IVF and Your Relationship: What Couples Wish They'd Known
By Mark Ryan, BACP Accredited Psychotherapist and NCPS Accredited Relationship Therapist
Much of what couples are told before IVF is medical. There are success rates by age, protocols, timelines and costs, and all of it matters. Far less is said about what the process does to the two people going through it, or about the conversations that tend to go missing somewhere between the first scan and the day the result arrives. This piece looks at what research and couples' own accounts suggest about how IVF reshapes a relationship, and at what tends to protect it.
If you are reading this mid cycle, between cycles, or still deciding whether to start, it may already feel as though your relationship has been handed a project manager, a calendar and a budget. That is a common experience, and it says little about how strong the relationship was before treatment began. IVF asks a great deal of two people at once, and it does so in a way that few couples have ever had to organise around.
Why IVF puts a different kind of pressure on a relationship
Couples who have been trying for a while often hope that IVF will be the point where things finally get easier, because at last something is being done. Sometimes that is true. It is also true that treatment brings its own strain, and the couples in one qualitative study described it in physical and practical terms as much as emotional ones. Knowing that in advance can make it less of a shock when it arrives.
In interviews with couples going through IVF in China, people described physical and emotional pain, the urgency and inflexibility of the wish to have a child, and disruption to their daily routines and work. They also described enduring it together and said that the support they gave each other shaped how they experienced the treatment. They were ambivalent about support from friends and family (Ying, Wu and Loke, 2015). The couples were Chinese, so the cultural weight of parenthood in their setting may differ from yours. The structure of the experience will still be familiar to many readers, a treatment that runs on a clinic's timetable, with a relationship organised around it.
That timetable is what sets IVF apart. Earlier stages of trying to conceive are usually open ended and private. IVF is scheduled, monitored and medicalised, with appointments that cannot move, injections that must happen at a set hour and decisions that must be made by a deadline. A couple's ordinary rhythms of work, rest, sex and conversation get bent around it, often for months.
Two roles, and neither is the easy one
IVF divides a couple into two roles, whether either person chose that. One person's body takes the treatment. The other attends, supports, drives, pays and waits. It is tempting to assume the first role is the hard one and the second is a supporting part, and that assumption causes more trouble than most couples expect.
For the person being treated, the load is bodily and constant. There are scans, blood tests, injections, the side effects of medication and a retrieval procedure, all fitted around a working life. For the other partner, the difficulty is often helplessness. They cannot take an injection on someone's behalf, cannot make the medication work and may not know whether to speak or stay quiet. Some carry their own grief, guilt or diagnosis, because the reason for treatment can sit with either partner or with neither.
Research suggests the supporting role matters more than it looks. A study of 67 couples experiencing infertility, each made up of a woman and a man, looked at how partners coped together. How the man coped alongside the couple, and how the woman experienced his efforts to cope with her, were linked to how well the couple adjusted. The way the man coped was also linked to his own depressive symptoms. The authors emphasised the importance of involving men in the treatment process (Chaves, Canavarro and Moura-Ramos, 2019). The study was cross sectional, so it shows a pattern rather than proving cause.
That finding describes the couples studied, and nothing suggests the pattern belongs to gender. The likelier driver is the structure of the roles. Where one person is the patient and the other is the support, the person in the supporting role needs a real job, real information and a real place in the process. Without those, they can end up feeling like a bystander to something that is shaping their whole life. The person being treated often needs the reverse, a partner in the process rather than a helper who follows instructions.
The rhythm of a cycle, and why you may cope differently
A cycle has a shape, and each stage has its own emotional weather. Couples often assume they will move through it in step, then find that one person is racing ahead while the other has gone quiet. That mismatch is not a sign of trouble, though it can feel like one at the time.
Stimulation is busy and practical, with injections, scans and adjustments to the plan. Retrieval often brings relief and a fresh set of numbers, including how many eggs were collected and how many fertilised. Transfer leads into what many couples find the hardest stretch, the wait of about two weeks before a test can be done, in which nothing can be done, and everything feels significant. Then comes the result. Protocols differ, and many couples have frozen transfers, so the order can look different, but the pattern of intense activity followed by waiting is common.
People cope with this kind of uncertainty in different ways. One partner reads everything, tracks every figure and wants to talk through each possibility. The other avoids the subject, keeps busy and finds the constant analysis exhausting. Each can read the other's style as a verdict, the researcher as controlling and the avoider as not caring. Neither reading is usually accurate. It helps for each person to say plainly what they need, whether that is information, distraction or simply company.
Blame, even when nobody says it
When the cause of infertility is known, or partly known, it can attach itself to a person. When it is unknown, blame looks for somewhere else to land, in a body, in a past choice, in the clinic or in the relationship itself. Couples often feel they have been careful never to say anything and still sense it in the room.
