What Happens if There is Infertility?

Co-Written with C.J. Fitzpatrick

“First comes love, then comes marriage, then comes baby in a baby carriage” Nursery Rhyme

For most heterosexual couples, that’s how they expect marriage to go. I, for one, expected that when we started trying it would just happen – immediately, with little or no effort. It took some time, more than I expected, but happen it did. I believe that had it not, I would have been devastated.

According to the CDC, among married women aged fifteen to forty-nine years with no prior births, about one in five are unable to get pregnant after one year of trying, which is the clinical definition of infertility. Despite such a staggering statistic, people tend to put little forethought into the possibility that this might happen to them and are therefore unprepared if and when it does.

This is definitely a conversation worth having, seeing as a study done by the medical journal Obstetrics and Gynaecology found that following unsuccessful fertility treatments, couples were three times more likely to end their relationship than couples whose treatments were successful.

Not everyone enters into a long-term relationship with the intention of having children. This is a good question to start off the conversation: do we want to have children at all? Some people enter into marriage without even having put much thought into the matter. They assume their partner is simply on the same page as them. Sometimes, couples have had the conversation, know they’re on different pages, and simply assume the other will change their mind. There are likely couples who have entered into marriage knowing their partner is on a different page, said they will think about it, all the while knowing they’re never going to change their mind. Is this fair?

Should infertility become an issue, how devastated would you be? Is having children a dealbreaker for you? Infertility can affect one partner, but not the other, or be an issue for both partners. Would you stay with someone if they were the problem, but you were fully capable of having children?

It seems that women are often more willing to accept that they’re the ‘problem’ – and therefore more willing to seek treatment options – while men may have more difficulty accepting their infertility. Oftentimes, a man’s virility is seen as being a sign of his ‘manliness’ and when infertility strikes them, they may feel as if they’re less of a man and it becomes a very shameful secret. Would this become an issue for your relationship, should this happen to you?

It’s also worth mentioning here that this is an issue that equally – if not moreso – affects LGBTQ+ couples for whom there isn’t always the luxury of an unassisted pregnancy.

1. Are you aware and prepared for the costs of fertility treatments? Have you considered additional expenses, such as travel costs, etc.

2. Are you aware of the different types of fertility treatments and are you open to any/all of them?

3. Do you have a limit of what you’re willing to spend and/or try? What is your time frame for trying?

4. What if the treatments are unsuccessful?

5. Is adoption something you’ve considered and are comfortable with?

6. Would you be willing to adopt an older or disabled child?

7. Would you use a surrogate if fertility issues only effected one member of the couple?

8. If you had a child that biologically belonged to only one member of the couple, would you feel differently towards that child?

9. Would you feel comfortable talking openly about your fertility issues or would it be secretive?

10. How would you feel about fostering children?

11. If you’re going the adoption route, would you want to adopt from a foreign country?

LGBTQ+:

12. Would you both want to try to become pregnant?

13. Would you want the sperm/egg donor to be someone you know?

14. If you’re using a known donor, are you prepared to accept that person’s medical history?

15. Have you done research into the laws concerning biological parent rights?

16. Should you later split up, how will you navigate the legalities if one person is biologically related to the child and the other not?

17. If using a known donor, would they have a role in the child’s life? Would you tell the child and if so, when?

Having a child is a serious decision and it’s not one that should be made lightly. Facing infertility can then feel like navigating a field of landmines, but the first step should be having conversations long before it ever becomes an issue.

Have You Explored How Having Children Can Impact a Relationship? Part II

Guest Post: C.J. Fitzpatrick

If you read the previous article on how having children can impact a relationship, you probably have a pretty clear idea of some of the questions you should ask. This section, will address the same question, but from a perspective of the queer community.

If you’re in a same-sex relationship, the issue of having children is one that will require much more thought and preparation than it does for your friends in heterosexual relationships. It’s simply not going to ‘just happen’...

There’s likely three routes that you’re going to see your relationship take:

1. You decide children aren’t a want or need for you.

2. You know children are wanted, but you either can’t become pregnant, don’t want to be pregnant, or can’t afford the medical intervention necessary to become pregnant and therefore decide to adopt.

3. You want children and one or both of you are prepared to become pregnant.

All of these are equally valid. But let’s look more in-depth at the latter two options.

