Impact of Fertility Treatment on Sexual Health

* Note this is an automatic transcription, please forgive the errors.

[00:00:00] Today we’re going to be talking about as I mentioned the topic I feel very passionate about and that is the impact of infertility and its treatment on sexual health. Our guests today are Dr. Beth McAveety. She is a board certified reproductive endocrinologist at our in May of New York. And Deborah Unger she is a therapy. She has been a therapist for over 20 years who specializes in the treatment of couples with infertility. Deborah and Dr. McAfee to creating a family thing here.

[00:00:36] Thank you so much.

[00:00:38] I wanted to begin with some quotes because I think that they capture so well the pregnancy and some of the struggles the very real struggles that a lot of women have with sex and intimacy after infertility or during treatment of infertility.

[00:00:59] Here is one infertility infertility treatments ruined sex for me. I no longer have intercourse because of the pain that I think is probably psychosomatic. I did physical therapy for the pain but it never went away. I also have pain during orgasm. Now I had a really enjoyable sex life before infertility. So it’s a shame but I haven’t met able to recover. It’s been about five years like the directive to have sex every day which we were told to do by a fertility doctor plus miscarriages. During that period probably contributed to a feeling like a failure and really just being disgusted by sex. I also I also feel like infertility changed my relationship to feeling feminine and to my gender for a period of time. This has gotten much better over time but it hasn’t totally healed. Another one. I think having sex is now a reminder in a way that my body doesn’t function. And I find sex depressing. I have certainly worked on this in therapy but it’s also hard to find a good therapist who really understands infertility. I’m actually a therapist and I find it hard to find one. And there’s someone else who talked about infertility treatment being a disaster for their sex life and she said had she known that this might have been the impact they would have on her and her marriage she would never have chosen to go down this path. So I think I think that many women have seen a change in their sexual health as a result of an infertility diagnosis or fertility treatment.

[00:02:32] But I think help to start by asking and I’m a directive to you Dr. McAfee if people with infertility are more prone in general to having less sexual desire and I realise that sex sexual desire is only one aspect of what we’re going to be talking about.

[00:02:48] But as you know there are we blaming a diagnosis of infertility or its treatment when in fact it’s really part of the underlying cause or something.

[00:03:00] I mean there are obviously several ideologies for infertility one in particular that comes to mind that certainly could have a real organic reason for sexual dysfunction would be something like endometriosis so Endometriosis is a diagnosis that often is linked to infertility. It is a condition when the endometrial tissue so the lining with the glands within the lining of the uterus actually leave the internal portion of the uterus and go elsewhere. So it can go to fallopian tubes ovaries wracked bowel a large bowel a small bowel the entire sort of sidewalls inside of the abdomen up to the liver and go to the longer they can go everywhere. But patients who have severe stage endometriosis often have quite significant pelvic pain. So for the non infertile patients there’s also there’s often a lot of sexual dysfunction from the onset due to deste Perine you know pain with intercourse and so those patients certainly do have much higher rates of infertility at baseline. So yes you know again depending on the etiology diagnosis of infertility it can be from the beginning. In general we know you know I would say beyond the diagnosis of endometriosis you know women with ovarian reserve issues are male factor infertility I would say not necessarily what was going to ask about low ovarian reserve which are sometimes called premature menopause.

[00:04:39] I mean we certainly have heard that sexual desire changes if if not diminishes with insurance with a woman who has had the biggest early onset of menopause be experiencing some of that.

[00:04:56] Sure. I mean you know we do see these patients rarely that thankfully but so the term premature menopause sort of technically we’ve replaced with the term primary ovarian insufficiency but it is a diagnosis of essentially menopause prior to the age of 40 so it’s actually in very young women. So in late 20s mid 20s or early 30s mid 30s. And essentially it’s when there is no there are no more eggs remaining. So the female does not violate and then doesn’t get a period. Those women experience menopause just like the average female who gets menopause at normal age in this country is around 50. So there are symptoms due to low estrogen levels that can affect sexual health so vaginal dryness is the big one. Again this Perugini pain you know pain with intercourse hot flashes. So all of those typical these are motor symptoms some kind of fact of course the so yes you know you are correct yes in the unfortunate patients diagnosed with the premature failure of the ovary we do see that.

[00:06:09] So now we know that there are some organic reasons but let’s now talk about some of the impact on sexual health caused by fertility meds the medications that people are taking to treat their fertility so start with females like the standard fertility methods affect sexual health and let’s start with what often let’s start with the oral meds people tend to think of them as you know baby med’s or the are the the beginning the right or neutral not the right. No one argues that that is or is not necessarily a good way to describe them but let’s start with the two that must offer her better are Clomid and Montreal. So how did the Raafat sexual desire sexual health.

[00:06:58] Right. So I will say Letrozole is more often a kinder drug. I definitely think it has a less significant side effects profile Clomid is are old gold gold standard though so a lot of practitioners use that. Moreover Letrozole although perhaps a push in the field you know to switch that. But so Clomid I would say that the most common side effects patients complain about are mood disturbance headaches and hot flashes and we certainly know all of that can affect sexual health or desire you know to engage in sex certainly mood disturbances for sure and we can speak about that and then physically also with repetitive Clomid use patients also often complain of also vaginal dryness. So I would say those are the four main things but most common is the mood disturbance and the hot flashes and those are the two big ones. Yeah and let’s look at all that perhaps last. You know we should not talk about dryness that’s one of the benefits it doesn’t affect your uterus also. But patients still often complain of hot flashes with Letrozole lasts just from my personal practice less mood changes and then the other thing I should mention actually with Clomid the other things sometimes patients complain about is breast tenderness like. And so again trying to engage in sort of normal spontaneous sex if your breasts are very tender you may not want them touched you know it all goes together.

