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    The medicalization of infertility has unwittingly led to a disregard for the emotional responses that couples experience, which include distress, loss of control, stigmatization, and a disruption in the developmental trajectory of adulthood. Evidence is emerging of an association between stress of fertility treatment and patient dropout and pregnancy rates. Fortunately, psychological interventions, especially those emphasizing stress management and coping-skills training, have been shown to have beneficial effects for infertility patients.

     -Best Practice & Research Clinical Obstetrics & Gynaecology, Vol. 21, Issue 2, April 2007, 293-308.

by Ruth Ellen Saul, LCSW

Psychotherapy During Infertility
by Ruth Ellen Saul, LCSW

If you are experiencing infertility, you know that it is an emotional roller coaster. Even though it is a major life crisis, it is often not recognized as such by those around you (if they even know). Research has shown that the stress of infertility is comparable to that for cancer, AIDS, and other devastating illnesses.(1)  It frequently leads to feelings of anxiety, depression, grief, and hopelessness. It can undermine even the strongest sense of self-esteem, and put even the healthiest relationships in a precarious state. The most intimate of experiences with your partner becomes cold, hard data for the scientists to examine. Most people come to feel quite isolated and misunderstood by well-meaning family, friends, and even spouses. Then, as if your foundation wasn’t already shaky enough, the entire experience can precipitate a spiritual crisis. 

There are lifelong consequences for you and others to the complex and difficult decisions you must make during this time—which medical treatments, how long, and what physical, emotional, and financial costs you are able and willing to bear. Pregnancy and parenting, while the blessed prize for all of this anguish, is often a bit different than those who have built their families easily. Later, what to tell your children may be an issue. 

Psychotherapy may be very valuable during this time. You are in a very stressful situation. Depression and anxiety are normal, physiological responses to your circumstances. Treatment eases the intensity and duration of your suffering. Take note of the following:

        --Depression can be triggered by conditions of extreme stress or grief, such as those brought on by infertility. It is a common disease with biological origins (NOT a weakness of character!) and needs to be treated with medication, psychotherapy, or both. Depressed people often do not recognize they are depressed.(2)

       --There is increasing evidence of a connection between the treatment of stress and depression and increased success with infertility treatments.(3)

       --Those who participate in “group psychological interventions” (support groups, counseling) while going through the infertility process are thirty percent more likely to achieve the birth of a healthy child than those who do not.(4)

These are some of the benefits that a psychotherapist trained in infertility can offer you. She can:

        --Treat anxiety and depression

       --Help you, individually or as a couple, sort out complex and difficult decisions

       --Guide you through relationship turmoil with those most important to you

        --Support you through times of grief and loss

        --Coach you in developing a specific plan to help you regain control over your lives again, taking into account your medical circumstances, strengths, willingness, limitations, spiritual beliefs, resources, etc.

       --Connect you to a support group with others working through similar issues

       --Help you strengthen your relationship with your partner

       --Provide a safe, confidential haven to express and resolve your frustration, jealousy, spiritual doubts, grief, guilt, anger, etc.

       --Give you information on local, informational, and supportive resources available to assist you with your specific concerns within the broad context of infertility

Some people use psychotherapy to help get over one particular hurdle. Others use it for support throughout the process. In dealing with infertility, most find it valuable to participate as needed, attending weekly for a time, taking a break, and returning for coaching or facilitation or psychotherapy as the process unfolds, and new circumstances or questions arise.

On a practical note, psychotherapy may be the least costly out-of-pocket medical treatment in your infertility experience. Psychotherapists treat anxiety and depression resulting from the dilemmas surrounding the infertility, and not the infertility itself. Health insurances and locales vary widely on this. In Wisconsin we have mandated mental health coverage for depression and anxiety, while medical infertility treatments are usually considered out-of-pocket expenses. Ask the therapist you are considering about your coverage.

A word of caution: choose a psychotherapist very experienced in infertility. You already feel isolated enough, without having to educate your therapist, define medical terms, and explain the implications of your situation. You need someone who understands the entire tangled web that you’re in: medically, emotionally, financially, relationship-wise, and spiritually. Look for someone who knows local resources, keeps themselves up-to-date with the quickly-changing field of medical treatments for infertility, is familiar with emerging mind-body research and approaches to dealing with infertility, and is associated professionally with infertility organizations such as Resolve and the American Society for Reproductive Medicine. Your psychotherapist’s personal experience with infertility helps tremendously, as they have walked a similar path before you.

Moving from infertility to having a child in your home can seem simply unattainable. Many couples delay seeking support, understandably, feeling paralyzed. But the earlier you cope with the emotional as well as the physical concerns, the greater your chances for a successful outcome.

All of my best to you on your journey. 



2. Domar, A.D., PhD, and Kelly, A.L., Conquering Infertility (New York: Viking Press, 2002)

3. Domar, A.D., PhD, Healing Mind, Healthy Woman (New York: Henry Holt, 1996: p.238) Hillary Klonoff-Cohen, PhD, et al. “A prospective study of stress among women undergoing in vitro fertilization or gamete intrafallopian transfer” (Fertility and Sterility, 2001 76:675-87).

4. Domar, A.D., et al. The impact of group psychological interventions on pregnancy rates in infertile women. (Fertility and Sterility, 73(4): 805-11, 2000 Apr.)

I do believe that when we face challenges in life that are far beyond our own power, it’s an opportunity to build on our faith, inner strength, and courage. I’ve learned that how we face challenges plays a big role in the outcome of them.
-Sasha Azevedo

Opposition is a natural part of life. Just as we develop our physical muscles through overcoming opposition-such as lifting weights-we develop our character muscles by overcoming challenges and adversity.
-Stephen R. Covey