Most people grow up believing that they can conceive children when they decide to begin a family. Experiencing infertility is an unanticipated shock and crisis (Wilkes, 2006). As their infertility becomes more evident and undeniable, a couple may feel a great sense of isolation from others during social discussions of pregnancy, childbirth, and child rearing. As one woman who has been unable to conceive stated,

Coffee breaks at work are the worst times; everyone brings out their pictures of their kids and discusses their latest parental trials and tribulations. When one of the women complains about having problems with something like child care, I just want to shout at her and tell her how lucky she is to be able to have such a "problem." (Authors’ files)

Problems with infertility can have profoundly negative effects on a couple’s relation­ship and sexual functioning (Keskin et al., 2011). Partners can also become isolated from each other and believe that the other does not really understand. Each partner might feel inadequate about his or her masculinity or femininity because of problems with conceiving. Each may feel anger and guilt and wonder, "Why me?" Finally, both may feel grief over life experiences they can never have—namely, pregnancy, birth, and conceiving and rearing their own biological children (Steuber & Solomon, 2008).

Intercourse itself can evoke these uncomfortable feelings and can become an emotion­ally painful rather than pleasurable experience, fraught with anxiety and sadness about failing to conceive. Studies have found that most infertile couples experience some sexual dissatisfaction or dysfunction at one point or another (Mahoney, 2007). In addition, the medical procedures used in fertility diagnosis and treatment are disruptive to the couple’s sex­ual spontaneity and privacy. Sex can become stressful and mechanical, resulting in performance anxiety that interferes with sexual arousal and emotional closeness.

In contrast, 20% of men and 25% of women report that infer­tility helped their marriage. The determining characteristics were whether men actively communicated their feelings instead of avoid­ing conversations about pregnancy and burying themselves in work. In addition to increasing closeness in the relationship, couples who communicated with each other about the infertility also reduced their overall individual stress by doing so (Aaronson, 2006).