Relationships
By Laura Covington, MSW, LCSW-C
Sexual Issues during Infertility
When you are first trying to have a baby, sex can be fun. However, when it takes longer than you wanted or hoped, feelings of stress, anger, and sadness become prevalent, and sexual issues during infertility can arise. When sex becomes baby-making and not a way to express intimacy and closeness within a relationship, it usually loses its enjoyment.
Grieving a Loss
If you are unable to conceive or dealing with feelings around pregnancy loss, sexual issues for both men and women can arise. It is not uncommon for sexual dysfunction to happen as a result of the stress surrounding infertility. One study found that about 40 percent of female infertility patients had an increased risk for sexual dysfunction compared with the control group with only a 25 percent increased risk. Desire and arousal decreased with infertility, and there was a lower frequency of sex.
Men Can Be Affected by the Pressure of Procreation
Men who are experiencing infertility have higher rates of erectile dysfunction and psychological burden and less sexual satisfaction. If a man is feeling the pressure of sex for the purposes of procreation, his own thoughts and feelings can cause difficulty for him to engage in sex. It can cause “performance” problems with the demand-nature of what he must do to make conception happen, whether it is in the bedroom or the sperm collection room.
While there are certainly struggles that can result from the stress of infertility, research shows that infertile couples can overcome sexual stress, and learning how to cope with these stressors helps with long-term protective factors in marriage. However, it should be remembered that if there were marital problems prior to the infertility or sex was not an important part of the relationship, your sex life can really take the hit from stress. Fortunately, with help and by restablishing the channels of communication beyond the bedroom, couples can work through this.
Suggestions for Overcoming Sexual Issues during Infertility
When dealing with sexual issues during infertility, I offer these suggestions:
- Take care of yourself: If you are not taking care of yourself, it makes it harder to be happy within a relationship. Remember to keep routines, yet change things up when needed. Keeping these routines and taking care of yourself are important boundaries to hold so that fertility treatment and trying to conceive does not bleed into all areas of your life. Continue to exercise and eat healthily. If you are taking care of yourself, then it will help in the bedroom.
- Communicate: Don’t forget to talk to your partner about how you are feeling and what you are thinking. Communication is key in emotional and sexual intimacy. Our significant others can’t read our minds or always know the best way to be helpful.
- Be creative and spontaneous: Sexual intimacy is not just the few minutes of intercourse or orgasm. You or your partner might not feel like having sex when you feel your body is being poked and prodded during treatment. Find other ways to pleasure your partner and increase your sense of closeness. This might be by telling your partner why you appreciate him/her. Even if he/she knows, it is always nice to hear. You can also carve out some time where you two are together doing something new or something fun that you might not have done in awhile.
- Avoid talking about infertility: This doesn’t mean never talk about it, but to limit it so that infertility isn’t all that you discuss. Help your partner out by cleaning the house or running an errand. Remember physical touch and affection does not need to lead to sex and orgasm in order to be pleasurable.
- Change things up: When there are “baby-making” nights, make them expressly different than the other intimate times together. Try having sex in another room when it is for baby-making and saving the bedroom for the other times. Also, when you are tired and stressed at the end of day, it can be even more of a challenge to then have sex, so try having it at a different time of the day, such as first thing in the morning.
About Laura S. Covington, MSW, LCSW-C
Ms. Covington has experience in providing assessments and counseling with individuals, families, and groups in a variety of settings. She has a special interest in developing strategies for stress and coping during infertility treatment. Ms. Covington is a Licensed Clinical Social Worker in Maryland, Virginia, Pennsylvania, and the District of Columbia. Ms. Covington sees patients in Washington, D.C., and Fair Oaks, VA. For more information, call 202-412-8022.
To learn more about Shady Grove Fertility’s support groups for individuals or couples experiencing infertility, or to schedule an appointment with a physician, please call 877-971-7755 or click here.
Medical Contribution By Dr. Melissa Esposito
When Dr. Melissa Esposito of Shady Grove Fertility’s Frederick office is asked by patients whether they can remain intimate during their fertility treatment cycle, her answer to them is simple.