A study of 279 couples enrolled in fertility treatment, analysed as men and women within each couple, asked each partner how much they blamed themselves and how much they blamed the other for the fertility problem. Self-blame predicted anxiety and depression symptoms in both men and women. Men's self-blame also predicted their own lower relationship satisfaction, while women's self-blame predicted more depression and anxiety in their partner. When women blamed their partner, both people's relationship satisfaction was lower (Péloquin, Brassard, Arpin, Sabourin and Wright, 2018). Findings of this kind describe associations rather than causes.
The pattern to notice is that blame is costly in both directions. Blaming yourself is linked to distress in you, and in some cases to distress in the person who loves you. Blaming your partner is linked to a worse relationship for both of you. Blame that has settled into a habit follows a familiar course, and how blame works between partners more generally is covered separately.
It tends to help to say the thing out loud. A sentence such as ‘I know neither of us chose this, and I don't hold it against you’ can loosen a belief that has been running unchallenged for months. It helps just as much to hear what the other person has been privately telling themselves.
IVF divides a couple into two roles, whether either person chose that.
Sex when it belongs to the treatment plan
Sex is often the first thing to change during IVF, and it changes in a way that can be hard to explain to each other. Depending on the protocol, some clinics advise avoiding sex at certain points in a cycle. Even where there are no restrictions, a body that is being scanned, injected and monitored often stops feeling like a body for pleasure. Many couples are surprised by how much they miss sex and how little they feel like starting it.
Research on couples facing infertility shows that infertility related stress is linked to lower sexual satisfaction in both partners, and that sexual concerns in one partner go with lower sexual satisfaction in the other as well (Nakić Radoš, Soljačić Vraneš, Tomić and Kuna, 2022). That cross-sectional study of 94 couples of a woman and a man covered infertility more broadly rather than IVF alone. Many couples in treatment will recognise the pattern.
It helps to separate two things that treatment tends to fuse, sex as a task and touch as connection. Intimacy that carries no timing, no purpose and no outcome can keep a sense of being together alive while the clinical side takes over the calendar. Talking about sex directly and early matters more than finding perfect wording. For the partner whose body is undergoing treatment, feelings about a body that has become a site of procedures can add another layer, and the link between body image and intimacy applies here as much as anywhere.
When a cycle doesn't work
A negative result, or a pregnancy that ends, is a loss, though it rarely gets treated as one. There is often no ceremony, no time off and no obvious way for anyone around you to respond. For couples, the difficulty is that both people are grieving at the same moment and often on different timelines, with a decision about what to do next arriving before either has caught their breath.
One partner may want to book the next cycle straight away, because action feels better than absorbing the result. The other may need a long pause or may feel privately relieved and then ashamed of that relief. Grief can look like anger, withdrawal, busyness or a sudden interest in logistics. None of these means one person cares less. Where a transfer led to a pregnancy that then ended, the loss has its own shape, and grieving a pregnancy loss together is covered in more depth elsewhere.
It often helps to agree, before a result arrives, how you will handle the first day if it is bad. Some couples decide who tells family and who does not, whether they want company or space, and that no decision about the next cycle will be made for a set number of days. This turns a moment of shock into something the two of you have already had a say in.
Money, decisions and the question of when to stop
IVF asks for decisions at a pace and scale most couples have never met. There is the cost, which varies widely and is often paid privately even where NHS funding exists in principle, because access depends on where you live. There are optional extras whose value is hard to judge. And underneath it all sits the question nobody wants to raise, which is how many cycles you will do and what happens after that.
Money is a frequent source of conflict in any relationship, and IVF concentrates it. Arguments about money often have less to do with the numbers than with what money stands for, security, fairness and control, and IVF puts all three on the table at once. It is common for partners to want to stop at different times. Neither is wrong, and the mismatch itself is what needs discussing.
Decisions are harder when they are made tired and at speed. Agreeing some boundaries before starting can help, such as a budget, several cycles and a rough sense of what each of you would want to consider next, whether that is another approach, donor conception, adoption or stopping. These are not promises. They are a shared starting point that spares either of you from proposing an ending alone at the worst possible moment.
IVF when the couple is not a woman and a man
Most research on couples and IVF has been done with couples made up of a woman and a man, which means much of what is above has not been tested elsewhere. IVF and donor conception are also routes to parenthood for lesbian couples, for trans people, for gay men working with surrogates, and for people building a family with a friend or on their own. The medical steps and the emotional questions can look quite different, and clinics do not always make it easy to feel expected.
