Women being treated for infertility tend to be informed and vocal about the challenges of the process. In the blogosphere especially, infertility patients share how expensive, regimented and fraught with emotional highs and lows they find the process.
But patients, doctors and researchers talk far less -- or at least far less openly -- about the toll the treatment takes on women's sex lives and sexual desire. According to a new study, one of the first to look at the issue here in the U.S., among women pursuing in vitro fertilization (IVF), in which the egg and sperm are joined in a lab dish, sexual problems are common.
"Women undergoing IVF report much lower scores in sexual interest, desire, orgasm, satisfaction, sexual activity and overall sexual function," study author Jody Lyneé Madeira, an associate professor in the Indiana University Maurer School of Law, told The Huffington Post.
"Sex becomes mechanical and enforced: a means to an end, rather than a source of pleasure," she added.
The new findings (which have not yet been published in a peer-reviewed journal) were presented at an American Public Health Association meeting earlier this week. Some 120 women who had been diagnosed as infertile and who have undergone IVF in the past five years filled out an online survey that asked about their sex lives. Many of the participants and their partners also did interviews with the researchers, who worked at Indiana University's Center for Sexual Health Promotion in collaboration with the School of Law. There were few same-sex couples in the study sample.
Almost 70 percent of the male and female respondents said that the IVF had hurt their sexual relationship, and just over half of the women reported reduced arousal.
It did not matter whether male or female factors were the cause of the couple's infertility, participants reported similar sexual problems regardless. The more cycles of IVF a couple went through, the greater its impact on overall sexual function.
"It's something that is never talked about, ever," said Pamela Fawcett Pressman, a licensed professional counselor who has written about the topic for Resolve, the National Infertility Association. She recently went back to get her sex therapy certification because she saw a pressing need to help the couples who attend her practice with their sexual problems.
One contributing factor, Pressman said, are hormones. Women undergoing IVF often get high doses of hormones to help stimulate the production of eggs.
But she suspects the causes of sexual issues are far more complex.
"There's a helplessness that so many of these women are experiencing, and depression and shame," Pressman said. "With that comes a lot of negative feelings about our bodies. It's really pretty traumatic to a woman's sexuality."
The procedures themselves can dampen sexual interest -- "Intercourse doesn't feel nice when it's associated with the transvaginal ultrasound you had earlier in the day," Pressman said -- as can the lack of spontaneity. Fertility treatment, particularly IVF, is very protocol driven.
One of the study participants told investigators: "My husband always says he feels like a science project, and we just don't feel sexual. We just don't feel sexual. We can cuddle all night, but sex just feels foreign and hard to enjoy ... how can sex be fun?"
Dr. Ann Hartlage, a psychologist and director of the marriage and sex therapy program at the Rush University Medical Center in Chicago, said that talk therapy can be helpful in that regard. The goal is to get women and couples to re-associate sex with enjoyment.
"It's not a question of 'Oh, let's just spice it up,'" Hartlage said. "It's much more like a trauma. There's a negative association."
Hartlage admitted she rarely sees patients while they are struggling with sexual problems, but rather after the fact. Many people, she said, do not know that sex therapy exists.
Pressman agreed that scant resources are available to women dealing with the sexual problems that accompany fertility treatment. When counseling patients, she often recommends they engage in sexual activities other than intercourse, which tends to become goal oriented for couples trying to conceive.
"I want to scream this as loudly as possible: People need to know that this is normal!" Pressman said of women and couples going through IVF. "Infertility really is that hard."