Infertility and Mental Health

When people find out that a woman is pregnant, there tends to be a deluge of congratulations, overwhelming excitement, and an abundance of anticipation and hope surrounding the news. While these are typical and kindhearted reactions – and very appreciated by many who share their good news with others – these responses often ignore the fact that some people struggling with fertility have endured a long, arduous journey. More specifically, many people who share their news about being pregnant may be filled with myriad emotions, which can range from joy to panic to guilt to excitement to fear, etc.

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In reality, conflicted feelings regarding becoming pregnant, being pregnant, and staying pregnant are much more widespread than many people realize, and it’s important to acknowledge that there may be various factors that are present with the announcement of a pregnancy.

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Before I begin to specifically discuss infertility and the ways in which that particular struggle tends to affect mental health, it’s important to note that there are many reasons why people may have a more difficult time starting a family. Those reasons include (though are certainly not limited to): women who are fertile yet require or desire a surrogate, people who want to engage in IVF for genetic or other medical reasons, gay and lesbian couples, individuals without a partner, women who become pregnant and struggle to hold a pregnancy or have complications, etc. It’s important to acknowledge that people have challenges for a multitude of reasons, and infertility is only one of the many challenges people may face.

Infertility Basics

Understanding some of the basics about infertility is an important place to begin this discussion. As the Mayo Clinic explains, infertility is defined as not being able to get pregnant for at least one year when actively trying to get pregnant. Infertility can occur for various reasons, and it may be a result of an issue with a woman’s reproductive system, the man’s system, or a combination of the two. 

Some of the causes of female infertility, which account for about a third of the cases, include: ovulation disorders, hyperprolactinemia, hyperthyroidism/hypothyroidism, uterine or cervical abnormalities, uterine fibroids, fallopian tube damage or blockage, endometriosis, primary ovarian insufficiency (otherwise known as early menopause), PCOS, infections, autoimmune disorders, and cancer/cancer treatments. Some causes of male infertility, which account for another third of cases, include: abnormal sperm production or function, problems with the delivery of sperm due to sexual problems, overexposure to certain environmental factors (e.g., cigarette smoke, alcohol, marijuana, anabolic steroids, or taking medications to treat bacterial infections, high blood pressure and depression), liver or kidney disease, genetic diseases, and damage related to cancer and its treatment. As noted above, the remaining one-third of cases tend to remain unexplained or a combination of the aforementioned factors. Since it’s such a complicated medical topic, it’s always best to seek guidance and treatment regarding fertility concerns from a Reproductive Endocrinologist, such as Dr. Edward Nejat of Generation Next Fertility.

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“The journey a woman takes to overcome fertility challenges and not only become pregnant but maintain a healthy pregnancy and deliver a healthy baby certainly has its fair share of obstacles,” Dr. Nejat states. “Our team at Generation Next Fertility is dedicated to providing a strong support system to make that journey easier.”

How Infertility Impacts Mental Health

Although a lot of people may know that infertility is a common problem, with roughly 10% (or about 6.1 million) of women in the US having difficulty becoming or staying pregnant, many people are still unaware of the deleterious effects that struggling with infertility often has on a family’s mental health. More specifically, there has been research that demonstrates that the emotional toll of infertility experienced by women is akin to coping with a physical illness, such as HIV, chronic pain, and cancer. Likewise, men have been found to struggle with anxiety, depression, and sexual dysfunction when faced with infertility within the family (i.e., regardless of who in the couple is struggling with infertility). 

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Moreover, given the societal and external pressures to start a family, individuals struggling with infertility may feel additional stress from well-meaning family, friends, or even strangers during the process.

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Oftentimes “helpful” suggestions are offered on how to destress, eat the right diet, not worry so much, or try a new tactic to become “magically” pregnant. For many people, they have tried most of the recommended ways to become pregnant and/or they have their own reasons for forgoing treatment or taking a different path to build a family. Therefore, when external pressure from others includes opinions about what one “should” be doing and why efforts are not quite enough, it can often lead to one or both members of a couple feeling like they are failing, broken, empty and/or inadequate.

How Stigma Surrounding Infertility Affects Mental Health

It’s also important to note that infertility is unfortunately still shrouded in shame and stigma. Many women and their partners may not feel comfortable talking about their experiences or struggles with others for fear of being judged, embarrassed, pitied, or even discriminated against. This may be partly due to infertility being a highly misunderstood topic by many people who have not experienced it and partly because it triggers negative feelings related to being a “failure” in regarding to “living up to traditional gender expectations.”

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As a result, people struggling with fertility concerns may hide information from loved ones, who could otherwise be supportive and compassionate during a very difficult period. Additionally, silence begets silence, which often leaves people feeling as if they shouldn’t discuss their struggles openly - even if they are desperate to be seen and heard. 

