How to Prepare Your Relationship for IVF

During the first months or years of a relationship, many couples are careful to avoid getting pregnant. So it can come as a shock when, upon trying to conceive, they find it's not as easy as their sex ed classes made it seem.

Research indicates infertility takes a toll on the psyche, eliciting anxiety, grief, shame and levels of depression comparable to when someone receives a cancer diagnosis. It can also feel incredibly isolating, even though about 1 in 8 couples struggle to conceive.

Assisted reproductive technology (ART), which includes procedures such as ovarian stimulation, intrauterine insemination (IUI) and in vitro fertilization (IVF), can help people overcome fertility challenges and related hurdles. However, these processes—especially IVF, the most prevalent and effective form of ART—can be physically and psychologically challenging.

Whether you're considering IVF or have already begun, here are a few tips to keep your relationship healthy throughout your fertility journey.

Be prepared for the long haul

The duration of fertility treatment depends on the cause of infertility and the type of treatment, among other factors, said Jason Franasiak, M.D., a reproductive endocrinologist with Reproductive Medicine Associates (RMA) of New Jersey. But it can be a lengthy process and it's important to be prepared.

Although a young person with fallopian tube factor infertility might need only one fresh IVF cycle, an older person with a diminished ovarian reserve and potential genetic imbalances in the embryo may need three to four cycles or more, Franasiak explained. Each cycle takes approximately two months, which could mean several months of trying.

Before starting IVF, experts suggest taking steps to bolster yourselves and your relationship against the stress, fatigue and disappointment that could arise. In addition to ensuring you and your partner feel supported by each other, friends and family, you might want to work with a counselor or therapist, suggested Matthew Macer, M.D., a fertility physician at Halo Fertility in Rolling Hills Estates, California, and Dan Nayot, M.D., a reproductive endocrinologist and medical director at the Fertility Partners in Toronto.

"Seeing a reproductive counselor prior to undergoing fertility treatments is highly recommended," Nayot said. "The fertility journey can be a marathon, and having a supportive partner can be a real advantage to help you persist until the finish line."

Set a budget

Infertility may be the most stressful experience you'll ever have as a couple, but concerns about money could come in a close second.

Although prices vary broadly depending on the type of treatment, your city, the clinic and how many rounds you require, fertility treatments can cost several thousand dollars. According to the American Society for Reproductive Medicine, the average cost of a single IVF cycle is more than $12,000 but can be as low as $10,000 or as high as $25,000. There may also be additional costs for medications and genetic or diagnostic tests.

Many insurance providers pay for one infertility treatment cycle, and workplace fertility benefits are becoming increasingly common. Some clinics offer a refund or "shared risk" programs, where a patient pays a flat fee for three to six cycles and is refunded if they're unsuccessful. But they receive no money back if they conceive on the first try. Nonetheless, it's important to be aware of the potential out-of-pocket expenses and to decide from the outset how much you're able and willing to spend.

Discussing finances is essential to avoid insurmountable debt and heated quarrels down the line, and to ensure you'll have the means to pursue other options, such as surrogacy or adoption, if ART doesn't work out. If plan A is ART, consider what plan B might look like.

Discuss big-picture questions now

There are many ways to build families, Franasiak said, including egg and sperm donation, surrogacy and adoption. The likelihood you'll need to explore these options depends on the cause of your infertility, but experts say it's wise to talk about it from the start to ensure you and your partner are on the same page. For example, if you need egg or sperm donations, you'll need to consider whose genetic material the baby will carry. Other topics to discuss include your thoughts on genetic testing and freezing embryos for subsequent children.

"It's beneficial for a couple to attend doctor appointments together so they can both hear the information from the medical professional themselves and ask questions," said Alyssa Baron, L.C.S.W., a psychologist and behavioral healthcare manager at WINFertility in New York City. "After gathering information, open communication about comfort with treatment and their goals is really important. Is there an alignment between our goals and what we're willing to do to get there? Or do we have different thoughts and feelings about the various treatment options?"

Decide how (or if) you want to tell friends and family

Just as it takes a village to raise a child, having a solid support network can prove immensely helpful in coping with the trials and tribulations of infertility. At the same time, if you tell people what you're going through, they'll likely ask for updates, and providing these on a regular basis can be draining, especially when it's not good news.

Problems can arise if one party tells a friend or family member before their partner is ready for that person to know.