[00:08:42] OK now let’s move to the medications that would be used primarily with IVF but also with great.

[00:08:52] So how has the same impact. So typically IVF medications or injection medications they are injectable Cañada trope and that’s what we call call them as a sort of you know general term and the idea for IVF medications is to purposely recruit or harvest as many eggs as we can in about a week’s time in the safest manner as possible. So instead of just making let’s say one or two eggs like we would on clomid or Letrozole when you’re just doing oral pills for simple oblation induction when you move to IVF were purpose purposely trying to get you know 10 eggs 12 eggs 15 eggs whatever your body is able to give. So there are a lot more physical symptoms patients feel and obviously the most common would be a lot of pelvic pressure and blued in. I will tell you as far as our recommendation for engaging in sex during an IVF cycle the answer is actually now. So we actually say no intercourse during an IVF stimulation. So you know patients really should not be engaging for multiple reasons. You know there’s actually there’s several reasons why but one of them from the ovarian stimulation side is that if the ovary itself is quite large obviously there could be a lot of discomfort with SAC’s their patients themselves are at risk of having something called a Torossian. Right. So twisting the ovary so we just don’t want a lot of physical activity. So we say no intercourse Dorien and no exercise.

[00:10:33] So that might have you multiple at that point you have many hopefully many correctible out for large large or multiple birth rates of sex or other.

[00:10:51] There are like. But you’re correct most of our cycles in today’s day we are we’re freezing all of the embryos and then doing the transfer in the following period when the patient is feeling much more normal and back down to physiological state and we test a lot of embryos now. But you are 100 percent correct. There are some patients still do in fresh fresh transfer cycles. And imagine if you go and you have 15 or you know follicles that have retrieval we harvest you know 14 or you know you think you got them all and you didn’t and then they have intercourse. You’re absolutely right and you do a transfer you can end up having Kylie and we’ve all seen that. I mean I’ve seen it in practice several times actually. So you’re correct.

[00:11:30] We’re going to be worried about how now to move on to the male what fertility medications are prescribed for male factor infertility and how do they affect sexual drive or sexual health or otherwise.

[00:11:43] Right. So. So two things that we think about I mean one is you know is there you know does the male partner actually have erectile dysfunction. Right so actual inability to perform sort of sexual you know I’d get it an interaction or a penetrating the female or properly ejaculate and have you know. So all of that is actually a very important part of the detailed history when you meet a couple. There’s actually a fair amount of erectile dysfunction out there. It’s very important to ask if the answer is yes obviously an appropriate referral to a urologist and specifically if possible and available in your area a fertility urologist. So there are urologists that specialty are our counterparts and specialize in infertility and reproductive care. So if that’s present we refer. And then secondly if there is notable Alagoas sperm Yemenia and decrease sperm count significant we would call it severe Alagoas sperm on the semen analysis meaning taking a sample from the male and analyzing it to see whether the count of the sperm is we often will also refer. Now if there is this there is presence of severe Alagoas Bermeo. The question is is it due to hypogonadism meaning low testosterone levels so low testosterone that regulates sperm production if it’s low it’s going to be low. And so for those particular men who are diagnosed with low testosterone in the setting of low sperm counts the urologist actually will give them Clomid so they will give the male partners oral Clomid which does a very nice job of Resine in dodginess or internal testosterone levels with the hope that it helps to regenerate higher counts.

[00:13:41] That’s amazing isn’t it. But but we’ve also heard reports and again these are anecdotal. To get your input back that Clomid decreases a male sex drive and makes it harder to perform or at least get in the mood. Is that just anecdotal or is that actually been supported by evidence.

[00:14:06] You know actually I don’t know the answer to that.

[00:14:09] I would probably defer to my counterpart to Barham from that regard I would say at that point if it’s a man is diagnosed with severe Alagoas sperm either under the care of the urologist. You know I think that it’s probably multifactorial at that point. I wouldn’t be surprised though Clomid again helmet for females has a significant side effect profile I would think it would do the same for the male.

[00:14:32] So I would think yeah I would. Neither does hearing that. You know it’s interesting when we think of fertility meds it’s almost universal that people think oh it’s just Clomid it’s like that’s the rate of the beginning and so many women find Clomid harder to handle than the injectable can opens. I mean it’s one of those interesting not great shocks that we all right now we’ve talked some about the physiology of infertility and how that can and as well as treatment and how that can physically affect your sexual health and your sexual desire. But now I want to move to the emotional realm and the emotional impact when we were having this discussion. Creating a family has a very large online support group. It’s a closed group which if anybody is interested you can and would love to have you join us on Facebook or a close group. You have to request a join go to creating a family. I mean I’m sorry go to Facebook dot com slash group slash creating a family. We’d love to have you join us. Anyway we were having a great discussion on this exact topic last week I guess it was maybe the week before and a couple of words came up over and over. I mean it was almost uncanny how often they came up talking about the question was How did infertility treatment impact her sex life. It became a chore it came up over and over again until the romance and the other thing that came out. An interesting one that sex feels pointless now. It’s just it’s those three things came up so often.

