Sex is one of the most intimate experiences a couple can share. Likewise, the decision to have a child. In both, two individuals decide to enhance the bonds between them of physical closeness, emotional support, and commitment. Both have the ability to bring immense joy and satisfaction to a couple. And when one goes awry the other can suffer. The focus of this piece is the impact of infertility and its treatment on your sex life.

We do live in a culture that celebrates instant gratification. We have instant food, drive-through windows for banking, and digital everything when it comes to entertainment. In all likelihood, you are reading this on a broadband connection with an internet service provider that promises you “blazingly fast” pages and downloads. And now you have to wait an agonizingly slow 28 days to discover if you have been successful on your "mission to a baby." 

If not, it is another eternal month before the next set of results is in. And while you are waiting perhaps you forget that the purpose of the union, the reason you are together is about the two of you. You might forget that “its la-la-la-la-love,” to steal a riff from an old Chris Knox song. 

Infertility, with its direct link to procreative sexual behavior, is a crisis most couples never thought they would face. But a failure experience each and every time you have intercourse and do not become pregnant can take a toll. The repeated pairing of sex and “failure” erodes the sexual image and behavior of the people involved. Sex can become routine, lacking in emotion, and devoid of excitement when couples are in infertility treatment. Patients often talk about it as though the doctor was with them in the bedroom. No wonder some couples experience evaporation of romance and feelings of sexiness while they are in treatment.

For most of us, sexual activity has at least three functions: procreation, emotional intimacy/relationship enhancement, and pleasure. Infertility tends to highlight procreation as the reason for sex. As a result, the idea of emotional closeness or providing pleasure to a partner seems less important. A couple can spend less time or totally ignore sexplay prior to intercourse because they feel under pressure to get to “the main event.” Some even avoid sexual activity at non-fertile times. This can lead to a woman feeling that she is a semen receptacle or a man feeling that his function is to produce an erection and ejaculate. Sex on demand can leave a couple feeling empty and unsatisfied about the physical component of their relationship under these circumstances.

I often hear from my patients that an exciting aspect of their relationship has become a chore. From the “joy of sex” to the “job of sex,” they will bemoan. “Our intimate time together was fun, romantic, and exciting. We no longer look forward to it, don’t feel sexy, and rarely feel good afterward,” is a common refrain I hear. 

Some couples report that sexual dysfunctions can creep in. He has trouble with erections or difficulty ejaculating. She is no longer orgasmic or has zero desire. Given the stress of treatment and the disappointment of a long and often drawn-out process, these unfortunate situations can happen. 

First, it is important to remember that the “fertile window” does not occupy the entire month! One of the beautiful things about human sexual behavior is that we can engage in it anytime, even if conception is not possible. Sex that does not achieve a pregnancy can feel like a “wasted effort” if the only time a couple makes love is during that narrow window of conceivability. Frustration, irritability, and feelings of being either a “receptacle” or a “source of semen,” can leave a couple unhappy and with the impression that one or the other is uncared for beyond their gametes. And since the solution is often beyond the control of either person a sense of helplessness can infuse the relationship. Who wants to “get it on” when it is so unsatisfying? 

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The following suggestions have helped others with these situations. See what makes sense to you and your partner and how they could fit into your relationship:

  • Remember that sexual problems can be normal during the challenge of infertility. While not desirable, they are common. Remind yourself that you are not alone and that others have had similar experiences.

  • Remember to focus on your relationship and not your infertility. Be available to talk about something other than your fertility status. Be sure to talk about things that bring you both pleasure and satisfaction, whether they are sexual or not.

  • Discuss what you want and what you find desirable. What do you miss about your sex life? What could you do to reconnect intimately? What aspect of your prior romance, sensuality, and eroticism could use rejuvenation?

  • Since sex for procreation can overwhelm other sexual aspects of your relationship, plan specific “sex” dates at non-fertile times. 

  • Do not forget that sex does not consist of intercourse alone. Be sure you make time for non-sexual pleasuring. Intimate physical contact that does not lead to intercourse and orgasm is an important part of a healthy sexual relationship.

  • If sex in the bedroom has taken on a negative stigma plan a date away from the bedroom or head off to a hotel.

  • Remember when sex had a more playful aspect to it and recreate some of that playfulness in your physical relationship. 

  • Do not let infertility treatment take the place of rewarding sexual encounters or intimacy. 

  • Consult with a therapist who is knowledgeable about both sex and infertility. They will both understand your concern and have the tools to help you. You can find them through the American Society for Reproductive Medicine’s Mental Health Professional Group

Dr. Bill Petok is a Licensed Psychologist with a practice in Maryland that focuses on reproductive health issues including fertility and sexual function. He has a special interest in male reproductive health. He has worked in the field of fertility since 1985. He served as a Board member of Path 2 Parenthood from 2007 through 2017. He is a past Chair of the Mental Health Professional Group of the American Society for Reproductive Medicine and is an associate editor of Topics in Obstetrics and Gynecology. He is also on the Executive Council of the Society for Assisted Reproductive Technology where he chairs the Branding Committee. In 2015 he was appointed a Clinical Associate Professor of Obstetrics and Gynecology at Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia, Pennsylvania.