Mental Health and Fertility: It doesn’t have to be a silent struggle

“I’ve seen patients who have had suicidal thoughts after a failed IVF. Some couples even ended up separating after a failed fertility procedure. The mental toll a couple endures from infertility is tremendous. Mental health issues due to infertility are real; it is not a non-issue to be taken lightly.”

Dr Navdeep Singh Pannu

Infertility affects the social and personal aspect of a person’s life. One of the most difficult emotional consequences of infertility is the loss of control over one’s life. The inability to conceive causes much distress, along with depression and anxiety.

This article/discussion aims to define the parameters of the issue, discuss the facets of how mental health is associated with fertility and the available ways of how the circumstance can be managed.

1. Introduction: Quick Overview of Infertility

Children are viewed as an integral part of our family units; so, a couple who has not been able to conceive after a few years of marriage is subject to much social scrutiny. Infertility is perceived as a problem across virtually all cultures and societies. It has been indicated by the World Health Organization (WHO) that 8-12% of couples worldwide experience infertility (World Health Organization, 2020). In recent years the numbers seeking treatment have dramatically increased.

As defined by WHO (2020, Sept), infertility is a disease of the male or female reproductive system defined by the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. Estimates suggests that between 48 million couples and 186 million individuals live with infertility globally.

Contrary to popular belief, infertility is not just a women’s issue. Up to 30 percent of infertility cases are due to men, 30 percent due to women, another 30 percent being due to both genders, and 10 percent due to unknown causes. Based on these statistics, men contribute to the cause about half of the time.

2. Rising Numbers of Mental Health Issues due to Infertility

Image credit: news-medical.net

In recent years, the number of couples seeking treatment for infertility has dramatically increased due to factors such as postponement of childbearing, development of newer and more successful techniques for infertility treatment and increasing awareness of treatments available.

As with all treatments, infertility treatments are not always successful. From what I have seen, failed fertility treatment outcome not only affects women, but men too, especially if it was caused by male factor infertility. Increasing participation in fertility treatment has inspired investigation into the psychological ramifications of infertility.

For a couple going through infertility, it is mostly a lonely journey. Oftentimes, I see couples struggle silently because they do not want to be viewed as inadequate and do not want people sympathising with them. It is said that patients going through infertility consider it as a non-fulfilment of a wish for a child and therefore, have profound feelings of depression, anxiety, isolation and loss of control, levels of which can be compared to patients who have been diagnosed with cancer.

According to the US National Library of Medicine, National Institutes of Health (2018, March), the overall prevalence of psychological problems among infertile couples around the world is estimated to be as high as 25% - 60%. In Malaysia, a study by a team from UiTM found that the level of anxiety, stress and depression among women going through infertility was 1.5 to 3 times higher than their male partners (Sham, et al.,2020). This is mostly due to the stigma surrounding infertility where women are most times blamed for not having the ability to procreate. With the high prevalence of mental health issues among couples going through infertility, it is so important to address and fix these issues.

3. Infertility and Its Psychological Impact

 Parenthood is one of the major transitions in adult life for both men and women. The inability to conceive children is a stressful situation for couples and can cause much anxiety.

There are several causes of psychological disturbances for couples going through infertility which include:

  1. Treatment-linked factors
  2. Social factors
  3. Personal factors
 
Treatment-linked factors

Prolonged exposure to intrusive infertility treatments affects mood and well-being, which further affects infertility. Infertility treatments and drugs also cause fluctuating hormones. Going through cycles of infertility treatments with much pain but no gain causes further anxiety and depression. I have seen some patients resorting to alcohol and even drugs as a form of release from pent-up feelings and frustrations.

Social factors

Image credit: healthcare.utah.edu

 

For a childless couple, it is hard to go out in public without constantly seeing parents and children. We live in a pro-natal society where emphasis on families with children is everywhere – commercials, TV shows and movies. As such, a couple is often reminded that they are not a ‘member of the club’. These feelings are quite complex and can be an emotional trigger to feelings of low self-esteem and depression.

