Coping With Infertility and its Emotional Toll
Authored by:
Anna Glezer, M.D.
Infertility for a couple is a highly stressful life circumstance. It can last months to years, and the chronic stress has mental health repercussions. These consequences – depression and anxiety – are important to recognize because these conditions can impact both ongoing problems with fertility as well as fetal development and pregnancy outcomes once the couple is able to conceive.
To learn more about the impact of depression on pregnancy, see my article, Guide to Depression During Pregnancy.
Causes of Infertility
There used to be a time, back decades ago, when it was thought that psychological problems themselves were the cause of infertility. We now have a number of difference medical explanations, and most commonly, infertility is a combination of male and female factors. However, the reason for a couple’s infertility can be difficult to find, and the treatments are nowhere near certain. This often leads to a sense of uncertainly that can last for years.
The stress of that uncertainty, coupled with repeated instances of hopefulness and hopelessness, can become a cycle of anxiety for a couple. Because of the stigma of infertility, many couples find themselves ensconced alone in this state.
Furthermore, the treatment for infertility can often include medications that have physical and emotional effects, though this will be discussed further in a separate article. Emotional distress is a reason some couples drop out of treatment.
Common Psychological Problems
A number of psychological factors arise with infertility. These include depression and anxiety (in about 3/4ths of women), marital conflict, sexual problems, and loss of self-esteem. One Swedish study found that a psychiatric diagnosis was made in almost 31% of women with infertility, the depression being the most common diagnosis.
In another study, women’s global distress was the same for infertility as it was for cancer and cardiac conditions. A higher level of stress affects many bodily functions. For example, it leads to an increase in the hormone cortisol, the increase of which can affect reproduction.
Yet a third prospective investigation followed couples for 18 months and found much higher rates of major depression compared to the general population, with an association between longer duration of infertility with depression.
Given the stigma of infertility and of mental illness, women whose fertility problems have led to mental health concerns might feel even more stigmatized.
Treatment Options for Psychological Problems
1) Psychotherapy
There is data supporting the positive effects of counseling on symptoms of depression, anxiety, and distress. Therefore, I would recommend that if you are struggling with symptoms of anxiety or depression, to seek counseling for an accurate diagnosis – the first step to treatment planning. If you have already begun the process of a medical work-up for infertility, the first place to look for this is the infertility clinic, as many have a mental health professional available for consultation. If you have not yet begun that process or your clinic does not offer this service, please see additional options for outpatient mental health counseling in the Resources section of this website.
2) Sex Therapy
Interestingly, one large study found that while psychotherapy might not significantly improve anxiety or depression, it improves pregnancy rates in patients with infertility. One potential reason why the psychological interventions improved pregnancy rates was that counseling can improve the sexual problems many infertile couples face. Simply put, if sex becomes regimented and scheduled, it becomes more of a duty or job rather than a pleasurable experience. That can lead to sexual problems including difficulties with arousal for women and men. Therefore, my next recommendation is to consider a couples counselor or one who specializes in sex therapy for those couples at risk or already struggling with sexual problems.
3) Time off
For some couples, work up, management, and treatment of infertility, particularly when it lasts years, can take over their lives. It is a significant time commitment, financial burden, and emotional toll. It can affect the relationship between the couples and other relationships in their lives, with some couples becoming more isolated from family and friends. Therefore, for some couples, I would recommend considering a break, however short, from the cloud that infertility can hang over a couple. This would be a time for each partner to reconnect with meaningful ways in which she (or he) used to define herself, so that “infertile,” does not become the definition.
4) Reach out for support
There are several advocacy and group support organizations that can help provide an open and safe space for couples going through infertility. Consider exploring what these organizations have to offer. I would recommend RESOLVE and the American Fertility Association.
Selected References:
Ramezanzadeh, F. et. al. Surveying of relationship between anxiety, depression, and duration of infertility. (2004) International Congress Series 1271: 334-337.
Hammerli, K., Znoj, H., Barth, J. The efficacy of psychological interventions for infertile patients: a meta-analysis examining mental health and pregnancy rate. (2009) Human Reproduction Update 15(3): 279-295.
Holley, S. et. al. Prevalence and predictors of major depressive disorder for fertility treatment patients and their partners. (2015) Fertility and Sterility 103(5): 1332.
Cousineau, T.M. & Domar, A.D. Psychological impact of infertility. (2007) Best Practice & Research Clinical Obstetrics and Gynaecology 21(2): 293-308.