One of the few studies to follow these couples gave broadly reassuring results. Researchers in Sweden followed 57 lesbian couples using donor sperm and 63 heterosexual couples having standard IVF, from the start of treatment to about three years after it ended. Lesbian couples reported higher relationship satisfaction than the heterosexual couples, whose satisfaction was not low either. The authors concluded that the lesbian couples reported stable relationships and high satisfaction even where treatment had been unsuccessful (Borneskog, Lampic, Sydsjö, Bladh and Skoog Svanberg, 2014). Satisfaction did dip a little in both groups over time, and only couples still together at follow up were included. The authors suggested that unsuccessful treatment may have weighed less on the lesbian couples because many plan for each partner to take a turn at carrying, so a failed cycle is not necessarily the end of the road.
That study set donor sperm treatment in lesbian couples against standard IVF in heterosexual couples, in one country. Research on gay male couples, trans partners and other family shapes is much thinner, so what follows rests on what these situations tend to involve rather than on strong evidence. Questions can arise that couples of a woman and a man rarely have to negotiate. Who provides the eggs and who carries the pregnancy? How is each person's link to the child recognised? How will legal parenthood be secured? How does each person feel about the donor or surrogate? These are relationship questions as much as medical ones, and they are best raised early. A clinic's forms and assumptions can also leave one partner feeling like an afterthought, which is a real cost and not a small one.
I work with couples of every gender and structure, and there is more on gay couples in therapy and lesbian couples in therapy elsewhere on this site.
What may help
Nothing removes the strain of IVF, and the couples who cope well are not the ones who feel calm throughout. The evidence points to something smaller and more practical. It is about staying a team in a process that keeps making you feel like separate people, one with a body under treatment and one at the edge of it.
Give the supporting partner a real role. Attending appointments where possible, learning the protocol and taking specific tasks such as the injection schedule or the paperwork can turn a bystander into a participant. Ask what they want to know as well as what they can do.
Set aside time when treatment is not discussed. A fixed evening each week, or a rule that the bedroom is a no clinic zone, protects the part of the relationship that has nothing to do with the outcome. It will feel artificial at first and matters more as treatment goes on. The couples in the Chinese interview study said that the support they gave each other shaped their experience of the process, and that is easier when not every conversation is about the cycle.
Ask what the other person needs today rather than assuming. Some days the answer is information, some days it is distraction and some days it is being left alone, and it can change within a single afternoon.
Look for support beyond the two of you. Advice from friends and family is often well meant and badly timed, which may be why the couples interviewed were ambivalent about it. A fertility counsellor, a peer group or one trusted person who knows the whole picture can take weight off the relationship, so that it is not the only place all the feeling has to go. Many clinics offer counselling. This matters because feeling alone inside a relationship is common during treatment, even when both people are doing their best.
How therapy can help
Couples come to this work at different points, some in the middle of treatment and some after it has ended or paused. Sessions can give each of you a place to say what does not fit into a clinic corridor conversation, including fears that feel too heavy to add to your partner's load. The work often involves bringing blame into the open and checking it, agreeing how you will handle results and decisions, and rebuilding some ordinary intimacy alongside the medical schedule.
It also helps to have one place where both roles are taken equally seriously, the person being treated and the person beside them. Where one of you carries a longer history, such as earlier losses or a diagnosis that has changed how you see yourself, that can be worked on alongside the couple's work rather than instead of it.
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 of you is welcome to make contact first, whether you are considering IVF, in the middle of a cycle, or working out what comes next.
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
Borneskog, C., Lampic, C., Sydsjö, G., Bladh, M., & Skoog Svanberg, A. (2014). Relationship satisfaction in lesbian and heterosexual couples before and after assisted reproduction: A longitudinal follow up study. BMC Women's Health, 14, 154. https://doi.org/10.1186/s12905 to 014 to 0154 to 1
Chaves, C., Canavarro, M. C., & Moura-Ramos, M. (2019). The role of dyadic coping on the marital and emotional adjustment of couples with infertility. Family Process, 58(2), 509 to 523. https://doi.org/10.1111/famp.12364
Nakić Radoš, S., Soljačić Vraneš, H., Tomić, J., & Kuna, K. (2022). Infertility related stress and sexual satisfaction: A dyadic approach. Journal of Psychosomatic Obstetrics & Gynecology, 43(1), 18 to 25. https://doi.org/10.1080/0167482X.2020.1752658
Péloquin, K., Brassard, A., Arpin, V., Sabourin, S., & Wright, J. (2018). Whose fault is it? Blame predicting psychological adjustment and couple satisfaction in couples seeking fertility treatment. Journal of Psychosomatic Obstetrics & Gynecology, 39(1), 64 to 72. https://doi.org/10.1080/0167482X.2017.1289369
Ying, L. Y., Wu, L. H., & Loke, A. Y. (2015). The experience of Chinese couples undergoing in vitro fertilization treatment: Perception of the treatment process and partner support. PLoS ONE, 10(10), e0139691. https://doi.org/10.1371/journal.pone.0139691
