Infertility and depression: A complex relationship

The journey to having a baby isn’t always easy. It can be a profoundly emotional journey and, when dealing with fertility struggles, full of big ups and downs that take a serious toll on mental health.

Many people struggling with infertility experience depression, anxiety, and stress. Individuals dealing with infertility and depression must understand they don’t have to tackle these feelings alone. So let’s talk about it. 

What is infertility?

Infertility is the inability to achieve a successful pregnancy after at least a year of actively trying to get pregnant when the birthing person is under 35 years old. When the birthing person is over 35 years old, infertility may be diagnosed after six months. Fertility struggles may be caused by health issues in one or both partners or by a mix of multiple factors that contribute to reduced chances of pregnancy.

How infertility can lead to depression

According to the World Health Organization (WHO), about 1 in 6 adults — or 17.5% of the adult population — struggle with fertility. An estimated one third of all fertility struggles are related to the birthing person, one-third to the parent providing sperm, and the remaining a combination of both. Despite this, women are most likely to undergo medical fertility treatment, which can be highly emotionally and physically taxing.

Pregnancy is a joyous occasion that future parents share with their friends and family. Fertility struggles, on the other hand, often exist in silence. Talking about infertility is incredibly hard and the lack of representation can feel isolating. 

Regardless of the cause of fertility problems, the effects are often the same: 

• Physical, financial, and emotional stress
• Feelings of loneliness and isolation
• Social pressure
• Anxiety and irritability
• Not being able to concentrate or think about anything other than fertility struggles

It’s no wonder depression in patients experiencing fertility issues has been compared with that of patients diagnosed with cancer. 

The emotional toll of trying to get pregnant

When an individual or couple is ready to start or expand their family, they enter a phase called “trying to conceive” (TTC) or trying to get pregnant. While the definition of TTC can differ between specialists and patients, the overall goal is the same: to get pregnant. 

Trying to get pregnant and depression can often go hand-in-hand due to the emotional toll of the process. While trying to get pregnant, individuals undergo a variety of stressors that can adversely affect their mental well-being.

The following factors can link this time period and depression for prospective parents:

• The pressure of tracking cycles, attending appointments, and keeping up with requirements and side effects of medical interventions. 
• Pervasive societal expectations around getting pregnant and having children. 
• Managing individual expectations and personal hopes for a successful pregnancy. 
• Feelings of isolation and inadequacy throughout treatment. 

Hormonal changes and their role in mental health

Adding to the stress and anxiety of infertility, many fertility treatments can involve medications like clomiphene, gonadotropins, and leuprolide — all of which can affect the patient’s mood. Side effects may include depression, anxiety, irritability, and sleep disturbances, among other reactions.

Hormonal changes, or hormone overload, can add to mental health strain. Prescribed hormones are intended to improve the chances of getting pregnant, but can also lead to mood swings or even anxiety and depression. This is a normal reaction to hormonal changes, though it can make the patient’s experience more intense. 

The financial and physical stress of fertility treatments

For many people, infertility treatments aren’t just emotionally demanding. They’re financially and physically exhausting, too.

Financially, the high cost of assisted reproductive technology (ART) can create added stress on individuals and couples. Take in vitro fertilization (IVF) for example. Even as one of the most common forms of ART, the cost of IVF easily adds up to thousands of dollars per cycle. Considering that people often require multiple rounds of IVF, this price tag can add another layer of stress. 

Physically, fertility treatments involve frequent doctor’s appointments, medication, injections, blood tests, ultrasounds, and other invasive procedures. These treatments don’t end in specialist offices, though. Individuals must also deal with side effects, including everything from nausea and vomiting, hot flashes, and headaches to bloating and mood swings. 

The psychological effects of infertility on mental health

Infertility impacts all areas of a person’s life: physical, financial, social, and mental. Over time, the emotional toll can manifest as psychological effects such as depression, anxiety, and even post-traumatic stress disorder. 

Trying to get pregnant and depression: the cycle of stress and hopelessness

For patients actively trying to get pregnant, fertility treatments can cause a constant tug-and-pull between feelings of excitement and hope, and uncertainty and fear. The repeated cycle of trying and failing to get pregnant can feel like being stuck on a treadmill that never stops, leading to chronic stress, disappointment with each cycle, and persistent feelings of grief.

Adding to the emotional toll, the time spent waiting for treatment to start and hoping for positive results can add to the stress and anxiety of fertility struggles. 

Over time, depression can creep in. Individuals may experience trouble sleeping from emotional distress, or lose interest in activities and relationships that previously brought them joy. 

The impact of infertility on identity and self-worth

Struggling to get pregnant can impact a person’s self-worth, making them feel broken, unfulfilled, or “less than” others. On the other hand, these individuals may feel like they are letting down their partners, families, or even themselves. 

