Welcome to this difficult, but important conversation. If you are reading this, I’m glad you are here. If you are struggling with infertility, please be gentle with yourself as you read, and if you are aiming to learn more in support of a loved one, I hope this helps you be the support they need.

As we discussed in Everything You Need to Know About Infertility and Assisted Reproductive Technology (ART), infertility impacts people in all sorts of ways and everyone has their own journey. Some people use Assisted Reproductive Technology, some want to but can’t, and for some it’s not the right fit. Some of you reading this will end up having the child you have dreamed of, and sadly, some of you won’t. This post will be going into depth about the different ways struggling with fertility can impact mental health, regardless of what their journey looks like (though it will of course be slightly different for each person).

My goal is for anyone struggling with infertility to feel seen, to feel their reactions are normal, and that they make perfect sense. While people tend to vary wildly in terms of why they are struggling with infertility and what, if any, treatment they decide to pursue, the impact of infertility tends to be much more consistent. This is not to say that everyone has the exact same experience, but rather, it is pretty universal to experience symptoms of depression, anxiety, etc., when you are unable to have a child the way you want. The difference is in the nuance of how these symptoms show up based on a person’s particular situation. If someone has a history of depression, anxiety, or other mental health condition, they are at greater risk of experiencing difficulty with mental health while experiencing infertility (and during pregnancy and postpartum too).

Infertility anxiety

Anxiety is excessive worry and stress about something that may or may not happen in the future. Everyone experiences worry and stress, but it starts to turn into anxiety when it is interfering with daily life. It is important to remember that while the anxiety may be unpleasant and ineffective, it makes perfect sense that you are anxious when you are having trouble getting something you want so badly and dealing with so much uncertainty. Symptoms of anxiety include difficulty falling or staying asleep, stressful dreams, difficulty concentrating or making decisions, and feeling irritable, keyed up, or on edge. Anxiety can also have physical symptoms like muscle tension, nausea, difficulty eating, fatigue (it is exhausting!), and headaches. While any number of stressors and situations can cause stress and anxiety, there are many aspects of infertility that can contribute to these uncomfortable symptoms. 

The “what ifs:”

The “what ifs” are undoubtedly the biggest contributor to anxiety for people struggling with fertility and the main complaint I hear from clients. There are just so many! In fact, they can seem endless. Just as soon as you conquer one, another arises. What if we spend tens of thousands of dollars on fertility treatment only for it not to work? What if we don’t and we regret it for the rest of our lives? What if I can’t get pregnant because of my size (you can)? What if we use fresh embryos instead of frozen? What if we use all our embryos up? What if we can’t have a child and I am depressed for the rest of my life? What if we get pregnant and have a miscarriage? What if our relationship can’t recover from this loss? What if I feel like our child isn’t mine because it’s not my egg? What if I never get pregnant? The list goes on and on.

The fact is, there are so many unknowns with infertility, especially if you choose to pursue treatment. The science is young, there is no one “right” protocol or treatment option, and so much of the outcome is dependent on factors beyond anyone’s control. In general, I find that the more difficulty a person has with coping with uncertainty, the more they seem to struggle with the what ifs. 

The thing is, there will always be a what if, because for every choice we make there is a choice we didn’t select and so we may always wonder how it would turn out had we chosen differently. Additionally, there often isn’t a “right” choice. There is only the best choice you can make with the information you have. Nothing is guaranteed and this can be very difficult to tolerate.

Stress related to infertility treatment:

The process of pursuing fertility treatment and utilizing ART is stressful in and of itself, and this is before you consider the impact that hormone treatment can have on emotions. There is the stress of making treatment decisions along the way, such as which procedures, when to start, and evaluating pros/cons to different strategies. Then there is the ever present stress of wondering whether it will even work. The cost of ART can go into the tens of thousands of dollars and this can increase anxiety about finances with questions of how you will afford it, added debt, or having to sacrifice or delay other dreams like buying a house.

Many people who end up pursuing ART also have significant anxiety about the process of giving oneself shots as a part of the treatment protocols. While this anxiety usually fades after a few days of having to do it, it can be really intense at first. Many IVF patients have had tearful conversations with the IVF nurse about their fear of inserting a needle into themselves. 

Trying to conceive becomes an emotional minefield:

When you are struggling to get pregnant, a lot of pressure gets put on trying to conceive. This creates a lot of difficulty and anxiety. People in this position worry about if they will get pregnant or not, how they will cope if they get their period again and have to face what feels like another failed attempt, worry about if they or their partner will be able to orgasm, worry about how their partner will take it, worry about feeling like a failure. 

The problem here is that what should be pleasurable and intimacy enhancing can quickly turn into something anxiety producing that feels like work and pressure. And, nothing kills a sex drive or the ability to experience pleasure or orgasm like anxiety. It is difficult to get or maintain an erection, let alone reach orgasm and ejaculate, when you are stressed. The pressure to perform can be paralyzing and make sex really unpleasant and stressful. Anxiety can also negatively impact ovulation, which could mean that although intercourse happens, ovulation doesn’t and so it does not result in a pregnancy.