“Listen to your body,” she explains. “There is nothing unsafe about having sexual intercourse while cycling, but many women who are using injectable medication for IUI or IVF may experience enlarged ovaries, which might make intercourse uncomfortable. While they’re in that pre-egg retrieval period of a treatment cycle, normal relations are perfectly fine if it’s not pain-inducing.”
She explains that there are only a few times in a treatment cycle that intercourse is discouraged.
Abstaining For Optimal Semen Sample
The first is when the male partner is asked to produce a semen sample for either a semen analysis or for an Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF). Our physicians recommend that the man abstain from any form of ejaculation for two to three days prior to collecting to insure a complete and reliable sample. Dr. Esposito says that there can be some negative effects to abstaining for longer periods than the recommended time.
“Some patients go overboard and abstain for a lot longer than three days because they’re thinking it will result in a build-up of new sperm cells,” Dr. Esposito says. “The truth is that too much time between ejaculations might actually wind up in dead cells clogging the tubules possibly resulting in additional problems.”
IVF Treatment & Intercourse
The other time intercourse may be discouraged is following an embryo transfer during an IVF cycle. This period called “pelvic rest” is recommended anywhere from five days to two weeks after transfer – when a pregnancy test can be reliably administered. This rest gives the embryo optimal time to implant into the uterine wall. Most IVF patients can resume normal sexual activity a week or two after their embryo transfer, but always check with your doctor or nurse prior.
IUI Treatment & Intercourse
If a couple is undergoing an IUI, there are few restrictions on intercourse since implantation doesn’t occur for about a week afterward. In fact, Dr. Esposito explains that there actually may be benefits to having sex following the IUI.
“During an IUI cycle, we may encourage the couple to have intercourse the evening after the insemination,” said Dr. Esposito. “This not only provides the couple time to be intimate, but it also may help increase the chances of fertilization by adding to the sperm that had been introduced during the insemination.”
Dr. Esposito says that during any cycle it is normal to expect some minor bleeding as a result of intercourse due to the highly vascular tissues of the female reproductive system. But if a patient experiences pain with the bleeding, she should refrain from intercourse.
Encouraging Intimacy During Treatment
Dr. Esposito heartily encourages patients not to lose sight of their relationship’s need for intimacy during fertility treatment. She adds that sex is a normal part of a couple’s relationship and that you shouldn’t be embarrassed to talk with your physician about being intimate during your treatment cycle.
“It’s stressful enough to go through infertility and then make the choice to enter treatment that I don’t want them to totally sacrifice their relationship,” she says. “I tell my patients that they should do whatever they need to continue having fun during their fertility treatment!”
Looking for tips on staying intimate during your fertility treatment? Sharon Covington, Director of Psychological Support at Shady Grove Fertility provides suggestions on how to keep the romance alive while trying to conceive.
For more information or to schedule an appointment with one of our physicians, please speak with one of our friendly New Patient Liaisons by calling 888-761-1967.
Medical Contribution By Sharon Covington
Sharon Covington, MSW, LCSW-C, Director of Psychological Support Services at Shady Grove Fertility hears the same question often from patients who are undergoing fertility treatment –“how can I keep the romance alive while undergoing treatment?” She explains that talking openly with your partner on this subject can be crucial to a couple’s relationship.
“When you take your fertility problems to an expert for consultation or treatment,” Covington says, “you’re exposing what’s usually a personal and private facet of your relationship. But those of us who work every day with people going through infertility see firsthand the lasting impact on marriages. When you’re desperately trying to get pregnant, sex becomes about procreation and not recreation.”
Covington conveys a message that must be heard by fertility patients early on: When sex goes from being fun to work, it will play havoc on your relationship — but partners can take the wheel and consciously steer their marriage back on track, and maybe even lead to better intimacy than before.
Redefining “Sex” During Fertility Treatments
One of the places where Covington and her staff discuss sexuality with patients is in their Mind-Body group sessions. Covington explains that intimacy is not all about physical technique. In fact, one entire session is devoted to redefining what “sex” is in a relationship and how men and women think differently about this specific form of communication.
