Mental Health and Emotional Well-Being During Infertility

Whether you are trying to conceive (TTC) or pursuing in-vitro fertilization (IVF), infertility can become a serious strain on your mental health and emotional well-being. In this article, we look at the reality of the strain of infertility and ways to cope during this time.  

Infertility: A Common Challenge

If you are having difficulty conceiving, you are far from alone. With over 6 million pregnancy-challenged couples in the U.S., this is a well-traveled -- if sometimes bumpy -- road.

Fortunately, medical advancements and practices have made it possible for many people to overcome infertility and achieve the family of their dreams. Assisted reproductive technology has moved light-years forward in the past few decades, delivering the miracle of life to over 10 million babies. Also, mainstream awareness of infertility as a commonmedical challenge has improved dramatically.Despite these progressions, one study suggests that the psychological impact of an infertility diagnosis is comparable to a diagnosis of cancer. It is typical – and perfectly normal -- for anyone to have a difficult emotional reaction to infertility.

The Challenge of Waiting and Uncertainty

Battling infertility can bring physical challenges, such as pregnancy losses, failed cycles, medications, and medical procedures. There may be a gauntlet of tests, calendars, doctors, and pills.Yet most people feel that it is really the uncertainty of infertility that presents the greatest challenge. Infertility can involve long periods of waiting combined with the ultimate fear of not being able to build your family or provide for your partner. You may have to sit with this discomfort for long and indefinite periods of time. It is common for those struggling with infertility to grapple with depression and anxiety.

Mental Health and Infertility

Infertility and Depression

One U.K. study found that 90% of people facing infertility reported experiencing depression.You may be experiencing  clinical depression (also known as major depression) if you exhibit at least five of the following symptoms for more than two weeks:1. Depressed mood2. Loss of interest/pleasure in everyday things3. Weight loss or gain4. Insomnia or hypersomnia5. Psychomotor agitation or retardation6. Fatigue7. Feeling worthless or excessive/inappropriate guilt8. Decreased concentration9. Thoughts of death/suicideDepression can be a painful condition in which your perception changes. You may begin to feel helpless and have a harder time seeing the possibility of ever conceiving. Infertility may seem like a life sentence rather than a temporary challenge.Depression also leads to changes in behavior. These can negatively impact your self-care, relationships, work, outlets, and other areas of life.

When to Contact Your Doctor

The onset of depression is not a medical emergency. In the U.S., over 10% of the population will experience major depression in a given year. 1 out of 6 Americans will experience depression at some time in their life. Depression brought about by life circumstances (like infertility) tends to resolve itself with time.If you have experienced five of the DSM-V symptoms listed above, you should mention this to your doctor. They can walk you through your options to find support and help monitor any worsening of your condition.If you are thinking about hurting yourself or suicide, you can call the National Suicide Prevention Lifeline to speak to someone who can help.

Infertility and Anxiety

Anxiety is another common source of discomfort when trying to conceive. Anxiety and depression occur together so commonly that clinicians call them “two sides of the same coin.”A common complaint among those struggling to grow their family is that their thoughts become dominated by infertility to the point of becoming overwhelming. This type of fixation and these intrusive, troubling thoughts can cause both depression and anxiety.

The Problem of Stigma

Infertility is not limited to women: male factor infertility accounts for about one-third of infertility cases. This is most often due to low sperm count.   Regardless of gender, everyone faces the challenge of stigma – both perceived and actual – because of fertility issues.Perceived stigma may be internalized from a young age. For women, entrenched, historically-based stereotypes suggest that they are primarily valued for their child-rearing ability. There may also be a complex about sexual inadequacy.Actual stigma only exacerbates these existing insecurities. A loved one that always asks, “When are you having children?” can make a family holiday a source of dread and fear.Stigma can lead to low self-esteem, guilt and shame. Even though both are patently untrue, those struggling with infertility may begin to think that there is something “wrong” with them or it is “their fault.”Another pervasive effect of stigma is for people to self-isolate and suffer insilence. Many fear being judged, invalidated, or embarrassed and are less likely to share what they are going through.

