You’re Not Broken:
The Mental Health Effects
by Andrea Rice
It's a lot to put your body through hormone hell for odds like that, but I did it anyway.
I had just turned 38 when my husband and I decided to start a family. Naively, I assumed I’d get pregnant immediately. But after a year or so of trying to conceive, we were diagnosed with unexplained infertility.
I quietly refused to accept the diagnosis, and it took a toll on my mental health. I was hung up on conceiving naturally and never thought I’d be one of those people who’d resort to fertility treatments. But here I am.
Fertility treatments are an emotional roller coaster of uncertainty with no guarantees. But there are
a few ways you can cope.
As my biological clock ticked closer to 40, we finally decided to try assisted reproductive technology (ART).
Not only is it harder to get pregnant at my “advanced maternal age,” but research from 2019 shows that it’s even harder to stay pregnant as you get older.
Infertility…the word itself carries so much stigma, whether explained or unexplained. But infertility is prevalent, and it affects people of all genders.
Infertility is more common than many people think
When infertility is unexplained, it means that standard testing measures — like pelvic ultrasounds and blood work for hormone levels — cannot provide a definitive medical reason for why a person can’t get pregnant.
Unexplained infertility is more common than many people may realize. Research from 2016 estimates that infertility is unexplained in 8% to 37% of couples with infertility.
What causes infertility?
Kecia Gaither, MD, MPH, FACOG, the director of Perinatal Services at NYC Health + Hospitals/Lincoln in New York City, explains that causes of infertility are multifactorial, ranging from stress to low sperm count, diminished egg quality, endometriosis, and ovarian failure.
But sometimes — as in my case — the exact cause is never quite determined, though my “advanced maternal age” is certainly a key factor.
“Infertility is becoming more frequent as many individuals are delaying childbearing,” Gaither says.
Though I resisted ART at first, the more I learned that medical interventions could increase my chances of a live birth, the more inclined I became to give it a try.
For most of my life, I didn’t give the prospect of motherhood much thought. My mother wasn’t around very much, which means that I don’t understand — or remember — the primal connection of a mother-child bond.
The word “mother” used to make me sad and angry —but when I think of what “mother” means to me now, all that comes to mind is “unknown.”
Fertility doctors order a slew of tests to rule out possible causes to reach a diagnosis. And with each test, there's a whole lot of waiting around for results.
For my husband and me, our “unexplained” diagnosis meant that all of our fertility test results came back as “normal.”
I was tested for polycystic ovary syndrome (PCOS). My thyroid was checked. The doctor ruled out that a lifesaving abdominal surgery I had when I was 35 may have affected my fallopian tubes.
A pelvic ultrasound revealed a small polyp, but when I went in for the scheduled procedure to remove it, the polyp had mysteriously vanished.
I was starting to feel like a lab rat. I was healthy, and my hormone levels were fine. On top of that, I had as many eggs in my reserves as a 25-year-old, according to my doctor.
Still, I desperately wanted a reason for my “unexplained” diagnosis to explain why my body couldn’t do the one thing it was designed by nature to do.
The journey toward finding a diagnosis
Many people find success in boosting their fertility with natural methods. I tried it all —but I still couldn’t get pregnant.
I went to acupuncture, took Chinese herbs, and practiced Qigong. I consumed nuts, seeds, and seaweed and cut back on caffeine and alcohol. I ramped up my exercise routine, prioritized sleep, and managed my stress with yoga and meditation.
At one point, I considered enrolling in an expensive “ancient healing” course called “Mother,” but realized that money was better spent saving for a child that did not yet exist.
Whether your diagnosis is unexplained like mine or due to medical reasons, there are options for treatment — but no guarantees. Because of that, some people may seek alternative ways to expand their families.
Efforts to treat and manage infertility
My friend Casey and I are about the same age, though her egg supply has dwindled significantly by comparison.
Casey’s best option is an egg donor, a process she describes as “sort of like Tinder,” except that you’re swiping left until you find a match whose genetics resemble your own.
None of Casey’s DNA will be in the child she hopes to carry, while 50% of that DNA will belong to her partner.
She says the egg donor process has been a lot of “separating logic from emotion” as she grieved the loss of her own genetics that would carry on in a child. At times, she questioned what she was doing and if this was really what she wanted.
“I feel like I’m just checking boxes,” she says. “I haven’t even been able to think about being excited to become a mom.”
While Casey hopes to feel some excitement about motherhood once an embryo is transferred into her womb, for the time being, the process feels burdensome.
