“Why is this so hard?” might be the #1 question TTC couples ask themselves when the journey takes longer than they expected. When what originally seemed like a simple process turns out to be complicated and sometimes heartbreaking, it can be difficult to ask the fertility questions that will guide you down the right path to successful conception.
We talked to three fertility experts about the reasons many couples are too afraid, ashamed or overwhelmed to get candid about their TTC journeys with their doctors, as well as the most important questions they should be asking. If there’s one thing you should take from their answers, though, it’s that whatever question you’re too afraid to ask, they’ve probably heard before — and you are very much not alone.
Nancy P Hemenway is the Washington DC Metro Region Executive Director for the International Council on Infertility Information Dissemination (INCIID, pronounced “inside”). “NCIID works with clinics across the country in a collaborative endeavor to support patients,” says Hemenway.
In her work with INCIID, Hemenway has helped countless couples and individuals alike explore their family-building options. Unfortunately, though, many of the couples she works with are too nervous or ashamed to ask the most important fertility questions. “I've been working in the field of fertility for almost 21 years,” says Nancy. “The stigma associated with fertility used to be enormous. It's better today, but there is still stigma.”
The consequences of not asking pressing fertility questions, of course, include not getting the fertility answers you need — which can delay your family plans. “The most successful fertility patients are usually those who will do their homework, research their options and ask the difficult fertility questions,” says Hemenway.
Fertility isn’t the easiest topic to address with anyone, let alone someone in a white coat. Hemenway told us some of the most common reasons patients are often too afraid to ask the right questions:
Class, gender and the power structure inherent in the doctor-patient relationship can sometimes intimidate patients. This can be doubly stressful for women, says Hemenway: “Fertility patients are often afraid to ask questions of their doctors because of (for a lack of better distinction) "class" differences. There are some doctors — both male and female — that don't want to answer questions, or don't have the time to answer questions, or feel like patients should just do as they say with no participation. After all, they are the doctor, right?”
“Wrong,” says Hemenway. “IVF, for example, should be a team approach. An educated patient is going to have a better chance of success. When everyone in a couple’s infertility support network is working to help a couple conceive and carry a pregnancy to term, you have multiple people in the same boat, working toward success. When doctors invest in their patients, everyone wins.”
“There is sometimes a desperation associated with the fear that a couple will never be able to conceive or carry a pregnancy to term,” says Hemenway. Of course, not asking a fertility question that’s been bugging you because you’re too afraid you won’t like the answer only makes the TTC journey more difficult, but that doesn’t mean asking the question isn’t hard. “One thing I still see is the shame associated with the inability to do what most of the rest of the world does without issue. Infertility treatment can be very stressful for patients!”
If fertility treatments are stressing you out, make sure you’re prioritizing self-care and seeking out ways to destress (here are five of our favorites!). Not only does reducing stress help make the TTC journey a bit smoother, but it can help you work up the courage to get the fertility answers you need from your doctor.
“There are often additional things you have to consider, both clinically and socially, when it comes to same-sex couples, or transgender persons,” says Hemenway. “So many things affect the ability for patients to be frank and open with doctors or other professionals.”
While society has come a long way in recognizing the importance of helping LGBT couples to grow and nurture their families, there can still be a lot of stumbling blocks, and unfortunately, not all doctors are as enlightened or educated in the options available for same-sex and transgender would-be parents. Fortunately, many fertility clinics specialize in helping LGBT couples overcome the medical, social and legal obstacles that sometimes stand in the way of finding the fertility answers they need.
“This is the most important question,” says Dr. Alex Shteynshlyuger, Director of Urology at New York Urology Specialists (@DrAlexUrology). “Only about 30% of infertility is caused by a problem in the female partner. About 50% of infertile couples have identifiable factors contributing to infertility in both the male and female partner. About 20% of infertility is caused by a male-only problem.”
The idea that women are responsible for all fertility issues is one of the biggest TTC myths out there (read more about this and seven other pervasive fertility myths). It’s important that men know how to maintain healthy sperm, and that loved ones learn how to support men struggling with infertility.
Some of the most uncomfortable conversations with doctors regard alcohol, tobacco and drug use. However, nothing is gained by not being forthcoming with your doctor. “Certain street drugs such as marijuana have been shown to have a negative effect on sperm quality. Tobacco is detrimental to sperm health as well,” says Dr. Shteynshlyuger.
Then there’s the risk from performance-enhancing drugs. You might love how they make your biceps and deltoids look, but the risks aren’t worth the benefits. “Men who use anabolic steroids as part of workout regimen have a high rate of infertility caused by suppression of testosterone production in the testis by supplemental testosterone,” says Dr. Shteynshlyuger.
“As a professional counselor, I specialize in women’s adjustment issues (often reproductive),” says Jessica Wade, MA, LPCC, a clinical counselor who owns Alfa Counseling in Dublin, Ohio. “Many of my clients confide that they want to know, especially after several treatment cycles, ‘What is my doctor learning about my fertility, after each cycle? Has my own doctor even reviewed my case and based on the progress so far, and does s/he recommend we change course?’”
Given the pressure on fertility doctors to see many clients in a short amount of time, couples can often feel as though they don’t get enough time to build a solid rapport with their practitioners, and this can add to their anxieties when trying to ask their most pressing fertility questions. “As their therapist, I urge them to find ways to speak up, ask their questions, or schedule separate consultations if needed, because answers to these questions often provide even the tiniest sense of control in a situation where a patient already feels out of control,” says Wade.
One fertility question many couples don’t think to ask, simply because it’s something they don’t often teach in sex ed, is whether the personal lubricant they use in the bedroom is sperm-friendly. However, many commercially available lubes create an environment that isn’t ideal for sperm to thrive in.
That’s why Astroglide TTC is formulated with adjusted pH levels, compatible osmolality and a consistency similar to a woman’s natural cervical fluids. If you need the increased comfort of a lubricant while trying to conceive, look for Astroglide TTC in stores or online in these convenient locations.
Images are for illustrative purposes.