[00:16:22] Deborah Unger I wanted to get you involved now since you’re often treating patients and couples who are experiencing some of this are. How common is it for women and men. I must say in our discussion that with almost predominantly male was predominantly women but without a doubt but many of them were speaking on behalf of their husband. So anyway let’s talk about that how common is it to feel like there is no joy in our bedroom any more because now it’s just work. Is that a common response.

[00:16:58] Well thank you for having me on the show. And yes I think I would say that that is something I would probably hear across the board that couples and like you said a lot of times might just be the woman that decides to come in for counselling will say that this is impacting our sex life. And as we all know going through any type of infertility treatment enhances our stress level. So that is going to have an impact on how we connect with our partner how we feel about ourselves our body. So yeah I do see that across the board and I see that because I would like to help people understand you know that it’s a normal response and now when we know that it’s a normal response that can become sort of a starting point for where we can address other issues that are coming into play.

[00:17:54] One of the things that becomes I’m really glad you mentioned stress because heaven only knows infertility and infertility treatment are stressful and we like you say we all know that stress can put the kibosh on desire and that timing and everything else. One of the other things that I thought was it was interesting that came up was the fact that oftentimes infertility makes us feel like failures. One woman had said it really interestingly she said we’ve had at least 48 cycles of trying that fails. That’s a lot of grief so tight that you know and by that I don’t think she means 48 IVF cycles I really don’t know but I’m assuming she means that they’ve been trying for forty eight months and so that you know cycle a monthly cycle. And I thought that was so poignant. That’s a lot of grief tied up to sex. That’s powerful.

[00:18:55] Yeah and she’s right. So yes. So and you already addressed that by starting a lot of couples do start with Clomid and then they move in the injectable cycle. And then they might end up in the IBF cycle. So that’s really very easy to imagine and actually pre Clomid. They might have had intercourse. So I mean a couple that could have been in treatment or trying are they going back three or four years. That would be a lot of relief. And unfortunately it becomes compounded grief when they don’t take help at an earlier stage and start addressing some of those issues.

[00:19:37] But disappointment that everything that goes along with trying to not succeed Yeah yeah try and let’s go back and talk just briefly about the impact of something as seemingly benign as time cycles. Dr. McAfee let me bring you in and say All right. At what point are you recommending time cycles. And at what point does what people are seeking treatment. Does that become less of an issue if ever.

[00:20:11] So it’s interesting. I mean I think there’s been a transition maybe because of this concept of the iPhone. You know I sometimes sort of even myself you know when I started I’m not that old when I started medicine. The iPhone didn’t exist so patients come into the office now it’s very different than it was you know 10 years ago. They come in with an entire year’s worth of tracking on app. You know the infertility patient isn’t just walking in saying I don’t know where my sakal is they’re coming in with literally 12 months of like here are the days that I was leading you know based on this statistic he did for oblation stacks. So the real truth of the matter is usually when they come to our office unless it’s something you know dear friends you know erectile dysfunction or the Seipel is completely off. You know they have been time and they have already been doing time cycles. So you know for the patient that gets a period every month they’re there. They’ve been doing their time cycles you know for six to 12 months before they come in. So the real truth is unless it’s just a simple erectile dysfunction with the male partner and we just want to do natural cycle time. You know let’s say you know you eyes or something along that line.

[00:21:31] Usually patients are going into some sort of medicated cycle and formated would be any of this or you should say that Werle meds are there is that of course the Filiu associated with that.

[00:21:45] But what are we. Yeah we would yes we would do the recommend time intercourse or UI which is intrauterine insemination. Okay. So young female.

[00:21:59] Yeah. Sorry go ahead.

[00:22:01] No this Kalika so let’s talk some about the the emotional impact of not the emotional mislay the impact on sexual health certainly spontaneity on timed intercourse. And Deborah I want to get your thoughts on this. And I think in particular let’s let’s take this path somebody who let’s keep in mind must put it this way. Let’s keep in mind that most of the people that we’re talking about have been doing time to intercourse for at least a year and some are made if they’re older they would have hopefully not had would have taken our ad buys and gotten treatment you know before that period of time. A real push for us. But but. So I think it’s important for those who have not experienced to understand that this is not a matter of oh OK we need you know we’re going to have to make certain that we have sex over these two days and this particular month it’s gone beyond that it’s been month after month after month that people are doing that. So why this timing. Why would that alone have make somebody feel bad about sex.

[00:23:13] Well I think that you know nobody really wants to feel pressure around having sex. It’s just not a way that we tend to approach that. And it’s not something that you know a couple comes together and they want to enjoy their sex life and anything that imposes additional pressure around that can delay just have a natural you know a natural meshing of your dry exacerbating diet a create just discomfort around the topic. So I think it’s just really important for couples that are going through whatever stage they are at in their infertility treatment to try to step away from that and really look more into their relationship and how they’re connecting how they’re communicating around these issues and they almost need to kind of rebuild an understanding about intimacy between them as a couple and sort of acknowledging you know we are dealing with all of these other issues and kind of coming together around that. So that makes sense. Pressure Off state you know and so revisit the relationship communicating supporting each other through this difficult time and then the will that you’re rebuilding a different type of intimacy that can help us come to help couples come together and enjoy sex again.

