Children are the essence, the core, of the traditional family. Traditionally and historically children have been prescribed, and frequently desired. Historically as well as today, children are seen as a necessity for carrying a family's name into future generations. They are a gateway for parents, families, and adults to escape back to that time of innocence and the kind of fun and careless joy it produces. For parents to go back and create a world for their child full of all the best things of their own childhood. A world with lots of room for the inclusion of new things and ideas that these new co-inhabitants will bring to this time of childhood. In a sense, it is a time of immortality.It follows then that when a couple is unable to have a child, this could be a tremendous source of stress. Those who are unable to have a child through the natural birth process are considered infertile.

What is infertility?

For a fertile couple in their twenties, having regular unprotected sex, the chance of conceiving each month is only 25 per cent. So how do you know when something is amiss? The answer depends on how old you are. While the man's age is thought to play a role, the medical definition of infertility focuses on the woman.
NA woman under 35 is considered infertile if she fails to become pregnant after 12 months of regular unprotected sex. But for those over 35, the threshold is six months instead of 12. There are of course degrees of infertility. The majority of infertile couples are actually sub fertile. They produce eggs and sperm but have difficulty conceiving due to disorders such as hormone imbalances and problems of the reproductive tract. Cases of total infertility where no eggs or sperm are produced are rare.

Emotional experience
The long term inability to conceive a child can evoke significant feelings of loss. Coping with the multitude of medical decisions and the uncertainties that infertility brings can create great emotional upheaval for most couples. If you find yourself feeling anxious, depressed, out of control, or isolated, you are not alone.
Infertility is the gradual death of a dream. As one young woman put it, 'Each time my period comes it's like a little death. I cry, or worse, feel numb.' 
Though the roles of men and women are changing today, for men who see their primary role in life as working outside the home, the loss related to infertility is the loss of a secondary role: that of being a father. But for women it is the loss of a primary role, that of being a mother.

Psychological impact on the self
The woman often feels she is not a total woman. It is the loss of a self-image. It is the loss of the pregnancy and birth experiences, the loss of emotional gratification surrounding pregnancy and birth. The depression and anxiety experienced by infertile women are often equivalent to that in women suffering from a terminal illness; some women were heard to say while terminal illness is short term, infertility is long-term - for a lifetime.
Apart from the emotional trauma, the woman continues to feel incomplete, disabled in some way. And if the cause for being infertile is identified, the concerned person carries a load of guilt right through his / her married life. The husband with male-factor infertility may link his sense of manhood with virility. It is understandable, therefore, that when a man is given a diagnosis of infertility, his identity as a man suffers a real setback.

Impact on physical intimacy
What was once a source of emotional intimacy often becomes ?love by the calendar?. It loses its magic during infertility treatment, because it must be executed or withheld regardless of mood. There is a constant feeling of inadequacy - a shadow between them. The focal point of the relationship becomes the fact that she cannot conceive and it overshadows all the other areas. It isolates the couple from the immediate and extended family and also the society at large.

Impact on the marriage
The couple often goes through incredible disappointment, shame, pain and blame. Very rarely are both the parties responsible for infertility. The guilty party either ends up feeling depressed and wants to move out of the marriage or else goes all out to strengthen other areas of intimacy in a marriage. But very often it is about the loss of privacy and the breakdown in communication and then sometimes permanent loss of the joy of sex. It is about higher-than-normal divorce rates or marriages that just never regain their intimacy. This is about life and death. And even when there is life, the marriage often still suffers a death.

Impact on the extended family
There is also the feeling that they would never be able to give their parents grandchildren. One woman wrote, 'I was keenly aware that I could not share with my mother the joys of being a parent. It dawned on me that although infertility was my experience and my loss, perhaps it was a loss for her as well. The child that my husband and I dreamed of...would also be an extension of our family-someone's niece or nephew, grandchild and cousin. This would be the ultimate gift to share with our family: a child'.

Impact of unasked-for advice on the couple:
Perhaps you are one of those who have been hurt and have decided to give up on trying to conceive and move on. What can be most distressing is when you are frequently given suggestions as to what you can do about it from friends and strangers who you meet.

Even if a couple decides to remain silent about it there are constant reminders and enquiries as to why they have not yet had children. Clearly, infertility can be like a moral maze full of constant turns and decisions and dead ends.

For those of us who know someone who is struggling with this issue, perhaps we should take a moment to be sensitive to their pain and be there for them and listen to them but definitely keep any suggestions or advice to ourselves and allow them to make their choice as to which road they would like to follow.

Reasons to seek help:
The waiting period, while you keep anxiously hoping that there would be a chance that you will conceive could be quite stressful. The physical intimacy that you once desired and shared will now remind you of the emptiness and a feeling of inadequacy. The treatment and procedures are something only a medical professional can handle but as you go through the process, the pain and despair could create a distance between husband and wife. The bond you once enjoyed with your partner may no longer be there.

The loss and grief of not being able to have a child naturally is very real. We cannot change the circumstances, but you could rediscover the love you once shared with your partner by talking to a counselor and seeking for help for grieving for your loss and look beyond it to see that there is life, love, laughter and joy even in spite of the loss.