How Does Infertility Impact Mental Health?
Content warning: infertility, pregnancy loss
The emotional weight of fertility struggles, and how to get support
The decision to become a parent is one of the biggest choices we make in our lives. Many pregnancies happen without any planning at all, of course, and that kickstarts its own journey and decision making process. But other times, we might have spent years preventing pregnancy while making the decision, finding the right partner, setting ourselves up financially, or accomplishing career goals. When you’ve put so much time and intention into preparing for this next phase of life, it can be devastating to encounter infertility issues once you finally are ready to build your family.
Difficulty conceiving and the journey to get pregnant looks many different ways. It can involve losses, failed attempts, and recurring disappointment, along with financial, emotional and physical stress. It also can put a strain on relationships, when the partner going through fertility treatments feels misunderstood or unseen by the partner whose body is not going through the same stress; or when both partners experience grief and disappointment about how this stage of life looks different than what they had hoped for.
It is normal to feel all of these things and more when you experience infertility. At Wild Hope, we consider conception part of the perinatal period; especially when you consider the emotional and physical demands of fertility treatments, it is a time that deserves specialized care from a therapist with the background knowledge to properly support you.
Does Stress Cause Infertility?
For women, guilt and shame are common emotions that can come up while trying to conceive when it is not going how you thought it would. So it’s understandable that this is probably the question people search most about infertility. When we are anxious, our thoughts become a loop-like pattern. If stress is contributing to infertility, then the emotional distress of trying to conceive becomes a self-fulfilling pattern. The fear that your own mental state is preventing pregnancy can compound the distress considerably.
This is a great question for your fertility specialist, but the answer is more nuanced than a quick internet search might make it seem. The technical answer is that significant or severe psychological stress can impact ovulation and fertility (Rooney & Domar, 2018). But this is much different than the everyday stress we experience, even the stress related to fertility treatment, which while significant and meaningful, is different from the type of stress that has been demonstrated to impact fertility. The research does not support the idea that ordinary anxiety or the emotional distress of fertility treatment is causing or significantly worsening infertility outcomes for most people. What the research does support, consistently, is that infertility causes stress and anxiety. So rather than stress and anxiety impacting your ability to conceive, infertility is the stressor. The anxiety and depression that follow are responses to that stressor, not its cause (American Psychiatric Association, 2022).
So the advice to just relax or stop overthinking that so many people receive from well-meaning friends and family is not only unhelpful, it is inaccurate. It also places the psychological burden of the outcome on the person who is already suffering emotionally. You absolutely deserve to feel better, but for your own sake. Your natural concern about what you are going through is not something to feel guilty about on top of what you’re already dealing with.
Why Does Infertility Feel Like Failure?
Feelings of worthlessness, body betrayal, shame, and guilt are among the most commonly reported psychological experiences of infertility, and they are also among the least talked about. People search for these feelings in private because they feel too raw or too irrational to say out loud. Verbalizing to a therapist who can provide a safe, non-judgement space can be incredibly helpful.
From a feminist-relational framework, we see that the cultural weight placed on reproduction, particularly on women, is enormous and largely unexamined. Many people grow up with an implicit assumption that their body will be able to do this particular thing if and when they want it to. When that assumption turns out to be wrong, the loss is not only about a specific future, but challenges a story we’ve both been telling ourselves and receiving culturally, our entire lives.
The feeling that your body has failed you is in part a grief response, and grief responses often contain elements that do not look entirely rational from the outside, especially to people who aren’t going through what you are going through. Shame about fertility is also shaped by social context: a culture that defines womanhood or partnership in relation to reproduction will produce this kind of internalized failure when things don’t go as smoothly or quickly as they are expected to.
Research consistently finds that the psychological profile of people going through infertility resembles that of people dealing with other serious medical diagnoses, including levels of depression and anxiety comparable to those seen in cancer patients (Domar et al., 1993). The time, energy, financial burden, and physical toll of fertility treatments are significant like any other ongoing medical treatment, and the emotional care you receive should acknowledge that.
How Do You Handle Pregnancy Announcements, Baby Showers, and Everyone Else’s Good News?
Social triggers are one of the most practically difficult dimensions of infertility, and they are relentless. Pregnancy announcements, gender reveals, baby showers, the inevitable questions at family gatherings about when you are planning to have children, all come without warning and without regard for where you are in your own process.
Grief about infertility is hard to compartmentalize when so much of our lives revolves around family and life events. It gets activated by the exact things that are supposed to be celebrations. And the associated feelings are some of the most ‘unfun’ ones: envy, bitterness, a complicated grief that arrives right alongside real love for the person announcing good news. The guilt that comes with those feelings is often its own layer of suffering.
