Cope with infertility using Total Force Fitness

Many couples struggle to get pregnant. Infertility—typically defined as an inability for a couple to become pregnant within a year of trying—can challenge your well-being. It can also affect your military performance. Challenges associated with fertility can affect your mental fitness, your emotional and relational health, and your physical and financial well-being. Total Force Fitness can help you can navigate those challenges by contributing to your resilience, whether you go on to have children or not.

If after a year (or more) of unprotected sex, you find that you still struggle to get pregnant, you might meet the criteria of infertility. While infertility is relatively common (estimates range from 6%–30% of the population), it’s still quite complex, with a wide range of causes. Many couples (up to 40% in some military populations) self-report having a difficult time getting pregnant, even if they aren’t formally evaluated. The term “primary infertility” is used to identify women or couples who have never conceived. However, infertility can happen even if you’ve been pregnant in the past. “Secondary infertility” includes women or couples who have successfully become pregnant and had children. But whether or not you meet the technical criteria for infertility, the impact can be the same.

Causes of infertility

Many different conditions can make it difficult to get pregnant. Those causes can stem from the male or the female. And sometimes a cause simply can’t be identified at all. Significant risk factors for male infertility include lifestyle and environmental factors (exposure to toxins, high temperatures, or radiation, for example). The most significant risk factor for female infertility is age. It’s unclear whether the link is significant, but it’s been suggested that Military Service Members are at increased risk of infertility because of exposures, traumas, or stressors associated with their job. In addition, the use of tobacco or alcohol tends to be higher among Military Service Members. Some potential causes for infertility include:

  • Anatomical and structural causes. In women, this includes ovulation disorders (sometimes noted by irregular or missed periods), issues with the fallopian tubes (blocked or swollen), uterine or cervical abnormalities (structural issues or growths), or a hormonal imbalance. In men, these causes might include low sperm production, abnormal sperm function (low motility), or anatomical issues with sperm transport.
  • Health and lifestyle causes. Some external causes around your general health (for men and women) can also impact fertility. This includes obesity, underweight, over-exercising, heavy tobacco or alcohol use, or illicit drug use. Age can also play a role, particularly for women who delay pregnancy into their 30s and 40s. Genetic and metabolic disorders can play a role as well.
  • Illness or injury. Previous illness or injury to your reproductive organs can also impact the ability to get pregnant. The latter is particularly noteworthy for Military Service Members and those whose reproductive organs have been damaged through combat injury.
  • Environmental causes. Exposures to toxins, radiation, high heat, or even some medications can affect fertility in both men and women. This particularly affects affect sperm function for men.
  • Sexual dysfunction. While not a technical cause of infertility, it’s important to note that sexual dysfunction can be an obstacle. Sexual dysfunction can be physical, external, or relational, so it’s important to explore.

How infertility can affect your well-being

If you and your spouse or partner, or you alone, have decided you’re ready to be parents, you probably don’t expect to struggle through the process of getting pregnant. In many ways, the idea of parenthood can hold a large space in your identity and your ideas of your future. Parenthood provides meaning and creates a family unit of support, and children can even help you feel more integrated into your community. Children are often the source of care for parents later in life too. Facing infertility, along with the idea that your expectations for those areas of your life might need to change, can be overwhelming.

Beyond that, many couples (and women in particular) experience stigma about not being able to conceive. This can vary greatly by culture and community, but it’s not uncommon to feel pressure from family or friends, and then feel embarrassment or shame when a pregnancy doesn’t happen. It’s also normal to experience other impacts to your mental fitness, such as depression, feeling like a failure, or feeling broken in some way.

The stress of infertility—and all the feelings it brings—can potentially put a strain on your relationship or become the sole focus, which can be damaging in the long run. Many couples who try to conceive experience impacts to their sexual relationship—sex can feel like it’s not spontaneous, or it can even feel like a chore. In many ways, sex is an expression of intimacy and connection. Some those feelings might be lost in the process of trying to become pregnant. But many couples become closer if they approach the challenge as a team.

