For couples facing infertility, defined as at least 12 cycles of random, unprotected intercourse without conception, the question of whether or not they will ever become parents can be as stressful as a cancer diagnosis.
An excellent first-line approach to helping couples conceive is helping them learn the optimal time to get pregnant, i.e., by helping them identify their fertility window with a fertility awareness method (FAM) [1]. In fact, for couples who have worked with a certified FAM instructor to accurately identify their fertile window, only 6 cycles of unprotected, properly timed intercourse without conception is grounds for seeking medical evaluation.
FAM instructors can therefore play a unique role in supporting couples during one of the toughest situations they may ever face. While there’s no foolproof formula for supporting couples experiencing the stress of delayed time to conception and a healthy, full-term pregnancy, the following are some key facts and tested strategies to keep in mind if you are part of a couple’s infertility support network, gleaned from my experience as a certified FAM instructor with over a decade in Restorative Reproductive Medicine (RRM).
The relationship between stress and infertility
While the relationship between stress and infertility is complicated, studies show that an infertility diagnosis is often accompanied by significant risk for depression, anxiety, and distress [2]. Fertility testing and treatments can bring their own stress, with the process of in vitro fertilization (IVF) causing notable stress in couples. The further a couple goes into exploring their options, the more at-risk they may become for “decision fatigue,” pressure, and feelings of inadequacy in their intimate lives, hopelessness, anger, guilt, loss, and depression. When infertility treatment is unsuccessful, couples describe failed IVF cycles in terms of “heartbrokenness” and “bereavement.” Whether one is utilizing IVF or RRM, these negative feelings are exacerbated by the hormonal drop-off women experience with each new menstrual period, realizing there was yet another failed attempt to become pregnant.
A diagnosis of “unexplained infertility” may be an especially frustrating experience. As a 2018 article published in Dialogues in Clinical Neuroscience notes, “Knowing the root cause of an infertility diagnosis can reduce the burden for patients as they understand why this may be happening to them; while still heart-broken, they can place blame on ‘something.’ Patients with unexplained infertility do not know why they cannot get pregnant. They may become obsessed with this diagnosis. In fact, infertile women may display a high prevalence of obsession” [2].
“Knowing the root cause of an infertility diagnosis can reduce the burden for patients as they understand why this may be happening to them; while still heart-broken, they can place blame on ‘something.’ Patients with unexplained infertility do not know why they cannot get pregnant. They may become obsessed with this diagnosis. In fact, infertile women may display a high prevalence of obsession.”
Ask couples: How are you, and what do you need right now?
At a recent international conference of certified fertility educators specializing in Restorative Reproductive Medicine, Ivana Zecevic, Psychotherapist and NeoFertility advisor, emphasized the importance of fertility awareness instructors learning “where a couple is at” when they initially seek a FAM consult. She recommends that, without being too direct, a fertility awareness instructor takes the time to discover if the couple just came from a doctor’s visit, if they’re in their “2-week wait” or if they’ve decided to “take a break.” An open-ended, non-specific question allows the couple to decide what to share. It’s okay if they don’t want to discuss fertility, Zecevic stresses. Honor their lead. She notes that following up with a more focused question adds to their sense of agency and control, while reinforcing that you are truly ready to try to support them at this very moment.
Remember: couples who are stressed about their fertility feel out of control due to the uncertainty of the issue, so it’s important to give them control over whether or not they want help and what any help looks like. While today’s stressors are likely transient, they are the only stressors that matter right now.
Inform them that fertility is a multi-factoral, multi-system issue
If you’re helping a couple facing infertility, it might be helpful to remind them that fertility is not an exclusively female concern. Male factors account for at least 40 percent of all factors contributing to couples’ struggles [2]. There are multiple body systems that will need a check-up for both partners, and encouraging the couple to take a multi-factoral, multi-system approach may help them understand what choices they can make, and over which factors they may have control. A thorough infertility workup will include an evaluation of the following aspects of a couple’s health:
- Metabolic, i.e., insulin resistance, which impacts ovulation and sperm quality [4] [5]
- Anatomical, e.g., varicocele, which affects up to 25% of men [6], or issues with the uterus or fallopian tubes
- Infections, e.g., ureaplasma or endometritis infections (both of which are diagnosable and treatable)
- Hormonal, e.g., low progesterone or low estrogen, both of which are risk factors for an inability to conceive and miscarriage
- Immunological, e.g., autoimmune conditions like certain thyroid dysfunctions (which are also diagnosable and treatable)
- Lifestyle, e.g., recreational drug use, alcohol, smoking or vaping, poor diet, low physical activity, exposure to known reproductive toxins, and more [7]
Help couples discover the root-cause approach to infertility treatment
As a FAM instructor, you are uniquely positioned to let couples know the good news: many, if not all, of the factors which contribute to infertility can be diagnosed, treated, or managed. Addressing these factors improves overall health as well as fertility—a crucial fact about which to remind couples. You can also let them know that they are unlikely to find an IVF clinic that will perform the thorough workup necessary to determine the root cause of their struggles to conceive, which is why up to 1 in 3 infertility cases treated according to protocols issued by the American Society for Reproductive Medicine remain “unexplained.” By contrast, NaProTechnology—a form of Restorative Reproductive Medicine (RRM)—boasts an “ability to identify specific etiological factors in nearly all couples,” as evidenced by a recent 2025 Spanish study published in Frontiers in Reproductive Health [8].
