I was talking with a couple about a difficult experience they had recently while visiting a reproductive endocrinologist. Both noticed that the doctor failed to address herself to the female partner, instead directing her comments to the male partner. Both had various explanations for the behavior – the wife noted a somewhat “flirty” vibe from the female doctor while the husband thought the doctor was uncomfortable with his wife’s somewhat emotional presentation. The wife then became sad and self-blaming for her tearfulness and anxiety. When I brought up some of the common dynamics that often emerge when entering the medical arena, both were surprised and relieved to have the opportunity to consider the complexities that may have colored the interaction.
When couples learn that they are struggling with infertility, they are confronted with innumerable stressors. When a couple enters the medical arena, they often feel that their lives are taken over by doctors. Both members of the couple usually have to undergo expensive and invasive testing. What was once spontaneous, private sexy time often becomes a prescribed, tracked and medically supported act. It is no wonder that many couples feel a tremendous lack of control when undergoing treatment for infertility.
Interestingly, this set of stressors can lead to some common doctor-patient dynamics that are worth exploring further. Triagulation sometimes occurs when one member of the couple forms an alliance with the doctor and the other member of the couple feels excluded from the relationship. This can occur in a number of ways. With assisted reproductive technology (ART) the medical procedures are often frequent and of an intimate nature, which can create a sense of closeness between the woman and her doctor that can lead the woman to idolize or develop a strong emotional attachment to the physician. Partners sometimes feeling excluded from this inner circle and like a “sperm donor.”
Conversely, women may feel sidelined as medical terms and procedures are discussed between a male partner and the doctor. While there are likely many reasons this could happen, we must certainly be sensitive to the possibility that patriarchal values may be subconsciously at play. The traditional physician-patient relationship tends to place more power in the hands of the doctor. Additionally the nature of treatments reinforce gender archetypes of forceful men and passive women.
Other potentially problematic relationship dynamics that can occur are trying to be the “good patient” and hiding sadness, anxiety, disappointment, anger or grief. This desire to be a compliant patient often leads couples to avoid questioning the doctor’s recommendations or seeking second opinions resulting in the couple having less input regarding the course, length and extent of medical procedures. Swallowing negative reactions can lead to bitter disappointment and unexpressed feelings of anger.
Below are some practical tips to ensure that you and your partner remain closely aligned throughout your engagement with the medical system:
1. Attend as many appointments together as possible.
2. Write a list of questions and each take turns asking them. Write down and review answers together.
3. Take some time to review some reputable websites to become more informed about infertility treatments. RESOLVE (www.resolve.org) has wonderful information about infertility as well as online support.
4. Interview several physicians before choosing one. In addition to analyzing potential providers professional credentials, make sure each member of the couple is comfortable working with the physician and medical team.
5. Talk often and openly about each partner’s feelings about treatment and infertility related topics.
6. Engage in ongoing conversations about treatment options and the amount of time and resources each member of the couple wants to allocate to infertility treatments.
Seeking treatment for infertility involves a number of profound decisions and it is key that couples are conscious and present for one another as they interact with the medical system. If you find that you and your partner are struggling with communication, it may be helpful to see the assistance of a psychologist or counselor to work with. You may also find that a support group for couples is a useful tool for keeping the lines of communication open during treatment.
