THE BLOG

The Intersection of Infertility and Intimate Partner Violence

10/22/2013 12:13 pm ET | Updated Jan 23, 2014

In the spirit of Domestic Violence Awareness Month, I spoke to Dr. Linda Ellison who, through her practice "Love Creates Life Fertility," specializes in helping couples with infertility problems. Based in New York City, Dr. Ellison explains the shifts in power dynamics that can occur in couples who have problems conceiving, and how this shift can materialize to intimate partner violence.

Pierre R. Berastaín: Tell me a little bit about your background and the work you do.

Linda Ellison: I grew up in a close Mormon family packed with siblings and cousins who felt like siblings. I lived in a town of about 500 people way up in the rugged mountains of northeastern Utah -- there were more cows than people. Being in a secluded place surrounded by boisterous, mischievous, creative, funny and extremely loving family members, my relatives were my world. I think it's because I had such a close connection to them that I feel motivated me to help other people create a unique and wonderful family of their own.

Having earned several degrees from Harvard, I gained insight and expertise in several fields ranging from women's health to medical anthropology to religion in culture. Yet, the most profound knowledge I have, I learned from my family. My grandmother was fond of saying, "Home is the people who love you." I help couples grow their love into a family and a more expansive feeling of home.

There exists this idea that planning a family is a happy time in the life of a couple. How does infertility impact a relationship?

Experiencing infertility can bring about a more gentle and compassionate interaction between partners. Yet, as time passes, anxiety and resentment often builds. There is a shift in the dynamic of the couple. The foundation of a relationship is unsettled for a variety of reasons. For instance, one person is medically absolved and the other is labeled the "problem." There is a difference of opinion about how much time and money should be invested in overcoming infertility, and sex becomes a chore instead of an intimate connecting experience. These strains introduce emotional distance into the dynamic of the couple and can escalate into psychological abuse.

So from observations in your work, do you see a link between intimate partner violence (IPV) -- you mentioned psychological abuse, for example -- and issues with infertility?

It certainly happens. Intimate partner violence is not limited to physical abuse. I've been present for discussions in which one partner tells the other that conversations about infertility have become so hostile that talking "feels like being punched in the gut." One woman sobbed to her partner, "Why don't you just slap me in the face? That's what your words do anyway." Words pierce, wound and leave scars. A particularly violent conversation gets rooted in memory like a shard of glass embedded in skin. Emotional abuse has serious repercussions on a couple's ability to conceive. Stress hormones negatively impact fertility and obviously any type of abuse triggers a stress response.

Do you see an effect on power dynamics when a couple is infertile?

Yes. In a healthy relationship dynamic, each person in a couple is interdependent, while maintaining his or her own sense of independence. Both interdependence and independence are necessary.

Infertility can shift the dynamic in such a way that one or both partners in a couple start thinking and acting as independent people, not part of a larger loving whole. This throws the relationship off balance. People sometimes stop acting like their best selves and resentment and fear overshadow love. Money is frequently a big point of tension. When one person is primarily financing infertility interventions, "our money" starts to be spoken of as "my money."

I've worked with couples in the midst of IVF, when the woman is taking lots of hormones. Commonly there is some weight gain during this process. I've heard men tell their wives they "aren't paying" for her "to get fat" and then demand that the wife spend more time at the gym as a condition of him continuing to cover costs of treatment. Sometimes one partner has adopted a strict diet and exercise plan and has cut out things like alcohol, nicotine and caffeine. These are healthy choices, but making demands and placing pressure on someone damages the couple's dynamic. The other member of the couple can start to feel like "home is boot camp," and they are "taking orders" instead of getting encouragement.

Feeling attacked and berated, a husband exploded at his wife saying, "It's my money and I could have gotten a boat with it instead of all this criticism from you." Defense often flips around to offense. Both people feel powerless in a situation that seems beyond their control, and want to gain some power over the situation. When a person approaches infertility from an individualistic position, the mutuality of the couple is ruptured.

Let me shift the conversation a little bit. We usually think of infertile couples in heterosexual terms, as we have been speaking thus far. However, you also work with LGBT couples

Right. I do.

How does intimate partner violence come into play in LGBT couples that are infertile?

A couple is a couple. The make up of a couple -- two women, two men, or a woman and a man -- doesn't mean that people in relationships don't face common sets of challenges. Relating to another person is tricky and involves a lot of compassion for our partner and ourselves. That said, LGBT couples have some unique challenges with fertility. Gay men obviously aren't able to carry a pregnancy, but they still face financial questions, they need to agree on an egg donor, a surrogate and they have to decide who is going to be the biological father. Those are all high stakes issues.

Shifting power dynamics can lead to some hurtful verbal sparing. For example, gay couples frequently come to a decision that one man will contribute his sperm, while a female relative of the other man is used as the egg donor or surrogate. I've seen heated conversations over whether to financially reward the female family member beyond medical expenses. Once, the allegation, "Your family is so greedy," was met with the response, "Your family has no concept of love!" Barbs about family turned personal. "I'm not greedy, I'm successful. You wouldn't know how that works, though. Remind me again where you went to school," was answered with, "I wouldn't expect a child of parents who both cheated to understand that love is more important than money."

Disparaging each other has a lasting impact. Eventually the couple decided on an amount to put in the sister's own child's college fund instead of giving her cash, but the each man still stung from the verbal fight months later.

Lesbians experiencing infertility face a complex set of questions. They have to decide who is going to donate sperm and how the medical bills get handled, but they also have the added discussion of who is going to carry the pregnancy and whose egg is going to be used. Sometimes one woman has always wanted to experience pregnancy, and the other is supportive of that. Among the most difficult challenges for lesbian couples is when the woman who plans to be pregnant experiences infertility. Does the couple proceed with infertility interventions, or does the other partner try to become pregnant instead? What happens if both women have infertility issues? Does a surrogate enter the picture, or does one or both women go through the IVF process?

Again, finances come into play, and economic imbalance is a difficult dynamic that can turn emotionally abusive. Everyone is capable of crushing someone with words. Sexual orientation doesn't make that more or less likely, and certainly any less damaging when it happens. However, sexual identity definitely introduces more layers into the fertility conversation.

What relationship advice would you give to couples who are struggling with infertility so that whatever the outcome, their bond remains strong?

First, a couple needs to be united in their desire to grow their relationship into a family. I often hear people say they "want a baby." A person is only a baby for the first year or 18 months of life. Having a baby is bringing a son or daughter into your life forever. Having and continuing conversations about what that looks like going forward is important. How will finances change? How will schedules need to shift? Will you need to move? So many people get in the middle of a pregnancy process only to start asking questions that would have ideally been addressed before they started trying to get pregnant. Second, many people make the mistake of placing the possible pregnancy as their primary joint focus. The foundation of a family is the love parents have for each other. We all exist because of love. The love you have with your partner is what builds the rest of your family. Focus on choosing your partner each day. Ask yourself how you can build him or her up, and be mindful of words and actions that tear your partner down. We are all responsible for our own happiness, but we are our best selves when we are contributing to the happiness of others. Last, reframe challenges that come up for you as a couple. Instead of investing in blame and criticism, spend time enjoying each other and being grateful for the love you share. Love creates life.