Melissa M. Gonzalez, Psy.D.
According to the CDC, infertility will impact 10 percent of women in the United States, which means that at least 6.1 million women will struggle to achieve pregnancy or sustain pregnancy. However, it is important to understand that infertility is not just a women’s problem. While one third of infertility cases result from women’s problems, one third of cases result from problems with the man. Another third of these cases result from some combination of male and female problems or from completely unknown causes.
When couples decide to start a family and actively begin trying to conceive, the expectation is often that pregnancy will be achieved easily. However, when a woman does not become pregnant within one year of actively trying, or six months of trying if she is over the age of 35, infertility is diagnosed and must be explored further.
As these difficulties emerge, couples often report feeling anxious, depressed, angry, or socially isolated. Marital problems and sexual dysfunctions can arise, which only interferes further with attempts at getting pregnant. Research has shown that infertility can certainly impact mental health; and mental health issues, such as significant distress, can affect a woman’s hormone balance and even ovulation, again making pregnancy even harder to achieve.
Many couples who struggle with infertility will use fertility medications, attempt procedures such as intrauterine insemination (IUI), or even turn to assisted reproductive treatments (ART) such as in vitro fertilization (IVF). In some cases, couples will choose to use a gestational carrier so that their children may be genetically related to one or both parents. Some couples choose to adopt children, while others eventually decide that they will not have children of their own. Many of these alternatives are quite costly; and they are not typically covered by most insurance policies. Financial strain can weigh heavily on a couple who struggles to decide if they can afford to continue trying to have a family. Additionally, research has confirmed the negative psychological impact of infertility and ART. Anxiety, depression, and distress often increase when couples undergo such procedures and treatment failures typically exacerbate such symptoms. Furthermore, we cannot ignore the psychological impact of medications often used as a primary treatment for infertility or even as an adjunct to other treatments. Finally, it is important to understand that pregnancy loss is, unfortunately, often a part of a couple’s struggles with infertility.
Ultimately, infertility treatment may become an emotional rollercoaster where couples become extremely focused on achieving pregnancy. Becoming pregnant may take precedence over all other areas of life. Individuals may experience times of hopefulness, fears about side effects or pain of procedures, anxiety as they wait to see if treatments worked, excitement if results are positive, and/or severe sadness, depression, or grief if pregnancy is not achieved or if miscarriages occur. Furthermore, for the couple who is struggling with infertility, it is sometimes quite painful and conflicting emotions often arise when other friends or family members become pregnant, achieving the one thing they desire so greatly but cannot obtain.
Overall, infertility has a profound impact on women and men who desire to form a family of their own. Infertility has been described as a transformational process where women often must mourn the loss of “normal” reproductive function, making restitution with the perceived social stigma and powerlessness they feel as they are unable to fulfill familial and societal norms. Individuals often feel excluded from the rituals of parenthood and denied the hope of having genetic ties to descendants. Intimate relationships are often altered as individuals may feel guilty about denying their partner a child. Consequently, a grieving process must occur and social support is tremendously important.
Studies have shown that psychotherapy (for individuals, couples, or in group settings) can be effective in alleviating the anxiety, depression, or distress associated with infertility. Also, a 2009 meta-analysis found that psychological interventions targeting such symptoms could actually improve some patient’s chances of becoming pregnant. In fact, many reproductive specialists are now including psychological interventions in their treatment plans for infertile couples and psychotherapy is often encouraged.