Infertility affects 186 million individuals globally, or 8–12 percent of reproductive-aged couples.1 It is defined as the inability to achieve a pregnancy after one or more years of unprotected intercourse.2 It may also refer to a woman’s inability to carry a pregnancy to full term.3 Lifestyle and environmental factors, such as smoking and obesity, increase infertility risk and pregnancy complications.
While 15 percent of infertile couples have “unexplained infertility,” approximately 85 percent of couples’ conception difficulties can be linked to ovulatory dysfunction, tubal disease, and male factor infertility.4 In fact, males are responsible for 20–30 percent of infertility individually and are co-responsible for half of all infertility cases.5
Infertility is ubiquitous, affecting couples in every community and congregation, suggesting that infertility is a reality that pastoral families must navigate. Too many pastoral couples suffer in silence or are invalidated in their communities. Elizabeth Hagan states, “As a Christian pastor who battled infertility for eight years before making peace with a child-free life and then being surprised by an adoption opportunity last year, I often wondered: If I wasn’t the pastor, would I come to church during this difficult time? The answer on many occasions was no.”6
The Bible acknowledges the anguish and desperation of Rachel, who retorted, “Give me children, or else I die!” (Gen. 30:1),7 and the sorrow of Hannah, who “was in bitterness of soul, and prayed to the Lord and wept in anguish” (١ Sam. ١:١٠). The Bible also recounts the psychological toll of infertility in Proverbs ٣٠:١٥, ١٦, when it says,
There are three things that are never satisfied,
Four never say, “Enough!”:
The barren womb,
The earth that is not satisfied with water—
And the fire never says, “Enough!”
Often, the involuntarily childless pastoral couple wrestles with bitterness and resentment, along with confusion and thoughts of apparent “unfairness.” These feelings may be intensified as the couple notes the Bible’s characterization of fertility as one of the blessings for the obedient (Deut. 28:4–11) and infertility as a curse from God (v. 18; Num. 5:11–28; Lev. 20:20, 21). Pastoral couples may value reassurance that infertility is rarely connected with personal sins.
The psychological distress of infertility is significant and comparable to that experienced by persons living with cancer or heart disease.8 It often contributes to relationship distress, stress, depression, and anxiety. Moreover, individuals who are involuntarily childless also grapple with feelings of isolation because they frequently struggle in silence. Approximately 56 percent of women and 32 percent of men with an infertility diagnosis experience significant depressive symptoms, and 76 percent of women and 61 percent of men report elevated anxiety.9 It is associated with lowered self-esteem, relationship conflicts, and divorce.
Dealing with infertility in their personal lives can be particularly difficult for pastoral couples because of the comprehensiveness of the ministry call and congregational and community expectations. Pastors, according to 1 Timothy chapters 3 and 4, are required to have an experiential knowledge of and devotion to Jesus Christ and the Holy Bible; be consistently invested; be dutiful in pastoral administration, care, and nurturance; and serve as ambassadors of the church to the community. Pastoral couples experience relationship stressors, such as infertility, similar to their non-clergy peers. However, others expect pastors to provide temporal, moral, and spiritual leadership but not to express feelings of anger, frustration, or sorrow.10
This unrealistically high expectation of pastors and their families to maintain calm and composure in every situation can be internalized and contribute to clergy identity difficulties, increased clergy family problems, loneliness, and life and vocational dissatisfaction.
The church and community celebrate children and parenthood, and the emotional turmoil of infertility among congregants and spiritual leaders is frequently overlooked. Pastors are a key emotional resource for families. They are required to perform dedication ceremonies and counsel couples who are preparing for the arrival of a child, grieving over the loss of a child, or struggling with infertility, even while they grapple with their own unwanted childlessness.
Although the agony and emptiness of permanent infertility may resurface at different points of the life cycle, a ministry and church culture that empathically acknowledges and nurtures those in the grips of the journey can be transformative.
Couples may benefit from support as they navigate the grief that accompanies child loss and long-term or permanent infertility and decide whether or not to seek out and act on medical recommendations. However, the decision of to whom, when, and how the pastoral couple discloses their infertility and child loss experiences is very personal. Some will publicly share, while others may choose to keep the details of their infertility and child loss journeys private.
The danger of exacerbating the emotional turmoil of infertility or child loss and the resulting unwanted childlessness can be paralyzing and mute well-meaning efforts to provide encouragement and support. Established data confirms that interpersonal support has invaluable emotional and spiritual benefits for couples coping with unwanted childlessness and child loss.11 It is, however, important that individuals witnessing potential infertility difficulties listen with compassion and patience and resist the impulse to provide unsolicited advice.
It is critical to be mindful of inquiries about a couple’s family planning decisions since these prompts can be hurtful and triggering for those struggling with infertility. The counsel of Colossians 3:12 to “put on tender mercies, kindness, humility, meekness, longsuffering” is particularly pertinent given that some social events that pastoral couples are expected to attend and participate in, particularly those involving pregnant women or babies, may be difficult for some pastoral couples.