Studies have found that queer couples and heterosexual couples experience similar levels of stress when becoming parents, as many of the aspects (such as sleep deprivation and less time spent as a couple) are the same. Of course, there are added aspects that make the experience different... For example, there are matters of ‘legal invisiblity’ that result when only one parent is able to be legally considered the child’s parent. As well, there is the issue of homophobia among doctors – the 2006 study by Goldberg found that as many as twenty percent of lesbians experience homophobia when trying to conceive.

While most heterosexual couples seem to divide household labour based on ‘gender roles’, research has largely found same sex couples divide labour in a more egalitarian fashion (Farr & Patterson, 2013). Research seems to suggest that, in lesbian couples, the biological mother does more of the childcare labour (Patterson et al., 2004); on the other hand, in gay couples, the biological father is not more likely to perform these same tasks. It has been proven that sharing in household and childcare tasks provides more satisfaction in a relationship, regardless of the genders involved in said relationship.

While it’s important that couples looking towards having children ask a lot of questions, such as parenting styles and division of labour, there are a number of questions that are unique to same sex relationships.

Before even beginning on the journey, a couple should do research into the different methods of growing their family – i.e. adoption vs. insemination – and each method’s strengths and challenges. Among these concerns are cost, availability, and legal matters.

An important conversation to have is how to manage and cope with stigma and discrimination that will inevitably be faced. Regardless of how understanding a society you live in, there will always be people who disagree with your lifestyle. A 2015 study by Sabin et al. has found that heterosexual health care providers have in implicit bias that favours heterosexual individuals – this bias will effect the way in which they treat their same sex patients during their conception journey. Experiences such these have a strong impact on the mental health of prospective parents.

One of the things that counteracts such discrimination is having a strong social network (Goldberg & Smith, 2011). It’s important to build up such supports – from family, neighbours, church, etc. - before a child comes along.

Having children as a same sex couple is never going to be as simple as it is for the average heterosexual couple, but take heart! A three year follow up after assisted reproduction (Borneskog et al., 2014) found that lesbian couples reported stable relationships and a high satisfaction with their relationship. As well, in 2012, Huebner et al. found that, among gay couples, there was increased commitment to each other and their relationship following children.

As a note: an excellent resource for lesbians looking to have children is The Essential Guide to Lesbian Conception, Pregnancy, and Birth by Kim Toevs.

Are You Ready for Children Worksheet - Non-Traditional Families

 Lesbians:

1. Do one or both of you want to carry a child? Who will go first?

2. Whose eggs will you use?

3. Will you use IUI or IVF?

4. Do you want to use a sperm donor who is known to you or a stranger?

5. If using a known donor, do you want them to be part of your child’s life? Are you prepared to negotiate a legal contract to make your wishes clear?

6. Do you want to use a sperm donor who has similar looks to your partner?

7. Is the non-birthing partner prepared for the child potentially being more bonded to the birthing person?

8. How will you negotiate the legal issues involved in making sure both parents go on the birth certificate (if any exist)?

9. Does the non-birthing partner want to breastfeed as well?

10. How will you deal with homophobia that comes up during and after the process of assisted reproduction?

11. Do you have a strong support network?

12. If pursuing adoption, how will you deal with the homophobia that may come up during the adoption process?

13. How and when will you have the discussion with your child about why their family is different?

Gay Men:

1. Who will you choose to be your surrogate? Do you want someone you know or a stranger?

2. Do you want the surrogate to also donate eggs or will you do that separately?

3. Do you want the egg donor to be a part of your child’s life? Are you prepared to negotiate a legal contract to make your wishes clear?

4. Who will donate sperm?

5. Do you want to use an egg donor who has similar looks to your partner?

6. Do you want to be present for the birth? How involved do you want to be during the birth?

7. Do you want/expect a say in how the surrogate chooses to give birth?

8. How will you negotiate the legal issues involved in making sure both parents go on the birth certificate (if any exist)?

9. Will you ask the surrogate to donate breast milk? If possible, would you want to induce lactation to breastfeed the child yourself? (Yes, this is possible!)