Stress about the impact of stress on fertility:

When you are aware that stress can negatively affect health, including fertility and ovulation, it is not uncommon to start to feel anxious about feeling anxious, which can really set off a spiral of anxiety. Unfortunately, worrying about anxiety makes it more likely to happen and can also contribute to self-criticism (“why can’t I manage this better?”). Telling yourself not to stress is both invalidating to your justified anxiety and it just adds pressure that increases stress. 

Anxiety about how to decide when to stop trying:

This particular anxiety is sort of a specific kind of “what if” question. How will you know when you are ready to stop trying to get pregnant? This is a very hard decision to make, and one that involves a lot of grief as discussed in Part 3 of this series. It’s common to worry about stopping prematurely and worry that you will always wonder if you would have been able to get pregnant had you kept trying. On the other hand, it is devastating and emotionally, physically, and financially difficult to keep pursuing pregnancy only to keep getting your period month after month. There is also a very real fear of the toll it will take to keep trying, especially if the evidence in your particular situation suggests it is extremely unlikely to happen. If you and your partner are not in agreement about when to stop trying, that can also create anxiety and stress. 

Infertility depression

While anxiety is universally experienced as intense worry that negatively impacts you, depression can manifest in different ways. In general, I want you to think of depression as a low mood. Sometimes this is experienced as sadness and tearfulness. For others, their motivation and interest in things just disappears and things feel “blah.” Regardless of how someone experiences depression, they don’t feel like themselves and may struggle with hopelessness, feeling worthless and/or empty, changes in appetite, sleeping too much or having trouble sleeping, a lack of interest in usual activities, fatigue, or difficulty concentrating. Just like anxiety, depression symptoms exist on a spectrum. Everyone feels sad or hopeless at times, but it starts to cross over into depression when these symptoms are interfering with your day to day life. If things are feeling particularly dark, thoughts of wishing you weren't alive or of harming yourself may occur. It’s natural to feel this way when one feels totally hopeless, which depression can cause. 

Note: If you or your loved one is having thoughts of self-harm, reach out to the doctor right away and if the person has the desire to hurt themselves or a plan to, seek emergency care by going to the emergency room or calling 911 or the new mental health emergency number, 988.

Infertility can cause depression in a number of ways. It is profoundly sad to want something so meaningful so badly, and be facing the very real possibility that you will not be able to have it in the way you imagined. This is a very real loss and it is very painful. It is completely natural to feel intense sadness at not being able to get pregnant. For many women, being able to have a child is totally tied up in their sense of what it means to be and feel like a woman. While having a child is of course not a required part of being a woman, for many women it feels like it is and this will be something they have to grapple with and grieve. Grief is heavy throughout the process of infertility and will be discussed in depth in a future blog post.

Similarly, feelings of worthlessness are also a part of depression. It is incredibly common to struggle with feeling worthless if you feel a large part of how you see yourself and your future revolves around becoming a parent. Again, while being a parent is not a required part of what it means to be a woman, it is important to acknowledge that women face immense pressure to become mothers and much of our value in our patriarchal society is based on our ability to perform motherhood, so it is natural that women who have received this message their whole lives may struggle with feeling less valuable and worthy if they are unable to conceive. 

Hopelessness about infertility

Another emotion that can be difficult to cope with is hopelessness. Feeling hopeless is both a feature of depression and a predictor of it. And unfortunately, struggling with infertility can feel pretty hopeless. This is especially the case if you want to be able to pursue ART but can’t, or if you endure repeated rounds of fertility treatment with no success, or are able to get pregnant but have miscarriages. The hope of having a child one day can dwindle and become nonexistent, and along with it, the hope of being happy or having a family. It is very difficult to not feel depressed when you are feeling hopeless. And it is soul crushing to get your hopes up over and over, only to be repeatedly and bitterly disappointed in the end.

Hopelessness can be particularly difficult and a bitter pill to swallow when it is the result of oppression. For example, many fertility clinics and doctors flat out refuse to help women above a certain BMI, despite fat women (reminder that I use fat as a neutral descriptor) having babies since the beginning of time. Women of color face a staggering lack of donors of color should they have a need for donor eggs or sperm. And women with disabilities often encounter significant ableism and unwillingness to assist them in having a baby. These forms of discrimination are modern day eugenics. Many people can also not afford the astronomical expense of fertility treatment, even though it may work beautifully for them.

Anger about infertility

Anger is also a common emotion to experience when dealing with infertility. Although I’ve included this under the depression section, please know that it can occur alongside anxiety as well. The reason we feel anger is because it is our body’s way of letting us know that a hurtful injustice has occurred and it spurs us to take action to protect whoever is hurting (you or someone else). Infertility IS an incredible injustice. It is completely unfair and something nobody deserves, so it is completely natural and appropriate to feel angry. It can feel irrational to feel angry since it’s nobody’s fault, but it is completely normal to feel angry about something so painful and unfair. It is also incredibly common to struggle with anger about the unfairness of people accidentally getting pregnant, who either don’t want the child or who are harming the child through abuse, neglect, or substance abuse. 