Couples who are curious about the physical nature of their difficulties may value a consultation, follow-up evaluations, and treatment with a gynecologist, urologist, and reproductive endocrinologist. Pastoral couples can participate in individual and couple psychotherapy with trained mental health providers to process feelings associated with unwanted childlessness and loss and explore coping resources. They can identify suitably trained therapists/psychologists and medical providers through their local conferences, national professional associations, or social or professional networks. Although couples with infertility and child loss may benefit from mental and physical health services at any stage of their journey, couples are encouraged to initiate treatment if they are experiencing chronic and debilitating feelings of depression and anxiety or feel overwhelmed to the point that their feelings interfere with their ability to attend to their daily living tasks and important relationships. Couples may want to seek mental health services when they need support exploring their options and available resources.
Most pastoral couples can benefit from a range of self-help and professional resources along with the support of family and friends. Books such as Toni Weschler’s Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health and Jody Day’s Living the Life Unexpected: How to Find Hope, Meaning and a Fulfilling Future Without Children are two of the many books that can offer information about the emotional and physical aspects of infertility. There are several Facebook and Instagram infertility support groups and other faith-based options that can reduce feelings of isolation and provide opportunities to pastoral couples to learn and share with others experiencing infertility, such as Hannah’s Prayer; Sarah’s Laughter; Christian Women; TTC, Pregnancy & Infertility; Resolve; The Bump; Hearts of Hope; Waiting for Baby Bird Ministries; and Babycenter.com.
The responsibility for creating emotional safety in our churches for couples grappling with infertility and child loss is shared. The church can be strengthened by health advocacy campaigns that focus on issues around infertility and child loss. This can be done by conducting Infertility Awareness weeks or days that include expert discussions on fertility needs and challenges, Walks or Runs of Hope events, gathering and providing local mental and physical health resources for infertility and child loss, and incorporating validating language and messages in our sermons and other programming to confront and eradicate misconceptions about infertility and child loss.
The agony of infertility can also serve as an impetus for mission and ministry within congregations and the wider community. Some pastoral couples on the healing journey may, of their own volition and in their own time, choose to establish ministries that spring from their experiences. They may have powerful insights because of their trajectory that allow for churches and communities that are emotionally safe and nurturing to families and individuals with histories of loss and infertility. It is, however, important that these couples arrive at this decision without the premature urging of others.
Permanently infertile pastoral couples can lead satisfying and fulfilled lives and ministries as they rediscover meaning, worth, and purpose and gradually adapt to life without their own biological children. This journey often includes discovering work and hobbies and may include engaging with and investing in other relationships with children of relatives and friends.
These efforts will go far in including and nurturing those who feel marginalized by their histories of long-term or permanent infertility and child loss and fulfill the admonition of 1 Peter 4:8 to “have fervent love for one another, for ‘love will cover a multitude of sins.’ ”
- Mélodie Vander Borght and Christine Wyns, “Fertility and Infertility: Definition and Epidemiology,” Clinical Biochemistry (Dec. 2018): 2–10, https://doi.org/10.1016/j.clinbiochem.2018.03.012.
- World Health Organization (WHO), International Classification of Diseases, 11th rev. (ICD-11) (Geneva: WHO; 2018).
- Marcy Maguire Lash, Afarin Yagnamee, William Strohsnitter, and Sasmira Lalwani, “Association Between Secondary Infertility and Fallopian Tube Obstruction on Hysterosalpingography,” Journal of Reproductive Medicine 5 (2008): 677–680.
- Sandra Ann Carson and Amanda N. Kallen, “Diagnosis and Management of Infertility: A Review,” JAMA 326, no. 1 (2021): 65–76, https://doi.org/10.1001/jama.2021.4788.
- Ashok Agarwal, Aditi Mulgund, Alaa Hamada, and Michelle Renee Chyatte, “A Unique View on Male Infertility Around the Globe,” Reproductive Biology and Endocrinology 13 (Apr. 2015), https://doi.org/10.1186/s12958-015-0032-1.
- Elizabeth Hagan, “5 Ways the Church Could Show More Compassion for Those Struggling With Infertility,” Time, May 22, 2017. https://time.com/4786683/church-views-infertility/.
- Scripture is from the New King James Version.
- S. M. S. Matthiesen, Y. Frederiksen, H. J. Ingersleve, and R. Zacheriae, “Stress, Distress and Outcome of Assisted Reproductive Technology (ART): A Meta-Analysis,” Human Reproduction 26, no. 10 (Oct. 2011): 2763–2776, https://doi.org/10.1093/humrep/der246.
- Lauri A. Pasch, Sarah R. Holley, Maria E. Bleil, Dena Shehab, Patricia P. Katz, and Nacy E. Adler, “Addressing the Needs of Fertility Treatment Patients and Their Partners: Are They Informed of and Do They Receive Mental Health Services?,” Fertility and Sterility 106, no. 1 (July 2016), 209–215, https://doi-org.ezproxy.ncu.edu.jm:2443/10.1016/j.fertnstert.2016.03.006.
- Lena Anne Brackin, “Loneliness, Depression, Social Support, Marital Satisfaction and Spirituality as Experienced by the Southern Baptist Clergy Wife” (PhD diss., University of Arizona, 2001), https://www.proquest.com/docview/304684904.
- Jennifer J. Bute, “The Discursive Dynamics of Disclosure and Avoidance: Evidence From a Study of Infertility,” Western Journal of Communication 77, no. 2 (2013): 164–185, https://doi.org/10.1080/10570314.2012.695425.