Does Depression Reduce Fertility?

The short answer is “no.”  While individuals may experience depression in relation to their infertility, several studies have concluded that depression and anxiety do not significantly impact the success of assisted reproduction.However, depression can have secondary effects on one’s behavior that could influence pregnancy attempts. Feeling helpless or shameful can discourage someone – perhaps even subconsciously- from pursuing all available fertility options. For those TTC, the tendency to isolate may reduce physical intimacy.Depression and anxiety can also bring about lifestyle changes, like overeating, missed sleep, or difficulty in being productive or active. These can all contribute to a cumulative deterioration of health and overall well-being. If you are not feeling physically healthy, it may be harder to find the courage and resilience to help you get through the trials of assisted reproduction.

Side Effects of Fertility Medications

Though far less serious than the aforementioned concerns, you may also experience some side effects if you are taking fertility medication. The most common are:·   breast tenderness·   hot flashes·   headache·   upset stomach·   bloating·   mood swingsFertility drugs may also involve health risks, most notably:·   Multiple pregnancies·   Ovarian hyperstimulation syndrome (OHSS)These effects will vary significantly by the drug taken, the dosage, and the individual. Your doctor can walk you through medication considerations.All of these potential side effects and health risks are not welcome news to anyone already managing anxiety and other infertility-related health concerns. However, these medications are all FDA-approved and have a proven track record of successfully helping achieve pregnancy. The benefits are considered to outweigh far the potential side effects and risks of these medications.On the other hand, fertility medications may offer a subtle boost to your mental well-being: they can provide peace of mind that you are doing everything possible to achieve conception.

Finding Infertility Support

Research has shown that participation in counseling that teaches coping tools for managing infertility-related stress is associated with significantly reduced emotional distress and even increased pregnancy rates in response to fertility treatment.  

Finding Personal Support

Professional one-on-one counseling can help you become more aware of your mental state and develop strategies for dealing with difficult emotions. A counselor with experience and specialized training in helping with fertility challenges is the ideal type of therapist to help, though many different types of therapeutic professionals can help. These include psychiatrists, psychologists, social workers, nurses, and life coaches. One-on-one therapists are particularly useful when you feel withdrawn or are having trouble communicating what you are feeling.

Group Support

Connecting with others is the best way to beat the stigma, secrecy, and isolation that so often make infertility painful.Research has consistently shown that group therapy – sharing your experience in a safe, non-judgmental forum – is one of the most effective forms of therapy available. Some groups may be led by professionals, while others are organized by members. In a cohort of people with the same fertility struggles, participants are typically eager to share their experiences and pool together information, including how they have coped with various infertility-related challenges. Within these support groups, powerful, lasting relationships are often formed.

Partner Support

If you are in a relationship with a significant other,  support from your partner is critical throughout this process. Depression and infertility-related stress can result in distancing and reduced communication. Couples therapy is a healthy way to improve communication in a constructive, mediated space.Some are surprised to find that their partner may be feeling helpless, worried, or upset – yet doesn’t feel like they should keep this to themselves so they can be “strong” for you. Even more of a surprise may be that your partner wants to better support you -- but doesn’t always know how. Therapists can help identify the best ways for partners to support one another.When someone we care about is experiencing difficult emotions, our first instinct may be to try to “fix” the situation. But often, what most people need most in these times is empathy - to be heard, without judgment, by someone who cares.A therapist can help you practice empathic listening. This can help partners validate one another’s feelings without trying to change them. Simply listening to your partner can be the best medicine of all.

Web Resources

A good starting point to learn more about support options is this fact sheet from the American Society for Reproductive Medicine.The National Infertility Association offers a wealth of coping techniques and practical tips, such as scripts that can help you prepare for – and no longer fear – conversations with family members about future children.