I am part of an email listserv for the Mental Health Professional Group of the American Society for Reproductive Medine, in which mental health professionals discuss psychological issues surrounding infertility. This week there was a fascinating discussion of what do when there is in impasse in couple therapy, in which one member of the couple wants to pursue having a child, but the other member does not. Perhaps there is a disagreement about what method of family building to use--one person is against using donor gametes, or adoption. Other times, the conflict centers around whether or not to have a child, or another child, at all. On the listserv, there were different suggestions about how to be helpful in this situation, but all the clinicians agreed that these are usually very difficult and painful situations for the couple involved.
I have come to realize that there are actually many different types of infertility. Of course, there is your garden-variety medical infertility, which in some ways, though emotionally painful, is a bit more clear cut. There is also situational infertility, in which an individual or couple cannot pursue having a family because of their circumstances, for example, if a family member develops a serious illness, or a financial crisis occurs. But when the members of a couple seriously disagree about if and how to have a child, then relational infertility occurs. This type of infertility often coexists with medical and situational infertility.
In many ways, relational infertility can be the most painful type of infertility of all. With medical or situational infertility, the causes are usually out of anyone's control. But when the family-building impasse is caused by a choice, the feeling is that things could be different--if only the other person would change their mind. In a couple, such a conflict can be very difficult on a relationship. Both partners have to face the dilemma of either having some serious regrets and resentments for the road not traveled, or conversely ending an important relationship. This is because it is often very hard to create a compromise in these situations--you can't have or not have a baby half-way.
One of the things that struck me about the discussion on the listserv is that my colleagues, like myself, didn't have any easy answers for dealing with such a dilemma. I suspect that this is because there simply isn't one. Having, or not having, children is one of the most important life decisions a person can make. At times, the importance of these desires can override the desire for being in the relationship.
However, if you find yourself in this type of conflict with your partner, there are some steps you can take to try to resolve the situation. The most important thing you can do is try to listen to your partner very carefully. Even if you don't agree with their perspective, it is important to try and understand it. Try to put yourself in your partner's shoes and see things from their point of view. If you can develop empathy for what your partner is feeling, you may be able to become less rigid in your own position, and a solution may be possible.
In cases of relational infertility, it is also important to consider whether or not other underlying issues and conflicts you are experiencing as a couple are coloring your feelings regarding having a family. For instance, if there are problems with emotional closeness and support in the relationship, one of the partners may be more hesitant to add on the additional work and stress of having a child. Certainly, if one of the partners is already having doubts about continuing the relationship, he or she may not want to make the additional commitment of having a child together.
In addition, at times an individual's psychological issues can contribute to an relational infertility impasse. For example, one couple with whom I worked was locked in conflict about whether to continue fertility treatments--the wife wanted to stop, whereas the husband desperately wanted to continue to try for a baby. Over time, it became clear that the wife had deep-seated doubts about her own ability to parent successfully. These doubts were rooted in her experiences growing up with her own parents. As she became more aware of these issues, and her husband developed a greater understanding and empathy for her feelings, the couple was better able to decide together what their future would hold.
With relational infertility, the stakes are very high. I think it must be very hard to be the person who kept a partner from his or her dream of having a child. Conversely, it must also be extremely difficult to feel that one's partner is resentful about parenting, or not fully committed to a child. Ending a relationship of long-standing can also be extremely painful. Thus, if you find yourself in this situation, think carefully before you act or make your final decision. Seeking couples therapy with a therapist knowledgeable about infertility would be very helpful in negotiating such an important and life-changing decision.