INTRODUCTION:

Motherhood has been defined as a transcendental state¹. The transitional process to maternity is reached through conceiving, carrying a pregnancy and giving birth. Family is the most important unit and is considered as a mini-commune. For women childbearing is associated with stabilizing their marriage and closer bonds with his family.

Psychological crisis may occur when reproduction appears impossible.

Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse². In case of a woman, it is inability to conceive, while in case of a man it is the inability to procreate.

Background:

Globally 48.5 million couples and 186 million individuals live with infertility³. Estimates suggest that approximately one in every six people of reproductive age worldwide experience infertility in their lifetime².On an average 60-80 million couples in world suffer from infertility every year, among these 15-20 million (25%) are in India alone. It is a global public health problem with high prevalence in South Asia. According to World Health Organization estimate the overall prevalence of primary infertility in India is between 3.9 to 16.8%⁴.

The prevalence of primary infertility in south India is about 12.6%. The states, namely- Goa, Kerala, Karnataka, Tamil Nadu, Telangana, Sikkim, Delhi, Himachal Pradesh and UTs- Lakshadweep, Daman and Diu, Andaman & Nicobar are having a high prevalence of infertility (above 20%) and low fertility rate below 2⁵.

Based on the Census 2011 data, the expected level of infertility for Kerala was approximately 6.1 percent among ever married women while the expected level of infertility among women in the age group 45-49 is 5.8 percent. The northern district like Malappuram (6.8%), Kasaragod (6.4%) and Palakkad (6.4%) have a higher expected level of infertility which means that a higher proportion of women in these districts were childless as they complete their reproductive ages. From the southern region, Thiruvananthapuram (6.2%) and Thrissur (6.0%) also have higher expected levels of infertility compared to other districts in this region⁶.

For most couples, infertility is a serious issue leading both partners to experience loss in ways that impact them as people, as family members, and as members of society throughout their lives². Although both women and men can experience infertility, women in a relationship with a man are often perceived to suffer from infertility, regardless of whether they are infertile or not. In some situations, the fear of not being able to conceive might discourage both men and women from taking contraception if they feels pressure from society to demonstrate their fertility at a young age due to the high social value placed on bearing children⁷. Women with fertility problems experience multiple changes in the normal course of their lives, leading to physical, emotional, psychological, sexual, spiritual, cultural and even social problems.

Therefore, in the present review, the main problems that a woman who try to conceive faces and how it affects her fertility life are discussed.

Physical Problems:

Pain during sex, or dyspareunia, heavy, painful periods, Having an irregular cycle, unexplained weight gain⁸, severe acne, cold feet and hands, reduced sex drive or loss of sexual desire⁹, nipple discharge, facial hair in females, thinning hair on the top of the head can be a sign of an underlying health problem that may influence a woman’s fertility¹⁰. Eating disorders such as anorexia nervosa, bulimia nervosa and obesity were also noticed among infertile women¹¹.

Psycho-Emotional Problems:

Parenthood is one of the major transitions in adult life for both men and women¹². Infertile couples are subjected to greater stress and have a greater risk of developing psychological disorders compared with normal, healthy couples. The relationship between infertility and psychological stress is complex. Typical reactions to infertility include shock, sadness, depression, anger and frustration, hopelessness, loss of self-esteem and self-confidence and a general loss of sense of control. Both men and women experience a sense of loss of identity and have pronounced feelings of defectiveness and incompetence¹³. Guilt, frustration, insecurities, turmoiland worthlessness in life are few feelings that start hovering in the mind of an infertile female¹⁴. Unhappy and nervousness was also reported among majority of females¹⁵. The most prevalent diagnoses in women with infertility in Japan was anxiety disorder (23%), mild depressive disorder (17%) and dysthymic disorder (9.8%)¹⁶. in another relevant study, mood disorders were reported to be 3.4 times higher and anxiety disorder 2.7 times more widespread in the infertile group of patients¹⁷.

Social Problems:

Women faces social blame, stigma and being targeted for her role failure. from their family and community¹⁴. Faces threats of divorce or polygamy, harassment, and communal ostracism, relationship instability/divorce, intimate partner violence, Lack of financial support from in laws and no power of decision making, disagreements with extended family members leading to isolation and discrimination¹⁸. social isolation and stigma can lead to secrecy, as couples may choose to keep their infertility journey private to avoid societal judgment. The reluctance to seek support or discuss their struggles can further isolate individuals and hinder their ability to cope effectively¹⁹.

Sexual Problems:

Sexual intercourse may be considered more as a task rather than a natural interaction. Low frequency of intercourse and sexual pleasure were lost during infertility therapy, the enjoyable experience of sexual intimacy may be adversely affected and this may lead to marital distress²⁰. Arousal disorder, libido disorder²¹, coital pain, lubrication disorders found significantly as duration of infertility increases²². It was found that majority of women with infertility had negative sexual confidence, sexual dysfunction, associated with lack of knowledge about sexuality, inadequate sexual stimulation, and communication problems²¹, some feels reluctance, coldness, and stress²³.

Spiritual Problems:

Lost faith in God due to struggle of infertility²⁴, Some may interpret infertility as punishment from a higher power for past sins and indiscretions, may experience heightened levels of distress from feeling that their prayers for a child have gone unanswered, or from agonizing over whether to pursue a treatment that may be specifically banned by their religion²⁵. Disbelief, uncertainty²⁶, becomes pessimist²⁷ and exhausted with religious visits¹⁵ were also noticed among infertile women.

Cultural Problems:

Women are not allowed to join auspicious occasions, sometimes gifts and financial benefits received by women during marriage are taken away when she is diagnosed with infertility¹⁸. Humiliation and lack of offering finances, carrying burden of male infertility²⁴.

CONCLUSION:

The reproductive and child health programmes, however, do not adequately address the infertility issues in India⁵. Women who have no children are undergoing various issues which are not giving necessary attention by others. Their relatives and the social group where they belong to may deliver so many advices to them without understanding these women’s problems. They don’t understand how much these talks are making wound in those women’s mind. This distress may unknowingly affect the fertility functioning of the women. General public must be sensitized with these issues faced by the infertile women. Once we started to identify their issues we can help them to come out of their problematic shell. This may help them to conceive without any pressure or stress. Healthcare professionals need to understand all dimensional implications of infertility in order to provide counselling, treatment and referring women with fertility concerns for consultation and further treatment²⁴. Various coping strategies like exercises, yoga, meditation, journaling etc must be trained and informed to infertile women to overcome those problems.

CONFLICT OF INTEREST:

The author declares no conflict of interest in the study.

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Received on 30.10.2025 Revised on 19.12.2025

Accepted on 31.01.2026 Published on 30.07.2026

Available online from August 05, 2026

Int. J. Nursing Education and Research. 2026;14(3):260-262.

DOI: 10.52711/2454-2660.2026.00053

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