Infertility-Related Distress: Understanding & Addressing the Impact

Based on article: Dube, L., Nkosi-Mafutha, N., Balsom, A. A., & Gordon, J. L. (2021). Infertility-related distress and clinical targets for psychotherapy: A qualitative study. BMJ Open, 11(11). https://doi.org/10.1136/bmjopen-2021-050373

Infertility, commonly defined as the inability to conceive after 12 months or more of regular unprotected intercourse in individuals under the age of 35, or 6 months in individuals over the age of 35 (American Society for Reproductive Medicine, 2023) affects around 15% of couples in Canada-  equating to roughly 2.5 million people. Alongside the physical challenges (like repeat blood work and ultrasounds, fertility testing, painful procedures), infertility is often accompanied by significant psychological struggles (Cao et al., 2022). We see this even more pronounced in the intended pregnant person. In women1 partnered with men, fifty percent report their experience of infertility as one of the most upsetting experiences of their life, while only 15% of their male partners report similar concerns. (Freeman et al., 1985) . The question is: why are we seeing such high rates of clinically significant levels of depression and anxiety among those facing infertility?   

            The answer lies in the gap between the mental health needs of these individuals and the limited psychological interventions available to support them effectively. Currently, few psychological programs specifically address the unique emotional impact of infertility, and existing treatments often fall short of addressing the comprehensive mental health needs of those affected (Dube et al., 2022). This study, co-authored by Psycle Lab director Ashley Balsom, aimed to explore the psychological toll of infertility-related distress, uncovering insights that can inform the development of more targeted treatments.

The Study: Exploring Infertility-Related Distress

This project engaged two key groups: (1) women experiencing either primary (having never conceived) or secondary infertility (having previously conceived) and (2) mental health professionals specializing in infertility. To reach these groups, flyers were posted at local fertility clinics, and it was advertised on the Facebook page of a local infertility support group.

In total, 21 women and 14 mental health professionals participated.

Key Findings: The Emotional Roller-Coaster of Infertility

Infertility is an intensely personal and emotional journey, and for many women, it can feel all-encompassing. Through this study, five core themes were identified that capture the unique challenges women face during this time. These themes also highlight areas where support can make a meaningful difference. The themes that define infertility related distress are (1) Anxiety, (2) Mood Disturbance, (3) Threats to the Self, (4) Threats to the Couple, and (5) Threats to Social Networks.

1.      Anxiety

Anxiety can be a common experience on the infertility journey. Women describe feeling consumed by their efforts to conceive, with their thoughts constantly circling around fertility treatments, timelines, and outcomes. Some individuals avoid other parts of life and may fixate on gathering information, hoping for answers.  

As one woman reflected:

“I was developing a lot of anxiety and spending so much time hovering about this like it was just becoming all consuming.”

2.     Mood Disturbance

            The emotional toll of infertility can feel like a roller-coaster ride, swinging between hope and despair with each passing month. Women may feel helpless or emotionally drained, frustrated by their lack of control over the process. As one woman shared:

            “I went to the doctor, and I said to her ‘I need to get off work, I need to be on stress leave because I can’t do this anymore’.”

3.     Threats to the Self

            For many women, infertility shakes their sense of identity. Dreams of motherhood, often imaged from a young age, feel shattered, leading to feelings of failure, shame, and self-blame.

            “When I was a kid, I wasn’t dreaming about being a doctor or a vet or thinking about the perfect wedding, I was thinking about being a mom. And it was just a sense that the vision of what I had for my future wasn’t possible.”

4.     Threats to the couple

            Infertility can strain relationships. The emotional and physical demands of trying to conceive can diminish intimacy, create disagreements on next steps, and amplify financial stress. Over time, sex may shift from an act of connection to a frustrating task; as one woman expressed:

            “It just seems like work.”

5.     Threats to social supports

            Many women describe feeling isolated during their infertility journey. Relationships with friends and family may become strained, especially if others struggle to offer empathy or understanding. Encounters with healthcare professionals can also feel dismissive or women may lack access to qualified professionals. One participant described the difficulty of finding a professional who truly “got it”:

“She gave me quite a cookie cutter approach to her counseling... like, you’re going through infertility so you must be experiencing this and this and this. I was like ‘Oh no, I am not experiencing that’.”

Big Picture

            Infertility is more than a medical condition—it is an emotional, relational, and social experience that can impact every part of life. By understanding these components of infertility-related stress, we can begin to offer more meaningful support to women navigating this challenging journey. This also highlights the pressing need for specialized and appropriate services for those going through infertility. Whether through therapy or simply more informed conversations, there is hope for creating a more compassionate path forward together.

1 All participants in this study identified as cis-gender women at the time of data-collection

References

1.              Dube, L., Nkosi-Mafutha, N., Balsom, A. A., & Gordon, J. L. (2021). Infertility-related distress and clinical targets for psychotherapy: A qualitative study. BMJ Open, 11(11). https://doi.org/10.1136/bmjopen-2021-050373

2.              American Society for Reproductive Medicine. (2023). Definition of infertility: A committee opinion.  https://www.asrm.org/practice-guidance/practice-committee-documents/denitions-of infertility/#:~:text=The%20inability%20to%20achieve%20a,any%20combination%20of%20those%20factors.

3.              Cao, D., Bai, C., & Zhang, G. (2022). Psychological distress among infertility patients: A network analysis. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.906226

4.              Balsom, A. A., Klest, B., Sander, B., & Gordon, J. L. (2024). Acceptance and commitment therapy adapted for women with infertility: A pilot study of the infertility action program. Reproductive Health, 21(1). https://doi.org/10.1186/s12978-024-01766-5

5.              Dube, L., Bright, K., Hayden, K. A., & Gordon, J. L. (2022). Efficacy of psychological interventions for mental health and pregnancy rates among individuals with infertility: A systematic review and meta-analysis. Human Reproduction Update, 29(1), 71–94. https://doi.org/10.1093/humupd/dmac034