Our doctor said in vitro fertilization (IVF) was our best chance of having a healthy child. In fact, research from 2022 shows that children conceived via IVF may even have a better quality of life as adults.
IVF begins with self-administered injections with different estrogen-blocking medications and follicle-stimulating hormones to get the ovaries to produce lots (and I mean LOTS) of eggs. By day 6, my bandaged-riddled belly looked like a minefield.
Once it’s time to trigger ovulation, the eggs are retrieved and fertilized in vitro (a laboratory dish), where they culture for 5 to 7 days. From there, the healthiest and strongest embryos in the batch are either transferred to the uterus (one at a time) or frozen (in bulk) for a later date.
I currently have four good-quality “normal” embryos in the freezer. That’s how many potential humans passed genetic testing and have the greatest chance of survival.
I consider myself lucky —many women my age end up with no embryos after their first cycle and have to start the emotionally draining process all over again.
According to the Centers for Disease Control and Prevention (CDC), there’s a 26.7% chance of a live birth from IVF. But according to my doctor, my chances hover closer to 50%.
It’s a lot to put your body through hormone hell for odds like that, but I did it anyway.
In vitro fertilization
A friend of mine, Katrina, had her first child in her 30s this way. After 18 months of trying to conceive, she says becoming pregnant via IUI came as a joyful surprise —she wasn’t expecting it to work.
“Not knowing if I’d get to be a mom after wanting it for most of my life took up a ton of mental and emotional space,” she says. “The struggle felt invisible. Feeling alone in my grief and longing was really painful.”
At the recommendation of our doctor, we bypassed intrauterine insemination (IUI) because our advanced ages have a higher risk of producing an embryo with chromosomal abnormalities.
During an IUI procedure, the sperm is injected into the uterus through a catheter to increase the chance of fertilization during your most fertile time.
Medications, such as a follicle-stimulating hormone (FSH), may be used to help the ovaries produce and release mature eggs at ovulation.
For younger bodies, the IUI procedure can be effective. A research review from 2008 shows a 13% pregnancy success rate and 9% to 10% live birth rate for women in their early to mid-30s.
Motherhood can mean many things for those
of us who yearn to be caregivers.
It's not easy to feel both excited for someone and sad for yourself at the same time.
When I realized I’d been internalizing feelings that were hardly unique to my experience, I took comfort in knowing I wasn’t alone in my struggle. The mental health effects of infertility may include:
- loss of control
When my husband and I agreed to try fertility treatments, I don’t think we could have imagined the long, uncertain, and stressful road ahead of us.
Anna Locke, PhD, LPC, a therapist in New Jersey specializing in infertility counseling, tells me the “unknown” factor of unexplained infertility makes the family-building journey far more ambiguous, uncontrollable, and anxiety-inducing.
“At least with a diagnosis, couples feel they have medical options that can help them conceive; while without a diagnosis, couples are left feeling helpless, powerless, and hopeless,” Locke says.
“When I began to view infertility as a medical condition instead of a body betrayal, I felt less ashamed,” she adds. “I accepted that infertility is common and that there are many medical options available to help me become a parent.”
The mental health effects of infertility
My friend Corrie, who’s in her mid-40s, had a hysterectomy for medical reasons a few years ago. She and her husband expanded their family with two cats and a dog, but she says her role as an aunt to her sisters’ kids is what’s really helped her to move forward.
This goes to show that motherhood can mean many things to those of us who yearn to be caregivers.
For many people, ART is off the table, whether for medical reasons or financial barriers.
Others might try multiple rounds of fertility treatments without success and face a tough decision when it’s time to move on.
Some couples might choose to grow their family through adoption, while others could explore a surrogate.
While the adoption or surrogate processes are hardly easy solutions, emotionally and logistically, it may be an option worth exploring for those who have their hearts set on raising children.
Adoption and other strategies
My fertility journey is far from over, but I’m hopeful that it’s possible to have a baby at 40 — despite the risks and uncertainty. For me, “becoming a mom” could help heal the wounds of my past, but I also understand I have no control over the outcome.
My story is one in a million, but in sharing it, maybe I can help make it easier for others to talk about their fertility journeys.
While the prevalence of infertility in modern society astounds me, it may also point to a larger trend of people delaying child-rearing to focus on their lives or careers.
Remember, you’re not broken. If you’re having trouble getting pregnant, remember you’re not alone. Consider talking with a reproductive endocrinologist about your options, and seek emotional support from loved ones or a mental health professional.
At times, intercourse was fun. Other times, it felt like something on our to-do list.
