When Fertility Struggles Hijack Intimacy; A Clinical Therapists Perspective
For over a decade, I have worked as a clinical therapist supporting individuals and families navigating the impacts of complex family trauma. In recent years, my practice has evolved to focus primarily on perinatal mental health, including infertility, pregnancy, and postpartum well-being. This specialization was not a random career choice, but one that emerged through both professional experience and personal insight. My own journey as an intended parent deepened my understanding of the emotional complexities that can accompany family building and inspired me to develop focused expertise in supporting individuals and families through these transformative years.
Relationships are often built around pleasure, companionship, joy, and intimacy. By the time couples begin trying to build a family, most have reached the understanding that they are ready to create a larger shared life together, one rooted in shared values, traditions, and hopes for the future. All of this grows from the love they have built with one another.
But what happens when that goal and the expression of that love, hits a bump in the road?
When a couple experiences infertility, many of the foundational elements of the relationship can become shaken. Communication may falter, sex can become clinical and scheduled, and the relationship is suddenly asked to withstand physical pain, loss, financial strain, and the demands of what can feel like a second full-time job. All of this unfolds in pursuit of a goal with no guaranteed timeline or outcome.
Within my own relationship, I felt disconnected from my partner at times. Their need for intimacy and my need for support were not always aligned, despite having built our relationship on strong communication and connection. It often felt as though many of the joys in our relationship had been placed on hold for a hope and a future we deeply wanted.
One of the central areas of my work focuses on the impact infertility can have on a person's sense of self and on intimacy within a relationship. The stress, uncertainty, and repeated cycles of hope and disappointment can profoundly affect how partners connect, communicate, and navigate their shared experience. Supporting couples in maintaining and rebuilding emotional and physical intimacy throughout this journey is a key aspect of perinatal mental health.
Fertility struggles often hijack both personal and partner intimacy
Fertility treatment can feel like a second full-time job. Between appointments, medications, hormone shifts, procedures, cycle tracking, and ongoing uncertainty, emotional exhaustion can become inevitable. Infertility impacts connection, identity, and sexuality. When people are emotionally and physically depleted, or feel disconnected from or hyper-focused on their bodies, intimacy is often one of the first areas affected.
Clients commonly describe:
Feeling physically unwell
Feeling betrayed by their body
Increased pain or sensitivity
Emotional dysregulation from hormones
Sex becoming scheduled and transactional
Pressure replacing pleasure
Many couples tell me:
“Sex feels like a chore.”
“It's too scheduled.”
“We've lost spontaneity.”
“We're only having sex to conceive.”
Even when infertility factors are medically linked to one partner, both individuals often experience guilt, shame, disappointment, and helplessness. The focus shifts from connection to performance, and from intimacy to outcome.
So What Do We Do About It?
One of the most important things couples can do during fertility struggles is intentionally nurture their relationship outside of trying to conceive. While having a child may be the goal, maintaining closeness, trust, emotional safety, and connection along the way matters deeply too.
Below are four areas I often encourage couples to focus on when intimacy feels strained during fertility treatment.
1. Communication Comes First
Open and honest communication is foundational. That means being honest not only with your partner, but with yourself.
What makes you feel supported?
What do you need when you are grieving?
What helps you feel physically safe or emotionally connected?
What makes you feel appreciated?
Partners often cope differently, and that is okay. One person may need closeness while the other needs space. Neither response is wrong, but unspoken expectations can quickly create resentment. Understanding these differences and finding common ground is essential.
Communication also lives in the small moments, not just the scheduled check-ins or date nights. Some simple ways to foster connection include:
Checking in during the day
Planning intentional time together
Expressing appreciation
Reminding one another that your relationship exists outside of fertility treatment
When you're deep in a treatment cycle, this last point can be particularly difficult to remember, but it remains an important grounding force within a relationship.
2. Touch Does Not Always Need to Lead to Sex
During fertility treatment, physical touch can become loaded with pressure. Many couples begin to associate affection with expectation, but intimacy is much more than intercourse.
This does not mean taking sex for pleasure off the table. Rather, it means acknowledging that this stage of life may make connection more challenging. I often encourage couples to prioritize simple points of physical contact throughout the day to help prevent slipping into a roommate dynamic.
· A hand on the shoulder.
· Cuddling on the couch.
· A forehead kiss.
· A back rub after a long day.
These moments matter. Having touch that exists outside of sex helps rebuild safety and connection without the pressure of performance or timing. Physical closeness can become therapeutic again when it is separated from the expectation that it must lead to intercourse.
3. Boundaries Are Healthy
Boundaries are essential during fertility struggles. There may be seasons when sexual intimacy feels emotionally or physically overwhelming. Being honest about that is not rejection, it is communication. Clear boundaries help reduce resentment, guilt, and misunderstanding.
It's okay to say:
“I need space right now.”
“I want to cuddle and be close, but not have sex.”
Boundaries allow couples to remain connected while respecting each other's emotional capacity. At the same time, it is important to remain mindful of your partner's need for connection. Relationships involve both giving and receiving, and nurturing the relationship during periods of uncertainty requires consideration of both partners' needs.
4. Redefine Sex Beyond Reproduction
When conception becomes the primary focus, sex can quickly lose its sense of enjoyment and connection. Whenever possible, I encourage couples to reconnect with sexuality outside of ovulation windows and fertility timelines. Not because they “should”, not because there is pressure, but because pleasure, playfulness, and intimacy deserve space too.
For many couples, sex was once associated with fun, closeness, and mutual enjoyment. While fertility treatment can make those experiences feel intertwined with reproductive goals, it is important to remember that they can exist separately.
Some ways to create opportunities for reconnection include:
planning a weekend away
having a staycation
creating intentional time together outside your usual environment
exploring intimacy beyond the bedroom
Novelty can help couples reconnect emotionally and physically in ways that feel less clinical and less tied to fertility treatment itself. Most importantly, these approaches should always align with the boundaries and comfort levels of both partners.
If You're at the Beginning of Your Fertility Journey
You do not need to navigate this alone. You are not expected to already know how to manage the emotional, relational, and physical realities of infertility. Seeking support, whether medical, emotional, relational, or familial, is not weakness; It is care!
If you ask for help and feel dismissed, continue advocating for yourself. Explore different ways of communicating your needs or seek a provider who is willing to listen. Talk about your fears, your needs, your grief, and your relationship.
Fertility struggles can feel incredibly isolating, but silence often deepens that isolation. Both my personal experience and years of clinical practice have taught me that we deserve support not only as people trying to conceive, but as whole individuals navigating one of the most emotionally complex experiences life can bring.
Author: Laura Reisman, MSW, RSW, PMH-C, Doctoral Candidate
Laura is a certified Perinatal Mental Health Therapist through Postpartum Support International, the co-creator of More Than Sleep at Have Baby. Must Sleep., and the founder of Rooted Perinatal. Laura supports clients navigating infertility, surrogacy, pregnancy, postpartum, perinatal mood and anxiety disorders, sex and intimacy concerns, trauma, and difficult partner and family relationships.
