How to Maintain Your Sex Life During IVF

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Becky: You’re listening to Becky & Ben’s Fertility Spotlight.

Ben: We’re putting IVF and infertility under the microscope, asking the questions that matter.

Becky: Joining us in the studio today is World-Renowned Sex Therapist Kate Moyle. We’ll be talking about IVF and its effect on our love lives.

Ben: Just a heads up, this interview contains strong sexual language.

Becky: Let’s explore sex, relationships, and IVF, and how they all connect.

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We’re delighted to have you here today, Kate. Thank you so much for coming into the studio. I’m going to launch straight in and ask you about sex. Sex is fun, but IVF isn’t. How do you marry the two?

Kate Moyle: Yes, I think that’s the perfect place to start, isn’t it? Sex, when it’s good, is fun, and when it’s not, really isn’t. One of the things that we talk about as sexual therapists is that sex is always in context. When the meaning of sex changes, it can change the whole thing. We often talk about the physicality of sex, but not the psychology of it. When we’re having IVF or going through any kind of trying to conceive, which isn’t going to plan, infertility experiences, miscarriage, any difficulties around that, the meaning of sex changes completely because we lose sight of the fun bit.

It becomes functional. It becomes about why. It becomes about what we’re trying to get out of it, which is conception. We can lose sight of the reasons that we originally would have had sex for. That means that we feel so disconnected and become so functional. Often, what can happen with couples is that it becomes something that we demand from each other at a certain time of the month or an ovulation window. It gets reduced to that, and that becomes a very difficult bridge to cross back into something fun, connecting, and intimate.

Becky: As a therapist, how would you suggest that IVF couples lessen the pressure?

Kate: I think it’s unavoidable, the pressure. Nobody goes into IVF not feeling the pressure. No one thinks that that’s where they’re going to end up. No one thinks that that’s a process that they’re going to have to start. I think that once we’re in that, I think one of the things is to acknowledge that it’s really hard and to say, ”Do you know what? We don’t feel like ourselves.” I think that’s the thing that I hear from couples all the time. It’s about then, how do we find each other within that, without putting pressure on sex?

Also, it’s sometimes about having to rediscover sex as a thing that we used to do for fun and that now perhaps the meaning of it has changed, particularly if we’ve had a really focused amount of time around ovulation windows, whether it’s timed ovulation, whether it’s fertility treatments. It’s medications. Sex can become so managed, and we almost in a way have to learn to un-manage it. It feels, at the time, I think, like it can be irreversibly changed, but changing it back or trying something different with it again feels sometimes, and for a lot of couples, a kind of unmanageable task.

Ben: I remember the pressure because Becky, you, and I met later in life, as we said before on this podcast. We wanted children immediately, so the pressure was on.

Kate: The waiting is agonizing sometimes. There’s this sense of there’s nothing that you can do but wait, a two-week wait, getting to a scan, the next scan, the timed treatments. Everything feels like waiting. That’s juxtaposed with the fact that most of us are experiencing this sense of the clock winding down all the time. Every extra month is another month gone, another opportunity gone. That’s a really strange thing to have to manage.

Ben: It’s quite a good idea also to test for semen quality and egg reserve. When you try naturally, most people wait until they start doing fertility treatment, but why not start when you decided to have children in the first place?

Kate: It depends on so many factors, doesn’t it? One of the things that we do know about testing semen quality is that it’s fairly simple test to do, actually, a lot less invasive. One of the things that is really important is if people are starting to test anything, that it’s both partners are checked rather than staying on something for one side. A lot of the time, when we look at fertility and infertility, we largely consider it a woman’s issue. Actually, we know that one in seven couples that it is, and then within that, the statistics are actually rising that male infertility is a big part of it as well.

Becky: In the last five years, I think people have realized that more, haven’t they?

Kate: Yes, absolutely.

