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The number, complexity, and invasiveness of medical procedures that a couple with a fertility problem go through in their search for an answer to why pregnancy is not occurring can be staggering. As one patient put it: " It's like donating your body to science while you're still alive!"
Many doctors still advise their patients to maintain a temperature chart. Although obsolete from a medical point of view, it can be extremely intrusive.
There is no inner recess of me left unexplored, unprobed, unmolested. It occurs to me when I have sex, what used to be beautiful and very private is now degraded and very public. I bring my chart to the doctor like a child bringing a report card. Tell me, did I pass? Did I ovulate? Did I have sex at all the right times as you instructed me?
The temperature chart becomes a way of ruling one's life - and ruining one's sex life. It is also a public declaration of making love. With the desire for a child becoming increasingly frustrated, life can become an endless maze of temperature changes, ovulation calculations, timing of sex and the disappointing signs of one's menstrual onset. Anxiety, depression and fighting over sex can often be traced to this source. "Ordinarily my husband was the instigator of sex. During my fertile time, I felt I had to seduce him. What quite often happened was that we'd end up fighting instead of making love."
It was pretty hard to feel an urge to make love when your wife is expecting a command performance.
It is not just the physical charting but the mental charting (which may continue indefinitely) that is a source of stress, even if the partner is not aware of what is happening.
Some of the comments about temperature charting are quite telling:
One of the things that freaked me out about charting my temperature was the accompanying need for the X's. I guess that is what brought home to me that we had stopped making love as frequently as we had used to.
The ultimate moment for me was when I found myself 'cheating' on the charts. I put in a few more X's here and there to make things look good...then I said to myself," Good heavens - has it come to this?"
At first it was quite exciting - I felt as if I was actually doing something. We would both look at the chart and go for, say, six X's in a row - in fact our frequency of intercourse increased I'm sure. By now we've gone through the stage of 'saving up sperm' and have hit the stage of almost total abstinence. I put in an occasional X so that the nurse doesn't get the impression that there's something wrong with our marriage.
Providing a sample for semen analysis can also be stressful for the husband:
I looked around desperately for something to turn me on - there was nothing - not even soap. After 15 minutes I gave up - literally sore as hell.
Most men feel their masculinity is 'on the line' when having this done, sometimes to the extent of being unable to produce the specimen. It is not uncommon for the man to become impotent for a short time while he is undergoing such procedures.
"The first time it happened I thought - here it is - middle age. I'll never get it up again."
While post-coital tests are painless and physically unobtrusive, many find them very difficult because they intrude so much on your relationship. There's the need to comply with a specific time, the rush to the clinic to keep the appointment, the embarrassment and real fear of 'failure' if all does not proceed as had been 'instructed'.
They told us to make love first thing in the morning and then come in. Well, what if you don't feel like it? We're dreadful in the morning. We put the alarm on at 6 o'clock and we had the kettle on to make coffee...making love was the last thing we felt like doing...he hated it and I hated making him do it."
The power play dynamics in the doctor-patient relationship takes on a new dimension when fertility is being investigated. Couples are desperate to find an answer to their difficulties and hence are compliant and rarely let the clinician know they are under stress ("not coping"). They must expose the most intimate aspects of their lives - their sexual relationship and their desire to have children.
There's a coyness about the way doctors handle sex. It's as if infertility has nothing to do with sex, yet it's everything to do with it. I never know whether I want them to assume that I don't have problems, or whether I want them to ask me if I do have any difficulties.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