[00:24:45] How do you go about rebuilding your idea of intimacy when when that’s something that’s usually has been so it’s been such an integral integral from the beginning you both.

[00:25:02] Yeah. Well I think it’s I do a lot of psycho educational work with couples because again whenever anybody could have bumped up against infertility we’re all caught off guard. I don’t think anyone is ever prepared for this. And it’s sort of the day that we run it through and it can often spiral. We don’t see it coming we don’t understand it. So we’re a lot of times just you know as you know looking to the Internet trying to educate ourselves on these issues.

[00:25:38] But often couples when they first bumping up against this they don’t have the information they need. And it becomes you know a lot of study here comes to play it comes into play. So when I see I. When they finally get to me you know they’ve been in it for a while just like when they get your reproductive endocrinologist. They’ve been in there for a while they’ve been alone and scared. And so really talking with people about expectations and helping to normalize what they’re going through. And that yes this is a scary time. Yes there’s a lot of information out there. It can be overwhelming your stress response is normal. And when we don’t know what we’re going to face anxiety comes into play and just helping couples understand that what they’re going through really is a normal response. They begin to turn to each other for support in a new way.

[00:26:39] You know the funny and the second in our discussion online it was so clear that that just knowing that others were experiencing or had experienced this was so powerful and it was it was nice to see it at some point. There was almost some hubris you know somebody was typing and you know what are you talking about. What is this sex life that you thought you had that you know so it just normalize it and normalization makes you feel like OK I’m not alone in this. And I can cope with it or I can conquer the world. And one of the things that I thought about when you spoke earlier when Dr. McCabe was speaking she said that you’d be surprised at how common erectile dysfunction is. Well you know there is I think for a lot of men there is the performance failure you know the fear of performance. I’m not going to be able to maintain an erection. This is the most important day of the month. It’s either now or yeah it’s just going to be bad. If we don’t do is why you know. I mean talk about a buzz kill but I mean that was really hard. So let me ask Dr. McAfee when you’re seeing these people in your office pull probably before Deborah Unger is seeing him in her practice or maybe at the same time. Is there anything you can say or to help people take some of the focus off of the immediacy of performance at this moment. You got to do it. You know forget about enjoyment or whatever.

[00:28:17] Just do it type of thing right. I mean it’s a hard one because if it’s true if it’s true it’s true. I mean we always make very you know sort of contingent backup plan so if I suspect that there is an issue again you sort of try to not to try not to make it a big deal but you’ll say you know maybe it’s best over the next few weeks at a time that’s good for you. Not a specific day. You know you could give a sperm sample and we could freeze it so that perhaps on the day of that we need it if there is an issue then we have what we need you know. So there are ways that you have the pressure off. Yeah. Take a lot of the price drop and that sometimes works actually quite nice so there’s any and so often the patients. Oh yes that sounds great. And then just that knowing that there is a backup plan. We always try for a fresh sample. If it doesn’t work. Not a big deal. We have what we need. So it does take a lot of the pressure off.

[00:29:16] Yeah exactly. Anything we can do Deborah. Other ideas that can take the pressure off of the of the guy especially if they’re having erectile inadequacies if not totally function.

[00:29:35] Well I wouldn’t say that it’s more than that. I think women also feel very uncomfortable at times but either with either partner if they’re are feeling that pressure. Again I would kind of pull back and talk more about what they’re dealing with emotionally in the relationship and how they can come together and support each other better through this very challenging time. I just I can’t say enough about that support that couples really need and deserve when they’re going through all of this information gathering and trying to figure out how to navigate all the different treatment options and that. The other thing I wanted to bring up though is thinking about when I say when I say that couples need support. A lot of times men and women have very different emotional responses to the treatment. And I see a lot more women in my practice than I see men but when women when women and men come in together as a couple the woman tends to be expressed her concern and worries more readily whereas now partner comes in and is trying to be strong and supportive of her emotional response to his recrossing his own fears which could translate into some erectile issues when it comes to performance anxiety. But if a man is coming in a hunt in this wrong I I’m here to support her no matter what she goes through role and she is in this role of worrying then a lot of times couples sort of given spiraling away from each other because she’s worrying more.

[00:31:24] So the two of them she’s doing all the work in the relationship he’s doing the care thing and then they spiral away from one another. I try to talk about that dynamic because I see it so often in my practice and I ask that maybe he the male partner considers being more open about his concerns. And I think that when that happen it actually for the female partner in a way that might allay her worries more than him saying it’s going to be OK it’s going to be hey I’m here I’m strong for you. Now if we can I’m using my hand which I can’t show you on the radio. We have a firewall. The woman is spiraling up and man is spiraling away and a downward place. But when he can’t share his concerns she can come up Shuler’s closer to where she is and she can come down from that role of wordier for the two of them and that in and of itself helps him connect in a much deeper way that might work in a better relationship. Yeah.