The stigma of infertility is common across cultures, adding even more societal pressures on those hoping to have children. 

Examples of how fertility stigma can contribute to low self-worth include:

• Not having children is seen as the birthing person’s fault.
• Infertility may lead to discrimination or prejudice.
• Fertility struggles can affect marriages and other familial relationships.

Those struggling with fertility challenges are often forced to deal with many outside and inside factors that can affect one’s sense of self. 

How sleep problems worsen infertility and depression

When was the last time you felt so stressed out and worried about something that you couldn’t get a full night’s sleep?

Many people struggling with fertility and undergoing fertility treatments feel significant levels of stress that can keep them up at night. 

This is significant because not only does lack of sleep cause mood swings and irritability, it has also been linked to negative impacts on fertility. Studies have shown that sleep deprivation can slow down sperm production and sperm motility, and impair the production of key reproductive hormones. 

Ultimately, sleep problems can worsen infertility in two main ways: by impairing the reproductive functions that contribute to successful pregnancy, and by exacerbating stress, anxiety, and depression that can impact the effectiveness of ART treatments. 

Can depression influence fertility?

Mental health and fertility are closely intertwined, for better or for worse. And while depression has not been proven to directly affect infertility, it can indirectly affect someone’s ability to get pregnant. 

Common ways depression influences fertility include:

• It can reduce libido and lead to a loss of interest in sex. 
• Medication for depression may affect someone’s ability to get pregnant.
• Depression can disrupt sleeping patterns. 
• It can lead to higher levels of cortisol and stress hormones, which may interfere with menstrual cycles and sperm production.

Taking care of mental health does more than support mental well-being; it can positively impact one’s fertility journey, as well.

The role of antidepressants in fertility and pregnancy

Some antidepressants, including SSRIs (selective serotonin reuptake inhibitors), can impact fertility. This may complicate a person’s decision to undergo mental health and fertility treatment at the same time.

However, discontinuing antidepressants without medical supervision can be risky. If you're trying to get pregnant and on medication for depression or anxiety, it's crucial to work with your doctor to find a treatment plan that supports both your mental health and fertility goals.

3 ways to manage mental health while dealing with infertility

Navigating fertility struggles while protecting your mental health is a delicate balance, but there are ways to feel supported and grounded along the way.

1. Seek professional support

If you notice depression interfering with your daily life, it may be time to talk to a professional. Some signs of depression disrupting quality of life include:

• Inconsistent sleep patterns
• Changes in appetite
• Low energy
• Losing interest in activities

People with fertility challenges must focus on prioritizing their mental well-being alongside fertility goals. Luckily, there are several coping strategies to turn to for those dealing with infertility and depression. 

Therapy can offer a safe space to process grief, frustration, and anxiety. Cognitive behavioral therapy (CBT) can offer an effective structure for treating depression and anxiety. Other types of therapy provide a safe space to process the frustration, grief, and stress of the trying phase of life. Additionally, support groups can give individuals a sense of connection with people who deeply understand their situation. 

If fertility struggles are persistent and pervasive, it might be a good idea to consider fertility counseling. Fertility specialists can provide more individualized care to address mental and physical symptoms and direct patients toward the right fertility treatments for them.

2. Build a personal support system

Even though fertility struggles can feel isolating, individuals should remember this: You don’t have to do it alone. 

Partners, close friends, and online communities can offer emotional support when you need it most. Building support systems is an essential, and impactful, coping strategy for those dealing with mental health and infertility. Sometimes just knowing someone else understands your experience can make a huge difference in how someone manages their stress and anxiety. 

Approach relationships with open communication. Individuals should talk honestly about how they’re feeling, what’s needed, and how friends and loved ones can support and encourage each other throughout the process.

3. Practice self-care and mindfulness techniques

Taking care of your body and mind isn’t a luxury, it’s essential — especially for someone dealing with the added emotional toll of fertility challenges.

Activities like journaling, yoga, meditation, and gentle exercise can help reduce stress and bring a sense of control. Many people may also find that prioritizing lifestyle changes, like getting a good night’s sleep, is good for stress management. 

Diet may also play a role in mental health and fertility. Consider how nutrition factors into your day-to-day activities and research myths and facts about diet and fertility to make appropriate changes. 

Even small steps add up as you progress through your fertility journey!

Resources for mental health and infertility

The connection between infertility and depression is real, valid, and complex. For anyone struggling with fertility, know that you’re not alone and your situation is not hopeless. 

If you don’t know where to look, start here:

• The National Infertility Association
• Infertility Counseling and Support: When and Where to Find It
• Mental Health Resources

Whether you're just beginning your journey or have been at it for a while, seek support, practice self-care, and give yourself grace through this process.