Fertility Struggles and Their Impact on a Relationship
By Mark Ryan, BACP Accredited Psychotherapist and NCPS Accredited Relationship Therapist
Trying to conceive is supposed to be one of the more hopeful chapters a couple goes through together. For many couples it becomes one of the hardest, a slow-building strain that touches sex, money, hope, grief, and the basic sense of being on the same team, often while everyone around you assumes nothing is wrong at all. This piece looks at why fertility struggles land on a relationship so heavily, what the research shows about the toll it takes, and what tends to help couples come through it without losing each other along the way.
Part of what makes this so hard to prepare for is that most couples enter it expecting a medical problem with a medical solution, tests, a diagnosis if one exists, a treatment plan, an outcome. What often arrives instead is an open-ended stretch of uncertain length, layered with decisions that have no clearly right answer and a toll on the relationship that nobody warned either partner about in advance.
The uncertainty itself is often harder to live with day to day than any single piece of difficult news. A clear diagnosis, even an unwelcome one, at least gives a couple something definite to plan around. Not knowing whether this will resolve in a month or several years, whether the next round of treatment will work, or whether to keep going at all, keeps both partners in a state of suspended waiting that ordinary coping strategies aren't well suited to, since most coping strategies assume an endpoint to work toward rather than an indefinite stretch of not knowing.
A significant strain, not an overreaction
The relationship cost of infertility is well established in the research rather than anecdotal. A dyadic study of couples experiencing infertility and couples experiencing miscarriage found that both a person's own sense of self-control and how much self-control they perceived in their partner predicted relationship satisfaction for both partners, with the effect moderated by how much each person sought and received social support (Wendołowska, Kiełek-Rataj, Kalus and Czyżowska, 2022). In plain terms, feeling like your partner is coping, and feeling supported by people around you, both measurably affect how the relationship itself holds up under this specific kind of prolonged uncertainty.
A separate dyadic study of 141 couples in fertility treatment found something more specific and, in its own way, more telling. Each partner's own marital satisfaction predicted their own depression, but only the husband's marital satisfaction had a measurable knock-on effect on his wife's depression, the reverse link, from her satisfaction to his depression, wasn't statistically significant (Maroufizadeh, Hosseini, Rahimi Foroushani, Omani-Samani and Amini, 2018). The study was conducted in Iran, so the specific cultural weight placed on parenthood there may not map exactly onto every reader's situation, but the asymmetry itself echoes a pattern seen elsewhere in the literature on infertility and couples, that one partner's state can weigh on the relationship more heavily than the reverse, often without either partner realising the imbalance is there.
This kind of asymmetry cuts against a common, private assumption that both partners are affecting each other equally, and that whoever seems to be coping better simply needs to hold steady for the other. The dyadic research suggests the traffic can run more heavily in one direction than either partner assumes, which means the partner working hardest to protect the relationship's mood may not be the one whose own mood is shaping it most.
Why this strain is so hard to talk about
Fertility struggles carry a specific kind of isolation that grief after a loss or a diagnosis often doesn't. There's frequently no single event to mark it, no moment where friends and family instinctively know to ask if you're alright. Instead, there's a slow accumulation of hope and disappointment, repeated month after month, often carried largely in private, since many couples understandably choose not to share what they're going through until, or unless, it resolves.
This privacy is often the right choice for a couple, and it comes with a real cost. The two of you can end up as each other's only source of support for something that's affecting nearly every part of daily life, with none of the wider network that usually helps absorb a hard chapter. Whatever tension exists between you has nowhere else to go, which is part of why the strain can feel disproportionate to people who haven't been through it.
The people around you are often unknowingly adding to the weight too. A casual pregnancy announcement, a relative asking when you're having children, a friend's easy second pregnancy, none of it is meant unkindly, and all of it can land hard when you're carrying something you haven't told anyone. Couples sometimes end up managing each other's exposure to this, deciding together which gatherings to attend, which questions to deflect, which relationships need a boundary for a while, which is its own quiet, constant labour on top of everything else, one that rarely gets acknowledged as work at all.
Fertility struggles carry a specific kind of isolation that grief after a loss or a diagnosis often doesn't.
Where the strain tends to concentrate
Sex is often the first casualty, and one of the more disorienting ones. Something that was previously private and pleasurable becomes scheduled, monitored, and tied to a monthly verdict, which tends to drain desire even in a couple who love each other and want the same outcome. What used to be spontaneous connection becomes a task with a deadline, and it's common for one or both partners to start dreading a part of the relationship that used to feel like the easiest part.
Grief shows up too, often without a clear target. There's grief for a version of this process that was supposed to be simple, for time that feels lost with every month that passes, and sometimes for specific losses along the way, a chemical pregnancy, a failed cycle, a diagnosis that closed off one path, that get compressed into the general phrase struggling to conceive without ever being named as losses in their own right. Each of those deserves acknowledgement rather than being absorbed silently into the ongoing process, and each one that goes unnamed tends to add quietly to the weight of the next difficult month.
Where a miscarriage has happened during this process, that loss deserves its own direct acknowledgement rather than being folded into the broader fertility struggle, since grieving a specific pregnancy and grieving a prolonged, undated struggle to conceive are related but meaningfully different experiences.
Blame, even when neither partner intends it, tends to surface too, particularly where one partner has an identified fertility factor and the other doesn't. Guilt on one side and a wish to reassure on the other can quietly calcify into a dynamic where one person feels perpetually at fault and the other feels unable to say anything that helps, a pattern that benefits from being named directly rather than left to run underneath the surface of every conversation about next steps. This can be especially pronounced where age, a specific diagnosis, or a past choice, delaying trying, an earlier procedure, gets quietly held up as the reason things are hard now, even when no one has said so out loud.