Before we started trying, I’d always said that if I couldn’t get pregnant naturally, I’d accept that it wasn’t meant to be. But once I started envisioning our life with a child, it was hard to just let it go.
The fertility tests and visits to the clinic dragged on for about a year during the pandemic while my husband and I continued trying on our own.
Each month was a waiting game that resulted in another period, a glimmer of hope followed by disappointment.
The toll of waiting
I began to distance myself from my Instagram feed. Perfectly crafted posts of burgeoning pregnant bellies reminded me of what I was not able to achieve on my own.
As we continued to try to conceive, another loved one would tell me they were pregnant. It’s not easy to feel both excited for someone and sad for yourself at the same time.
I shared my experience with my therapist. I found solace among friends who’ve had or are having similar experiences. I developed a closer connection with family members, including my dad, when I finally started to open up about what was going on (and why I still wasn't pregnant).
Because of the stigma surrounding infertility, a lot of people don’t talk about it. They may feel embarrassed or ashamed or worry that sharing their experience may make others uncomfortable.
Though it wasn’t easy, I realized that talking about my journey helped me normalize it.
Whether you’ve been diagnosed with infertility or are currently in the throes of treatment, here are a few coping strategies to consider as you navigate the emotional roller coaster.
My inability to conceive left me feeling broken — like something was wrong with me. But in sharing my story, I began to feel empowered. I reminded myself why I chose to wait to start a family.
Tips to cope
You might also consider speaking with a therapist who specializes in working with individuals with infertility if you’re not ready to share your experience with other people in your life.
I encourage you to lean on loved ones for support so you feel less alone. Connect with those you know will listen and validate your feelings rather than try to “fix” the situation or offer unsolicited advice.
Remember that you’re in control of the conversation, so you don’t have to share everything about what you’re going through unless you feel comfortable doing so.
Talk with your loved ones
That said, you may wish to familiarize yourself with your treatment plan. Mentally preparing for the medications and procedures may help you feel more in control and ready for what’s to come.
I went into IVF somewhat blindly because I was terrified of the injections. I was worried that if I learned too much about what the process would entail, I’d back out.
Know what you’re getting into
“Those who’ve walked in your shoes will understand the feelings of grief that come along with infertility in ways that others — no matter how badly they may want to — just can’t,” Levich says.
“RESOLVE (the National Infertility Association) offers support groups with topics like pregnancy loss, donor conception [or] third party reproduction, adoption, childfree not by choice, and so many others,” she adds.
As an experiment, I briefly searched Instagram for camaraderie. There are more than a million posts tagged #IVFjourney alone.
I found the #IVFwarriors and their pineapple mascot (the bromelain in pineapple is thought to help with implantation, though there isn't much science to back it up), and it took me less than 5 minutes before I realized that social media wasn’t the right sounding board for me.
But there are other ways to find support. Stephanie Levich, founder and president of Family Match Consulting in Los Angeles, says that support groups can connect you with people going through similar experiences.
Connect with a support group
“Whether that’s planning weekly distractions with a loved one or feeling comfortable turning down a baby shower invitation, it is OK to put your mental health first,” she says.
For me, meditation helped stabilize my moods, and journaling allowed me to make sense of it all. For you, it might be something else.
Fertility treatments are hard on the body and mind. What’s more, many insurance companies do not recognize infertility as a medical diagnosis, which, to me, only adds to the stigma and stress.
When coping with infertility, Levich says it’s important to try to treat yourself with kindness and grace.
Prioritize your mental well-being
Andrea Rice (she/her) is an award-winning journalist based in Raleigh, North Carolina. As a staff writer for PsychCentral, she covers mental health news and trending topics. Her work has appeared in news outlets such as The New York Times and INDY Week, and wellness publications such as Yoga Journal, Verywell, and mindbodygreen. As a yoga and meditation teacher since 2010, Andrea’s book, The Yoga Almanac, offers seasonal practices to nourish the body and mind. Connect with her on LinkedIn and Twitter, and read more of her work on her website.
This article focuses on the mental health effects of infertility. To learn more about possible causes and diagnostic criteria, consider reading Healthline's in-depth overview article.
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Child-Free by Choice: Challenges of Deciding Not to Become Mom
What I Wish More
People Knew About Queer Parenthood
Back to top
Child-Free by Choice: Challenges of Deciding Not to Become Mom
Child-Free by Choice: Challenges of Deciding Not to Become Mom
What I Wish More People Knew About Queer Parenthood
You’re Not Broken:
The Mental Health Effects of Infertility