These days, it is not unusual for many people to have difficulties starting families of their own. Middle class women are often engaged with career advancement when they are in their twenties and thirties. Marriages are often beginning later than in previous generations, thus making the time for giving birth to children more limited. When couples wait until their late thirties to begin pregnancies, they are sometimes surprised to find that they have medical problems in conceiving.

This experience can introduce a painful set of new feelings into a marital relationship. Suddenly, there can be feelings of shame, helplessness, and rage directed at oneself, one's partner, extended family and friends. Partners, unsuccessfully trying to conceive can become depressed, and preoccupied with irrational thoughts concerning their inadequacies. Despite wanting children of their own, they might suddenly realize they cannot socialize with friends who have children, and might become reclusive in order to avoid being with children.

In addition to identifying and dealing with these powerful new feelings concerning identity, infertile couples often need help sorting through the myriad of mixed messages and information concerning any actions they might take.

  "Should I stick with my gynecologist of 10 years, or switch to a fertility specialist?"
  "Should my husband (or male partner) go to a urologist and have tests, or is it my fault?"
  "What sorts of books should I read?"
  "Should I go to an acupuncturist, an adoption agency, or just pray?"
  "How many times should we go through invitro-fertilization before considering adoption, surrogacy, or egg (sperm) donation?"
  "If we use a donor, should it be an anonymous or known donor?"

Many couples have to face the challenges of daily self-administered injections and appointments for blood tests, in addition to the considerable financial strains of medical tests and invitro fertilizations.

Given the complexity of this problem, it is often wise for individuals or couples to seek a therapist's help during a period of infertility. Much can be done in the way of support, demystification, and provision of resources. I have had experience with both gay and straight couples confronting these issues.