Infertility and mental health

Infertility is usually described as difficulty becoming pregnant after a period of trying, or difficulty carrying a pregnancy to term. It affects people of all genders and backgrounds, including same-sex couples and single people building families with medical help.

For many, trying to conceive is one of the most emotionally demanding experiences of their lives. Each cycle can bring hope followed by disappointment. Medical appointments, tests and treatments can be physically and emotionally exhausting, and financial costs can add significant pressure.

Infertility is often a hidden struggle. People may not share what they are going through, and well-meaning comments from others can hurt. Feeling isolated is common, and so is feeling that your body has let you down. Recognizing the emotional impact is an important part of caring for yourself.

Common emotional responses to infertility include:

• Persistent sadness or low mood
• Anxiety about the future, tests or outcomes
• Infertility grief for the pregnancy or family you imagined
• Guilt, shame or feeling like a failure
• Jealousy or pain around pregnancy announcements or babies
• Anger at the unfairness of the situation
• Feeling out of control or obsessed with tracking and planning
• Withdrawing from friends, family or social events

Trying to conceive stress can affect sleep, concentration, work and intimacy. When low mood, hopelessness or loss of interest last for weeks, it may be depression, which deserves care in its own right.

Fertility treatments such as IVF can be particularly intense. People often describe a cycle of hope, waiting and fear, especially during the period between procedures and results. IVF anxiety may include racing thoughts, trouble sleeping and fear of bad news. Hormonal medications can also affect mood for some people.

Decisions about treatment, such as whether to continue, use donor options, consider adoption or stop treatment, can be emotionally complex. Couples may disagree or cope in different ways, which can create tension.

A failed cycle or pregnancy loss during treatment can bring deep grief. Many people find it helps to plan emotional support around key moments in treatment, not only after difficult results.

Infertility can put pressure on even strong relationships. Partners may cope differently: one may want to talk constantly while the other withdraws, or one may want to continue treatment while the other needs a break. Sex can start to feel like a task rather than intimacy.

Relationships with friends and family can also change. Baby showers, holidays and questions about when you are having children can be painful. It is okay to set boundaries and protect yourself during this time.

Couples therapy can help partners understand each other's experience, communicate about difficult decisions and stay connected.

Therapy offers a space to express feelings, make decisions and find ways to cope. Cognitive behavioral therapy can reduce anxiety and depression and help manage thoughts like "I'll never be a parent." Acceptance and commitment therapy and mindfulness-based approaches can help people live according to their values during uncertainty. Grief counseling supports people through losses and endings.

Some therapists specialize in reproductive or perinatal mental health and understand fertility treatment. A psychiatrist may be involved if depression or anxiety is severe, especially as some decisions about medication may be affected by fertility plans.

Psychologists, clinical psychologists, therapists and licensed clinical social workers experienced in fertility issues can help, as can couples therapists. Many fertility clinics offer or can recommend counseling. A first session usually covers your journey so far, what feels hardest and what support you need.

Coping strategies:

• Give yourself permission to feel what you feel.
• Limit fertility-related research or tracking if it increases anxiety.
• Plan something comforting around test results.
• Set boundaries with social events or questions.
• Connect with peer support groups.

If you feel hopeless or have thoughts of harming yourself, call or text 988 in the US, Samaritans on 116 123 in the UK and Ireland, or 911 or your local emergency number.