Becky: It’s definitely out there on Instagram, and people are becoming much more aware of that. I was going to ask you, though, just going back to actually having sex, if you are lucky enough to get pregnant, is it actually safe to have sex during pregnancy?

Kate: Providing you’ve been given no medical reason or advice from your doctor not to. The one thing I would say is if you are nervous or if there have been any complications or anything like that, speak to your doctor. There are often people who have gone through whole series of fertility treatment without ever really talking to their consultant about sex. It’s always about fertility. There is a lot of space within the vagina, obviously, for sex to happen if that’s the type of sex that you’re having. It’s much more about the anxiety that comes with it for people a lot of the time, and particularly if sex feels like it’s changed.

Ben: I know fertility patients might worry after they’ve finally had their hard one pregnancy confirmed. They might just worry that I’m thinking, let’s not risk it. You can understand that, can’t you?

Kate: You worry about everything. You worry about going to the loo and seeing blood. You worry about having sex. You worry about exercising. You worry about what you’re eating. You worry about drinking a cup of tea. You worry about everything. It feels so precious.

Becky: When I finally got pregnant after five years of infertility, I remember we were very, very careful because we’d been through so much. I’m going to be quite honest here, we basically just didn’t have sex. It wasn’t really part of our mindset.

Kate: You are in such a different mindset at that point. Particularly, I think there’s not much that feels less sexual than IVF, than having your body medicalized, people talking over you, hands on you, things inside your body, injections, drugs that make you feel sometimes awful, and the anxiety associated with getting pregnant and then staying pregnant.

Becky: Would you say it’s okay then for fertility patients once they achieve a successful pregnancy, just to say, “Okay, I’m going to have a break?”

Kate: Yes, I think it is. I think the thing is, it’s about what’s happening between the two of you in that dynamic. Sex and intimacy, they’re not a perfect word match. You can have one without the other and the other without the other. You don’t necessarily need both all the time. For some people, you can have a perfectly wonderful relationship, which is really intimate but not sexual. For others, you can have a really sexual relationship that’s not intimate. Sometimes it can just be about, “Okay, we’re really scared. How do we stay intimate? How do we stay close? How do we stay connected?” One of the things that we know is that IVF can create a lot of disconnection in couples.

Ben: Fertility patients monitor every aspect of their pregnancy. Things do go wrong. That makes it even harder to reconnect, doesn’t it?

Kate: Yes. You become so hyper aware of your body, every twitch, every pain, every spotting, every day. In particular, for example, we have miscarriage where sex and pregnancy or sex and conception are completely linked, even when fertility treatment is involved. Then we have to, in order to try again, face the thing that has caused us that pain again. Understandably, we become attached with a whole backpack of worries, concerns that we have to put ourselves through that again in order to try and get to where we want to get to.

Becky: Associating trauma with sex is such a disconnect, isn’t it?

Kate: Completely. It involves having to go back and start again on a process which you’re terrified of. I’ve worked with huge numbers of people who, for example, experience sexual dysfunction for the first time in their lives, erectile dysfunction, difficulties ejaculating, because they’re really scared. Sex has taken on a whole weight, a whole different meaning, a whole different change. How do you unattach that? Then, also the more pressure that builds around that.

We see performance anxiety, particularly around these types of sexual dysfunctions, because there’s a pressure. It’s a certain day, a certain time. We feel like we have to perform then. The fact that sex becomes a performance in itself becomes a negative cycle. Couple that with– the last time that happened for us, it was agonizing. We were both devastated. We felt so much pain physically, emotionally. Then we expect to have to switch that off. It doesn’t make any sense.

Becky: Fertility treatment can take years. How do fertility patients maintain a sexual closeness when their emotional health is so challenged?