Some helpful tips for navigating your social life while navigating infertility:
• Envy in the context of infertility is part of a grief response, and while it can be hard to believe this at the time, it is not a character flaw. It emerges from loss, not from the absence of love for the other person. Both things can be true simultaneously.
• You are not obligated to attend every event that activates your grief. Declining a baby shower is a self-protective decision, and boundaries are a healthy part of any relationship. Most relationships can hold an honest explanation, and even if someone’s feelings are hurt, repair and reconnection are again a normal and healthy part of long term friendships. This is what it means to put yourself first sometimes.
• It can be useful and comforting to prepare a script for the questions and announcements you know are coming. Having a simple, practiced response ready for “when are you having kids?” like “we’re working on it” or “it’s complicated, but thank you for asking” and then redirecting with a question about them or back to the hosts, reduces the mental communication gymnastics you have to do on the spot.
• Social withdrawal is a common response to infertility, and while some degree of it is self-protective, sustained isolation tends to compound the psychological impact. Selective withdrawal, such as skipping a baby shower instead of every dinner with friends, tends to be more sustainable than full retreat.
• Telling a trusted person or two what you are actually going through reduces the amount of energy you spend managing other people’s assumptions. You do not owe anyone a full disclosure, but having at least one person in your life who is not requiring you to perform ‘being ok’ matters. Ask yourself, how would you treat a friend who came with you in the same way? You deserve the exact same care.
Do Fertility Medications Actually Affect Mood?
Yes, and more significantly than many people are prepared for. Fertility medications, particularly gonadotropins (injectable hormones used in IUI and IVF cycles) and medications like Lupron or Clomid, can cause rapid and significant mood changes, sleep disruption, heightened anxiety, and in some cases, depressive symptoms. It is important to be aware of this, especially if you have experienced mental health conditions previously.
It’s not always easy to separate out what is coming from the medication and what is coming from the emotional reality of the treatment itself. Both are happening simultaneously; and the suffering you’re experiencing regardless of the cause is real. The mood disruption from a stimulation cycle can coincide with the anticipatory anxiety of a retrieval, the grief of a canceled cycle, or the particular suspended quality of a two-week wait. The layers compound each other.
And a therapist who specializes in infertility will be aware of this and have the right questions to ask to help you differentiate and understand what you are experiencing; and to help you prepare for conversations with your medical providers.
Some things to consider before talking with your medical provider (and that a therapist can help you think through and practice!) include:
• Telling your reproductive endocrinologist about significant mood changes during treatment. This is important data for your doctor and should not be seen as a complaint or weakness. Your medical team needs this information to manage your care well.
• If you are already working with a therapist during treatment, flagging where you are in your cycle and what medications you are on helps your therapist contextualize what they are seeing. The mood state during a stimulation cycle is genuinely different from your baseline.
• The two-week wait after a transfer or insemination is its own psychological event. The combination of progesterone supplementation and the unbearable uncertainty of that period produces a specific kind of suspended anxiety that is difficult to describe to anyone who has not been through it. Naming it as a discrete, genuinely hard experience (rather than something you should be able to manage with adequate positivity) is more accurate.
• If mood symptoms are severe or you are having thoughts of self-harm, please seek help at the nearest emergency room. An internet search, a blog post like this one, an AI chat, or an email to your therapist is not a substitute for therapy with a professional or crisis support. You are worthy of care and if you have concerns about your immediate safety or wellbeing at this time, you should seek immediate professional support.
How does Infertility Impact Relationships?
Infertility is a shared experience, but the person receiving the physical treatments often feel as if they are suffering alone. Given the emphasis on the body, time, and mental space of the partner receiving treatments, partners rarely move through the emotional process in synchrony, and the mismatch can create distance even between people who love each other and are genuinely trying to be supportive.
One common pattern looks like one partner processes outwardly, through tears, talking, and visible distress, while the other internalizes, becoming quieter, more task-focused, and perhaps more stoic. To the person who is expressing themselves openly, the internalizing partner can look like they do not care; while the internalizing partner may experience anxiety about their ability to properly support their partner or know how to help carry the emotional load. Usually, both partners have good intentions, but have found themselves in a very specific situation that they may not have developed the communication and emotion management skills for yet.
The medicalization of sex is its own relational stressor. When intimacy becomes scheduled, timed, and purpose-driven, it changes the tone of the relationship in ways that are rarely discussed openly. Many couples report a significant loss of desire and spontaneity during treatment, and some experience sexual dysfunction during periods of high treatment intensity. Given that fertility treatments involves scheduling and timing, it makes sense that this would happen and it is a natural and predictable response to an extraordinarily demanding set of circumstances.
From an attachment-based framework, infertility challenges the sense of safety and predictability that partnerships are built on. The emotional responses that each partner is managing can activate attachment needs in ways that become difficult to meet when both people are depleted. It is very common for couples to feel less connected during treatment precisely when they most need connection.