Before telling anyone, Franasiak suggested talking to your partner to decide who you'll tell, what you'll disclose and when. He added that initial discussions with loved ones may be lengthy, so choose a time when you won't feel rushed.

"Ensure that when you talk with people, you set healthy boundaries," he explained. "They may be interested to know how things are going with your journey. It will be important to ensure they know when it is OK to ask how you are doing. Be upfront and specific with the people you tell about how they can offer support. When you talk with people about this, they will likely be sympathetic but may not know how to help. Help them help you."

Communicate often and respectfully

Communication is key to a healthy relationship in general, but it's crucial during times of stress, including infertility.

Alice Domar, Ph.D., a psychologist and the chief compassion officer of Inception Fertility, based in Sudbury, Massachusetts, and Jennifer Gamper Meenan, R.N., L.C.S.W., a psychotherapist and mental health director at RMA New Jersey, suggested regularly setting aside time to talk about your feelings and concerns, ideally in a calm, relaxing environment, such as during dinner or while taking a walk.

"Our daily lives can be hectic between work and treatment, therefore, finding the time to spend together can be helpful rather than shouting out a concern or feeling while running out the door to morning monitoring or work," Meenan explained.

However, it's important that infertility isn't the only topic you talk about. Domar suggested setting a timer for a 15- to 20-minute discussion every evening. During the discussion, she advised practicing active listening to ensure both parties feel respected and heard.

"When one person is talking, the other person has to just listen to them, which means not looking at the TV, not looking at their phone, not looking at a computer or a tablet, but just actually having a conversation," she recommended.

Recognize you might handle things differently

You and your partner are in this together, but that doesn't mean you'll have identical experiences. For one, although both of you carry an emotional load, one party will almost certainly bear most of the physical burden.

In most cases, that's the person capable of becoming pregnant, Domar noted.

On top of the psychological strain, a person undergoing fertility enhancements can experience a host of physical effects, including bloating, pelvic discomfort, headaches and breast tenderness, according to Nayot. Mood changes and irritability also commonly occur with hormone fluctuations.

"Everyone is different and so is their experience," he said.

Domar added that acknowledging these struggles and providing support can help a partner cope.

Equally important is accepting that you and your significant other may process emotions differently, according to both Domar and Baron. For example, some people prefer to talk about bad news immediately, while others may need some time to think.

"In general, women tend to want to talk about their infertility more than men do," Domar said. "A woman can't assume that he doesn't care just because he's not talking about it all the time. And he should not assume that she's crazy because she wants to talk about it all the time. That's a pretty normal reaction to infertility."

To avoid misunderstandings, Domar and Baron suggested eschewing judgment and discussing with your partner what you each find helpful and hindering.

"Each of us has our own set of coping skills and sometimes those vary from our partners or others around us," Baron said. "When we have an open conversation with each other, we can find ways to help one another. Instead of assuming what our partner's needs are during this journey, we should ask what they may find helpful."

Making space for romance

Between ovulation calculations and hormone injections, sex during infertility treatment can begin to feel more scientific than sensual. Depression, stress and treatment side effects don't help. In some cases, sex can start to feel like a chore or a reminder of "failure," according to Franasiak and Domar.

"The woman may only want to have sex midcycle because it's trying to make a baby," Domar said. "The man tends to feel the only reason his wife is willing to make love with him is to extract sperm from him."

The hit can be particularly hard when infertility is a couple's first crisis to weather together. After a year or more of marital bliss and great sex, she explained, many couples toss out the birth control hoping to get pregnant, only to find it's not happening. This can shift the perception of sex from intimacy to the inability to conceive.

However, sex and intimacy are important for much more than conception, Macer said.

"Additionally, despite the belief that men can have sex whenever, wherever, most men reach a point where they are unable to perform if they know they 'have to,' so it's crucial to keep the relationship spiced up and not view sex solely as a means to an end," he said.

To maintain romance and keep sex sexy, Domar advised making a point to have sex during non-fertile times. Also, if you have multiple beds in your home, she suggested designating one the "make a baby bed" and the other as a "let's have fun with sex bed."

Mindfulness can be useful as well, she added.

"The whole concept of mindfulness is being in the moment. You can eat a piece of chocolate mindfully or you can take a shower mindfully or you can make love mindfully," she said. "And that can really add more sensuality back into the equation."