Kate: One of the things is to say is don’t expect it to be a constant. Anything in our life can affect sex, and sex can affect anything else in our lives. We have this bidirectional relationship between sex and mental health, for example. Very few of us are having the best sex of our lives, and we’re not psychologically feeling great. We’re not psychologically feeling great, we’re not feeling happy in ourselves. We’re not physically happy in ourselves. Good sex can make us feel good, positive, and connected, and our relationships can have a massive factor in our lives. Or if we’re single, good masturbation, good relationship with self. I think that one of the things about fertility treatment, as well, is we have no idea of the ending.

We have no idea how many rounds, how many goes, how many injections, what this cycle is going to look like. It’s about knowing what are the minimum things that we can do. I think sometimes we’re focused on the big picture. I often talk to couples about if I’m working with couples, what’s the absolute minimum that you can do to feel closer to each other, to stay a bit connected, to take the pressure off this week? Because I think so often we go big and actually then it feels unachievable, and then we feel anxious and avoidant and stay away from it even more.

Becky: Do you think culturally that we are, as British people, worse at talking about sex?

Kate: Funny enough, we actually have a really booming sexual wellness industry in the UK. We have some amazing psychosexual therapists, sex educators. We’re quite stiff upper lip, but actually, we are also quite open to the discussions in the UK, and we’ve seen a real change. I’ve been a psychosexual therapist for 10 years, and over the 10 years that I’ve been doing this, I’ve seen such a massive change.

We are in a very interesting time at the moment, where we have a clash of don’t talk about it, it’s behind closed doors, people do it, but we don’t discuss it, and the fact that sex is everywhere. It’s in every perfume advert, every Netflix episode, it’s on the side of the bus, but only a certain representation of sex.

Becky: The idealized version [crosstalk].

Kate: The idealized version of sex, a non-representative version of sex. I think that we’re seeing a real shift in that in terms of a lot of the content that’s been created, TV shows, films. Recently, we saw Dying for Sex with Michelle Williams, which was fantastic, things like Sex Education. At the same time, it doesn’t always represent the sex that people feel like they’re having. For me, the most dominant side effect of a sexual problem is the feeling of isolation and shame that go with that. I find the term trying so invasive that whenever else would we ask people in life if they’re having unprotected sex or not, but for some reason, when it’s around children, it’s [crosstalk]

Becky: It’s everyone’s business, isn’t it?

Kate: Yes, it’s everyone’s business. It’s in some way permissible, and people make assumptions.

Becky: In a party, you might have a deeply personal question from a complete stranger, but I want to pick up on your word isolation because I think that’s something that fertility patients often feel is isolated, separate from society.

Ben: I just remember thinking we needed to escape from all this. There was quite a long period of our time where we really didn’t see people, and I didn’t feel the need to see people.

Becky: I was quite different from you because I needed to talk to my very old friends, and they were fantastic, and I saw them, and so on. Actually, our little house in Lincolnshire was like a cocoon. Our relationship was, I think, strengthened by the difficulties we went through. That’s something I wanted to ask you about because you touched on it earlier that couples can split up.

Kate: Absolutely. Every relationship therapist will say this. It’s not about keeping couples together at every expense. Some couples come to relationship therapy sometimes to separate because they feel like they don’t know where they’re going or how to get there, or that it’s even possible. There’s no rule book. Nobody’s saying, okay, well, if this were to happen, this is how you communicate about it, how you manage your disappointment, how you have to do that hundreds of times over in numerous ways.

It’s about how do we find the togetherness in that, which might feel impossible, particularly if you’re on different pages. Couples, for example, might have conversations about how long they want to do this for, and you can have two partners who are on a completely different page. What do we want to try? How far do we want to take this? One of the things I often talk to couples about is you don’t have to be on exactly the same page.

Ben: It definitely does occupy your time, actually, the idea of succeeding. I wanted to talk about sex again. Specifically, sex is so powerful, isn’t it? Martin Amis, I think, said once that you never forget a sexual partner.

