Stress, Anxiety, Depression, and Trying to Conceive

Heather Toum M.ED, LMHC

Deciding to have children is one of the most exciting times in a person’s life…until it doesn’t happen.  Cycle after cycle is an emotional rollercoaster of hope, followed by disappointment. Women under 35 who have been trying to conceive for a year and women over 35 who have been trying for 6 months without success are diagnosed with infertility. Many women at this point, may choose to seek medical care in order to identify the cause(s) of the infertility.

How Common is Infertility?

Unfortunately, infertility is common. According to the U.S. Department of Health & Human Services, 12 out of 100 couples have trouble becoming pregnant. Some sources report this number is as high as 1 out of 8 couples. Approximately one third of cases are due to female infertility causes, one third from male infertility, and the remainder are from a mixture of male and female causes or the cause is unknown (called unexplained infertility). Infertility causes include conditions such as ovulation problems, semen issues, or physical issues with reproductive organs including the uterus or fallopian tubes.

Depending on the cause(s) of the infertility, the couple will undergo medical treatments which may include tests, medications, procedures, and even surgeries. The treatment plan will most certainly include multiple visits to providers and lots of waiting… waiting for appointments, waiting for results, waiting until the next intervention, and finally, waiting to find out of the intervention worked. This process can become very stressful and overwhelming.

Infertility and Psychological Distress

            Research indicates that infertility increases rates of stress, anxiety and depression. In one study, infertility patients’ level of distress was reported equivalent to that of cancer patients, those with hypertension, and patients recovering from a heart attack. Many studies have found infertility patients to have higher rates of depression and anxiety, including generalized anxiety disorder and major depressive disorder more specifically. They are also more likely to report suicidal ideation (study reported almost 10% occurrence). The rates continue to rise after unsuccessful treatments.

            While research has noted a clear link between stress and infertility, it is not clear whether stress can cause infertility. When people are stressed, they are more likely to engage in unhealthy behaviors such as using substances, changing eating habits, and may have a low sex drive. These behaviors can reduce chances of conceiving. Some research has also noted physiological changes in cortisol levels and enzyme(s) in the saliva (alpha-amylase), indicating higher levels of stress. Since much of the time, a physiological cause has been linked to infertility, it is likely that stress is a product of the infertility, not a direct cause. However, the longer the distress progresses, the more likely to reduce the person (or couple’s) quality of life and chances of conceiving or maintaining pregnancy. The depression and anxiety is also more likely to progress during pregnancy and during the postpartum period (http://cpw.care/pmads/).

Getting Help

            Despite the prevalence of mental health issues associated with infertility, many couples do not seek treatment (APA cited one study with rates as low as 6%). Reasons are unclear but may have to do with the isolation that women feel when struggling with trying to conceive. If you are struggling with infertility, you may be dealing with:

  • Isolating from loved ones, friends, family, and/or social events, in order to avoid interactions (or criticism) related to conceiving
  • Feelings of grief
  • Loss of identity: Perhaps you imagined having children and now are unsure if this is possible
  • Feelings of guilt, regret, and lack of control
  • Mood, sleep, and concentration issues
  • Increased anxiety and/or and depression
  • Marital issues: Infertility is stressful for men and women, however, they process in different ways
  • Libido Changes: Sex often feels like a chore in order to procreate
  • Financial Strain: Seeking medical care can become expensive, between preliminary testing and procedures. The average IVF cycle is $12,000, and it sometimes takes multiple cycles to achieve pregnancy
  • Medication side effects

Most of the research on reducing the psychological distress of infertility patients has found that a mind/body program incorporating cognitive-behavioral therapy techniques and relaxation strategies have been most effective at both reducing distress and improving pregnancy rates. These strategies include:

  • Progressive muscle relaxation
  • Yoga
  • Meditation
  • Maintaining a gratitude diary
  • Guided imagery
  • Practicing mindfulness skills such as self-compassion
  • Cognitive-behavioral therapy-involves challenging automatic thoughts (example, “The infertility is my fault”

Here at Center for Perinatal Wellness, we are licensed therapists trained in cognitive-behavioral therapy and mindfulness, utilizing a holistic approach to healing. We are keenly aware of the psychosocial challenges trying to conceive has on your health, well-being, and relationships with others. Whether you need a space to process this stressful life-changing event or are worried your symptoms may have progressed into a more serious mental health condition, we are here to support you.  

Please contact us for more information or if you would like to make an appointment.

413-203-1300 or visit our contact page http://cpw.care/contact/

https://www.health.harvard.edu/newsletter_article/The-psychological-impact-of-infertility-and-its-treatment

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016043/

file:///C:/Users/htoum/Downloads/Resource-Document-2019-Psychiatric-Aspects-of-Infertility.pdf