[00:32:32] Yeah absolutely. You are listening to creating a family. Talk about infertility and adoption. And today we were talking about the impact of infertility and infertility treatment on sexual health. This show as well as all the resources provided by creating a family. And we do have a lot of resources could not happen without the generous support of our partners who believe in our mission of providing unbiased medically accurate information to the patient community. One of our great sponsors is reproductive medicine Associates of New York. They are a full service fertility center specializing in in vitro fertilization egg donation egg and embryo freezing LGBTQ family building reproductive surgeries and male reproductive medicine. Highly individualized patient care is offered through 13 reproductive into chronologies and fertility specialist as well as a urologist and their support team. And we thank them for their support. I want to bring in now Dr. Jody Madeira. She is a professor at Indiana University Bloomington. She is an expert on law and medicine in bioethics and a researcher on the impact of fertility treatment on sexual health. And she is the author of an upcoming book that will be published this year. Taking baby steps how patients and fertility clinics collaborate in conception. I wanted to bring a doctor. And now to talk with us about her research on the impact of fertility treatment on health and she is having a call from a cell phone.

[00:34:08] So we’re keeping our fingers crossed as to the quality. So Dr. Madera can tell us about your research on this as to how fertility treatment impacts kind of generally sexual health.

[00:34:25] Yes it is well we’ve got to.

[00:34:29] Let’s see. Let’s try and we’re going to try to give this a go. I think our connection is not terribly good but let’s give it a try and if I interrupt it’s because we’re not. The reception is just not good enough to continue. But let’s give it a try. KING

[00:34:46] Yeah I think we’re going to have to. OK.

[00:34:50] OK. Yeah OK. Hello. Hello. Now you’re sounding much better OK. Go ahead. Yes.

[00:34:55] OK. So actually the issue of infertility affecting reproduction actually surfaced even before they begin treatment. I think it’s often compounded by the time they start treatment. And it’s especially compounded if they don’t seek treatment in a timely manner. So what happens is people try to create a problem but does it last have struggled and because of something which they might not know a lot about they might not know how to work through it. They might feel for your friends about reproductive issues after especially after these friends have children already. It was a very quiet Saturday in bed in particular might not want their wives to disclose that he’s having perhaps doubts he might be having trouble getting direction because they’re just trying so hard they might not even the type of months that they’re fertile. And so I think a lot of it stems from a lack of knowledge I think you may be right.

[00:35:56] And you know one of the interesting things that came up in our number of times and when we’ve had online discussions in our porkers is that I think this is so interesting women not telling. And again I think this is more of the before they’re actually in fertility treatment with a reproductive in the chronologies. But women not telling their partner during their fertile time and they’re doing it because they don’t want to lose the spontaneity and while they’re losing spontaneity they lose the feeling of of of romance. They also don’t want their husbands to feel the pressure. And I think it’s also a little bit because they’re taking full ownership of the of the couples infertility. And we could talk some about that. Deborah Unger has already alluded to that being a fairly common thing. Do you see that in your research. Women taking ownership of the at least the treatment of their infertility is that a common thing that you think this is the doctor but they’re oops I think we may have lost a lack of knowledge effects infertility.

[00:37:18] That is that is that your question. Yes. No that women take ownership of infertility in a relationship.

[00:37:26] I definitely think it’s.

[00:37:32] Well and sometimes it does have some more variants. My book right right. No but they tend to think it’s their fault even if it’s not right. Yes. Put you know both cultural ownership of reproduction on women. This is supposedly women’s work. And again it’s not an all couples but I think this is something that you see many patients. So for my book I interviewed 130 patients and 90 physicians and almost everyone affirmed that you know there was this kind of cultural narrative about how you’re supposed to have a child and it’s supposed to take place and who love and the like as you mentioned very romantic. And the farther these couples get from that reality the more it starts to problematize that narrative it starts to what traumatized is. Yes but the board starts the problem problematize ties that narrative so that they’re not creating a child in the circumstance that they want it to. And yet it just creates like a spiral of guilt and shame that not only is a sexual act not fulfilling not only are they not conceiving. So the goal was not realized but also just that theory nothing’s turning out the way they imagined.

[00:38:45] Right. Yeah and then that and then it and then that goes back to the spiraling that Deborah was talking about you know everything and then and then the feeling of of this is not how all this is not this is not following the cultural narrative and then that sort of setting pressure and stress and then that spirals into perhaps the performance anxiety or just lack of desire. One of the things that actually there’s the quote at the very beginning of the show alluded to and I want to talk some about that and she said it affected her relationship to feeling feminine and to her gender. And I think that perhaps not said quite so eloquently but I do believe that infertility affects how we feel as a woman or as a man. Deborah Unger can you talk about do you see that in your practice as well.

[00:39:47] Yes I think that it can have I think often it just creates a cascade of as John was saying and doubt and shame. And people are kind of frantically trying to figure out and navigate this unexpected journey that they have to take on. I actually wanted to piggyback on your last question about how it affects women and whether women feel more responsible. What I can’t see is that women take on the lion’s share of the research and they’re cheering for answers and for treatment protocols. And I see that happen almost just a 100 percent across the board. So whether it affects it generally a woman or not this is what they’re doing with that. You know with this the the shock and despair of the reality is that they’re stuck. And and I think that the research can be a wonderful way to feel empowered and to try to navigate what to do with you know all the different options but sometimes it does go a little bit too far and it can exacerbate anxiety and make it you know more fearful journey. So I work a lot with people trying to find the right balance. And yes if they feel responsible for what’s happening what is their behavior that can and can kind of trigger more more fear and anxiety and we want to make sure that they find the right balance.