Kate: It can play such a pivotal part in a relationship. Often, we now feel like flatmates. We now feel like friends that live together. We feel really distant from each other. That’s how we felt close. For other people, sex changes because it’s life or because of a medical reason, or because of something to do with mental health, or becoming parents, or fertility treatment. For some people, they’re like, that’s okay. We have enough of other things in our life. It’s the mismatch or the discrepancy between partners. I know we’re focusing more on people in relationships here, which is the thing that needs navigating.

Now, if you have two people who are quite aligned with how they feel about it generally causes less of a problem. You speak to couples, and you say, “Okay, well, if you’re not having sex at the moment, how could you name another time that you feel desired by your partner?” They’re like, “Oh, when they came up behind me when I was doing the washing up and gave me a hug and a kiss.” Or, “When we’re sat on the sofa, and they bring me a cup of tea, and they come and sit next to me and put their arm around me.” Or, “When they tell me that I look great in that dress.” If sex becomes eroded by something like fertility treatment, it’s not just the act of sex; it’s all of the things that sex represents to us and means to us in our relationship.

Becky: That’s really interesting. For me, those little moments of affirmation in a relationship. I think that’s, in some ways, so lovely for fertility patients because maybe one of the partners or both partners could really think about that. Could possibly step up and go, oh, God, you look great today, or just buy a bunch of flowers, or just those little moments which actually don’t take that much effort, but might just be a ray of sunshine in the gloom.

Ben: The little moments.

Becky: Yes, the little moments.

Kate: We use that term sexual currency, which is something I can come back to, which is the things that contribute to your sexual relationship, which aren’t about having sex. Also, so many people feel completely unaffirmed when they’re having fertility treatment. As you might have heard, I’ve been through IVF myself. You feel let down by your body in lots of ways.

It’s not how you expected this part of your life to be going. You can feel quite confused about what’s happening in your body. Then you’ve got this medical treatment. Both partners, this isn’t just about gender differences at all; same-sex couples can also feel this, might be having a different experience of the same thing. It’s very difficult to then cross over to each other’s perspective sometimes.

Ben: There were many times during our process where I felt that we were thinking things in a different way, approaching things in a different way. It’s very hard to keep things light, isn’t it? You try your best. Let’s keep this light. We try again, keep it light. The challenges keep coming. It’s hard to keep positive.

Kate: There is different psychology for both. Often, people might say, we talk about this idea of masculinity and femininity. Again, those being really connected to what we can achieve fertility-wise and those ideas in society. That really rocks our identities. It really challenges all of that stuff.

Ben: There is inevitably sometimes a bit of a blame game going on, isn’t there? Some of the patients that we’ve helped, I’ve spoken to them initially. Sometimes they will say, “Oh, it’s him,” or the other way around. One can sense the slight tension there. I feel very sad for those patients who feel a bit uncomfortable with each other when they’re just going through this difficulty.

Becky: I think, as you were saying, that basically the woman goes through the physical challenges because with the injections and the blood tests, et cetera, et cetera. It’s very hard, I think, for the other partner to not feel useless.

Kate: Yes, absolutely. There’s nothing that can be done above what’s being done. That’s a very strange place sometimes for couples to find themselves in.

Ben: An IVF couple have succeeded. They’re obviously happy people. They’ve given birth. They may still have gone through that trauma. Do you see patients who, despite being happy with the little baby, still need a bit of help in rekindling their closeness?

Becky: Yes, absolutely. I think that it’s totally expected for new parents. Your sex life, your intimacy, and your relationship is completely under-resourced at the point that you have a small baby. There is a longitudinal piece of research done by some amazing, very famous relationship therapists called the Gottmans. They found that I think it was 67% of couples in the first five years, three years of their child’s life reported it was actually, if you were measuring just the relationship happiness, would say it’s one of the most unhappy or unconnected their relationships were. It makes complete sense.