“We talk about the range of behaviors that make up what we refer to as ‘sex’. It’s not entirely new to most of us, but when you’re trying to get pregnant, it’s easy to forget that sex isn’t just intercourse,” Covington explains.
Covington refers to “Nine Areas of Sexual Relationships” as listed in the book Hot Monogamy: Essential Steps to More Passionate, Intimate Lovemaking by Patricia Love, MD and Jo Robinson (1995):
1. Communication about Sex: the ease with which you talk about your sexual relationship
2. Sexual Desire: how much physical desire you experience on a regular basis
3. Intimacy: your ability to share your thoughts and feelings with your partner on an ongoing basis
4. Technique: your skill at arousing yourself and your partner
5. Sexual Variety: your willingness to add creativity and novelty to your lovemaking
6. Romance: your desire to show love for your partner in concrete ways
7. Body Image: your inner image of your outer self
8. Sensuality: your willingness to relax and involve all your senses in your lovemaking
9. Passion: your ability to combine intense feelings of arousal with love for your partner
“Every single one of these aspects is strongly impacted by the infertility experience,” Covington says. “Acknowledging and understanding the basics is the first step in either protecting or renewing your sexual relationship. I suggest to couples that they make a goal of coming back to what brought them together in the first place.”
New, Creative Ways To Be Intimate
Still, she says many couples feel overwhelmed by the infertility experience to the point of being “just too darned tired to even imagine what they enjoyed before.”
Here’s what Sharon Covington recommends:
Plan Playtime
“We often think sex has to be spontaneous, but the reality is different. Since sex starts with our minds, waiting for spontaneity to erupt probably won’t work like we hope. Put time and energy into planning and then doing some fun things, sexually.”
Be Creative
“Most couples, even in the best relationships, can get into habitual ruts. Sparking things up may require changing it up for playtime. Consider different types of attire and surprise your spouse, or maybe try a candlelight dinner with mood-enhancing scents. Try to think outside of your comfort zone with the intention of just giving something a try.”
Recreate Your Early Sexual Relationship
“We forget about the things that really excited us and aroused us early on in the relationship. Take some time to remember those first exciting times. Even just talking about it can help heat each other up.”
Explore Your Surroundings
“When love-making becomes baby-making, try designating one room of your house for one and another room for the other. Consider trying someplace else to have exciting interludes.”
Look to Non-Fertile Times for Making Play & Love
“Try some of the above to get your energy back, and then remember that your sexual relationship is about far more than intercourse. Take time to engage in some non-intercourse pleasuring, particularly during non-fertile times. Plan some playtime for those ‘off-times’ — decide and agree *not* to have intercourse to pleasure each other and show your love.”
The Ginger Jar Technique
“Two jars: one for you, one for your partner. In each, put 4 to 6 slips of paper with ideas jotted down — things your partner could do for you that let you know how much they care about you. These can be overtly sexual or non-sexual, because after all, our minds are what get the ball rolling. For example, surprising some women with flowers might lead to even sexier outcomes. Each of you takes an idea out — try it daily or every other day — but don’t tell your partner what you picked. Then follow through when the time is right and your partner is not expecting it. It’s like planned spontaneity that’s sure to target your lover’s erogenous zones.”
Try A Little Massage
“In one of our group sessions, I’ll bring out some hand cream, and just have the partners apply the cream to each other’s hands and give a little massage. It’s pretty incredible for demonstrating how simple yet thrilling even a mild form of physical intimacy can be.”
Even if they’re new to fertility treatment, most couples have some idea that their sex lives have taken on new meaning. Covington says sometimes it necessary to “commit to taking a few steps toward the outcome you want, and in most cases, couples will find that they can keep their relationship simmering (and maybe even hotter) through the whole journey together.”
To read additional articles about the emotional side of infertility, learn more about our mind/body skills groups or see dates for upcoming support groups, please visit our Psychological Support Services section of our website.
For more information or to schedule an appointment with one of our physicians, please speak with one of our friendly New Patient Liaisons by calling 888-761-1967.
