When Sex Becomes a Task: Intimacy During Infertility
Brittney and I lost a pregnancy, and then spent nearly two years trying to conceive again.
Isla is four now. She exists because of IVF, and because we were willing to spend money we did not entirely have on a process that was physically brutal for Brittney, emotionally brutal for both of us, and offered no guarantees at any point along the way. She was born when I was forty-three and Brittney was forty-one, which meant that alongside everything else, we were working against a clock that does not negotiate.
I am not going to describe that period as a growth experience. It was one of the hardest things we have been through, and the parts of it that were hardest were not the parts anyone prepares you for.
One of those unprepared-for parts was what happened to our intimate life.
Sex became scheduled. Then it became clinical. Then it became a task with a pass-fail outcome announced roughly two weeks later and that repeated experience of trying, hoping, and being disappointed attached itself, month after month, to an act that used to be about something else entirely.
We were fortunate. Not every couple who goes through this ends up with an Isla, and I hold that carefully. But the intimate strain we experienced was not unique to us, and it is one of the most common and least addressed crises I am aware of. The research suggests that almost nobody in the medical system is asking about it.
What the Research Shows
The numbers here are striking, and they deserve to be more widely known.
According to a multi-study review published by the National Institutes of Health and summarized in Psychology Today, infertility negatively affects the sexuality of between 43% and 90% of women and between 48% and 58% of men.
The same review found something I want to sit on: very few patients are asked about their sex lives by their medical team.
Read those two findings together. A condition that disrupts the sexual functioning of the substantial majority of the women experiencing it, and a treatment system that does not ask about it.
Research published in the Journal of Reproductive and Infant Psychology studying 113 couples attending fertility clinics found consistent infertility-related sexual and relationship concerns in both partners — with a significantly higher proportion of women reporting that their partner did not understand how the fertility problem affected them, and worrying that they were drifting apart. Significantly more men than women considered their sex life to be lacking in quality.
A 2023 cross-sectional study of 117 couples undergoing IVF, published through the NIH, found a significant negative correlation between marital intimacy and infertility-related stress. As the stress went up, intimacy went down — reliably.
And the American Society for Reproductive Medicine's own patient education materials state it plainly: many couples in infertility treatment avoid sexual intimacy during non-fertile times, lose pleasure in sexual activity that is not for conception, and experience a broader loss of affection and a sense of disconnection.
What Actually Happens to the Intimate Life
Sex becomes instrumental.
This is the core mechanism. When intercourse has a purpose beyond itself — when it is the means to an outcome that both partners desperately want — it stops being an end. The body registers this. Desire, which is fundamentally about wanting rather than accomplishing, does not survive well in an instrumental frame.
The calendar takes over.
Ovulation windows, timed intercourse, the specific pressure of "we need to tonight." Spontaneity is not merely reduced; it is structurally eliminated. And for the partner whose desire is responsive rather than spontaneous, the demand to produce arousal on a schedule set by a fertility app is close to the worst possible condition.
Performance pressure arrives for the partner who has to perform.
The ASRM materials name this directly: pressure to perform on demand is a documented contributor to sexual dysfunction during fertility treatment. A man who has never had difficulty with erectile function may develop it in the context of scheduled, high-stakes, must-happen-tonight intercourse. And that difficulty then becomes its own source of shame and pressure.
Non-fertile-window intimacy disappears.
This is the pattern I find most quietly damaging. Many couples stop being physically intimate outside the fertile window entirely — because if it does not serve the goal, it can feel pointless, or exhausting, or like an unwelcome reminder. The result is that intimacy contracts to a handful of scheduled, pressured, clinical encounters per month and nothing else.
Bodies become medical objects.
Injections, ultrasounds, sample collection, procedures. Both partners' bodies become sites of clinical activity. Reinhabiting those same bodies as sites of pleasure and connection requires a genuine transition that nobody prompts them to make.
The asymmetry of grief.
The research consistently finds that women report higher infertility-related stress and more often feel their partner does not understand the impact — while men more often report the sex life itself as the deficit. Two people grieving the same loss in different registers, each partly invisible to the other.
What Actually Helps
Separate connection sex from conception sex — explicitly.
This is the single most useful intervention I know of in this situation. Deliberately protect physical intimacy that occurs outside the fertile window and has nothing to do with conception. Name it as such out loud: this is not about that. Some couples find it useful to make these encounters structurally different — different room, different time of day, anything that separates them from the clinical version.
Reclaim non-goal-directed touch.
Given that scheduled intercourse is a source of pressure, the couple can build a substantial amount of intimate connection through physical contact that has no destination at all. Extended physical closeness with an explicit agreement that nothing further is expected. This maintains the intimate bond while removing the performance dimension entirely. It is also, for couples where intercourse has become genuinely fraught, frequently the only accessible form of physical intimacy for a while.
Grieve out loud, together, in both registers.
The research on asymmetric experience suggests each partner is partly invisible to the other. Saying explicitly what this is costing you — and asking specifically what it is costing your partner — closes a gap that silence widens every month.
Talk to your medical team even though they did not ask.
The finding that very few patients are asked about their sex lives means you will likely have to raise it. Reproductive endocrinologists can adjust protocols, and many have referral relationships with therapists who specialize in this. The question is available to you even if nobody offers it.
Get support that specifically understands this.
Research on couple-centered counseling during infertility found measurable improvements in marital intimacy for couples who received structured relational support during treatment. And Psychology Today's summary of the research notes that couples who receive support from a therapist specializing in fertility issues cope better and experience less strain on the relationship.
Where Coaching Fits and Where It Does Not
I want to be direct about scope.
The medical dimension of infertility is medical. The grief dimension — and it is genuine grief, repeatedly experienced — frequently warrants a therapist, particularly one with specific expertise in reproductive loss. If you are in acute distress, that is the appropriate resource and I will say so.
Where coaching is genuinely useful is in the specific intimate dimension: rebuilding the connection between two people whose physical relationship has been colonized by a medical process, restoring non-instrumental intimacy, and doing the deliberate work of reinhabiting bodies that have become clinical objects.
That work is real, it is learnable, and almost nobody is offering it to couples in the middle of this.
A Word to Couples in the Middle of It
What is happening to your intimate life is not a sign that something is wrong with your relationship. It is the predictable, documented, near-universal effect of a genuinely difficult process on the specific dimension of life that process most directly touches.
You are not doing this badly. You are doing something hard.
I want to say one more thing, carefully, because I am aware of how this can land depending on where you are.
Our story resolved. Many do not. If you are reading this in the middle of it, I am not offering our outcome as a promise, and I would not insult you by suggesting that persistence guarantees anything — it does not, and anyone who has been through this knows it does not.
What I can tell you is that the intimate connection between you is worth protecting deliberately during this, independent of the outcome. Not because it will help you conceive. Because it is yours regardless of what happens, and because you will want it on the other side of this no matter which side that turns out to be.
Brittney and I did not protect it particularly well while we were in it. That is one of the reasons I write about it now.
Book a free discovery call — confidential, and a space where this specific difficulty is genuinely understood.
And if you would like a way back to physical connection that has nothing to do with the calendar, Coelle offers guided audio experiences built entirely around presence rather than outcome.
Scott Schwertly is a Nashville-based sex and intimacy coach, founder of Coelle, and co-host of Do You Feel That? with his wife Brittney. This post is educational and is not a substitute for medical or psychological care.
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