Couples therapy during infertility treatment can help to not only sustain the relationship through this experience, but help a couple to become closer through supporting one another in a difficult time. Developing a support structure for two people dealing with a shared trauma who need a facilitated space to stay in communication with each other is a wise and loving step for a couple to take.
When Should You See a Therapist?
You should reach out to a therapist as soon as you want to. Even if you are still contemplating doing fertility treatments, or haven’t even tried to conceive yet, establishing a relationship with a trust provider can help you throughout your journey to parenthood. You don’t need to hit rock bottom or be suffering “enough.” The experience is stressful enough on its own to warrant support, without requiring that you first reach a crisis point.
That said, there are specific signs that suggest the psychological impact has moved beyond normal stress into something that deserves more structured attention:
• Persistent difficulty concentrating or functioning at work or in daily life that has lasted more than a few weeks
• Sleep disruption that is not explained by medication side effects and is significantly affecting your daily functioning
• Sustained social withdrawal that has extended beyond the events that are most triggering, to the point where you are largely isolated
• Feeling that your distress is out of proportion to where you are in the process and that you have lost access to any experience of relief or pleasure
• Relationship distress that feels significant and is not improving on its own
• Any thoughts of self-harm or hopelessness about the future that extend beyond the infertility context
• A sense that you are managing this entirely alone and that the weight of it is becoming unsustainable
Therapists who work with perinatal mental health and fertility-related distress are familiar with the specific texture of this experience. You will not need to explain why a failed cycle is devastating, or why you are avoiding a certain friend right now, or why the two-week wait feels like its own particular kind of suffering. That familiarity matters more than people often realize until they experience it.
Wild Hope Therapy works with people at every stage of the fertility process, including those who are in active treatment, those who have experienced pregnancy loss, and those who are trying to find a way forward after treatment has ended. With in-person therapy available in Cleveland Heights and virtual counseling across Ohio, including Columbus, Cincinnati, Akron, and beyond, the work here does not require you to justify why this is hard. It is hard. That is the starting point.
What About Grief After Treatment Ends?
One of the least-discussed dimensions of infertility is what happens psychologically when treatment ends, whether because of a successful pregnancy, a decision to stop, a transition to adoption or donor conception, or a choice to remain childless. Each of these outcomes carries its own psychological weight, and none of them neatly resolves the grief that accumulated during the process.
A successful pregnancy after infertility does not always return you to a baseline of over-the-moon happiness about being pregnant. Many people find that pregnancy after loss or treatment is accompanied by significant anxiety, difficulty attaching to the pregnancy, and a complicated relationship to hope. These feelings are natural and do not mean you aren’t grateful or going to be a wonderful parent. Through your experiences, your nervous system learns that good news does not guarantee a good outcome.
For people who reach the end of treatment without a pregnancy, the grief is often described as ambiguous, without a clear ceremony or social recognition. There is no vocabulary for it in most families. There is no bereavement leave. There is often an expectation, spoken or unspoken, that you will move on. Moving on is a process that takes time and support, and it does not happen on anyone else’s schedule. A specialized therapist will understand this and validate it for you, even if you’re not yet able to do it for yourself.
You Are Allowed to Take This Seriously
Infertility is a medical experience with a psychological impact that is routinely underestimated, including by the medical systems treating it. The emotional distress you are carrying is proportionate to the experience. The grief is real.
We help clients experiencing infertility from a relational, trauma-informed lens; and our approach is informed by years of working with women throughout the perinatal period, including conception.
You get to decide what kind of support makes sense for where you are right now. If this post has named something you have been carrying quietly, that is enough of a starting point.
Clinical References
American Psychiatric Association. (2022). Infertility, the impact of stress and mental health. APA Blogs. https://www.psychiatry.org/news-room/apa-blogs/infertility-the-impact-of-stress-and-mental-health
Domar, A. D., Zuttermeister, P. C., & Friedman, R. (1993). The psychological impact of infertility: A comparison with patients with other medical conditions. Journal of Psychosomatic Obstetrics and Gynaecology, 14(Suppl), 45–52.
Rooney, K. L., & Domar, A. D. (2018). The relationship between stress and infertility. Dialogues in Clinical Neuroscience, 20(1), 41–47.
Society for Assisted Reproductive Technology. (n.d.). Stress and infertility. ReproductiveFacts.org. https://www.reproductivefacts.org/browse-resources/videos/sart-fyi-stress-infertility/
Williams, K. E., & Zappert, L. N. (2006). Psychopharmacology at the interface of infertility and mental health. In S. N. Cover & L. S. Cohen (Eds.), Psychiatric illness in women. American Psychiatric Press.