Personal factors

Infertility can have a profound impact on the identity of a person as it is seen as the disruption to the expected development shift to parenthood. Women especially often begin to imagine themselves as mothers long before actually trying to have children. This is influenced by cultural and societal messages that idealise motherhood. When this imagined self of a parent is withdrawn, it may result in the feeling of a loss of control, threaten their imagined future and feel like an assault on their ability to self-actualise.

Stress, depression and anxiety not only affect the psychological state of a person, but also their physiological state. When we are depressed or stressed, the body responds by elevating levels of prolactin in the body and there will be disruption of the hypothalamic-pituitary-adrenal axis and thyroid dysfunction. Luteinizing hormone, a hormone that regulates ovulation, starts to become abnormal and this adversely affects reproductive function. The effect of a person’s mental health on their physical body is so profound that it impacts the ability to conceive.

4. Different Management Strategies that can be Helpful in the Treatment of Mental Illness associated with Infertility

 Through my years as a Fertility doctor, I have seen the negative impacts of stress, depression and anxiety on a couple going through infertility, which is why I truly feel that mental health issues relating to infertility for both men and women need to be addressed at the soonest. With more and more people these days seeking infertility treatments, there are more interventions available to help with mental health issues. Here are just some interventions that couples can look for:

Image from: drnavdeepfertility.com

 
a) Uplift – Mind/ Body Program

Uplift’s Mind/Body program is designed to help individuals or couples who are participating in fertility treatments cope with the physical and emotional impact of infertility. Stress and depression disrupt the natural harmony of the body which reduces chances for a successful pregnancy.
The goal of the program is to help improve a person’s sense of control, decrease both physical and psychological symptoms of stress and help decrease the intense lows of infertility. Skills that are taught include relaxation techniques, good lifestyle habits and psychological techniques such as learning to challenge recurrent negative thoughts.

b) Fertility Coaching

Our Fertility Coach, Joyce Simson, helps couples journey through the loss of a failed fertility treatment which can be quite overwhelming and isolating. Her work is about helping couples look deeper into themselves and process their emotions. Fertility Coaching is truly a great help as couples get that extra mental and emotional support while navigating through their fertility struggles.

c) Hypnotherapy

Hypnotherapy is another form of intervention that couples may consider. While hypnosis may not directly help a couple get pregnant, it will aid the process. It can help alleviate intense anxiety around fertility treatments, increase positive thinking and relax thoughts of self-doubt and self-blame.

 Acknowledge your feelings and seek the right help

My Fertility team and I, having vested our heart and soul into helping couples conceive get deeply affected by negative fertility treatment results. We always put our best foot forward in hopes of helping couples achieve that dream of a baby in their arms, but sometimes it just doesn’t happen. At times my team of embryologists, nurses and myself included goes through the same motions and roller coaster of emotions that our patients go through when there is a negative fertility treatment outcome. The sense of loss can be quite overwhelming for us too.

As such, we truly understand how devastating it would be for couples to go through cycles of infertility treatments without achieving the goal of cuddling that baby so wished for. The grief can be somewhat similar to one who has lost a child.

Image credit: everydayhealth.com

To a couple going through depression and anxiety from failed fertility treatments, know that we, the Fertility team, are on the same team as you and we always hope for the best for every couple who walks into our clinic. If you are feeling overwhelmed by the motions of your fertility treatments, my advice is to stop and take a break to seek the help that you need. The first step is to acknowledge what you are feeling; don’t brush it aside. There is help available. Talk to someone; vent out your frustrations. You do not need to struggle alone and silently.

 

When Trouble Conceiving Affects Your Mental Health

In conversation with BFM 89.9 on Mental Health and Infertility “When trouble conceiving affects your mental health” I had the opportunity to speak on BFM recently where I shared my personal insights on the topic of “When trouble conceiving affects your mental health”.