“Infertility,” my husband once observed, “is one of those topics you want to bury, and then bury the shovel.”

His perspective is hardly unique among those who have had to confront infertility head on. The diagnosis packs a devastating punch and cuts to the very core of what it means to be a man or a woman. Not surprisingly, it also elicits a sense of shame.

Why? Partly it’s the taboo thing. Sure you see plenty of breathless reporting about fertility advances and baby-making success stories, but dig deeper and you’ll find narratives that reveal a different kind of drama.

Today one is six couples seek treatment for infertility, and despite all the breakthroughs in reproductive medicine, one in 20 couples will not succeed.  In our society everybody loves a winner. Failure? Not so much. As a result, when Mother Nature and science find their limits on the conception front couples routinely find themselves at the end of a long, painful road without the social safety net and support that accompanies other equally devastating conditions.

“Infertility patients are as distressed as cancer patients,” Dr. Alice D. Domar explained in a recent interview. She should know. She has devoted much of her career to studying infertility and was recently involved with a survey conducted by GfK Roper Public Affairs for Schering Plough. The study found “women feel flawed and men feel inadequate” as a result of infertility.  The results also reported that 54 percent of couples feel overwhelmed; 20 percent of couples have contemplated divorce.

“The numbers here point to a very dramatic psychological need,” she said. “These couples are very distressed.”

With no readily available support network, many go online to find understanding. Search any infertility forum and you’ll find pseudonyms shielding those who sheepishly discuss their diagnoses and struggles.

“I have not seen a whole lot of progress in terms of people’s comfort level with disclosing the fact that they have infertility, and I've been in the field since 1987,” Dr. Domar added.  Compounding the problem, most couples are not adequately counseled about how to manage the stress they’re under. They also can’t count on a receptive audience.

“One of the reasons a lot of people don’t talk about it [infertility] is that they’re going to open themselves up to insensitive or stupid comments,” Dr. Domar noted with more than a little exasperation. In fact, the survey found the majority of people had not told anybody that they were seeking help for infertility. “We need to educate the public as a whole about how to better support people in their world who have infertility.”

Dr. Domar believes some parts of the world are more equipped to help than others. “Europe, in my opinion, is better about acknowledging the psychological interface than the America medical system is. There’s a massive disconnect in this country in terms of handling those with infertility.”

Those who don’t succeed with treatment are left to cope not only with feelings of failure and heartbreak, but at the extreme, discrimination. Among the blogs and forums are stories from women who have either lost jobs or had to quit due to hostile environments caused by those unable to identify with those at the less fruitful end of the fertility spectrum. One case involved a non-profit workforce development agency. A female boss fully aware of one woman’s extended, unsuccessful infertility treatment experience allowed an “uplifting poem” to be distributed around the workplace. Here’s what went down:

“In an effort to make women feel better about themselves a co-worker circulated a poem that told them to look at the empty lives of women who appeared to have it all. The poem listed three things that these women could have going on in their lives....they could have hell in their heart, be unable to have children, or be lonely. When I told [my boss] how upset it made me, she told me she didn't see it that way. We argued the point and I said that I wanted our Board to review it. The next day I was fired.”

In another case an office transfer had to be arranged after the workplace turned toxic. It seems a well-meaning but ham-handed male boss mishandled a request to tone down the office mommy and baby talk. Said the woman who wanted to be spared the daily blow-by-blow pregnancy updates, “You can just imagine how much fun it is to 'fess up to your infertility and its accompanying lack of emotional reserve to your (clueless) boss, who—for the record—up to that point had thought of you as a child-indifferent.”

So much for empathy from the “haves” to the “have nots.”

Ironically, today’s less tolerant, insensitive societal response is due in part to the perception that the fertility problem can easily be remedied through science. As a journal article, The Psychological Impact of Infertility, put it: “The medicalization of infertility has unwittingly led to a disregard for the emotional responses that couples experience, which include distress, loss of control, stigmatization, and a disruption in the developmental trajectory of adulthood.”

It doesn't require much to eliminate some of the stigma and misunderstanding. One way to do so is to learn more as part of National Infertility Awareness Week April 24- May 1. 

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Infertility has been called the “silent disorder,” and remains something of an ugly stepchild among diseases -- a curiosity considering the large numbers of couples affected: 50 to 80 million worldwide according to the World Health Organization, and in the United States, one in eight couples of child-bearing age.

 Pamela Mahoney Tsigdinos is the award-winning author of Silent Sorority: A (Barren) Woman Gets Busy, Angry, Lost and Found.