You can help couples interested in root-cause diagnosis and treatment of infertility to find a doctor or other healthcare professional trained in RRM by directing them to this Natural Womanhood resource. You can also let them know that the International Institute for Restorative Reproductive Medicine (IIRRM) hosts a scientific resource page where scholarly articles from a variety of publications are available to read. Perusing this page may help couples think about their medical options based on current scientific evidence.
As a couple’s FAM instructor, you can be a critical support person, encouraging a positive view of health and lifestyle changes to increase their energy levels, longevity, and fertility. The broader view of fertility goals in the context of health optimization can prevent “tunnel vision” on the wish for a child. You can also assure them that it is also completely acceptable to forgo medical evaluation for fertility, and to be at peace “letting it be” while focusing on living well.
As a couple’s FAM instructor, you can be a critical support person, encouraging a positive view of health and lifestyle changes to increase their energy levels, longevity, and fertility. The broader view of fertility goals in the context of health optimization can prevent “tunnel vision” on the wish for a child. You can also assure them that it is also completely acceptable to forgo medical evaluation for fertility, and to be at peace “letting it be” while focusing on living well.
Encourage them to nurture other interests and goals
On that note, ask yourself: Did you know the couple before they started trying to conceive? If so, remind them to prioritize doing the things you know they loved before infertility took center stage. Even if you didn’t know a couple well before they started trying for a baby, you can gently remind them that there’s more to their identity and life together than trying to have a baby.
Without making light of how heavy and unforgettable fertility challenges can be, encourage the couple to make time to explore new hobbies, travel, or pursue professional development. Creative hobbies in particular, like art, music or theatre, can be a healthy outlet for emotions. Regular, shared, recreational activities, including sports or learning a foreign language, can help a couple re-connect in ways that support co-creation without the pressure.
While fertility appointments can feel like a part-time job, every couple can choose how much time and effort they put into fertility. Encourage discussion on boundaries and allotting space for other meaningful activities. This safeguards from obsessing over their struggles to conceive, or from creating a false idol of the wished-for child.
While fertility appointments can feel like a part-time job, every couple can choose how much time and effort they put into fertility. Encourage discussion on boundaries and allotting space for other meaningful activities.
Ask (and answer) the hard questions
Fear of childlessness can fizzle if you shine a light on it and face it head on. Supporting a couple may mean offering (just offering, not insisting) to listen to them talk about their biggest fears and their ideas around parenthood and their fertility journey. Examples of some hard questions, inspired by the Organic Conceptions program, could be:
- When did you first start wishing for parenthood? What does parenthood mean for you? Are there other hopes for your future that you can start exploring right now while waiting for parenthood?
- Without giving up on parenthood, can you imagine what “taking a break” would feel like for you, for your partner, and your life together?
- What, if any, does the role of faith/spirituality play in your fertility journey? Do you believe in a Creator who has a plan for you, or is this journey solely based on yours and your partner’s plans? If you believe in a Creator or Giver of Life, can you include them more in this journey?
- Have you or your partner felt broken or ashamed in this process? How might you help each other to see the truth that you are not broken or at fault, and to heal from these blows to your spirit?
- What does it mean to be a family? Is there only one way to build one? What are their thoughts on adoption? Are there any objectively unethical ways to become parents?
It’s important to just listen, not offer solutions. And be prepared for tears. There are no wrong answers to most of these questions. Remember that, as a couple’s FAM instructor, you can be a powerful support person—especially if you indicate a willingness to put your own ideas aside, signaling confidence that the couple can process their emotions and find their own solutions.
As a FAM instructor, your listening ear can be invaluable, and you may sometimes hear clear signs that the couple could benefit from working with a mental health professional. It is important to suggest a professional who has experience with fertility. Here’s one directory with many therapists who offer introductory phone calls.
Walking with couples on their fertility journeys—no matter what those journeys entail—is an incredible gift you can give others as a FAM instructor.
