What I Tell My Patients About Mental Health and Infertility

Infertility affects about 15 in 100 couples. It’s diagnosed if you haven’t gotten pregnant after a year of having vaginal sex without using birth control—or after 6 months if you’re over age 35. Today there’s a great awareness of the emotional impact of infertility and its treatments.

Anyone going through this experience may feel stressed, depressed, or anxious. If infertility treatment fails, there can be deep feelings of loss and grief. I’ve seen this personally as an ob-gyn and psychiatrist.

Here I’ll describe common emotional challenges related to infertility and the treatment process, along with my advice for finding help.

Coping with depression or anxiety

It’s common to start infertility treatment feeling that something is wrong with your body, or that your body has failed you. Then once treatment begins, worry and fear can set in.

Sometimes infertility treatments take several years. The longer the stressors last, the more impact they have on the brain and the body.

My advice: Talk with your doctor about treating depression and anxiety with medication and therapy. These treatments are proven to work. They are shown to decrease levels of depression and anxiety and even increase the number of successful pregnancies.

Antidepressant medications can help with both depression and anxiety. There are medication options that are safe and effective for when you are trying to get pregnant or when you are pregnant.

Therapy can be done one-on-one, with a partner, or in groups, where you’ll meet others with similar struggles. Just knowing that you’re not alone can be a huge relief. You’ll also learn how to deal with the ideas and thoughts that cause stress, anxiety, and depression.

Talk with your ob-gyn or fertility specialist about mental health before starting infertility treatment. If you already have symptoms of depression or anxiety, it’s best to get help before infertility treatment begins.

Healing relationship strains

Infertility and its treatment can be hard on relationships. One partner may want to stop treatment while the other wants to continue. One may want to adopt and the other doesn’t. Friends and family members can give unwanted or hurtful advice.

My advice: Before starting infertility treatment, I encourage couples to discuss what they will do if initial treatments don’t work. Would you ever consider adoption? Would your partner? You can talk through scenarios together, and it may help to consider couples therapy.

With friends and family, try to set boundaries with those who say things that bother you. If someone’s behavior keeps hurting you, you could limit contact or even end contact temporarily.

Addressing side effects of infertility treatments

Sleep disruption, mood swings, and irritability are some of the possible side effects from infertility medications.

My advice: Antidepressants and therapy can be helpful with some of these symptoms. Again, antidepressants generally are safe in pregnancy and during infertility treatment. Talk with your fertility specialist about all the possible side effects of treatment and options for managing them.

Coping with feelings of grief and loss

Getting pregnant may be a closely held dream or goal. It’s normal to feel grief and loss if you’re having trouble getting pregnant, especially if infertility treatments aren’t working.

My advice: Medication and therapy can be helpful, as can infertility support groups. You can share your thoughts with others going through a similar experience. RESOLVE, an infertility support website, has directories of local support groups led by peers or professionals.

Thinking about pausing or stopping infertility treatments

In some cases, your fertility doctor might suggest taking a break from treatment and coming back 3 to 6 months later. In other cases, there might be a reason to consider changing course (such as using donor eggs) or ending treatments.

My advice: Talk through the decision with your fertility specialist. Be open with your feelings and questions. Together you can discuss all the options, the science behind any recommendations, and how you want to move forward. This is also a good topic to bring to support groups, or to individual or couples therapy.

Remember

None of this is easy, but help is available to support you through the process. Getting the help you need can help you feel stronger, healthier, and ready to face what comes your way.

Copyright 2023 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.

This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.