The grueling process of fertility treatments can take you on a roller coaster of emotions with more downs than ups. Innumerable doctor appointments, balancing schedules to accommodate them, invasive procedures, and timing physical intimacy with your partner to a specific schedule (how romantic… not!) can all take a toll on you mentally and emotionally.

Thankfully, there is no science behind the common misconception that mental health problems can affect your fertility—even though 70% of women believe it to be true. Even when your menstrual cycle is disrupted by physical or emotional stress, it tends to fix itself pretty quickly on its own.

Infertility is normally attributed to physiological factors such as age, previous physical conditions, or temporary interferences, which may explain why health practitioners tend to focus on the physical alone. The sad truth is that while stress does not cause infertility, infertility can definitely cause stress. More stress means you’re more likely to experience anxiety and depression, leaving you vulnerable during an already exhausting time. Those who experience recurrent pregnancy loss (RPL) are even at risk for more serious psychological problems, such as PTSD.

Today, we explore the often unspoken underbelly of emotional wellness in the face of infertility. With the proper tools, you can learn what to look for, when to get help, and where to find it.

How Infertility Affects Your Mental Health

Infertility can be treated in dozens of ways, from timing intercourse to drug therapy, surgery to in vitro fertilization (IVF). While these medical advancements give help and hope, they might also heap on additional stress, which may not be so easily diagnosed or treated.

As if infertility on its own wasn’t bad enough, you are also at-risk to experience these mental health inhibitors:

–       Financial Problems: It’s no secret that seeing the doctor can be expensive, especially if you are living in the United States. Only fifteen states mandate insurance coverage for fertility treatments and said coverage varies from plan to plan. Fertility treatments are not cheap, with the average IVF cycle and drug treatment costing between $11,00-$13,000.  That’s not even including the price of consultations from specialists. Even with insurance, the frustration of investing so much carries its own emotional tax. With finances listed as one of the leading causes of divorce, it’s no wonder that it can impact your emotional health and personal relationships, as well as your pocketbook.

–       Relationship Strain: Between scheduling appointments amidst conflicting schedules, sharing heavy disappointment and grief, and money woes, even the strongest relationships can be rocked to their core by infertility. Even though infertility issues have been shown to be pretty evenly split between men and women in a physiological sense, it’s easy to play the blame game when frustration builds—one partner may feel at fault for the whole ordeal, or conversely, feel that they are shouldering all of the responsibility and work. It’s not helpful that one of the more commonplace fertility treatments of scheduling intercourse to maximize the chance of conception is, to put it bluntly, not very romantic. Taking the fun out of sex and adding the pressure to perform can also lessen the intimacy and connection; a less than ideal contribution to an already difficult time.

–       No Support System: When your time, money, and life, in general, is dictated by your journey through infertility, it can be hard to maintain the friendships you had before it began. Those who experience healthy, normal pregnancies may find it less easy to relate to you, and in turn, it may be easier to be jealous or bitter in return.  Social media is flooded with picturesque depictions of pregnancy and parenthood, but rarely does it shed light on the struggles so many are dealing with. When those close to you aren’t equipped to comfort you, and the world doesn’t seem to show you that your hardship is valid, feelings of isolation are inevitable.

–       Side Effects From Medication: While infertility hormones and drugs offer huge hopes for conception, their side effects can be detrimental to your mental health. The synthetic estrogen clomiphene citrate (often prescribed to improve both ovulation and sperm production) can cause anxiety, mood swings, irritability, and sleep interruptions. Other medications can cause depression mania, irritability, and thinking problems. Patients and clinicians may even find it hard to figure out which reactions are psychological and which are caused by medications.

When To Get Help

It’s normal for you to experience frustration and feel a little stressed out during fertility treatment—you’re only human, after all. However, it’s important to look out for yourself to be sure you aren’t overwhelmed so that you can ask for help when you need it.

Here are a few signs that you should treat yourself gently, or even seek professional help:

–   You check off one of “The Three Ds”: disorganization, dependency, and difficulty making decisions. Whether you’re having trouble keeping track of simple tasks, constantly losing things, unable to settle on small things like what movie to watch, or always wishing someone would take the reigns and run your life for you… all of these seemingly innocuous symptoms show that you are overloaded and need to SLOW DOWN.

–  You are exhibiting signs of depression.  Mild depression can be as simple as feeling more tired and down-in-the-dumps than usual, but severe depression can mean frequent crying, emotional outbursts, and dangerous changes in your appetite and sleep schedule. All symptoms of depression should be taken seriously; you shouldn’t wait until you are experiencing suicidal ideation before getting help.

–  You feel anxious or angry all the time. If your thoughts are always turning to how nervous you are about conceiving, or if you are constantly getting jealous and bitter at those who seem to have it easier, it’s a sign you’ve stayed in a stressed headspace for a long time. You may wish to talk through those feelings with a qualified professional to get back into a better place.

–  You aren’t taking care of yourself. Normally, those trying to get pregnant are hyper-aware of their health and do what they can to stay in peak physical shape. If you find yourself on a strange sleep schedule, gaining or losing a lot of weight, or using drugs or alcohol to get through a day, there’s a good chance you’re experiencing depression, anxiety, or both. Get help as soon as possible.

Where To Go and What To Do

If you exhibit any of the above-listed symptoms of stress, anxiety, and/or depression, it is imperative that you make your mental health your top priority until you find yourself in a better, safer emotional space.

Here are a few simple strategies that may help lighten the load:

–       Practice self-care. Despite what Instagram may say, self-care isn’t always bubble baths and a box of chocolates. At its core, it is making sure you are properly taking care of your body, mind, and heart. Make sure you are getting enough sleep, remaining active, spending time with friends and family, and taking special time for yourself. Sometimes that means getting a mani-pedi, sometimes it’s giving yourself time to explore your hobbies, sometimes it’s indulging in a few moments of solitary meditation, and sometimes it’s speaking to a therapist. It may even be time to consider changing or pausing your fertility treatment—remember, no matter what, your health should come first.

–       Reach out. Many people tend to feel the urge to retreat when battling infertility—there is a fear of receiving judgment and unsolicited advice, or hesitating to share personal and private medical information. There is also the very real social stigma of speaking about anything pertaining to pregnancy that isn’t positive and perfect. However, while navigating this journey can be lonely and leave you feeling misunderstood, you will need your support system now more than ever.

–       Speak to a therapist. Ideally, counseling should begin before or at the start of your fertility treatment to help to equip you with the tools to handle the eminent stressors. Short-term counseling is incredibly common for those trying to conceive, and can provide you with information on how to handle fatigue, manage stress, and improve communication. There is no shame in extending the length of your counseling to suit your needs, especially if your anxiety went untreated for some time before. When looking for a therapist, be sure to check if they have a graduate degree in a mental health profession, a license to practice and state registration, clinical training in the psychological aspects of infertility, and experience in the medical and psychological aspects of reproductive medicine. You may need to interview a few different doctors to tick off every box on the list, but it will be worth the effort to find someone with the knowledge to suit your needs. Thankfully, many fertility clinics and consulting companies already have a list of qualified professionals who are ready to help.

More Resources

American Society for Reproductive Medicine (ASRM)

Call 205-978-5000 or visit www.asrm.org

This professional organization for infertility specialists publishes guidelines and hosts meetings about the medical management of infertility. Its Mental Health Professional Group focuses on the psychological and emotional aspects of infertility treatments.

RESOLVE: The National Infertility Association

Call 703-556-7172 or visit www.resolve.org

This organization provides education, support, publications, and advocacy for women and men facing infertility.