need to be sensitive about the needs of the infertile couple, particularly around child centered family gatherings. It is important that they understand the infertile couple’s decision not to come may be important.
  • Always keep the lines of communications open. Stress the importance of honesty, candor, tact, and diplomacy in family interactions. It is not a good idea to hide pregnancies ‘out of kindness’ or not invite the infertile couple to child-centered family events; or keep secrets out of fear of upsetting the couple. Always think about how things are told as much as what is being told: tact, kindness, and privacy can go a long way to soften the blow of difficult news. Open communication also means being able to express concern if there is evidence of significant emotional distress. When expressing concern always offer suggestions for help, such as seeking support and counseling through RESOLVE or an infertility counselor.
  • Respect the boundaries the infertile couple sets regarding their infertility. Some couples prefer a high level of privacy about infertility. Other choose a more open approach. When in doubt, ask the couple their preference.