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."
Related on HuffPost:
<strong>1. Your fertility is mostly determined by genetics, which influences how many eggs you are born with. </strong> Doctors believe that the number of eggs you have at birth determines the length of time you will remain fertile. At birth, women have about two million eggs in their ovaries. For every egg ovulated during your reproductive life, about 1,000 eggs undergo programmed cell death. Other things, such as smoking cigarettes and certain types of chemotherapy, can accelerate egg cell death and promote an earlier menopause.
<strong>2. Regular menstrual cycles are a sign of regular ovulation.</strong> Most women have regular cycles lasting between 24 and 35 days. This is usually a sign of regular, predictable ovulation. Women who do not ovulate regularly have irregular menstrual cycles. Those who do not ovulate at all may have a genetic condition called polycystic ovarian syndrome (PCOS).
<strong>3. Basal temperature charting does not predict ovulation.</strong> An older method of tracking ovulation involves taking your oral body temperature each morning before getting out of bed. This is called basal body temperature. This method is used to spot a rise in basal temperature, which is a sign that progesterone is being produced. The main problem with using this method is that your temperature rises after ovulation has already occurred. This makes it more difficult to time intercourse at an optimal time for conception. A better method is to use over-the-counter urine ovulation predictor test kits such as Clearblue Easy. These kits test for the hormone that prompts ovulation, which is called luteinizing hormone (LH).
<strong>4. Most women with blocked fallopian tubes are completely unaware they may have had a prior pelvic infection.</strong> About 10 percent of infertility cases are due to tubal disease, either complete blockage or pelvic scarring causing tubal malfunction. One major cause of tubal disease is a prior pelvic infection from a sexually transmitted disease such as chlamydia. These infections can cause so few symptoms that you may be completely unaware your tubes are affected. This is why fertility physicians will order a dye test of the tubes, called a hysterosalpingogram (HSG), if you have been trying and failing to conceive for 6 months or longer.
<strong>5. In most cases, stress does not cause infertility.</strong> Except in rare cases of extreme physical or emotional distress, women will keep ovulating regularly. Conceiving while on vacation is likely less about relaxation than about coincidence and good timing of sex.
<strong>6. By age 44, most women are infertile, even if they are still ovulating regularly.</strong> Even with significant fertility treatment, rates of conception are very low after age 43. Most women who conceive in their mid-40's with fertility treatment are using donated eggs from younger women.
<strong>7. Having fathered a pregnancy in the past does not guarantee fertility.</strong> Sperm counts can change quite a bit with time, so never assume that a prior pregnancy guarantees fertile sperm. Obtaining a semen analysis is the only way to be sure the sperm are still healthy!
<strong>8. For the most part, diet has little or nothing to do with fertility.</strong> Despite popular press, there is little scientific data showing that a particular diet or food promotes fertility. One limited study did suggest a Mediterranean diet with olive oil, fish and legumes may help promote fertility.
<strong>9. Vitamin D may improve results of fertility treatments.</strong> A recent study from the University of Southern California suggested that women who were undergoing fertility treatments, but had low vitamin D levels, might have lower rates of conception. This vitamin is also essential during pregnancy. At Pacific Fertility Center, we recommend our patients take 2,000-4,000 IU per day.
<strong>10. Being either underweight or overweight is clearly linked with lowered levels of fertility.</strong> The evidence in recent years is that obesity is clearly linked with a longer time to conception. Having a body mass index less than 18 or over 32 is associated with problems ovulating and conceiving, as well as problems during pregnancy.