You are sleep-deprived. There’s extra financial stress. Your time is taken away, your energy, your capacity. We all know what those stages are like. That’s also fine to be in a different phase. If you think that you can’t get yourself back from that or into something different or finding ways to reconnect again, it’s actually okay to be like, “Okay, we don’t know how to do this. None of us are taught how to do this. We don’t see people discussing actually that this is really hard or that we almost can’t remember what we were like as a couple.”

Ben: There is a reclaiming element to your life, isn’t there, after the burden of fertility treatment?

Kate: Yes, absolutely. I think things change, and we might have felt that we had to sacrifice that change in order to get the thing that we wanted or to go through fertility treatment. That was the major compromise that we had to make. Then once that’s over, how do we reconnect that? As you said, it’s five years for you. That’s longer than a lot of marriages.

Ben: I was always a results-driven husband in the sense that after treatment, particularly when you were pregnant, I binge-watched One Born Every Minute.

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Becky: [unintelligible 00:20:33]

Ben: I just wanted to see babies being born, and they were. Things generally turned out okay.

Becky: Yes, I know. It was very funny because I couldn’t go near it either. I was just like, “I just can’t deal with this.” In fact, both our girls were cesareans because of the difficulties I’d had. I was just so delighted because I didn’t need to go through natural childbirth in order to have my kids, because I just wanted to have my kids. I was so grateful to have Medical Science there helping us.

Ben: Most people do succeed with fertility treatment. It’s worth just pointing that out.

Becky: I think it’s so interesting hearing you talk in great depth about the things that fertility patients have to navigate in terms of sex and in terms of your relationships. I do think that couples who are listening or couples out there going through fertility treatment deserve a medal, really.

Ben: It is amazing. I think you’re then in such a period of your life where there isn’t really much time or capacity for healing. Yes, the process itself of having a baby and having a child can be healing in many ways, but it’s also incredibly hard. I think what’s really positive is we’ve seen this big branch of podcasts. People connect to hearing other people say exactly what’s going through their heads. The sigh of relief, I think you can feel when you’re like, “Oh, that’s exactly how I feel.”

I’ve never heard anyone else say that. No doctors have said to me, “Just so you know, this is how you might feel.” Nobody has said to me, every time I go for a pee, I’m terrified to find blood in my underwear. No one is saying those things which are so particular to trying to conceive, miscarriage, fertility, multiple miscarriage, infertility. Those are actually the things I think are so helpful. That patient-to-patient learning.

Becky: Yes, absolutely. I must say, social media, the good side of social media is that it promotes all this nowadays, especially Instagram. The people you can follow and the stories you hear are quite considerable, aren’t they?

Ben: Absolutely. These conversations weren’t being had 10 years ago, even. People are connecting up. They are communicating more. That is basically for the good, isn’t it?

Kate: Yes, totally. For me, I very much just view it as a part of my life experience now. I was one of the lucky ones that came out with a child of it at the end. I’m also acutely aware that lots of people don’t, and that is a whole different experience.

Becky: That’s so true.

Kate: Whether we talk about healing process or recovery, or for a lot of people, the process of healing is, I have the child that I always wanted. That sounds straightforward, but for a lot of people, it’s also not straightforward. Children with additional needs, for example, or that it’s irreversibly damaged their relationship or affects their career or their mental health, or they have post-natal depression, and there’s so many other factors that go into that.

Becky: Sex and emotional intimacy, which is more important?

Kate: It’s not about the physicality of what they’re doing. It’s about, “Okay, well, this is-” as people often describe, “-it seems like the glue. This is the glue in our relationship. This is the reminder.” People use intimacy and sex together, but they are both intertwined and can be completely separate.

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Becky: Thanks for tuning in to Becky and Ben’s Fertility Spotlight.

Ben: You can find out more about us on the official website, fertility-spotlight.com.

Becky: Up next, we’ll be talking about fertility foods.

Ben: Remember, always speak to a qualified doctor for personalized advice.

Becky: Don’t despair.

Ben: We’ll get there.

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