Why Infertility Is More Than A Physical Disorder

photographed by Eylul Aslan.
When you're growing up and learning about the birds and the bees, the general narrative is often that two people can meet, fall in love, and have a baby, and it's as easy as that. And sometimes, it can be. But for many of us, reality is a lot more complicated in all of those aspects — but especially when it comes to having a baby.
According to the Centers for Disease Control and Prevention, 7.3 million women in the U.S. have struggled to conceive (or, at the very least, used infertility services). Studies have suggested that the emotional stress that comes with infertility can be comparable to the levels of stress that cancer patients experience, and that rates of anxiety and depression can be high amongst those who experience infertility.
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Marra Ackerman, MD, clinical assistant professor of psychiatry and director of reproductive psychiatry at NYU Langone Health, says that she's certainly noted mental health struggles in patients of hers who are experiencing infertility.
"I’d say probably the large majority of patients who are undergoing infertility treatments will experience mood or anxiety symptoms, but I think it’s underreported because [those] people may not seek out mental health treatment because they’re often so burdened with all the appointments of fertility treatments," she says.
Not to mention, there's already stigma around both mental health problems and fertility problems. And the pressure to have children can make it even harder to talk about how difficult the road to parenthood can be.
"As a society, we need to consider the fact that pregnancy and getting pregnant is very complicated," Dr. Ackerman says. "I think what happens is, people ask quite insensitive questions, making assumptions about timeline or ease of getting pregnant, and project those expectations onto women. I think that’s something we all have to work harder to be more mindful of."
But well-meaning yet insensitive questions aren't the only reason that infertility is emotionally taxing. There are several reasons why your mental health can suffer if you're struggling to conceive — read on for six of them.
If you are experiencing depression or anxiety and need support, please call the National Depressive/Manic-Depressive Association Hotline at 1-800-826-3632 or the Crisis Call Center’s 24-hour hotline at 1-775-784-8090.
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You might feel isolated.

You might feel isolated.

"I’ve had patients who say they talk about fertility struggles with their partner, but not anybody else, because it’s very private, or they’re ashamed or don't want anyone else involved in their business — which is a personal choice — but I think the isolation can be challenging," Dr. Ackerman says.

She says that she often hears from patients who feel insecure being around pregnant friends, and who might not feel up to going to baby showers and first birthday parties while they're having trouble conceiving.

The societal pressure around getting pregnant can make fertility struggles even more isolating, Dr. Ackerman says, because people who are trying to get pregnant might be triggered by questions like, "You've been married for a few years, when are you having a baby?"
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It can affect your relationships.

It can affect your relationship.

Dr. Ackerman says she's had patients who may feel like they've done enough in vitro fertilization (IVF) cycles to try to conceive, but whose partners might disagree — causing stress and relationship friction.

"There can be disagreements if it’s a couple disagreeing about how many cycles to do, or how much money and resources they’re willing to allocate, so that can be a major source of stress," she says. "There can be a lot of emotional burden on the couple that's going through the fertility treatment: There are constrictions in terms of physical and sexual activity during treatment, there’s a lot of stress, disappointment can come on either side about who’s the one who has the challenges in terms of fertility, and it can place a lot of strain on primary relationships."
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You might encounter a lot of uncertainty.

You might encounter a lot of uncertainty.

There's a lot of uncertainty about getting pregnant in general, but especially if someone is trying to conceive through IVF or wants to freeze their eggs, they might need to be prepared to do more than one round, which can be emotionally taxing.

"There are so many ups and downs, the whole expectation that it’s going to work, and then the disappointment that it hasn’t so that can fuel depression, anxiety and anger," Dr. Ackerman says. And when there's so much uncertainty, that can add to anxiety.
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You might experience hormone shifts.

You might experience hormone shifts.

If someone is going through IVF, Dr. Ackerman says, there can be hormonal effects that impact their mental health.

"Biologically, you’re giving women very high doses of hormones, both estrogen and progesterone," she says. "There are some patients who are more prone to have an adverse reaction, psychiatrically, to hormone shifts, and those are people more likely to experience trouble around mood and anxiety."

Dr. Ackerman says she's also seen women stop using anxiety or mood medication when they're trying to get pregnant, but you really shouldn't do so without consulting your doctor.
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You might be anxious about medical procedures in general.

You might be anxious about medical procedures in general.

It may sound like a small issue, but Dr. Ackerman says she often sees people who are afraid of needles begin to develop more anxiety as they go through fertility treatments.

"There’s a lot of injection involved in these treatments and so that can be a source of anxiety, having to self-inject or have their partner inject them," she says.

And if you're already anxious about your health or medical procedures in general, it can be even more difficult to go through something as heavily medically involved as fertility treatments often are.
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You might have to spend more than you anticipated.

You might have to spend more than you anticipated.

"These treatments, for a lot of people, are completely out of pocket," Dr. Ackerman says. "Some people have some insurance benefits, but the complexity of navigating the insurance process is really hard, time-consuming, and confusing, and that creates a lot of anxiety."

Apart from the anxiety of payment processes, treatments can be expensive. According to the American Society for Reproductive Medicine, the average cost of an IVF cycle is $12,400, and if you need more than one cycle, you can imagine how much the cost adds up — and financial strain definitely can be a source of stress and anxiety.

"For a lot of couples, they didn’t anticipate this when they were doing financial planning to start a family, and now they’re spending thousands to make it happen," Dr. Ackerman says.
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