Moreover, discrimination in the workplace for women going through fertility treatments is a major problem, as well. For one, infertility treatments are not always covered by all insurance plans, which leads to financial hardships for many women and families. Additionally, women usually have to take time off from work in order to attend appointments and endure treatments, which can bring about questions regarding their loyalty and commitment to their company. More specifically, as Harvard Business Review explains, “many women hesitate to share their infertility struggles because of concerns about its impact on their careers. According to a survey from Fertility Network UK, 50% of women did not disclose their treatment to their employer out of fear that the employer wouldn’t take them seriously and over 40% due to concerns about its negative effects on their career prospects.” That same survey from Fertility Network UK noted that more than 90% of people experienced feelings of sadness, stress, or depression during treatment, with roughly 42% experiencing thoughts about suicide during their struggles with fertility. If one slows down and allows these numbers to truly resonate, it really helps to highlight the emotional struggle that infertility takes on women and their families.

Furthermore, societal discrimination can create feelings of sadness, grief, stress, and anxiety within the family unit that relate to: 

• Comparing oneself to others who have children
• Losing a sense of control over one’s future
• Worrying about the “clock” ticking away
• Not being able to pass on family genetics
• Feeling a loss of family stability
• Having to schedule time to be intimate with one’s partner, which can subsequently lead to marital distress
• Feeling excluded from family-oriented celebrations (e.g., baby showers, birthday parties)
• Not becoming a parent in a societally conforming, gender-normative way
• Struggling with what it means to be a man or a woman struggling with a body that won’t cooperate, which can lead to lower self-esteem and a fractured sense of self-worth

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And although many of these thoughts and fears may be objectively untrue, until the stigma that continues to surround the world of infertility debunks these myths more overtly and stridently, these destructive ideas will continue to flourish and permeate many people’s mindsets. As a result, couples may continue to hide their struggles with infertility and delay treatment for fear of facing a difficult or shame-filled journey to parenthood.

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In turn, this only acts to create additional stress, anxiety, depression, and frustration for so many people who need the very opposite environment to thrive and survive during fertility treatments. Taken together, the stigma and silence that surrounds infertility tends to leave people feeling alone and isolated, which can lead to subsequent mental health concerns, problems within relationships, and an overall sense of feeling defeated and hopeless.

How To Feel Supported During Infertility Struggles

Although there is no “one size fits all” approach to feeling supported while going through struggles related to infertility, there are certainly ways to be more compassionate to yourself and family. For one, seeking out a mental health professional who specializes in understanding the difficulties surrounding infertility is a great first step. As noted in the Journal of Human Reproductive Sciences, effective psychotherapy can help people with the following:

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• Better understanding of treatment and procedural information
• Enhanced communication between partners about their desires and difficulties
• Reframing what infertility means to a couple and how it affects their relationship
• Shifting unhelpful styles of coping
• Exploring long-term choices for various options
• Bringing awareness to other options (e.g., surrogacy, donor eggs, adoption)
• Exploring how reproductive technology can be helpful, but may not always be effective
• Redefining what infertility means to their identity 

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Additionally, joining informal support groups, such as those through Resolve’s network, can be instrumental in feeling more connected, less alone, and more supported during difficult times. Even Facebook groups or websites/apps such as What to Expect When You’re Expecting or The Bump have great forums that can connect you to other individuals struggling with similar concerns. It’s important to ensure you don’t feel alone in your journey, and these groups will allow you to connect with real people going through the very same struggles. 

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And as noted above, finding a supportive and nonjudgmental medical practice to help with your fertility journey is of the utmost importance, as well. The process can feel so much more difficult if one feels like a statistic or just another paycheck for a practice. As such, it's vital to find a doctor who helps you feel seen and heard, as well as one who treats you as a unique individual with specific needs. As Dr. Nejat from Generation Next Fertility explains:

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“In addition to the individualized treatment plans we create based on our patients’ specific set of needs and the wealth of knowledge we regularly share, Generation Next Fertility also has a passionate and committed team of Clinical Assistants that become our patients’ ‘Fertility Friends.’ They serve as a vital partner for our patients as they answer any questions they may have, help coordinate care, and be a much-needed resource for our patients throughout their fertility journeys.”

If possible, it's also helpful to receive support from friends and family during the process; however, it’s important to note that not everyone will be as compassionate or understanding as you may want. Therefore, taking time to become more aware of who may be more or less understanding about your situation is important, as well as realizing that some people may be well-meaning, yet still be unsure, awkward, or uncomfortable regarding how to react to your news and/or updates. Therefore, take all the time you need to figure out what you want or need from others, and then try to ask for it directly. More often than not, loved ones want to understand what is best for you; so if you can communicate it to them, it’s likely that they will be appreciative of the direction and more than happy to oblige. Again, some people may never be able to offer you what you need, and if that happens, it’s okay to take time and/or space from that person in order to take care of yourself during difficult times.

And most importantly, try to incorporate more self-compassion into your daily routine, as well as garnering a little extra compassion for your partner as you go through difficult experiences related to fertility. One area that people tend to struggle with the most during fertility treatments is the time between procedures (e.g., the weeks between an egg retrieval and waiting to learn whether any embryos are viable), so using mindfulness tools and breathing exercises can be extremely helpful for those extra anxiety-provoking moments. All in all, the challenges of infertility can feel endless and exhausting, and although it’s easy to let them take over your life, using mindfulness to stay in the moment can be extremely helpful for both your mental health and the outcome of your treatments.