For many couples, the early months of trying for a baby are full of hope. But when month after month passes without a pregnancy, hope can turn into worry, grief and strain. In many communities, especially across Africa and South Asia, infertility also brings stigma, intrusive questions and pressure from relatives, often directed unfairly at women.
The World Health Organization estimates that around one in six people experience infertility at some point in their lives. You are not alone, and there is help. Most importantly, you can face this together rather than letting it pull you apart.
What is infertility?
Infertility is usually defined as not becoming pregnant after 12 months of regular unprotected sex. Many doctors advise seeking help after 6 months if the woman is 35 or older, or sooner if there are known problems such as irregular or absent periods, previous pelvic infection, endometriosis, or a history of undescended testes or mumps in the man.
It is not just a “woman’s problem”
In many cultures, women are blamed for infertility. The science is clear: male factors contribute to around a third to a half of cases. Causes include:
- Female factors: ovulation problems (for example polycystic ovary syndrome), blocked fallopian tubes (often from past infections such as chlamydia or gonorrhoea, or unsafe abortion), fibroids, endometriosis, and age-related decline in egg quality.
- Male factors: low sperm count or poor motility, varicocele, infections, hormonal problems, and effects of smoking, alcohol, heat exposure and some medicines.
- Combined or unexplained: sometimes both partners have factors, and sometimes no cause is found.
That’s why both partners should be tested. A semen analysis is simple and inexpensive and should be part of the first assessment.
The emotional toll
Infertility can cause grief, anxiety, depression, shame, anger and jealousy (for example at friends’ pregnancy announcements). Couples may experience:
- Sex becoming scheduled and stressful
- Blame, spoken or silent
- Different coping styles: one partner wants to talk constantly, the other withdraws
- Financial strain from tests and treatment
- Pressure from in-laws, including suggestions of a second wife or divorce
- Isolation, avoiding baby dedications, naming ceremonies or family gatherings
For nurses who work in maternity or children’s units, being around babies every shift can add to the pain.
How to support each other
- Say “we” not “you”. Treat infertility as a shared challenge. Agree that blame has no place in your home.
- Get tested together. Attending appointments together shows commitment and avoids one partner carrying the burden.
- Respect different ways of coping. One of you may need to talk, the other may need space or practical action. Find a balance, for example a set time each week to talk about it.
- Protect your intimacy. Make time for closeness that isn’t about conception. Remember why you love each other.
- Decide together what to share. Agree on how much to tell family and friends, and a simple, united response to intrusive questions.
- Defend each other. If a relative criticises your partner, step in. This is especially important for husbands when relatives blame wives.
- Look after your mental health. Talk to a counsellor, join a support group, and seek help if you notice signs of depression.
- Keep living. Plan things that bring you joy as a couple, so infertility doesn’t become your whole life.
Medical help: what to expect
A doctor or fertility clinic may offer:
- Initial tests: medical history, examination, hormone blood tests, ultrasound, semen analysis, and tests of the fallopian tubes.
- Lifestyle advice: healthy weight, stopping smoking, limiting alcohol, treating infections.
- Treatments: ovulation induction medicines (such as letrozole or clomifene), surgery for fibroids, tubal problems or varicocele, intrauterine insemination (IUI), and in vitro fertilisation (IVF) or ICSI.
IVF can be expensive and is not always successful. Ask clinics for their success rates for couples of your age and situation, and be wary of anyone promising guaranteed results.
Be cautious of exploitation
Desperation can make couples vulnerable to unproven herbal remedies, expensive “miracle” cures or spiritual exploitation. Before paying for any treatment, ask what evidence supports it and whether a qualified health professional recommends it. Some herbal products may contain harmful substances or interact with medicines.
Other paths to parenthood
Some couples consider donor eggs or sperm, surrogacy, fostering or adoption. Laws and cultural views on these vary widely between countries. Others decide, after careful thought, to live child-free and build meaningful lives in other ways. Whatever path you take, it should be a decision made together, without pressure.
A note for nurses and midwives
Professionally, we can help reduce infertility by:
- Promoting prevention, testing and early treatment of sexually transmitted infections
- Supporting safe abortion care and post-abortion care where legal, to prevent infection
- Encouraging couples to seek help early and both partners to be tested
- Challenging blame and stigma in our communities
And personally, if you are going through this yourself, please be gentle with yourself. Your worth, and the worth of your marriage, is not measured by whether you have children. Hold on to each other.