Are you having trouble keeping the romance alive while undergoing fertility treatment? You probably wouldn’t be surprised to learn it’s a common topic patients talk about with Sharon Covington, MSW,
LCSW-C, Director of Psychological Support Services at Shady Grove Fertility. “I hear the same question from many of the couples I work with –“how can I keep the romance alive while undergoing treatment?”.
The first step is crucial to a couple’s relationship: talk openly with your partner; the second step is to find ways that work for you to re-ignite the spark and keep it from going out. To help kick off your Valentine’s Day Sharon Covington shares some of the tips she gives to couples to not only celebrate the day devoted to love but to also spread it all throughout the year, making everyday feel like Valentine’s Day.
What Is Intimacy Anyways?
While many people associate the word intimacy with intercourse, it’s really not all about physical technique. Before you can start to be more intimate, it’s important to understand what intimacy is and how it is different than just sex, especially since men and women can think very differently about these interactions.
When working with patients either one-on-one or in a support group setting one of the things frequently covered are the different behaviors associated with intimacy. There are a range of behaviors that make up what we refer to as ‘sex’. It’s not entirely new to most of us, but when you’re trying to get pregnant, it’s easy to forget that sex isn’t just intercourse. These behaviors, also called the “Nine Areas of Sexual Relationships”, are outlined in the book Hot Monogamy: Essential Steps to More Passionate, Intimate Lovemaking by Patricia Love, MD and Jo Robinson (1995)
Nine Areas of Sexual Relationships
Communication about Sex: the ease with which you talk about your sexual relationship.
Sexual Desire: how much physical desire you experience on a regular basis.
Intimacy: your ability to share your thoughts and feelings with your partner on an ongoing basis.
Technique: your skill at arousing yourself and your partner.
Sexual Variety: your willingness to add creativity and novelty to your lovemaking.
Romance: your desire to show love for your partner in concrete ways.
Body Image: your inner image of your outer self.
Sensuality: your willingness to relax and involve all your senses in your lovemaking.
Passion: your ability to combine intense feelings of arousal with love for your partner.
Creative Ways to Be Intimate
Using a combination of the nine areas of sexual relationships, try some of the ways Sharon Covington suggests to keep the romance alive throughout the year.
Make Plans
“We often think sex has to be spontaneous, but the reality is different. Since sex starts with our minds, waiting for spontaneity to erupt probably won’t work like we hope. Put time and energy into planning and then doing some fun things, sexually.”
Get outside of Your Box
“Most couples, even in the best relationships, can get into habitual ruts. Sparking things up may require changing it up for playtime. Consider different types of attire and surprise your spouse, or maybe try a candlelight dinner with mood-enhancing scents. Try to think outside of your comfort zone with the intention of just giving something a try.”
Reminisce and Recreate Your Early Sexual Relationship
“We forget about the things that really excited us and aroused us early on in the relationship. Take some time to remember and even reenact some of your first exciting sexual interactions. Even just talking about it can help heat each other up.”
Become an Explorer
“Look around the house and find other locations to be intimate. When love-making becomes baby-making, try designating one room of your house for one and another room for the other. Consider trying someplace else to have exciting interludes.”
Don’t Forget about the Other Three Weeks in the Month
“Try some of the above to get your energy back, and then remember that your sexual relationship is about far more than intercourse. Take time to engage in some non-intercourse pleasuring, particularly during non-fertile times. Plan some playtime for those ‘off-times’ — decide and agree *not* to have intercourse to pleasure each other and show your love.”
The Ginger Jar Technique
“Two jars: one for you, one for your partner. In each, put four to six slips of paper with ideas jotted down — things your partner could do for you that let you know how much they care about you. These can be overtly sexual or non-sexual, because after all, our minds are what get the ball rolling. For example, surprising some women with flowers might lead to even sexier outcomes. Each of you takes an idea out — try it daily or every other day — but don’t tell your partner what you picked. Then follow through when the time is right and your partner is not expecting it. It’s like planned spontaneity that’s sure to target your lover’s erogenous zones.”
