Sex and Infertility

SEX AND INFERTILITY: THE UNTOLD STORY

Anya, the protagonist of MISCONCEPTION, renowned fertility doctor, suffers severe sexual dysfunction which threatens to leave her childless.

How many people suffer from sexual dysfunction but present to the doctor complaining of infertility?

The stigma of infertility is gradually diminishing.  Couples are more open about it than ever.  Still, many fertility patients are uncomfortable telling family members, even close friends, that they are seeking medical help to have a baby.

Now what about sex?  It seems that while couples feel less reluctant to go to the doctor for fertility treatment, they are still extremely reluctant to admit that they have sexual dysfunction.  And they rarely seek help.

* How frequent is sexual dysfunction?
   43% of women and 31% of men (American Society for Reproductive    Medicine 2008)

* SEXUAL DYSFUNCTION AND INFERTILITY: THE CHICKEN AND THE EGG

* Which came first?

* In many patients, sexual intercourse is rare or nonexistent because of pain, discomfort, lack of understanding of the sexual response, performance anxiety, or a more specific sexual dysfunction.

* Other couples have enjoyed good sex life for years, working on, if anything, avoiding a pregnancy.  And then one day they wake up and say, time to have a baby.  And everything changes...

* From RECREATION to PROCREATION!

* Yes.  Sex is no longer just for fun.  It becomes a CHORE!  Like adult homework. 

* Now it's all about doing it at the right time.  Not just doing it.  God forbid you'd waste all that precious sperm!  When you could make a child with it.

* And you know what they say, MEN ARE FROM MARS, WOMEN ARE FROM VENUS.  Have I already told you I hate clichιs?  Well, I do.  But I have to admit, this is a good one.  Men and women go about problem solving so differently, they do seem like they've come from different planets.


* So she gets all these self-help books of how to get pregnant, spends hours on the internet, she may check her morning temp but most importantly — checks her urine for ovulation.

* And when he feels like, doing it, she might say, I think I'm ovulating tomorrow, honey.  We should wait.

* Now most men don't find OVULATION sexy.

* So just as he is about to go have a beer with his buddies, or watch his favorite game on TV, she says, "I'm ovulating, honey."  He knows what that means.  Sex on demand.  Not because the want to do it but because the have to do it.

* There goes the fun.

* Enter performance anxiety.  If he is distracted, preoccupied — he may have an erection or ejaculation failure or both.  And then what?  Next time will be worse, after the first power failure.  And for guys it is much more obvious: A woman can get pregnant without an orgasm.  But if the man doesn't deliver — there will not be a pregnancy in the absence of sperm! 

*and so they become embroiled in this vicious cycle: attempted conception — failure in bed — more attempts — worsening sexual dysfunction — infertility!

* This turn of events only applies to some people.  But I bet many of you, reading these lines, are nodding their heads, finding this scenario familiar, so close to home.

* And then there is the other sequence, the couple clearly has sexual problems initially.  The problem is never properly addressed or treated, and now they find themselves in the fertility clinic.

* The fertility doctor may or may not be aware of the sexual dysfunction.  Yes, there are sex related questions in the patient questionnaire (frequency; orgasm; pain; response of partner).  Sometimes one or both partners will admit to a problem, but more commonly not.  Many times, the wife fills out the husband's forms as well (symbolic of his non-involvement?)

* The doctor has powerful ways to help patients get pregnant without intercourse.  Inseminations.  IVF. 

* I tell my patients, "from now on, you don't have to shoulder the responsibility of trying to conceive.  Everything directed at a pregnancy will be done here, at the office.  All you have to do is show up."

* And romance can be reintroduced to the bedroom.  Once again, SEX IS FOR RECREATION, NOT PROCREATION.

*The question — is this enough to turn things around and make patients sexually happy again.  Also — soon they are going to be pregnant (average time to conception 6 months).  Sexuality changes in pregnancy.  If you start out having problems in the non-pregnant state — what is the chance things will improve in pregnancy?

* One approach practiced by many physicians is to ignore the sexual dysfunction while treating the fertility problem alone.  Patients may conceive easily, but are likely to remain frustrated and upset over their marital relationship run aground.

* In such cases, fertility treatment may become the SEXUAL DYSFUNCTION BYPASS OPERATION! 

* There are 2 essential components to sexual healing: honesty of the patient(s) and sensitivity and caring of the physician. 

* Doctors who are aware of sexual dysfunction should discuss it with their patients.  This is not always easy.   There may be cultural, religious, ethnic and gender obstacles.  But I find that, in most cases, patients are yearning for this conversation to happen.  They take a deep breath as if saying, "Wow, I can talk about it with this doctor!  It's not taboo.  Maybe I found someone who can finally help me!"

* And the fertility doctor can help a lot.  First — just listening means so much.  Then — with the patient understanding that he or she is not alone.  That this problem is COMMON, TREATABLE and REVERSIBLE!

* Many problems can be resolved by guidance of the fertility doctor.  Others — may need a referral to a sex therapist. 

* For a list of local certified sex therapists, log on www.aasect.org