The Role of Blame Attribution in Infertility-related Depression, Anxiety and Lower Marital Satisfaction

The role of blame attribution in infertility-related depression, anxiety and lower marital satisfaction

Infertility is defined as the failure to conceive within 12 months of unprotected and regular intercourse. In Singapore, about 15% of its couples experience difficulties in conceiving. Statistics show that an increasing number of couples are turning to assisted reproductive technologies to conceive (Teo, 2016). This trend is partly due to more individuals in Singapore choosing to start having families at a later age, after completing tertiary education and seeking to obtain financial stability beforehand.

As a psychologist providing couple therapy, I have noticed the trend of an increasing number of couples coming in for fertility-related adjustment issues- catching up with issues such as poor communication and infidelity. The current research paper discussed sheds some important light on how couples adjust when faced with difficulties in conceiving.

In the study, 279 couples seeking treatment in two fertility clinics in Canada were recruited to understand the relations between blame attribution (self-blame or partner blame), with psychological adjustment and marital satisfaction (Peloquin, Brassard, Arpin, Sabourin & Wright, 2017). The results of the study were published in the Journal of Psychosomatic Obstetrics and Gynecology. Participants were asked to complete three self-report questionnaires measuring (i) blame attribution for the fertility problem, (ii) psychological distress experienced (assessing four domains: anxiety, depression, hostility and cognitive disturbances) and (iii) marital satisfaction.

The results revealed certain gender differences. Women are significantly more vulnerable to blaming themselves with regard to the fertility issues, although there are no gender differences in blame attributed to the partner.

In both genders, the higher level of self-blame attributed, the more depressive and anxiety symptoms experienced. Elevated levels of self-blame in men are also associated with poorer relationship satisfaction. Self-blame in women predicted more anxiety and depressive symptoms in their partners.

Interestingly, blaming the partner for the fertility issues by the men did not influence psychological adjustment or marital satisfaction. On the other hand, partner-blaming in women is associated with lower relationship satisfaction in both parties, as well as increased symptoms of depression.

The results of the study bear important clinical implications for medical practitioners, such as gynecologists and psychologists, highlighting the potential negative impacts on the mental well-being and marital satisfaction of couples facing infertility. Although the causes of infertility are largely physiological in nature, it is certainly important to address the emotional and psychological toll on the couples.

Diamond & Jaffe (2010) highlighted that couples struggle to cope psychologically with infertility as it is a complicated process of grieving- an invisible loss. Unlike the loss of a loved one in the case of death, couples struggling to conceive are facing a loss of opportunity. For example, they may find it difficult to accept that their vision of how they would bring up their children together, or going on holidays with little ones in tow, may not become reality.

Seeking couple therapy from a psychologist can support the couples in several manners. Rebuilding the connection between the couple is often much needed when I see cases of couples dealing with infertility. On top of the negative consequences of partner-blaming highlighted by the study, intimacy is also affected. Sex becomes more of a task that needs to be “checked off the list” instead of love-making. Poor communication and quarrels are also a common feature. Thus, therapy provides a safe space for the couple to be open and improve their communication.

Psychological therapy would also seek to assist the couple to effectively cope with the negative emotions experienced, buffering the couples from falling further into depression and anxiety. I believe that this support is especially important in the Singapore culture, where there is a tendency to blame women for infertility, even though the likelihood of infertility issues are similar for both genders.


Diamond, M., & Jaffe, J. (2010). Reproductive Trauma: Psychotherapy With Infertility and Pregnancy Loss Clients.

Péloquin, K., Brassard, A., Arpin, V., Sabourin, S., & Wright, J. (2017). Whose fault is it? Blame predicting psychological adjustment and couple satisfaction in couples seeking fertility treatment. Journal of Psychosomatic Obstetrics & Gynecology, 1-9.

Teo, J. (2016, March 22). More Singapore couples getting help to conceive. The Straits Times.

Muhammad Haikal Bin Jamil

About the Author

Haikal received his Master degree at the National University of Singapore (NUS), under a full scholarship awarded by the National Council of Social Service (NCSS). Before entering private practice, he has gained much experience in both hospital and social services settings.

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