Money and decision fatigue add their own pressure on top of the emotional weight. Treatment is frequently expensive, rarely fully funded, and the decisions involved, how many rounds to try, which clinic, whether to change approach, tend to arrive relentlessly and without a natural pause between them. Making significant decisions repeatedly while already depleted is a different task from making one difficult decision once, and couples often underestimate how much that repetition itself wears down their ability to communicate well with each other, long before either partner notices the toll it's taking.
Timelines rarely match either, which adds its own friction. One partner may feel ready to stop, or to pause, well before the other does, or one may want to explore a different route to parenthood sooner than the other feels able to consider it. Neither position is wrong, and the mismatch itself, rather than either partner's specific view, is often what needs the most direct, patient conversation, ideally before either partner feels forced to choose between the process and the relationship.
What tends to help
The research offers a real, hopeful note here. A systematic review and meta-analysis of counselling interventions for infertile couples found that psychological support meaningfully improved both marital and sexual satisfaction (Alirezaei, Taghipour and Roudsari, 2022). This isn't a marginal or vague finding. It's evidence that the strain fertility struggles put on a relationship is responsive to support, not simply something to endure until treatment succeeds or ends.
This matters because many couples wait to seek support until the relationship itself feels at risk, treating counselling as a last resort rather than a standard part of getting through treatment well. The evidence points the other way. Support during the process, not only after it's gone badly, is what the research on counselling interventions measured, which suggests the more useful moment to start is earlier than most couples assume.
Deliberately separating sex from conception, protecting some intimacy that isn't tied to the calendar, tends to help preserve part of the relationship that treatment schedules otherwise consume entirely. Talking about this directly, rather than letting scheduled sex quietly become the only kind there is, is often the difference between a couple who feel disconnected by the end of treatment and one who don't.
This doesn't need to be elaborate to matter. A single evening a month with an explicit agreement not to discuss anything related to trying to conceive, treated as seriously as any appointment, is often enough to remind both partners that the relationship exists independently of the process, rather than as something currently on hold until the process resolves.
Given how isolating this experience often is, finding even one or two people, or a couple in a similar situation, to feel truly known by during this time tends to matter more than it might seem to from outside, precisely because the usual sources of support are so often unavailable here by choice.
How therapy can help
Couples navigating fertility struggles often come to therapy not in crisis exactly, but worn down, having spent so much energy managing appointments, decisions, and each other's reactions that the relationship itself has had little attention left over. Useful work usually starts by making space for what hasn't been said yet, the grief that's gone unnamed, the resentment that's gone unspoken, the fear that saying it out loud will make it more real.
It also often means slowing down enough to notice how much of the couple's conversation has narrowed to logistics, appointments, medication schedules, test results, with very little space left for anything else. Rebuilding some of that other space deliberately, conversations that have nothing to do with fertility at all, tends to matter more than it sounds, since it's often the first part of the relationship to disappear and one of the last things either partner thinks to protect.
Where blame has settled in around an identified fertility factor, that dynamic deserves direct, careful attention rather than reassurance alone, since reassurance without addressing the underlying guilt or resentment tends to wear thin with repetition. Where a decision point is approaching, further treatment, a different path to parenthood, or stepping back for a while, the work often shifts to making sure that decision is being made together, deliberately, rather than by exhaustion or default.
This work also isn't only for couples in active treatment. Some come while still deciding whether to start. Others come after stopping, whether by choice or because options have run out, and need space to grieve a chapter that ended without the outcome either of them had hoped for. Wherever a couple is in this process, the aim is the same, protecting the relationship itself as something separate from, and as important as, the outcome either of you is hoping for.
Couples who stop treatment, whatever the reason, sometimes describe a strange, disorienting quiet afterward, an absence of the structure that had organised so much of daily life for months or years, alongside grief that doesn't always have an obvious place to go once the appointments and decisions stop. That transition deserves as much care as the active treatment period did, even though it often receives far less attention from everyone around a couple, since from outside it can look like the hard part is finally over, when for the couple themselves it can mark the start of a different, quieter kind of difficulty.
If you feel like now might be the right time to talk this through with a therapist, I offer a free 30-minute consultation in person (in London) or online. Either partner is welcome to reach out first, wherever you currently are in this process.
About the Author
Mark Ryan is a BACP Accredited Psychotherapist and NCPS Accredited Relationship Therapist working in person across central London, from rooms in Pimlico, Kensington, and Angel. He works with couples, individuals, and polycules on relationship issues including jealousy, affairs and betrayals, sex problems, and considered separation. His practice is integrative, sex-positive, and affirming of all relationship structures and identities.
References
Wendołowska, A., Kiełek-Rataj, E., Kalus, A., & Czyżowska, D. (2022). Perceived partner's self-control and social support effects on relationship satisfaction in couples experiencing infertility or miscarriage: Dyadic analyses. International Journal of Environmental Research and Public Health, 19(4), 1970. https://doi.org/10.3390/ijerph19041970
Maroufizadeh, S., Hosseini, M., Rahimi Foroushani, A., Omani-Samani, R., & Amini, P. (2018). The relationship between marital satisfaction and depression in infertile couples: An actor-partner interdependence model approach. BMC Psychiatry, 18, 310. https://doi.org/10.1186/s12888-018-1893-6
Alirezaei, S., Taghipour, A., & Latifnejad Roudsari, R. (2022). The effect of infertility counseling interventions on marital and sexual satisfaction of infertile couples: A systematic review and meta-analysis. International Journal of Reproductive Biomedicine, 20(10), 803–818. https://doi.org/10.18502/ijrm.v20i10.12264
