When Seattleite Kendall was in his twenties, he and his first wife conceived each of their two children the first month they tried. Then, he got a vasectomy. After divorcing and remarrying, Kendall had his vasectomy reversed—but this time, he and his new wife had trouble conceiving. “To be on the other end of the spectrum and have it be such a challenge was mind-boggling for me,” he said.

For about one-third of heterosexual couples that struggle with fertility, male factor infertility is the cause. And some sperm abnormality or problem with sperm production or delivery is a part of almost half of fertility challenges. Yet no matter what the cause, the woman is almost always the primary focus of treatment. If a man’s sperm count is low, his partner may have his sperm injected through intrauterine insemination, or her eggs might be harvested to combine with his sperm in the lab. 

As a result, men and women may respond differently to infertility. Women might process their feelings about what’s happening in their bodies outwardly—whether through tears or simply wanting to talk. 

Seeing grief, anger, and other strong emotions may make a man feel powerless, as there’s little he can do to fix the problem. “The most painful part is seeing the person they love more than anyone in the world in so much pain,” said Gretchen Sewall, a registered nurse and licensed clinical social worker at Seattle Reproductive Medicine. Men may put their energy into work, exercise, and other pastimes, needing to feel productive and in control.

In the heterosexual couples that Sewall sees at the fertility center, men are often very focused on protecting their family. Infertility threatens that very family unit they work so hard to shelter. 

Even though much of Kendall’s professional work focused on women’s health and well being, he fell into a typical male role, and struggled to support his wife while dealing with his own emotions. At times, he felt ambivalent about having more children. At the same time, he realized his wife—whom he’d only seen in her role as an accomplished, high-level professional—also considered having children to be a critical part of her identity. “While you’re going through infertility together, it really does feel like you’re stuck in your own silos,” he said. 

For lesbian couples dealing with infertility, other challenges can arise. Sometimes couples come in where one partner wants to be the one having the baby; the non-gestating partner may need support defining what her role is, because she’s “not simply like a dad,” Sewall said. A woman struggling with fertility can become jealous of and competitive with a partner who can conceive easily. (Male couples can also be confronted with fertility issues if a surrogate has a miscarriage—what seems like an adventure into parenthood can become a much harder process.)

Struggles like these can try any relationship. One strategy is to plan 20-minute sessions in which the couple talks about what they’re going through—both talking, both listening, both responding to the other’s concerns. After those 20 minutes, the couple doesn’t bring up the subject until the next designated time. 

Only after his wife became pregnant after five rounds of IVF did Kendall realize that they’d been on a long journey during which most of the attention had been focused on her—“and rightly so,” he said. Looking back, he thinks that had he been more aware of the importance of finding support for himself, he would have been better able to help his wife. 

Both Sewall and the staff at Resolve have noticed that, in relationships with a solid foundation, infertility can often strengthen a couple’s bond, while in partnerships with problems, on the other hand, infertility can expose the fault lines. While Kendall and his wife are just beginning to deal with some of the issues that infertility brought up in their relationship, their commitment to each other is stronger than ever, and the joy that they share in their young son is “just immense,” he said.

And revealing their deepest fears and grief can often show a couple just how strong they are. Sewall recalls a session in which she asked a husband and wife to tell each other three things they really needed from the other person that day—anything at all, from making dinner to better listening. The woman looked at her partner and told him there was only one thing, and she’s been embarrassed to ask, because she was worried he would be too hurt: that he be there to hold her hand while she was inseminated with donor sperm. And the husband replied that he had ben worried about embarrassing her, but that’s exactly what he wanted, too.