[00:41:27] On the other it does. Another underlying thread that quite frankly I wouldn’t necessarily have thought about and that is the impact of I think perhaps more infertility or the failure to conceive the impact that has on one’s body image. How and I think that in some ways may be tied into how we feel about ourselves with women. And before I documentarian or turn this over to you but before I say that let me quickly mention that I think while I think infertility certainly can affect a woman’s feelings of femininity I think that going back to the term that Dr. Madeiros used cultural narrative I think our cultural narrative makes it such that many many men feel like infertility if it’s a male factor affects their masculinity. And I think that we can’t we can’t over overlook that. But I wanted to talk a little bit about the impact on body image and how we view ourselves as a body one woman in the group. Dr. Mateer said I after my diagnosis I’ve really let myself go and I’m very unhappy with how I look right now. I have zero she’s no longer confident as to who she is and that’s reflected in and how how she feels about her body is this something that you in your interviews did do. Did you touch on the body image part.

[00:43:02] Yes absolutely. And what happens with body image is that women start feeling bad about themselves. It could it could actually create a lack of sexual desire. It could actually lead to problems in the relationship. But it goes further still. First of all you know it could just lead to feeling unsexy. That’s kind of the least worries that people have when they start to what it starts to get worse over time they get increasingly worried increasingly anxious increasingly guilty. They actually start to feel that they will add that feeling of brokenness actually is what really is haunting. So when women have such interviews for example I told my husband you could exchange me for a better model. I told I told him that I was you know his time was up under the lemon law. Again this just reaffirms that women are not products. Right. And the third thing I’ll say about that is when you actually start to get into infertility treatment and you start to experience side effects from the drugs whether it’s hormonal or whether it’s actually gaining weight that could even make this worse.

[00:44:14] What’s the good point about we did talk about with Dr. McAfee at the beginning and Dr. Makary I really have forgot to even ask about that weight gain associated with it and look beyond weight gain does not affect many women or man men’s feelings of sexiness or worth wildness and nor should it. However it is a valid point especially in culture. So is there a medication any of the meds cause us to gain weight.

[00:44:49] I mean typically the IVF medications can cause water retention and there is some weight gain a few pounds I mean nothing so so drastic. And I often tell patients after the procedure the body will actually hopefully release the water and the weight will become back to normal. But yes we do see some more water retention and we gain from the injectable medications from the IVF in particular. So for patients that are undergoing you know consecutive cycles it can be an additive concern you know for the female.

[00:45:24] Of course. Yeah. Yeah. Well before and you think yeah.

[00:45:31] Oh yeah yeah. Why was I add that a lot because they’re going stress. People might turn to hurt her compered.

[00:45:41] We need. And also there’s a fear of the exercise. I don’t want to jar my body right now. I want to stay as low as possible so that thing. Absolutely. So I think it’s really important to encourage patients to continue to eat healthily and you know keep a strong and healthy relationship with their eating habits and also to get regular exercise which can have the added benefit of reducing the stress.

[00:46:11] Oh yeah. Yeah.

[00:46:15] We hope from an exercise standpoint. Yeah there is the jostling it’s a really good point. But there’s also the concern about oh you know women we recognize aren’t going to argue like that. How much of an issue is that really.

[00:46:28] It’s rarely an issue. You know except obviously in the extreme exercise or or the the patient that is food restricted and so the very low BMI patients so low Bascome body mass index you know height weight that’s a function of hey those patients if if it’s quite low it can inhibit any sort of spontaneous ovulation. So that’s a that’s a longer standing issue usually ongoing with the patient for decade. You know for a long time not not just showing up in our office with that from a short period of time that we really exercise.

[00:47:05] And so for the electric Sursum average.

[00:47:08] Yeah we always think words you know healthy weight healthy eating habits we actually have a dietitian because we feel it is so important that is available to all of our patients to just help with questions or advice or dietary advice and for those you know patients undergoing treatments and it’s actually quite a quite nice you know additive I’m assuming and then the practices have. But we definitely think that’s important.

[00:47:37] Yeah and we’ve done a lot on that as well about the impact of diet. Dr. Madera I’m curious to know if in your interviews you ask how long it takes to get back to a normal sex life once treatment is finished. We we asked this question not really. We do more formalized surveys frequently of our audience but this one was more just in passing. So it wasn’t very formal but we heard anything from six months to not until we had a baby or not until we adopted and then a number of people said never it never went back. Did you ask this question about how long it took to get back to normal whatever normal was for you. Normal for normal sexual health.

[00:48:22] Yes I did. And actually you know sometimes there was a new normal subtype the kind of light could not go back to where they were before. But interestingly enough some would not have had it either way because they did find themselves as more happy more satisfied after they become closer they become able to discuss these issues and perhaps this is kind of bordering on fertility because they can discuss infertility perhaps they discuss other lakes just like that they’ve had but they never shared. So this kind of opens up a watershed. At some point opens up the floodgates and sometimes you really get lots of communication about likes and dislikes and desires and actually things get better. But in terms of that time I think it really depends upon how much how much of an impact to the infertility has had upon the relations that the couple has. You know sometimes the profound impact it might take longer in terms of length of time people mention anywhere from like a few months to years. You know again the years would be people who are still going through the infertility.