Try a Little Massage
“In one of our group sessions, I’ll bring out some hand cream, and just have the partners apply the cream to each other’s hands and give a little massage. It’s pretty incredible for demonstrating how simple yet thrilling even a mild form of physical intimacy can be.”
Even if they’re new to fertility treatment, most couples have some idea that their sex lives have taken on new meaning. Covington says sometimes it’s necessary to “commit to taking a few steps toward the outcome you want, and in most cases, couples will find that they can keep their relationship simmering (and maybe even hotter) through the whole journey together.”
To learn more about fertility testing or to schedule an appointment at Shady Grove Fertility, please speak with one of our New Patient Liaisons at 877-971-7755.
Keeping the romance alive while trying to conceive and infertility treatments can be a challenge within itself. But today is Valentine’s Day! Take today and celebrate the love that has brought you down this path. Celebrate the person that is on the journey with you. If that means no infertility treatment talk today – that is okay. If that means trying to find the passion that was around before regulating intercourse to your most optimal days for conception – do it. Or if Valentine’s Day happens to be the day of your egg retrieval or embryo transfer – know that you child was made with that much more love! Cristen from our Facebook community found that to be the truth and now celebrates today with her young son.
However you choose to make today special, we have found some resources that might help.
From Shady Grove Fertility:
- Keeping the Romance Alive While Trying to Conceive: “Sharon Covington, MSW, LCSW-C, Director of Psychological Support Services, hears the same question often from patients who are undergoing fertility treatment –’how can I keep the romance alive while undergoing treatment?’ She explains that talking openly with your partner on this subject can be crucial to a couple’s relationship.”
- Sex and Infertility Treatment: “Listen to your body,” Dr. Melissa Esposito explains. “There is nothing unsafe about having sexual intercourse while cycling, but many women who are using injectable medication for IUI or IVF may experience enlarged ovaries, which might make intercourse uncomfortable. While they’re in that pre-egg retrieval period of a treatment cycle, normal relations are perfectly fine if it’s not pain-inducing.”
- Enhancing Your Relationship During Infertility: “Most couples enter the path towards parenthood expecting that it will occur without too much problem. After all, they spend most of their lives trying not to get pregnant and assume that when they consciously start trying, pregnancy will soon be achieved. As the months or even years go by without a baby, and efforts to achieve pregnancy are increased—from intrusive testing to high technology treatments—the path turns into the emotional rollercoaster of infertility.”
Talking to Your Spouse: “Going through infertility may be the first major life crisis that a couple faces together, and it may be the time when you need each other most. Yet sometimes couples withdraw from each other at a time when they most need support because of problems communicating.”- Fertility Facts: Sex Position Doesn’t Matter: “While the goal is to have the sperm as close to the cervix as possible, in general, the sexual position you choose will not have any bearing chances of conception. There are no studies to support that any one position increase the likelihood of pregnancy.”
From RESOLVE:
- Becoming a Couple Again: “The struggle with infertility presents numerous challenges to couples. Regardless of how you resolve your infertility, it affects your relationship. Your infertility experiences may strengthen your bond as a couple or that bond may weaken or become fragile. Infertility changes us. We make many sacrifices in our parenting quest: personal, physical, emotional, professional and relationship sacrifices.”
- Low Sexual Desire and Infertility: “Women’s sexuality is a complex issue, made no simpler with the addition of infertility! In order to understand your own low sexual desire and develop a plan for managing it, let’s take a look at some information from the academic world of sex therapy.”
From Attain Fertility:
- Sex and Relationships: “After spending so many months and years trying to conceive without success, sex has lost its spontaneity. It often feels like a chore, and it is often on a schedule. How can we make it more fun and pleasurable? Is it possible to keep the passion and intimacy alive when trying to get pregnant?”
- Sex, Romance and Infertility: “Here at Attain Fertility, we understand the challenges that infertility can bring to your relationship. Know that we don’t just want to help you get pregnant – we want to help you get pregnant while maintaining a loving and fulfilling relationship with your partner.”
If you ready to schedule an appointment Shady Grove Fertility, please speak with one of our New Patient Liaisons at 877-971-7755.
