Infertility has become one of the most common reasons that women between the ages of 20 and 45 seek medical treatment in the United States. According to the CDC, 19% of women experience physiological (medical) infertility. Additionally, many more people experience social infertility (infertility caused by social relationships and circumstances). Given this significant portion of the population experiencing infertility, it’s critical that psychotherapists working with anyone in this age group have a robust understanding of what infertility is, how it’s treated, and its mental health impacts on individuals and couples.
The American Society for Reproductive Medicine provides a three-part definition of infertility, updated in 2023 to reflect a growing need to acknowledge the fertility journeys of the LGBTQIA community and single individuals. Infertility is defined as:
The inability to achieve a successful pregnancy based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of these factors.
The need for medical intervention, including but not limited to, the use of donor gametes or donor embryos to achieve a successful pregnancy either as an individual or with a partner.
In patients having regular, unprotected intercourse and without any known etiology for either partner suggestive of impaired reproductive ability, evaluation should be initiated at 12 months when the female partner is under 35 years of age and at six months when the female partner is 35 years of age or older.
Given this robust definition, the actual number of people struggling with infertility is presumably significantly higher than statistics would suggest.
There are various physiological causes for infertility. Age is a common factor, as the chance of conceiving each month drops from 25-30% for a woman in her 20s to 10% for a 40-year-old woman. Problems related to ovulation, such as PCOS, thyroid disease, and other hormonal imbalances, can also cause infertility. Blocked or damaged fallopian tubes can prevent successful pregnancy, as can a variety of sperm-related issues, such as problems with sperm count, motility, morphology, or ejaculation.
The mental health toll of infertility cannot be understated. Women going through infertility have been shown to have similar rates of depression to those undergoing treatment for cancer. Studies have demonstrated that as many as 52% of women experiencing infertility suffer from depression, and in a large study in Northern California, 76% of women undergoing infertility treatment reported symptoms of clinical anxiety. In addition to the grief and anguish associated with infertility, the testing, medications, and treatments can exacerbate mood-related symptoms. Whether or not infertility was the presenting problem bringing a patient into therapy, it’s likely that it will impact their mental health and need addressing in the therapeutic space.
Infertility also significantly impacts couples. Couples experiencing infertility report lower relationship satisfaction than those who have not faced infertility. Multiple studies demonstrate lower sexual satisfaction among couples dealing with infertility. Psychotherapists working with couples are likely to see the impact of infertility manifest in various ways within the partnership.
The world of testing and medical treatment for infertility is complicated and often not well understood by those who haven’t experienced it. Often, psychotherapy patients feel compelled to spend precious session time explaining various treatments or tests related to infertility, leaving less time for support and psychotherapy. One way psychotherapists can provide attuned care to those struggling with infertility is to educate ourselves on its causes, testing, treatment, and mental health impact. Having a robust understanding of the world of infertility can help our patients feel understood and supported and can help therapists stand firmly in a confident role as experts.
For more information on infertility and supporting psychotherapy patients through infertility, we encourage you to view our online course, Introduction to Infertility. Additionally, find more resources and information in our Coping with Infertility Resource Guide.
References
Definition of infertility: A committee opinion. Practice Committee of the American Society for Reproductive Medicine, American Society for Reproductive Medicine, Washington, DC. 2023. https://www.asrm.org/globalassets/_asrm/practice-guidance/practice-guidelines/pdf/definition-of-infertility.pdf
Defining infertility – fact sheet. American Society for Reproductive Medicine. (2014). https://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/defining_infertility_factsheet.pdf
Hirsch, RN, DNS, A., & Hirsch, PhD, S. (n.d.). The effect of infertility on marriage and self‐concept – Journal of Obstetric, Gynecologic & Neonatal Nursing. https://www.jognn.org/article/S0884-2175(15)32784-2/fulltext
Lin, J., & Susser, MD, L. (2022, July 27). Recognizing the psychological toll of infertility in women. Anxiety and Depression Association of America, ADAA. https://adaa.org/learn-from-us/from-the-experts/blog-posts/professional/recognizing-psychological-toll-infertility
Rooney, K. L., & Domar, A. D. (2018, March). The relationship between stress and infertility. Dialogues in clinical neuroscience. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016043/
Starc, A., Trampuš, M., Pavan Jukić, D., Rotim, C., Jukić, T., & Polona Mivšek, A. (2019, September). Infertility and sexual dysfunctions: A systematic literature review. Acta clinica Croatica. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971809/#:~:text=It%20can%20be%20concluded%20that,report%20less%20satisfaction%20with%20sexuality.
Yahya, Fadi, MD. (2022, August 24). Infertility and stress. Mayo Clinic Health System. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/infertility-and-stress#:~:text=In%20a%20nutshell%2C%20infertility%20can,are%20blamed%20for%20their%20condition.
