June 29, 2023

A Focus on Mental Health and Infertility in Women

woman sad by a window

By Gabriella Watson, MS, Science Programs Coordinator

For many, having children is a natural and profound desire – but when faced with the challenges of infertility, the journey to parenthood can have wide-reaching and negative impacts on the lives of all those affected.  

Infertility is defined as the inability to become pregnant after 12 months of regular, unprotected sexual intercourse, and it can be caused by any number of issues related to both female and male factors. In women, the most common cause (40%) of infertility is the failure to ovulate; failure to ovulate can result from gynecologic conditions like polycystic ovary syndrome (PCOS) or endometriosis, older age (35+), endocrine disorders, and/or lifestyle or environmental factors. In around 15-30% of cases, the cause of infertility cannot be determined and is labeled as ‘unexplained infertility.’  

According to new data from the World Health Organization, infertility affects 17.5% of the adult population – about 1 in 6 people – worldwide. In the United States, 9% of men and 11% of women of reproductive age are reported to experience fertility problems. Despite the widespread prevalence of this issue, disparities exist in the prevention, diagnosis, and treatment of infertility due to barriers such as high costs, social stigma, limited accessibility, and physician bias. In 2021, the Society for Women’s Health Research (SWHR) convened an interdisciplinary working group for a roundtable meeting to discuss how to reduce health disparities and eliminate such barriers – a summary of which can be found here.   

Impacts on Mental Health 

While infertility is often discussed within the context of medical interventions and reproductive health, the mental health implications should not be ignored. Receiving a diagnosis of and pursuing treatment for infertility can evoke a range of complex and intense emotions, such as stress, anger, fear, guilt, grief, shame, hopelessness, and isolation. For women in certain communities, the emotional burden of infertility can be further exacerbated by stigmatization, gender norms, and a cultural pressure to conceive.    

Infertility can have an impact on almost every area of a woman’s life. In addition to the physical and financial stressors associated with infertility, women have cited diminished self-esteem, decreased occupational engagement, a reduction in sexual pleasure, and strained relationships (with intimate partners, friends, and family).

Research suggests that anywhere from 30-60% of women with infertility experience challenges with their mental health, though the true prevalence is unknown.

When compared to men, women with infertility show higher levels of anxiety, depression, and psychiatric disorders – the severity of which are dependent upon several factors, including the cause and duration of infertility, the type of treatment methods, the number of unsuccessful rounds of IVF, and level of emotional support.  

While the research is inconclusive, there is some evidence to suggest that anxiety and depression can heighten the risk of infertility. In a Danish study, researchers found that among women with a history of depressive symptoms, there was a significant association with infertility. However, this study and others like it have not been able to control for external factors that may also contribute to infertility (e.g., smoking, alcohol use, BMI, low libido) and more research is needed to determine whether there is a casual relationship.  

Seeking Support 

Shouldering the stress and mental health burden of infertility is not something that anyone should endure alone – support is available. But mental health services are often underutilized, as data suggests that less than 21% of individuals with infertility have sought professional help. Though more research is needed to develop effective and evidence-based interventions, participation in counseling, therapy, and support groups have been shown to help reduce infertility-related stress and develop resilience. To better support women at every stage of their journey, policymakers could explore methods, such as integrating mental health screenings and services into fertility care and expanding insurance coverage for mental health services in order to reduce the already significant financial burden that fertility treatment places on women.

Addressing the mental health impacts of infertility also requires a comprehensive public health approach that promotes awareness and education among both health care providers and the general public. Reducing the stigma and dispelling misconceptions surrounding infertility are essential steps in fostering an environment where women are not just supported, but also empowered. As we close out Infertility Awareness Month this June – and in every month moving forward – SWHR and its partners are working to advance research, policy, and education on infertility and improve the lives of those affected.

 

For more information regarding infertility, check out these SWHR resources:  

And the following fertility wellness organizations:  

 

Do you have a fertility story to share? SWHR wants to hear from you! Sharing your story could help inform future resources and policy. Visit swhr.org/shareyourstory to learn more.