Even under the best conditions, trying to get pregnant using assisted fertility can be incredibly challenging. It is an intense process with an uncertain outcome. The nature and degree(s) of the intensity can vary widely according to the expectations, identities, and circumstances of those involved. Person(s) without significant economic resources or health insurance that covers these treatments will face considerable added stress. Additionally, people with non-dominant identities or family structures (including single individuals, people in same-sex or queer relationships, and people who identify as transgender or non-binary1) will likely have an even more difficult experience due to ignorance and bias in the medical system.

A note on language: this resource uses gender-neutral and family-neutral language in recognition that there are multiple paths under which an individual, couple, or group of people might be involved in assisted fertility treatment. In some cases, for example, donors of eggs and/or sperm play an ongoing role beyond their donation of genetic material. Also, a same-sex couple or an individual trying to get pregnant on their own is not struggling with “infertility” per se. The phrase “assisted fertility” is intended to include both these situations where additional genetic material must come from elsewhere, as well as situations where a male-female couple is unable to conceive on their own.

Understanding the Context

Providing effective pastoral care starts by recognizing and affirming that the assisted fertility process can be incredibly disruptive in many ways. These include:

  • Emotionally and Spiritually: Few people imagine their future as needing to include extensive fertility treatment. Even for people in same-gender relationships, or those who are pursuing pregnancy as individuals, most people’s imaginations and hopes paint a positive picture of how it is going to go. For some people, having children has been a central lifetime goal and/or is deeply tied to a person’s sense of worth and identity. It can be particularly challenging for those whose religious views link childbearing with acceptance or favor from God. Overall, the loss of an imagined future is a central source of stress and grief. Needing assisted fertility can also raise particular challenges for people who, for economic or other reasons, are used to getting the things they want in life. Even with extensive financial resources, many aspects of the fertility treatment process are simply beyond control, which can lead to significant frustration.
  • Relationally: The people involved, whether they be partners, co-parents, siblings, grandparents, aunts/uncles, friends, or otherwise, may have very different beliefs and ideas about what to do, feelings, and/or intensity of feelings about the process. It can result in complicated family/community dynamics that put additional pressure on the person(s) seeking assisted fertility treatment. This includes navigating the relationship to donors of egg and/or sperm, from selecting the donors to if/how they will be involved in the life of the child/family on an ongoing basis.
  • Ethically: Decisions related to donors can bring up complex ethical questions around genetics, race, disability, class, education and more. Also, the amount of money required, and choosing to spend it on assisted fertility rather than other priorities, can also raise significant ethical concerns.
  • Practically: Fertility treatment can be highly disruptive simply for the time commitment. It often requires numerous medical appointments, frequent testing and/or administration of medication, and hours of conversation with medical professionals and between partners. During a cycle of treatment, a person or family’s life might have to be based around the scheduling demands of the process.
  • Sexually: The process has a notably different impact based on the biological sex and/or gender of people involved in the relationship. For male-female couples, the process of trying to get pregnant often starts joyfully–especially if it is a first child. As months pass without a successful pregnancy, sex shifts from being a source of joy to being an obligation. This shift can have both short and long-term impacts on a couple’s intimate relationship, as well as an individual’s sense of themselves as a sexual being.
  • Physically: Some of the drugs used to stimulate fertility require one or more injections per day, and can have significant side effects. Also, misgendering and other errors/bias in the medical establishment can reinscribe trauma for transgender and gender nonbinary people.
  • Financially: Fertility treatment can easily cost tens of thousands of dollars. Some people have insurance that covers some or all of these costs, but many do not. The stakes can feel higher if the person(s) involved can only afford a limited number of attempts.

Providing Effective Pastoral Care

  • Remember that your role is not to provide advice or make suggestions, but to listen, reflect back, and validate whatever they are feeling. The key is to create a space where the person(s) you’re talking to feel welcome to bring the full range of their identities and experiences into the conversation. It may be helpful to ask open-ended questions about one or more of the areas above to show that you have some sense of what they are going through.
  • Help the person(s) involved recognize that their emotional responses may be different and may need to be addressed differently.
  • Help them develop rituals to cope with different aspects of the process, especially related to learning that a cycle was not successful or that a pregnancy was lost.2
  • Only on their timeline, talk about other options such as pursuing adoption or foster parenting, deciding to live without children, and/or taking a more active role in other children’s lives as Aunts/Uncles, Godparents, etc.
  • RESOLVE: The National Infertility Association has excellent resources on how friends and family members can provide support here.


1 For more information on what it means to be transgender or non-binary, visit the National Center for Transgender Equality.
2 This essay on What Parents Need Most from Their Pastors After a Miscarriage is written for counseling cisgender male-female Christian couples, but many of the recommendations can be adapted for other person(s).

Additional Resources

Unfortunately, we have found only two other easily available resources on this topic. They are limited in scope, but may be helpful if your specific context is similar. If you have resources to suggest, please let us know by contacting RESOLVE at info@resolve.org.

Article contribution by Rev. Rob Keithan

As the Minister of Social Justice, Rev. Rob Keithan supports the church’s many issue groups, works to bring effectiveness and spiritual depth to the social justice ministry overall, and helps to lead the church’s efforts to challenge racism and white supremacy. He also support the church’s small group ministry. Beyond All Souls Church Unitarian, Rev. Keithan serves as a consultant specializing in counter-oppressive transformation, congregational social justice programs, and long-term culture change related to reproductive health, rights and justice.