Sometimes people can unfairly take our anger out on our partners, but also sometimes there is an underlying conflict creating anger. For example, if there was a disagreement about when to start trying to get pregnant, if partners have different opinions about pursuing treatment, or if a partner did not follow up with treatment or other fertility enhancing measures in the way the other partner would have wanted. In these situations, anger can fester and turn into resentment that may boil over into other areas of the relationship. 

Shame about infertility

Lastly, people struggling with infertility can feel shame. When there is so much pressure in our culture to have biological children, especially for women, it is natural to feel like you failed at what you’re “supposed” to do as an adult, as a woman, as a partner. Also, all too often women are shamed about their weight and incorrectly told they are to blame for their infertility. However, infertility is never your fault and it is always undeserved. Shame is appropriate to feel when you have willfully violated your moral code and harmed someone, but not being able to have a baby through no fault of your own does not constitute this type of violation, so shame is both inappropriate and unfair to yourself.

This is true even if some of your past behaviors may have contributed to infertility, such as past drug use or not getting needed treatment sooner. This is also a big if- it’s impossible to know how much, if any, impact it had or if it would have changed anything had you made a different choice. There’s a lot of hindsight bias where shame is involved. You were doing the best you could at the time with the information and skills that you had. And if you have had your infertility blamed on your size, or are blaming yourself because of your size, check out my post Weight and Fertility: What Does the Science Say and know that your size is not to blame.

It makes perfect sense that many people going through infertility struggle with depression symptoms - it is a profound loss that takes time, resources, and support to cope with and adjust to. A future post will highlight strategies to help you cope and access support and I will link it here once it is live.

Infertility trauma

As if going through infertility wasn’t enough, some people also endure trauma on their quest to become a parent. The most common trauma people experience while dealing with infertility is miscarriage and pregnancy loss. A miscarriage can be devastating at any time, but when a person becomes pregnant after struggling to get pregnant in the first place, it can feel extra difficult to cope. 

Though rare, sometimes people experience medical trauma like having to seek emergency treatment due to a severe case of Ovarian Hyperstimulation Syndrome or an ectopic pregnancy. 

The stress people experience after trauma is called post-traumatic stress and it makes perfect sense that people feel this stress after a trauma. Trauma is so upsetting that survivors can relive it even after the danger has passed. The trauma can feel like it is haunting your thoughts and showing up in your dreams. It can feel both emotionally upsetting to be reminded of the trauma as well as physically upsetting (racing heart, shortness of breath, nausea, muscle tension, etc.). If a survivor is feeling bombarded by upsetting and unwanted thoughts of past trauma, they are likely going to feel on edge and avoid anything and everything that reminds them of the trauma, which can gradually make one’s world feel smaller and smaller. This can include avoiding talking about it, avoiding other people, or even avoiding one’s own feelings. The survivor may develop all-or-nothing negative beliefs like “no one can be trusted” or “I’m damaged goods.” Other symptoms of post-traumatic stress include anxiety and fear, irritability, difficulty sleeping, feelings of guilt and shame, lack of interest in usual activities, and feeling detached from others. If this resonates with you and you’d like more information about what trauma is and how it impacts people, read my article “Comprehensive Guide to Understanding Trauma and Treatment for Women.” 

You make perfect sense and I hope you feel seen…

My hope in writing this post on infertility is that you (or your loved one who is struggling) feels seen in your pain. That you know your reactions and pain are normal and that you are not alone. I hope you learned more about why you are struggling and can be a bit more gentle with yourself. There is nothing wrong with you and you are doing the best you can. 

Get Support With Infertility Therapy in Los Angeles, CA

Well Woman Psychology can help you get the support you deserve as you navigate infertility, wherever you are in your journey. It can be overwhelming to reach out for this support but you are not alone. Struggling with infertility is often one of the most emotionally painful experiences a person can go through - don’t do it alone. Start connecting with your own inherent resiliency, build healthy coping skills, and gain support through infertility therapy with these steps.

1. Reach out for a consultation at Well Woman Psychology

2. Meet with an infertility therapist.

3. Start receiving the support you deserve.

About the Author, A Los Angeles Infertility Therapist:

Dr. Linda Baggett is a Licensed Psychologist at Well Woman Psychology, serving clients online in California, Illinois, New York, and Washington. She received her PhD in Counseling Psychology from the University of Memphis. As infertility therapist in Los Angeles and Manhattan Beach, she has niche expertise in supporting women along their journey to hopefully have a child, no matter what the end result. Specializing in women’s issues broadly, she also has expertise in relationship issues, sexuality, pregnancy loss and miscarriage, birth trauma and postpartum issues, trauma and PTSD, EMDR, and body image and size-based oppression.

Disclaimer:

This blog is for educational and informational purposes only, is not a substitute for individual medical or mental health advice, and does not constitute a client-therapist relationship.