[00:49:28] Yeah we’ve seen that too and you know I’m glad that you mentioned that because I’ve had this later for us to talk about that. It was interesting to me that a number of people said came back and said you know for us the impact really wasn’t negative. You know some talked about how they know each month even though the odds were very very slim. There was that spark of hope. And they they didn’t find it as the rollercoaster of despair following the spark of hope. They they really did view it as something a woman said. You know we we actually are our sexual frequency really increased you know and it was very enjoyable for both of us. And others talked about how they the struggle brought them closer. And this is what you were alluding to. Dr. Madeira encouraged them to seek each other out. And then Deborah mentioned Deborah Unger mentioned that you know oftentimes it’s encouraging them to get into treatment and just the treatment alone has allowed them to feel closer as a couple and that has improved so improve their sex life. So it’s important to realize that it’s not doesn’t necessarily mean that that you’re never going to get back to whatever whatever normal is. Let me stop for a moment and to remind people that you are listening to creating a family. Talk about infertility and adoption. And today we’re talking about the impact of infertility and infertility treatment on sexual health. On one another I mentioned that our show as well as our other resources are brought to you by our partners.

[00:51:09] Another one of our partners is Manhattan Cryobank and they are dedicated to helping clients have healthy babies by analyzing a client’s DNA in combination with the DNA of prospective sperm donors to provide the client with a personalized catalog of Seyffert donor matches. And in addition to their sperm donor subsistent and Cryobank also also offers a full range of Andrology and fertility preservation as well before it would be remiss of us not to talk about. So far we’ve mainly been talking about heterosexual couples. Dr. McCabe I’m I’m not. I struggle to think I would think at least with lesbian couples that some of the same issues would be there but perhaps I’m wrong. Do you see that the impact of fertility and fertility treatment on sexual health differs with your clients that are LGBTQ.

[00:52:09] That’s a good question. I think that I mean obviously any couple male to female or female female that are you know that are struggling with infertility there’s just there is a lot of added stress and certainly will impact just daily daily living you know. And obviously that includes sexual function. Obviously when as a female female couple we’re not dealing with actual performance anxiety issues lack of work intimacy. Yeah. Right. So it’s more intimacy issues and I would think the same. So I think that you know for a female female couple struggling if it’s going on to a you know a handful of months I’m sure there is certainly an impact on intimacy issues.

[00:52:56] Yeah and I would guess with a male male couple there’s obviously not if they’re using treatment as a surrogacy. But I will take it back to what Deborah was saying earlier. It’s still stressful and stress crack and perhaps quiet intimacy. And so anything can affect less from a medical standpoint obviously but in fact I wanted to come back to some of them. This I think comes to how it affects relations how fertility fertility treatment affects relationships. Some of the things that we’ve heard from our community is the women feeling resentful that they’re doing so much and he’s complaining about having to have sex or not having them.

[00:53:45] The one that you know you don’t you’re not making it special for me. She was like well what do you think it’s best for me. You know get over yourself. So Debra let’s talk a little about that just a mismatch both. Well at least the woman feeling resentful both are probably both of those scenarios both partners feeling underappreciated and and resentful thoughts on how people can get through or get past that which is a very common feeling.

[00:54:21] That’s a great question. I think really helping each other supporting each other through this difficult time and understanding you know that they’re both experiencing maybe a different set of stressors and we talked earlier about how a woman might feel the stigma that she’s not a woman or a male partner feels that he’s inadequate if it is his diagnosis that hold that back.

[00:54:48] I think it really comes down to communicating and learning that we. We all have different stress responses and we need support in different ways. We’re going through this stressful journey together. And instead of you know having it be as I talked about earlier the male partner may be supporting and playing that strong supportive role and the woman doing all of the research and caring mistrust for the couple when they can talk about the details to gather and then equalize that sharing the responsibility in some other way. That’s going to improve the relationship in the sense that it’s OK that we both do our share of worrying and it’s okay that we both took our share of supporting each other through this. And I think that that’s where we come together. Couples come together and face the journey and a more equalized way and that you can do all kinds of things for the relationship.

[00:55:52] So I can’t speak enough about how they have to they have to find maybe a new balance between them as to how they each deal was struck and how they support each other through the journey and that knowledge alone not only improve sexual intimate intimacy in general which can lead to sexual Yassi but it can also be used throughout their life because this is a highly stressful event. There will be others. And if they’re successful and are able to parent heaven only knows will be a lot of stressful events coming up. I wonder to to speak about an issue that came up over and over again and that after treatment is over sometimes after successful treatment or unsuccessful treatment unsuccessful treatment or or adoption that people routinely talked about. I’m over it. You know I’m past I’m past thinking about it I’m past the stress. We’re no longer trying except every month. I can’t help but now know where my fertile time is I can’t help you know I noticed my cervical mucus I notice my feelings I can feel the ovaries or whatever. I’ve been so attuned to it for so long. There’s no way I’m not going to know. And there’s no way that I’m not going to want to have sex. And then if I if I do have sex then there’s no way that I can not on some very small level perhaps jump back on that rollercoaster of hope and despair. And it’s so even well after sometimes even when they’re thinking they’re not even actively wanting to add another child to their family.

[00:57:31] They still talk about the emotional rollercoaster monthly because they’re they’re still tuned in. Let me start with you Dr. Maderal on that one. Even after the fact trying to connect yourself with your your body’s fertile time and the expectation that maybe just this once it will happen the way it’s supposed to.