Finally, if your infertility journey has led you to pursue alternative treatments or to become parents by alternative means, you might experience another set of challenges. For example, many fertility medications, the use of intrauterine insemination (IUI), or assisted reproductive technologies (ARTs) are costly and not typically covered by insurance. And all these alternatives can take months, or even years, to result in pregnancy. The treatments can be highly stressful, and consume much of your energy. For military families, it can also be difficult to maintain continuity of care through the treatment process if you are frequently PCSing. And pursing parenthood via alternative means, like fostering or adoption, is a lengthy and highly emotional process.

Total Force Fitness tips to cope with infertility with resilience

While infertility can feel like a huge obstacle, Total Force Fitness can help to break down the challenges into smaller pieces. Then you can tackle each one with purpose.

  • Know the facts. Start your fertility journey with a handle on your health so you can identify the causes of any potential issues. So many possible causes and external factors can result in infertility, and often those issues can be treated. Schedule time to talk with a medical professional if you’re concerned about conceiving or have difficulty doing so.
  • Explore your values. Cultural factors can affect your feelings about becoming a parent and your expectations for the process. The messages you get about pregnancy and parenthood can come from your community, your family, your friends, TV, and online. But it’s important to think about your own values, what matters to you about your journey to parenthood, and what drives or motivates you to create a family—outside of external influences. Consider how you feel about having a biological child rather than a non-biological child, or maybe even not having a child at all. Sitting strong in your own beliefs and values can help you navigate the route forward.
  • Evaluate the costs. Like most things in life, the path to parenthood comes with costs and benefits, particularly when you struggle with infertility. It’s important to think about the costs you might face, and discuss them with your partner or support network. This includes evaluating the costs or benefits to your time, your energy, your well-being, and your finances. Treatments are expensive, so explore coverage options and don’t let financial burdens become relationships burdens either.
  • Share the experience. Despite the extra stress infertility puts on couples, it can make your relationship stronger. Couples who approach infertility as a shared issue and who problem solve as a team become closer through the experience. Attend medical appointments together, talk openly and empathetically if you struggle, and support each other as teammates.
  • Make active decisions. It can be easy to be passive in a process you feel you don’t have complete control over. But it’s important to problem solve and be deliberate and optimistic about your choices. Remember that optimism is about being realistic, while you focus your energy on what you can control. Get all the information you need, understand any barriers you might face in becoming a parent, and explore alternative outcomes. Actively decide on a path forward—for example, think about how long you’ll try to conceive using a particular method or ART. Be flexible as needed, but also be deliberate.
  • Prepare for next steps. Most couples who experience infertility do become parents, but they might also find the transition to parenthood a little more anxiety ridden. If you decide the pursuit to parenthood (by whatever means) is the right path for you, think about what it might mean for you, and understand the changes that being a new parent can bring. If you decide not to pursue parenthood, expect some changes on that path too. It’s normal to have a hard time when you stop “trying” or stop treatment, but many people experience less depression once the decision’s been made.

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References

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Greil, A. L., Schmidt, L., & Peterson, B. (2014). Understanding and treating the psychosocial consequences of infertility. In A. Wenzel (Ed.), The Oxford Handbook of Perinatal Psychology (pp. 693): Oxford University Press.

Covington, L. S. (2016). Intimacy post-injury: Combat trauma and sexual health. In Psychological Aspects of Infertility Post-Injury (pp. 97–108): Oxford University Press.

Shreffler, K. M., Greil, A. L., & McQuillan, J. (2017). Responding to infertility: Lessons from a growing body of research and suggested guidelines for practice. Family relations, 66(4), 644–658. doi:10.1111/fare.12281

Luk, B. H.-K., & Loke, A. Y. (2014). The impact of infertility on the psychological well-being, marital relationships, sexual relationships, and quality of life of couples: A systematic review. Journal of Sex & Marital Therapy, 41(6), 610–625. doi:10.1080/0092623X.2014.958789

Stahlman, S., & Fan, M. (2019). Female infertility, active component service women, U.S. Armed Forces, 2013-2018. MSMR, 26(6), 20—27.

Williams, V. F., Atta, I., & Stahlman, S. (2019). Brief report: Male infertility, active component, U.S. Armed Forces, 2013-2017. MSMR, 26(3), 20–24.