Breaking the silence: prioritize your mental health during fertility treatment

Since fertility issues are often kept private, some people may not realize just how common they are. Research suggests that about 19 percent of women between 18 and 44-years old and 9 percent of men experience problems trying to conceive. This may contribute to a range of emotions—with waves of excitement, worry, guilt, sadness, disappointment, grief, and more. Feeling alone during this time can make the ups and downs even more intense.

While your healthcare provider (HCP) can talk to you about the medical advances that have helped many people start or expand their family, it is also important to prepare for or acknowledge the mental health aspects of fertility treatment. There are no right or wrong feelings, and everyone’s experience is different, according to Angela Lawson, PhD, a psychologist who specializes in women’s reproductive health at Northwestern University’s Feinberg School of Medicine in Chicago, Illinois.

Understanding there may be highs—and lows

Unlike treatment for other common health issues, fertility issues may feel uniquely personal. Some people may imagine their path to parenthood, and it may not include medical intervention to conceive.

For some, these challenges may cause feelings of inadequacy or even shame. “Many people who struggle to have a child either before or during fertility treatment also report feeling unnecessary guilt,” Lawson says.

It’s also common for people to feel sorrow if they wanted to avoid fertility treatment or if they do not get their desired outcome—conception or biological parenthood, Lawson says. Others may be anxious about the uncertainty or angry about the perceived unfairness, she points out. Why does conception come so easily for some but not others?

The range of emotions may also vary depending on someone’s past experiences, health history, and other individual variables, Lawson adds. For example, research suggests that anxiety and depression can stem from related factors, such as managing endometriosis—a chronic and often painful condition that may cause infertility.

How fertility treatment, itself, may affect mood

Some fertility medications may result in hormonal shifts, which can also lead to mood swings. Treatment can contribute to depression and anxiety, particularly among those with a history of these mental health conditions. Some people who effectively manage these issues with the help of talk therapy and medication may experience a worsening of their symptoms while facing fertility challenges or undergoing fertility treatment.

The duration of fertility treatment may also contribute to stress and anxiety. It takes time—one round of In vitro fertilization (IVF) (an egg is combined with sperm outside of the body in a lab) may last four to six weeks—and many people need more than one round. While the uncertainty of starting treatment may be stressful, comparisons between people undergoing repeated IVF cycles and those undergoing their first round of treatment suggest that ongoing treatment may lead to an increase in symptoms of depression.

Grief may also arise during treatment, resulting from unsuccessful attempts, pregnancy loss, and the very personal decision to either try again or move on.

Anxiety may persist—even beyond treatment

The news that fertility treatment has succeeded in establishing pregnancy may lead to relief, happiness, or other positive feelings for some people, along with a reduction in anxiety and depression. But unexpected feelings may also arise. For many, the emotional challenges of fertility issues do not disappear following conception or delivery.

“When treatment does work, people may be afraid that they will experience a pregnancy loss. The first trimester and the remainder of the pregnancy may be marked by intense anxiety,” Lawson explains.

Although some research suggests that anxiety levels may decrease as pregnancy progresses, Lawson says that it’s not uncommon for people to ask for extra ultrasounds or blood draws to provide reassurance that the pregnancy is still healthy. But those extra exams or blood draws can, in turn, cause more anxiety, she adds.

For some people, high stress levels may continue beyond pregnancy, with some people experiencing fear of birth and continued anxiety—even after delivery.

“The birth of a healthy child does not necessarily mean this anxiety will vanish,” Lawson says. “In addition to the expected new parent anxiety, people who had to fight to have their child by undergoing fertility treatment still may fear that their joy will be short-lived and that something bad will happen to their child.”

Worrying about stress—a double whammy?

Stress or anxiety stemming from fertility treatment may be exacerbated by the belief that stress causes infertility or reproductive loss, Lawson says, noting it may lead some people to feel that their difficulty in becoming a parent is somehow their own fault.

It’s clear that fertility challenges contribute to stress, but there isn’t clear evidence that stress causes infertility, she points out. In fact, a systematic review and meta-analysis of existing research published in Human Fertility (Cambridge) in 2022, analyzed the results of past studies that looked at the relationship between emotional health and outcomes of assisted reproduction. While researchers found a potential link between male anxiety and decreased sperm motility, they found no significant relationship between the emotional health of women before they started fertility treatment and outcomes of treatment, including pregnancy and live births.

But certain studies may be limited by self-reported stress levels among participants, leading to mixed results. And there is some evidence that strategies used to help ease psychological distress are associated with increases in pregnancy rates.

So while this remains an area under investigation, what we do know for sure is that stress takes a toll on the body in a variety of ways. So, taking steps to manage or relieve stress can help ensure you’re getting enough sleep, eating a healthy diet, and getting physical activity—all of which can help protect your health and well-being, and potentially support a healthy pregnancy.

“I recommend people speak with a qualified healthcare professional who can provide counseling about the myths and truths surrounding fertility,” Lawson says.

Finding the support you need

When coping with the emotions of fertility treatment, many people benefit from individual therapy with a reproductive mental health professional throughout the process, including pregnancy, Lawson advises.

“I recommend that people going through fertility treatment receive counseling from a mental health professional who belongs to the Mental Health Professionals Group of the American Society of Reproductive Medicine (ASRM) and has received specialized training in reproductive mental health,” she says, noting that those who are experiencing intense psychological distress should speak with a reproductive psychiatrist to discuss medication options that are safe to take during fertility treatment and pregnancy.

Lawson also advises being very selective in what you choose to follow or see on your social media feeds. It may be helpful to build an online community of people who help you feel supported. This may include following those who are experiencing similar challenges or have in the past, and limiting your exposure to accounts that—for whatever reason—may make you feel sad, worried, or more anxious. For example, if you are anxious about being able to sustain your pregnancy, it may be wise to avoid an account that documents a recent pregnancy loss.

Research also suggests that mindfulness meditation is an effective way to help manage chronic stress related to fertility challenges. Mindfulness involves greater awareness that comes from paying attention, on purpose, non-judgmentally, in the present moment. As a coping skill, this form of meditation can help people shift how they perceive situations—they are not “infertile,” they are “experiencing issues with conception.”

“Lastly, I encourage people to reach out to supportive family or friends who can help provide emotional support,” she says. “I also recommend people share their feelings of grief and anger as a way to help them cope.”

If you do not have a spouse of partner, or you are not able to get the support you need from family or friends, participating in a group intervention with other people who have been through fertility treatment may also help. An analysis of 30 studies on this topic, published in Health Psychology Review in 2022, found that group psychological interventions for people participating in fertility treatment were associated with significantly improved depression, anxiety, fertility stress, marital dissatisfaction, and pregnancy rates.

Information about in-person and virtual support groups for people coping with the emotions surrounding fertility treatments can also be found at RESOLVE: The National Infertility Association. RESOLVE and Family Equality, national organization for current and future LGBTQ+ families, also provides information on safe, affirming support groups for LGBTQ+ people attempting pregnancy.

Lawson also recommends support groups run by members of the Mental Health Professionals Group, a professional group run by the ASRM. You can ask your HCP, fertility specialist, or local Planned Parenthood health center how to find a trained therapist or support group.