"I love Bob dearly, but maybe marrying him wasn't the right thing to do," said Katie, 32, a marketing supervisor for a chain of nursing homes. I knew when I accepted his proposal that he might not be able to father a child, but I didn't realize just how devastating the reality of it would be. I don't know if I can accept going through life without children.
"We've been married only five months, but Bob and I have been dealing with infertility ever since our relationship became serious. We met two years ago at a friend's cookout. I was instantly attracted to Bob, and we had so much in common: We were raised in Irish-Catholic families in suburban Philadelphia; we were divorced; and we liked biking and camping. Within four months, we were madly in love.
"One night, Bob hesitantly told me he'd had a vasectomy during his first marriage. I assumed it was because he'd had two kids and didn't want more. This was a potential deal breaker, since I always wanted to be a mother someday.
"After college, I married Roger, my college boyfriend, but our marriage lasted only ten months. I spent most of my twenties concentrating on my career, taking for granted I'd eventually have children with Mr. Right.
"Except for his vasectomy, Bob was that man. So after three days of soul-searching, I told him bluntly: 'I want to have a family. If you're serious about marrying me, you'll have to get the vasectomy reversed.' Bob was stunned at first, but a few days later he said, 'I love you, and I'll do whatever it takes to have children with you.'
"As a result, we're drifting apart. Our conversations are impersonal, and we rarely laugh anymore. We're strapped for cash-IVF costs around $10,000, and we're maxing out our credit cards to pay for it-so we've stopped doing things we enjoy.
"My other relationships are suffering, too. Lately, I've been making excuses to go out when my stepson visits, because seeing him makes me sad. It's awkward being around friends who have kids, and I hate it when people ask, 'Why don't you just adopt?' That makes me feel as if it's somehow wrong to want a biological child when this other option is available.
"I told Bob I wanted to try IVF again, but only if we saw a marriage counselor, too. I hate feeling so bitter all the time. I don't want to lose my marriage — but I don't want to live with regrets the rest of my life, either."
"I wouldn't blame Katie if she left me," said Bob, 46, a mechanical engineer. "It's my fault she had to suffer through those shots and surgeries. I feel guilty that my sterility is causing her so much pain, and I'm devastated that it's jeopardizing our relationship.
"Katie and I used to be candid about our feelings. No topic was taboo, not even our failed first marriages. Now, we haven't talked about our feelings in months. We should be discussing our other parenthood options, but I don't dare bring up the subject. Katie is so intent on getting pregnant that I'm afraid of upsetting her if I suggest adopting. But the truth is, I think adoption would be a good solution for us.
"From the start, I dreaded telling Katie about my vasectomy. I figured she would leave me — just like everyone else in my life has. I married my first wife four years after we first met in high school. We fought all the time about finances, child rearing — you name it. Then Denise said she didn't want any more children and demanded I get a vasectomy. At first I resisted, but she kept pressing and insisting that I would do it if I really cared about her. I finally gave in for the sake of our marriage, not thinking that I might regret it later on. A few years later, Denise cheated on me, and I filed for divorce.
"When I met Katie, I was ready for a serious relationship. She was everything I wanted in a woman: smart, warm, witty and beautiful. I'll never forget her disappointed expression when I told her I was sterile. I didn't hesitate to get the procedure reversed, and I was miserable when it failed.
"I'm glad we're trying the in-vitro process again. I can endure the cost and the emotional roller-coaster ride if it means we can be parents. I'm also grateful that Katie suggested counseling. She's the love of my life, and I'll do anything to save my marriage."
The Counselor's Turn
"Katie and Bob felt helpless, hopeless and cheated by life — emotions that are typical among the more than six million American couples who can't conceive a baby. As the American Society for Reproductive Medicine reports, infertility can trigger overwhelming feelings of loss. The decisions and expense of medical intervention can be daunting. It's no wonder, then, that marital dysfunction is both common and normal among infertile couples.
"Psychological symptoms are also typical: mild depression, persistent feelings of bitterness and anger, social isolation, feelings of pessimism and guilt.
"Shortly after they started therapy, the couple's second IVF cycle failed because Bob's sperm quality was too poor, so they tried insemination with donor sperm. After four unsuccessful attempts, Katie insisted on undergoing infertility tests herself.
