Although infertility is widely acknowledged as a crisis for individuals and couples, it is less recognized as a trauma that impacts their families. Yet, involuntary childlessness is an inter-generational crisis that has the ability to strain, even damage, family relationships over time by impairing communications and interactions. Invisible losses, such as miscarriages, failed medical treatments, or adoptions have gone awry, may highlight a family’s inadequate means of dealing with problems. Old family issues, jealousies, and resentments may resurface or other family struggles, such as parental illness or the pregnancy of a sibling, may take priority over reproductive difficulties, leaving the infertile couple feeling isolated and abandoned. The lack of acknowledgment of the losses associated with infertility may damage family interactions, particularly if family members use negative coping techniques such as blaming, side-taking, denial or avoidance. However, the family experience of infertility also has the potential to bring out the best in the family system, promoting growth and well-being of the members.
Some families faced with infertility grow closer and find ways to provide support, compassion, and understanding in the midst of the maelstrom of profound loss and despair. These families are able to handle the myriad of negative emotions of infertility, and weather the pain of its many losses. They acknowledge the despair of this unique loss and its impact on the family as a whole, not simply on the individual or couple. Family members listen, openly communicate warmth and compassion, and ask for what the couple wants or needs during the infertility journey. And, they are willing to provide support in a variety of ways, and a willingness to adjust family life to accommodate the realities of the infertile couple’s situation (e.g., adapt gatherings to meet treatment plans or emotional needs). However, even strong, healthy families can find the challenges of infertility daunting and draining, particularly the pain of being an observer in a drama in which your loved one is suffering and there is little one can actually do to relieve suffering.
Involuntary childlessness is an interruption of the family life cycle. Family building is a developmental stage that represents generativity or fostering the next generation. It is a life cycle stage in which each and every member of the family transitions from one developmental stage to another, and in the process assumes new roles and new role responsibilities: couples move from being spouses to parents; their parents become grandparents; their siblings become aunts or uncles; nieces and nephews become cousins, and so on. Infertility is the obstacle blocking these normal transitions and preventing all family members from assuming new developmental roles.
Interruption of normal life cycle transitions can highlight a family’s unique flaws, precipitating negative behaviors such as: parental favoritism; poor communication; and/or unhealthy coping strategies. Infertility may also require family members to re-examine some long-held family beliefs if they cause increased distress. For example, the belief that an offspring is not an adult until he/she is also a parent, or children owe parents grandchildren. In short, infertility has the ability to distress not only infertile couples but also, their families, resulting in ‘collateral damage’ that lingers long after the problem of childlessness has been resolved.
Very often parents of an infertile couple feel caught between their infertile child and their ‘fertile’, sometimes pregnant, child(ren). Naturally, both offspring may expect to rely on their parents for emotional support at this significant time in their lives. While this is a realistic expectation, many parents may, for a variety of reasons, end up providing more support to the ‘pregnant’ child than the infertile couple. Sometimes this happens when a parent is more knowledgeable about providing support around pregnancy and parenthood issues than about infertility. Other times, it may be that pregnancy and grandparenthood is a happier, more enjoyable experience, while infertility brings sadness, loss, and a variety of negative emotions. In addition, the infertile offspring may not have asked for parental help, keeping infertility a secret, or may have asked for assistance that is impossible to provide. Many parents become paralyzed by their child’s pain and feel helpless to know what to do. Sometimes they feel trapped in the middle—or worse, their children demand they declare a specific loyalty or that they take sides. It is important to remember that parents still set the tone for family interactions and values, even in adulthood, and must refuse to take sides.
A significant challenge to parents of adult children is knowing when and how to provide feedback—particularly when it may not be wanted or appreciated. It may be difficult for a parent to say, “Telling me to support you by asking that I reject your sibling is inappropriate. I will support you in any way I can, but not by being hurtful to your sibling.” Or, “While it is wonderful that you are overjoyed with your new baby, I expect you to be compassionate of your sibling’s feelings while they struggle to have children, too.” Parents must be aware that watching a sibling move through the stages of pregnancy is typically most difficult for the infertile couple.