10. How will you deal with homophobia that comes up during and after the process of assisted reproduction?

11. Do you have a strong support network?

12. If pursuing adoption, how will you deal with the homophobia that may come up during the adoption process?

13. How and when will you have the discussion with your child about why their family is different?

Transgender:

1. How will you deal with any dysphoria that may come up during pregnancy?

2. Is your healthcare provider knowledgeable in transgender pregnancy?

3. As a trans man, are you prepared to stop taking testosterone to get pregnant?

4. How will you deal with the stares and conversations that will come with being a pregnant man?

5. Have you done research into trans pregnancy?

Have You Explored How Having Children Can Impact a Relationship?

“The fact that the transition to parenthood places strong and unique strains on a couple’s relationship is rarely addressed, yet can be critical in their growing together—or apart.” John W. Travis MD

While dating, we spend time getting to know our partner to determine if we want a life together, but few put thought into the costs of having children; physically, emotionally, and financially. Children come with a huge financial cost: estimates are that, to raise a child to the age of eighteen, you should expect to pay two hundred thousand dollars.

Most couples have their children early in their marriage, in the years when they aren’t so secure financially. This only adds pressure to the situation. Now, there is the cost of daycare or the lack of a second income if one person chooses to stay home. In addition to the money, there is also the fact that you are responsible twenty-four/seven for the next eighteen years, at least.

Fewer prepare for the impact this life event will have on your bond as a couple. The Holmes & Rahe Stress Scale puts pregnancy and gaining a family member at number twelve and fourteen out of forty-three items, indicating these are pretty stressful events. We all know babies are demanding creatures that cry and poop, yet few are prepared for the toll it takes. The lack of sleep, the detective work to figure out why they won’t stop crying, never eating a meal while it’s hot... These all mean that the effort we were putting into our bond as a couple takes a back seat. Forget the lazy Sunday mornings sleeping late and snuggling in bed.

Division of labour is a source of contention in relationships even before children come along. How to manage all the work that comes with children only adds to the strife. There are a huge number of questions that need to be asked, now that children are on the scene. Who gets up in the night for feedings? Who will put the children to bed? Who takes care of doctor appointments and immunizations? We rarely think ahead of how to handle regular duties, let alone who is going to stay home when the children are sick.

There is also a lack of sex due to tiredness and poor body image post-baby. It is easy to see how people come to feel lonely and unfulfilled in the post-baby period. It is even conceivable that some begin to feel unloved, especially if their love language is quality time or physical touch. For these people in particular, having children in the home will be difficult.

For some – those that are ready for children and are strong in their relationship – this time won’t destroy their bond. A child can bring a couple closer together, but in some cases, it pushes them apart. Research has shown that there is a dip in the happiness in the relationship following the birth of children (Twenge, Campbell, & Foster). A study by The Baby Show found that a third of couples experience serious problems in the months following a birth. One fifth of couples will split up during the first twelve months.

Becoming parents can highlight how different you are. Religion, family traditions, and ideas on child-rearing that were never even thought of before, now can be a source of contention. You might find family and friends often feel the need to insert themselves into how we parent our children. If you didn’t have mother-in-law issues before, you might now.

This is a time when unsolved issues and feelings from our past make a reappearance for us. It is said that it is hard to give what we were not given or taught. “Without an awareness of the themes of our own early years, we find ourselves reacting to our children out of our own unmet needs, and embodying the same dysfunctional behaviours our parents—albeit unwittingly—inflicted on us.” (John Travis) I have written before of developmental tasks we are trying to achieve in our marriages; the birth of children can often be a trigger for things such as for nurturing we didn’t receive or emotional stability that was not gained.

Dealing with an infant is challenging enough on its own, but even more so when it opens old wounds. One spouse may resent the attention the child is taking away from them. It is actually not uncommon to feel jealous of this child, especially among men. “As a mother’s bond with a child grows, it’s likely that her other relationships are deteriorating.” (Matthew D. Johnson)

Are You Ready for Children Worksheet

 General:

1. Do you both want children? How many?

2. Do you think having children will fix problems in the relationship?

3. Do you think the lifestyle you envision is conducive to children (travelling, career, etc.)?

4. Do you think you have what it takes to be a good parent?

5. Is your relationship stable enough to withstand the stress of parenthood?

6. Are you willing to put someone else’s needs first?

7. Does the sex of the children matter?

8. Is the desire for children so strong you would divorce if it didn’t happen?

Pregnancy/Conception:

1. When will you start trying?

2. Will you plan when to have children or just see what happens?

3. Would you undergo medical procedures (such as varicocele repair or hysterosalpingogram) to make conception possible?

4. If you can’t get pregnancy naturally is in-vitro an option?

5. How many in-vitro treatments would you try?

6. Is in-vitro available where you live or would you need to travel?

7. Is surrogacy or egg/sperm donation an option?

8. How will you deal with the loss of income if the pregnancy is difficult and requires bedrest?

9. Are you prepared for how your partner’s body and mental/emotional state will change over the course of pregnancy?

Birth:

1. Do you want a natural birth (no drugs involved)?

2. Do you want/expect a say in how your partner chooses to give birth?

3. Do you want to be present during the birth?

4. How you handle the restrictions necessary if a C-section is needed?

5. Are you prepared to accept the risks of birth, including to maternal death?

6. Are you prepared for your partner potentially requiring an extended hospital stay?

Postpartum:

1. Will your child be breastfed or formula fed? Do both partners need/get a say in this?

2. Are you prepared for your child potentially requiring an extended hospital stay?

3. How would you handle a child that was constantly fussy and needed a lot of attention?

4. How would you handle a child that is born with a disability or an ongoing medical condition?

5. Will your relationship be able to withstand postpartum depression – which can show up in the non-birthing person as well – should it happen? Are you knowledgeable in the other potential postpartum mood disorders that may occur (such as postpartum mania and postpartum psychosis)?

6. Where will the infant sleep: with you or a separate room?

7. How will you deal with a reduction to your sex life?

Cost:

1. If conception doesn’t happen naturally, how will you pay for interventions like in-vitro?

2. Could you afford a doula?

3. Can you afford things like acupuncture, chiropractic care, and other medical interventions to make pregnancy easier?

4. Have you priced out supplies like diapers and formula?

5. Are you able to afford a special needs child in that eventuality?

6. How will you pay for children ($200,000 to age 18)?

7. Will you save for the child's education?

8. Can you afford to take maternity/paternity leave? Is this leave offered by your employer?

9. Can you afford to put the children in daycare?

10. Can you exist on one income if one parent chooses to stay home?

11. If you want to delay having children, can you afford to freeze eggs or sperm?

Living Situation:

1. Will you need to move to accommodate children?

2. Is the house easy to baby proof?

3. If your child is born special needs and requires, for example, a wheelchair, can you afford to remodel your home? Or would you need to move?

4. Will you want a live-in nanny? Where will you house the nanny?

Outside Influence:

1. Is your family willing and able to support you through raising a child?

2. Do you even want your family to be involved or will they be a toxic influence?

3. Will you need outside support like a nanny or cleaning services?

4. How will you handle family or friends who interfere in your parenting?

Adoption:

1. Would you consider adoption?

2. Is a hard to place child an option (older, handicapped, from another country)?

3. Can you afford the adoption costs?

4. Are there criminal records that would make adoption difficult?

Parenting:

1. Have you discussed your ideas on how to raise children?

2. Have you discussed how holiday traditions will be handled?

3. Will you raise the child in a certain religion? Does your partner agree?

4. How will discipline be handled?

5. How will you manage if your parenting styles are very different?

6. How will you handle a child who doesn’t adhere to gender expectations? A child that is transgender? A child that is homosexual?

7. Could you handle a child that was very disobedient or disrespectful?

Miscellaneous:

1. How will you deal with the reduced free time and lack of freedom?

2. How much time will each parent spend interacting with the children on things other than needs?

3. What activities am I willing to give up or cut back on to be with my children?

4. How will you deal with the child being the focus of your partner rather than you?

5. How capable are you to deal with reduced sleep due to dealing with the child?

6. How will you add child care responsibilities to the division of labour you now have?

Difficult Questions:

1. What will you do if you become pregnant before you’re ready?

2. How will miscarriages/pregnancy loss be handled?

3. Will you try again if you lose a pregnancy?

4. Will you have a funeral for stillborn children?

5. What would you do if you were informed your unborn child has a genetic condition that means it won’t live long? What if your child would live, but would suffer greatly? What if your child wouldn’t suffer but would have, for example, Down’s Syndrome?

6. What would you do if you were informed your pregnancy isn’t viable?

7. What are both of your thoughts and beliefs on abortion?

8. What would your partner do if they had to choose between your life or your unborn child’s life if you were not able to participate in the decision? What would you want them to do?

9. If your partner were to die or leave while you were pregnant, would you be able to afford to raise the child on your own?