"It turned out that she had endometriosis, which had caused scar tissue to block her fallopian tubes, preventing the eggs and sperm from passing through. This made it impossible for her to become pregnant through insemination, which involves assisting the fertilization in the tubes. Another IVF, using donor sperm, was their only option. But by then Katie had had enough of shots and procedures, and she wasn't sure she really wanted to bear another man's child. 'It's time for us to move on,' she said.
"Despite their ordeal, Katie and Bob remained in love and were determined to stay together. I was confident they could if they followed a multistep plan to heal and reconnect. First, I urged them to mourn openly.
"Infertility is like a death: Couples must go through the stages of grieving — including anger, denial and sorrow — before they can reach acceptance. By keeping their pain inside to avoid hurting each other, they'd become estranged emotionally.
"Katie and Bob were suffering in different ways. Katie needed to vent her anger at Bob for having had the vasectomy and at her doctor for not diagnosing her condition earlier. Bob needed to alleviate his guilt over his voluntary sterilization, his disappointment that the reversal had failed and his fear that his choices would cost him his marriage.
"I instructed them to remember each other's positive qualities and express their appreciation for those traits every day. Couples in crisis often become so focused on their problem that they forget why they fell in love. By sharing the things they enjoy about each other — Bob's gentle nature and sense of humor; Katie's intellect and outgoing personality — they began to distance themselves from all the negative emotions.
"I also urged them to have fun. Even though money was tight, they could still afford to rent videos, order take-out pizza, snuggle on the sofa, take long walks and ride their bikes — activities they'd enjoyed before infertility treatments consumed their lives.
"Katie and Bob hadn't been making love very often, either because they'd had to abstain during part of the IVF cycle or because the medication and Katie's weight gain had caused her desire to ebb. Cuddling, hugging and kissing at every opportunity went a long way toward reviving their intimacy. Once Katie was off the fertility drugs and started exercising, she lost twenty pounds, and now she frequently initiates sex.
"Next, the couple confronted their upbringings and how they influenced their feelings about infertility. Katie had grown up believing her mother's implied message that her self-worth was linked to her ability to bear children, and she felt she'd failed as a woman. I helped her understand that this attitude was only making her more unhappy, and reminded her that she was a worthwhile person with or without a baby. 'You can still become a parent through adoption if you want to,' I added. 'But not having children is an equally valid choice.'
"Meanwhile, Bob's childhood fear of abandonment had turned him into a classic people-pleaser, to the point where he sacrificed his own best interests and frustrated Katie by not speaking his mind. 'Be assertive,' I advised. 'Your wife will respect you for standing your ground.' Over time, Bob has become more outspoken, and he feels secure that Katie won't leave him if he disagrees with her over any given issue.
"I advised the couple to reach out to supportive friends. Katie and Bob had stopped socializing, and the isolation exacerbated their loneliness and despair. It was also vital that Katie renew her relationship with her stepson if she didn't want to alienate him forever. She went back to attending Brad's soccer games, watching TV with him and talking about school.
"Finally, I encouraged them to look into adoption. 'You don't have to make a snap decision,' I said. 'Just learn about the process and live with the idea for a while.' Bob was enthusiastic, but Katie was worried at how ambivalent she felt. I assured her that this was normal, and that couples can change their minds many times before reaching a decision. After several months, Katie made peace with her infertility and realized that she did want to adopt a child. Much to her delight, Bob scheduled interviews with adoption agencies and completed the paperwork. 'I feel relaxed knowing that every decision doesn't rest on my shoulders,' said Katie.
"Katie and Bob were ready to end counseling after eighteen months. Recently, they called to report good news: Their application to adopt a baby girl from Korea was approved, and they'll be bringing their daughter, whom they'll name Erica, home this summer. 'Bob and I are renovating the room that will become Erica's nursery,' said Katie. 'Soon I'll have everything I always wanted — a loving husband, a strong marriage and a child.'"
"Can This Marriage Be Saved?" is the most enduring women's magazine feature in the world. This month's case is based on interviews with clients and information from the files of Catherine Marshall Bean, M.F.T., a marital and family therapist in Philadelphia. The story told here is true, although names and other details have been changed to conceal identities.
Originally published in Ladies' Home Journal, June 2002.