Parents faced with their children’s infertility are often baffled by this crisis. It is an ‘invisible’ loss that involves private marital issues, complex medical treatments, and a rollercoaster of emotions. They may know how to support a fertile child, because of their own experience, and may be less clear about their role of support for an infertile child. As with other experiences in parenting, they may have difficulty dealing with different children, with different needs, and coming from two very different life experiences.
Families dealing with infertility must find ways to help each member feel respected and acknowledged, despite their differences. It is important to define goals for strengthening the family which helps to keep the group intact, communication open, and strengthening the functioning of all members.
FOR FAMILY MEMBERS
Acknowledge infertility as a medical and emotional crisis with a wide variety of losses, disappointments and ‘costs’: physical, financial, social, marital. Do not attempt to deny or minimize involuntary childlessness either by avoiding the topic or offering empty platitudes like, “Everything will be fine” or “Just relax”. Avoid offering unsolicited advice and never interfere by taking sides, blaming, or imposing rigid expectations or limitations.
Be sensitive to the pain, stress, and emotional pressure of childlessness or the inability to expand one’s family as desired. If it is difficult to know what to say, tell the couple rather than saying nothing. Ask them what you might say or do that would be helpful. Try to frequently convey care and compassion and do not ‘forget’ the couple over time as the months and years of the infertility struggle drag on. Be cognizant that some junctures in the journey may be more difficult than others such as after a miscarriage, failed in vitro fertilization cycle, or surgery that fails to produce the hoped-for results. Remembering the couple with a card, phone call, donation in their names, flowers, or some other kind gesture can make the journey less difficult.
Be supportive. Do not assume you know what supportive means to your loved one but, instead, ask how you can be supportive: what would they find most helpful and useful? If you are able, consider ways in which you can assist emotionally (listening during a ‘good cry’) and functionally (offering financial assistance). Offer to simply listen and be ready to listen when called upon.
Emphasize the importance and value of the couple (and each partner) in the family. Encourage and welcome their involvement as a couple or individually in family events and activities. Once it occurs, infertility becomes a part of the family’s history; how a family adapts and copes with the events and stress will be forever part of the family’s past. Like any stressor, infertility can strain family functioning or improve it. Families need to be sensitive about the needs of the infertile couple, particularly around child centered family gatherings. It is important that they understand the infertile couple’s decision not to come may be important.
Always keep the lines of communications open. Stress the importance of honesty, candor, tact, and diplomacy in family interactions. It is not a good idea to hide pregnancies ‘out of kindness’ or not invite the infertile couple to child-centered family events; or keep secrets out of fear of upsetting the couple. Always think about how things are told as much as what is being told: tact, kindness, and privacy can go a long way to soften the blow of difficult news. Open communication also means being able to express concern if there is evidence of significant emotional distress.
Respect the boundaries the infertile couple sets regarding their infertility. Some couples prefer a high level of privacy about infertility. Other choose a more open approach. Be sensitive to the couple’s boundaries as concern for one couple can feel intrusive for another. When in doubt, ask the couple their preference.
FOR INFERTILE COUPLES
The infertile couple must recognize that very often parents and siblings are unable to comprehend the depth and multifaceted nature of the ‘costs’ of infertility. Ignorance does not mean that family members are callous or heartless. Recognizing that family members may need to be educated about how infertility impacts the couple is important.
Parents may feel guilty or responsible for infertility, distressed by their inability to ‘fix things’, or they may be experiencing their own life stressors.
Remember that you are and always will be a part of your family. Your infertility is now a part of your family’s legacy and your ability to manage the crisis in a healthy and admirable manner will set the tone for handling similar problems in the future. Do not let infertility become a single issue that permanently damages family relationships. As much as possible, continue participation in the life of the family as an active member of the family. If your family is very unsupportive, you may distance yourself from them. Seek the assistance of a therapist to help you understand your family dynamics.
Keep the lines of communication open and avoid conflict based on misunderstandings and misperceptions. Be prepared to educate your family about infertility. Educate them with books, articles, brochures, and websites.
Be aware of healthy boundaries. If you and your partner would prefer more privacy on the issue of infertility, each of you must convey this to your family. Privacy boundaries can be maintained without excluding loved ones from a difficult life experience. It just may take more communication.
If you have an unsupportive family, build a healthy support network for yourself. Continuing to expect support from family members who are unwilling or unable to provide it will only add stress to your life.