Living with infertility means experiencing a lot of big—and often painful—emotions. Taking one pregnancy test after another and getting negative results can lead to shame and despair. You might feel grief or anger when you hear a friend or relative is pregnant. Seeing baby clothing in a store or a commercial with a toddler could make you cry for hours.
“Emotional distress is an incredibly common response to infertility, and according to one paper, levels of depression and anxiety among infertility patients are equivalent to women with cancer, heart disease and HIV,” says Jodie Lisenbee, PhD, a clinician at the UNC Center for Women’s Mood Disorders.
Every person’s emotional response to infertility is different, but Dr. Lisenbee shares some strategies that can help.
1. Find support.
Infertility—defined as the inability to achieve a pregnancy after a year of unprotected sex—is incredibly common, with the World Health Organization estimating that 1 in 6 people of reproductive age are affected globally. But because many people don’t talk about it, you might feel very alone. Support groups, mental health professionals and trusted loved ones can help.
“Fertility challenges can be so private, but it helps to hear others normalize the experience and share what’s going on,” Dr. Lisenbee says. “You need social support during the highs and lows, whether it’s good news or a negative outcome.”
That doesn’t mean you have to tell everyone about a miscarriage or go into all the details of your latest treatment, but you’ll want to think about who in your life is a comfort to you and seek them out.
“Be clear about asking for the support you need from the people who will be most useful to you at that moment,” Dr. Lisenbee says. “Sometimes you need someone to talk to about what’s going on, but other times you need distraction and companionship in a way that takes your mind off of it.”
That includes connecting with your significant other.
“Infertility puts so much strain on relationships, particularly the sexual part of the relationship, so it’s important to work on communication and validate each other’s feelings,” Dr. Lisenbee says, noting that individual therapy and couples counseling can be helpful to navigating intimacy and emotions during this time.
2. Set boundaries.
When you desperately want a child, it’s easy for that to become the only thing you think about, affecting your ability to talk about anything else or see anything that reminds you of what you don’t have. Instead of allowing the topic to dominate your life or attempting to avoid every trigger, Dr. Lisenbee recommends setting boundaries for yourself on the topic.
“You have to find balance—you don’t want to avoid the topic, but it shouldn’t be all-consuming,” Dr. Lisenbee says. “Some couples need to set conversation parameters, such as scheduling two check-ins a week where they talk about it, because it can become the only topic of conversation if they don’t.”
Setting limits on how often you talk about babies, pregnancy or treatment options can help you stay present and try to enjoy the current state of your life.
“Grounding yourself into where your life satisfaction came from prior to pursuing parenthood can help with tolerating the uncertainty and loss of control associated with infertility,” Dr. Lisenbee says. “You might have to zoom back from this big issue and connect with your values and other parts of yourself.”
It’s normal to feel sad or jealous of a friend who becomes pregnant easily, which might cause you to avoid that person or celebrations related to their baby. This is another place where boundaries, rather than total avoidance, can be helpful.
“If you can come up with a plan that addresses the moment you’re afraid of that’s more useful,” Dr. Lisenbee says. “You can share in advance that you’re going to drop in at the beginning of a baby shower but that you’ll bow out early. You can sometimes dig yourself into a deeper hole of guilt and shame if you don’t show up for someone if that’s important to you.”
Still, Dr. Lisenbee says these boundaries can shift depending on your situation.
“There are going to be times when you feel more vulnerable—after an unsuccessful cycle of IVF or a negative pregnancy test—and times when you feel more resilient,” she says. “Be honest with yourself, and don’t go when things feel too difficult. There are other meaningful ways to connect and be a supportive friend.”
3. Have a plan A and a plan B.
It can be hard not to ruminate on every single thing that could happen when you’re dealing with infertility, and the range of possibilities can be overwhelming. Dr. Lisenbee recommends working with your care team to create a road map but to think about only two steps at a time.
“People who have a plan B established before starting plan A find that reassuring and comforting,” she says. “It can be harder to deal with a negative result to plan A if you don’t know what comes next. But you don’t need plans C, D, E or F. The road map doesn’t need 47 additional steps; it should be your current step and your next step.”
When your plan B becomes your current step, then you can add a new step to the plan. For example, if intrauterine insemination doesn’t work, then you might decide you’ll pursue two cycles of in vitro fertilization. When IVF is the new plan A, you might decide that using a donor embryo or adoption is the new plan B.
For some, remaining child-free will become the plan.
“Look at your first step and your next step, but at some point, child-free living might be put on the table, and it can be important to talk about it,” Dr. Lisenbee says. “A therapist can help to manage grief from that decision, but we ultimately see high rates of life satisfaction among child-free couples compared to parents, especially when they’ve spent time talking about what that life would look like and what they want it to be.”
4. Expect an emotional roller coaster during treatment.
Dr. Lisenbee says patients should prepare themselves for a very specific emotional roller coaster during a treatment like IVF.
“During weeks one and two, you’re typically in an action phase of getting tests and procedures that tends to be hopeful, and then week three is a waiting phase that can become very anxious,” she says. “During week four, you tend to get news, which can potentially be devastating. You have to prepare for these vulnerable periods when you’re waiting or when you might have to make a big decision after a result.”
Finding ways to manage stress during all the parts of this process is key, whether that’s taking a walk (vigorous exercise is usually off the table after fertility treatments), time in nature, a relaxation practice, such as meditation or writing in a journal, spending time with friends and family, or simply having a queue of funny shows and movies to watch.
“The biggest myth perpetuated about infertility is that stress causes it, but stress does not cause infertility. It’s the other way around—infertility and infertility treatments cause stress,” Dr. Lisenbee says. “The most common reason for terminating fertility treatments is stress. When you begin fertility treatments, it’s a time to bolster your coping efforts and proactively turn up the volume on the things that make you feel good. When you’re investing so much in trying to conceive, it’s also important to invest in your mental health.”
Struggling with your mental health? Talk to your doctor. If you need a doctor, find one near you.