[00:57:57] Right. So I think women you get more in touch with their bodies when you’re doing fertility treatments and eventually you know we talked about a lot of very negative prostheses eventually most people the vast majority I think you come out the other side with more self awareness more bodily awareness. The one thing that’s really difficult I think is I think sometimes it’s hard to get face back in your cycle. It’s hard to know what’s going to happen in my own case personally for a second. We had triplets when I was 30. I did not obviously beforehand because I had had a miscarriage and I didn’t know if I had the trip. I had the triplets or the that would be such what my body would do. I think there’s a period of like waiting and you can see you know just what happened in that period of waiting is often very painful. But then if things do turn out well if they do things stirred up as they can. What’s really interesting is there is almost very common story out there about women who are able to conceive naturally particularly if they had unexplained infertility either after going through fertility treatments and thinking that they would not be successful or conceiving through infertility. So you do see that that you.

[00:59:16] But I’m always very cautious because the reality is that that’s that’s the exception not the rule. And we certainly see it in the world of adoption where people treat the idea of adoption as a type of infertility elixir or you know oh just adopt and you’re going to get pregnant when in fact there has been some research on that. And no you’re not more likely. I mean yes even in typical infertility patients there is a small percent chance. But there’s a chance and so the statistics would bear out that that side of boys is a little cautious that people just don’t know. Let me ask you this. We didn’t they didn’t necessarily come up in recent discussions but I certainly have heard this talked about not infrequently although I still think it’s probably not terribly common and that is women choosing to either have their tubes tied or have their have their husbands go through a vasectomy even though they’re infertile but feeling that it is the only way they know of to stop this. The the monthly expectation and just want to get back to normal and feeling like this is the only way thoughts on this.

[01:00:33] Deborah Unger Oh I I haven’t seen that. That’s her. That’s a very that when you share that you know rush of pain came to me to think that a couple goes through everything they’ve been through and that they haven’t been able to come to that supporting each other and having worked through that. But the shame and the grief cycle that they’re going through and it just made me think wow those couples probably would benefit from honestly going to counseling. I know that I’m biased as a mental health practitioner but when you come through it at the other end and you feel this trauma these unresolved feelings of grief and fear and anger. I think that we’re at a place where the couple should maybe talk about how can we find peace in this journey and how do we resolve these unresolved feelings of grief. And really I’m thinking of it as sort of an ongoing it’s like a PTSD response. Right. But you’re still haunted by the trauma that you went through. And and I would I would turn first to a counselor to talk about the leftover unresolved feelings before resorting to a medical intervention at that later stage.

[01:01:59] Doctor were there any final thoughts on you get the last word. Any final thoughts in your research on methods that people have used including sterilization to help them cope after they no longer want to get pregnant with they are or are not actively seeking to get pregnant with the monthly hope despair cycle.

[01:02:26] Yes I do think actually I have seen that many of the women I spoke with said that after it they were done trying they would certainly obtain procedures or take permanent steps so that they wouldn’t be surprised they felt for some reason it was unbearably painful to be surprised after years of trying which is kind of the opposite of what you would expect to hear. But they just want it back. I don’t like this term generally but closure of knowing that it was very very unlikely to happen. So I do think that that can be a grab something that they have to grapple with. But it’s a measure of reestablishing control over their facility when they lacked control over their fertility for so long. And certainly after they are done having a family that they are very eager to take control again because it’s been denied to them.

[01:03:18] Yep. I think you’re I think you’re on to something very much. Well thank you so much Dr. Jody Madera Dr. Beth McAveety and Deborah Unger for being with us today to talk about the impact of fertility and infertility and its treatment on sexual health to get more information and get healthy about Beth McAveety Dr. Beth McEvoy. You can go to the Web site of our Amay New York which is our M a Gen Y dot com R and D of New York dot com are in a NY dot com to get more information on Debra Unger. You can go to her Web site which is hunger counseling dot net. You in G.R. counseling dot net and Dr. Madera where can people. First of all will your new book come out taking baby steps how patients and fertility clinics collaborate in conception. When will it be coming out and where can people get it.

[01:04:16] Actually it is already out. So it’s published through University of California Press and it’s for sale on Amazon. So just look up search taking baby steps or you can go to University of California Press and order it there.

[01:04:30] Perfect. Excellent. Thank you so much. And for everybody our audience. I will see you again next week thank you for hosting.

• Many of the woman saw a change in their sexual health as a result of an infertility diagnosis or fertility treatment, but are people with infertility are more prone to have less sexual desire or poorer sexual health?
• How do infertility medications affect your sexual health? Female? Male?
• How is low testosterone in men treated?
• Emotional Impact of Infertility and how that affects libido, sexual health and enjoyment?
• Impact of timed intercourse on sexual health and intimacy?
• How does feeling like a failure at conception affect sex?
• Male sexual performance failure. How common in couples going through infertility treatment? Can anxiety and stress over infertility contribute to erectile dysfunction?
• Impact on how we feel as women or man?
• Effects on the concept of womanhood and sex drive.
• Impact on the concept of manhood and sex drive.
• How common is erectile dysfunction with the pressure of having to perform?
• Impact on body image
• Some women describe feeling guilty, and the guilt killed their sexual desire.
• For some, the impact is not negative: it may bring the couple closer emotionally.
• Impact of infertility and fertility treatment on the LGBTQ community.
• How long does it take to get back to normal once treatment is finished?
• Who “owns” the infertility in a relationship, and how does that impact sexual and marital health?
• How can you ever get off the monthly emotional roller coaster, because you can’t really turn off the awareness of when you are fertile or the hope that you will get pregnant?