Sex in a relationship plays a significant role in whether one can have a baby or not. Although reproduction can take place without sex, most couples wanting to have a baby begin so by engaging in sex that includes intercourse. The beginning phase is sex on a regular basis and if a pregnancy does not occur, the next step is assisted reproductive technology. Repeated unsuccessful attempts at pregnancy is followed by deciding whether to stop infertility treatment and then choosing to remain childless or adopt.
During infertility treatment, which can take place over a number of months and up to several years, couples go through many changes in their relationship and a particular area of concern is within the sexual relationship. There is a recognizable shift from sex for the sake of pleasure, intimacy and spontaneity to calculated, routinized and analyzed intercourse for the sake of pregnancy. Reproduction is intimately connected to sexuality and therefore it effects one’s self-image and self-esteem, especially when sex does not produce a child.
When couples go through a year of unprotected sexual intercourse without becoming pregnant, they may begin to feel an increasing pressure on their sexual relationship to make something happen and then experience tremendous disappointment when nothing does. This seesaw of emotions each month increases the likelihood that emotional baggage will enter the bedroom. As infertility treatments begin and continue, more people enter the bedroom including doctors, nurses, family and friends, making sex a group act that does not resemble the sexual relationship that once was.
If infertility treatments do not result in a pregnancy, couples then face the concept of childlessness. To many this is inconceivable and can result in delaying the end of fertility treatments. When couples decide they will no longer continue treatment, they must take the time to understand the loss. They have already experienced an initial sense of loss by the discovery of an infertility issue and the inability to conceive naturally. This can seem like a betrayal of one’s body and a loss of self, femininity and masculinity. Ending treatment is an expression of the permanence of not having a biological child and feeling the death of that wished for dream.
The phase that follows is taking the time to process that loss. Seeing a future self without children is extremely painful and couples need the opportunity to grieve and slowly develop a new concept of themselves and their future. Childlessness represents a different world view than originally anticipated; from an internal perspective about one’s place in the world to an external perspective of how one is seen in the world. The emotions that accompany involuntary childlessness need to be validated, heard and held within the couple framework and hopefully, by a therapist who can provide a safe place for grief to be expressed. Saying goodbye to the dreamed for child is painful and can occur as couples begin to envision a future that has meaning and a renewed sense of hope.
Couples who decide that having a child, whatever the method, is their desired outcome face adoption as the next option after infertility treatment has ended. The key point here is that couples do have to commit to stopping treatment to allow for time to grieve the loss of a biological child. If that does not take place, couples may find themselves stuck in past grief that prevents them from making positive a attachment to their adopted child. It is important to let go, as much as possible, the idea of a biological child because an adopted child is not a replacement but a unique child entitled to love that is not based in loss. It is also important for both partners to agree to the idea of adoption so that the foundation is set up to accept an adopted child as a result of a joined commitment.
There are many challenges couples deal with when going through infertility treatment including pressure and changes to the sexual relationship, coming to terms with not having a biological child, a future without children and adoption. Each of these issues has deep and lasting ramifications and they require energy, trust, insight, time, support and education to get through each of these stages.