The impact of infertility on couples' sexuality

One thing is certain: the discovery of infertility and the ART process that follows are not without consequences for a couple's sexuality.

In some cases, it can be useful to get help and advice from a sex therapist. For some, this is undoubtedly a difficult and intimate process, and there's no reason to be ashamed. Above all, it's a way of strengthening the couple's bond if it has been weakened by the discovery of infertility and the difficult IVF process. This support is all the more useful when the IVF process is long and unsuccessful.

Everyone can imagine that the battle against infertility is a trying one, and that it takes its toll on the libido and feelings. It can sometimes strengthen a couple's bond, but it can also destroy fragile couples.

The first thing to do is talk to your partner about it. Denying or hiding your sexual problems, such as reduced desire, anxiety, doubts, etc. will only aggravate your stress and thereby reduce your chances of reproduction, as we now know that stress is a major cause of ART failure. 

The links between sexuality and infertility are twofold: sexual dysfunction can be the cause of infertility and ART treatments for infertility lead to sexual difficulties and dysfunction.

We will briefly discuss these two aspects from the point of view of the man, the woman and the couple, to make you aware of the need to seek help if any of these difficulties arise.

Sexual dysfunction as a cause of infertility:

In men (10% of cases of infertility are due to sexual dysfunction in men):

• desire disorders (conflicts, relationship problems, stress),
• premature ejaculation ‘Antes Portas’, i.e. ejaculation ‘at the door’ before penetrating one's partner. This affects 9% of men,
• failure to ejaculate into the vagina due to anejaculation or retrograde ejaculation (sperm passing into the bladder),
• erectile dysfunction preventing penetration of the woman (affects 5-20% of men, depending on age).

In women:

• vaginismus: this is a complex dysfunction that prevents penetration of the vagina due to severe pain. It is a psychological disorder,
• other pain during sexual intercourse: can be caused by organic causes, infections or other deep-seated gynaecological illnesses. It affects 18% of women,
• vulvodynia: unexplained pain in the vulva,
• anorgasmia or absence of orgasm. Strictly speaking, this is not a cause of infertility, but it must be treated because the absence of female orgasm will, in the longer term, have consequences for the couple's sex life and therefore their ability to procreate.

In couples:

•  some couples do not have sexual relations (this concerns 1% of the population or incomplete sexual relations without penetration or ejaculation. A large number of consultations with sexologists concern marriages that have not been consummated),
•  conjugopathy or relationship problems within the couple.

ART treatments causing sexual dysfunction:

In men:

• having sex without desire, for medical reasons, makes men feel like ‘standards’. 20% of men have difficulty ejaculating in these circumstances,
• if infertility is the man's fault, he feels ashamed, his virility and masculinity are affected, and he may even feel impotent, leading to sexual problems,
• psychological problems linked to infertility can lead to a drop in testosterone levels, and therefore in libido,
• the man may not dare fantasise during planned intercourse with his wife or on the day of the sperm collection, resulting in a lack of erection or ejaculation.,
• masturbation to collect the sperm in the unexciting ‘back room’ of a laboratory or clinic is often a source of stress and often even failure. What's more, it seems that the longer it takes to collect the sperm, the poorer its quality. What's more, masturbation is sometimes considered shameful by some men for moral or religious reasons, and sometimes even impossible,
• the 3 to 5 days' abstinence from sex prior to the collection procedure is sometimes difficult for some men to bear,
• more than 10 days without ejaculation impairs the quality of the sperm. The man must therefore ejaculate at all costs, by any means necessary, to maintain good sperm quality. It's all very romantic...!
• nor should we forget the symbolic component associated with medically assisted procreation: sperm collection brings to mind the idea of masturbation, which is still frowned upon by some people and cultures, sperm donation treatments bring to mind adultery, artificial insemination or IVF brings to mind the penetration and fertilisation of one's wife by another man, etc.

In women:

• feelings of guilt if the woman is the cause of the infertility, i
• n some cultures, female infertility calls into question society's image of the good wife. Women see themselves as worthless, and those around them sometimes think so without saying so,
• certain medical examinations are highly intrusive, such as the one that consists of observing how spermatozoa move in the cervical mucus after intercourse,
• women suffer the side-effects of ovarian stimulation: weight gain, pain, nervousness, insomnia, hot flushes, which are not conducive to libido,
• taking the ‘LH-RH agonist’ drugs used in ART treatments reduces libido by creating an artificial menopause and causing vaginal dryness,
• vaginal discharge due to certain medicines used in vaginal form can cause discomfort for the woman or her partner during intercourse,
• the normal female cycle is replaced each time her period appears by a period of intense disappointment, which follows a period of hope. These cycles of hope and disappointment are repeated every 28 days, and some couples end up ceasing all sexual relations to avoid this emotional yo-yo!
• egg punctures during IVF are anxiety-provoking and disrupt sexuality. Often after embryos have been implanted following IVF or IVF with egg donation, couples no longer dare to make love for fear of causing the embryo's nesting to fail, embryo transfer can lead back to the symbolism of the surrogate mother.

In couples:

• with ART treatments, sexuality is no longer recreational and spontaneous, based on pleasure, but often programmed with a single objective: ‘to conceive a baby’. The intervention of a third party, the doctor, who programmes and analyses your sexuality, is resented by the couple. These programmed relationships tend to destroy the ‘erotic’, ‘playful’ and ‘sensual’ side of sexuality. Sexual relations are seen as a ‘performance’ to be achieved and a constant reminder of the pain of infertility,
• mechanised sex generates intense stress within the couple, such as the unexpected phone call from the wife to the husband at work: ‘Darling, come home straight away, my temperature has gone up 1 degree’!
• during ART treatments: insemination, IVF, some couples no longer have sexual relations because it ‘rests’ them from these long periods of programmed, compulsory sexual intercourse on fixed days and at a high rate ‘on medical prescription’,
• depression in both men and women is not uncommon,
• feeling of injustice.

Solutions exist for all these difficulties and it will be useful to consult a sexologist as well as a doctor and/or gynaecologist for organic and functional causes.

The sexologist's role will be to detect the difficulties, guide, advise and direct the man and woman individually if necessary, and of course the couple. He will be able to refer them to alternative therapies or to doctors depending on the problems detected. He or she will listen carefully, and each member of the couple will be able to tell him or her about their doubts, questions and pain.

Depending on the degree of attraction between the partners, the sexologist may suggest working on self-esteem, feelings of guilt and abnormality. He will be able to talk to the couple about playful sexuality, which they have often forgotten, and about the beneficial role of fantasies, which are necessary for happy sexuality. He will advise them to vary their practices, positions, places and times, and remind them that sexuality is above all about loving each other.

He will be able to make women understand the male suffering that they often do not perceive or refuse to see.

The sexologist's role will also be to motivate the couple to go into therapy if necessary.

Consulting a sexologist does not replace conventional medical treatment for infertility. It provides additional help.