153. Infertility Is Hard — And Your Mental Health Matters Too

The psychological burden of infertility is comparable to a diagnosis of cancer, heart disease, and other potentially terminal illnesses. And yet most fertility clinics offer no mental health screening, no referrals, and sometimes no acknowledgement at all that what a couple is going through is genuinely one of the hardest experiences of their lives.

In this episode of Cycle Wisdom, Dr. Monica Minjeur makes the evidence-based case for treating the mental health dimension of infertility as a clinical priority — not an optional add-on. Through Elena and James's story, a couple three years into their fertility journey who were quietly losing each other through the process, you will see what comprehensive fertility care can look like when the whole picture is finally addressed.

You will learn:

• What the research actually shows about depression, anxiety, and infertility — and why the numbers are staggering
• How men and women experience the psychological burden of infertility differently — and why those differences can silently drive a wedge between partners who most need to be a team
• What evidence-based psychological interventions look like — and why one study showed a 52% pregnancy rate in women who received mind-body support compared to 20% in those who did not

If you or your partner have been struggling emotionally through a fertility journey and nobody has asked about it — this episode is for you. Learn more or schedule a free discovery call at radiantclinic.com.

Transcript

Speaker 0:02

Infertility is listed in the medical literature as a disease, despite actually being characterized as a symptom of different processes that are causing that infertility in the first place. However, what it rarely gets treated as is a mental health crisis, even though the research is clear that the psychological burden of infertility is comparable to a diagnosis of cancer, heart disease, and other chronic diseases. If you or someone you love is struggling to conceive, and you've been wondering why it feels so much harder than anyone around you seems to understand, today's episode is for you. I'm Dr. Monica Minjeur, the host of Cycle Wisdom, where we help women and couples restore hormonal balance and reclaim their wellbeing through personalized healthcare grounded in clinical excellence. Let's start off today, as always, with a patient story, and we'll call our couple today Elena and James. They were three years into their fertility journey, and after two failed IVF cycles and one early miscarriage, Elena felt increasingly unsure of how to find help. She was a high-functioning professional who described herself as someone who solves other problems. James was quiet and steady and incredibly supportive, but felt a bit lost as to know what needed to happen next. When she came to see us, Elena described feeling like she was grieving, but she had never really lost that thing in the first place, and then she would feel guilty for being upset of the grieving. She was angry at her body, ashamed of her anger, and uncertain if she wanted to continue forward on the fertility path, especially after having a miscarriage. James, on the other hand, was quiet. He watched his wife quietly fall apart every cycle after being told that repeatedly her numbers were fine at the IVF clinic. He started to withdraw, and Elena interpreted that as the fact that he maybe didn't care or maybe didn't want to proceed with infertility treatments. Both of them were sleeping poorly, and they weren't talking about it. After a second failed IVF transfer, Elena called this IVF clinic and said, "I can't do this anymore," and she didn't ever call them back. A few weeks later, she made an appointment at Radiant Clinic, and we asked that James would come along, too. We talked to both of them not only about the medical side of infertility, but also talked through what else was going on from a psychological standpoint. Elena broke down in tears, and she said, "I didn't think that we would end up losing each other through this process, but that's exactly what has happened." As we talked further, we realized that both of them actually met clinical criteria for signs of mild to moderate depression. Elena also met criteria for clinical anxiety, especially at certain times of her cycle. And so instead of just covering that up or starting them on medications, we talked through ways in order to manage that and started off, as always, with our complete hormone and cycle evaluation. From day one, we referred them to a couples counselor, one that specialized in fertility treatments, because we know the significant burden that this can place on a couple. We also talked through what it looked like to continue working together or to give themselves time to just take a break. With a plan in place, both Elena and James felt for the first time that they were on the same page and in this together. Throughout all of our upcoming appointments, they came to visits together, and we continued to address not just what was going on medically, but also made sure to take care of their mental health and always keep their relationship at the center. The thing that changed wasn't necessarily the outcome. They are still waiting and hoping for a pregnancy, but they feel more together in this process and have resilience knowing that their healthcare team is also watching out for their mental health. Let's back things up a little bit. Infertility is common. We talk about this a lot on this show, and we talk about the fact that on average, one out of six people globally are experiencing infertility, subfertility, recurrent miscarriages, or otherwise unable to conceive. And despite the fact that infertility is so common, the emotional experience that people have is almost never proactively addressed in clinics. Most couples receive no mental health screening, no referrals, and sometimes no acknowledgement whatsoever that what they're going through is genuinely hard, and in some cases, one of the most difficult things that they will deal with in their entire lives. Both partners can be impacted, but in different ways, and those differences can silently drive a wedge between individuals who most need to be a team. This is why we always talk about in our practice, my priority is making sure that you are a strong couple, a strong unit that gets through this no matter what the outcome is Now, I want to make sure that we're very clear that, yes, depression and anxiety are very normal and very common with infertility, but this does not mean there is nothing to do about it, and it doesn't mean that it has to be a part of the added suffering. Depression and anxiety are treatable, and there are evidence-based interventions that can meaningfully reduce distress, and in some studies actually show improved pregnancy rates. Now, this does not mean, "Oh, just relax," or, "Just stop stressing and it'll happen." This is not specifically how stress works. But we know that that chronic psychological distress can have measurable impacts on the hormone environment and on treatment outcomes. And if you wanna hear more about this, go back to last week's episode where I talk about chronic stress and its impact on your adrenal glands and hormone production. So how common is this? A 2025 review looked at 40 different studies done over the past few decades, including 16,000 participants. And of individuals experiencing infertility, the numbers are staggering. 48% of women experienced anxiety and symptoms. 36% of women experienced depression symptoms. Of men who were suffering from infertility, 28% of them experienced anxiety, and 18 and a half percent experienced depression symptoms. This is much higher than the national average, which is approximately 5 to 7% of individuals experiencing depression symptoms. So if we look at this, this is approximately a three to fivefold increase in depression alone in couples who are dealing with infertility. A 2024 analysis looked at the incidence of major depressive disorder, so this is clinically diagnosable depression, in infertile women, and found it to be at about 23%, and generalized anxiety at about 13%. Now, this is clinically diagnosable, meaning evidence exists to be able to treat these individuals with therapy, with prescription strength medications. So just because you have symptoms of depression and anxiety doesn't necessarily mean that you meet the criteria for the medical diagnosis of it, but again, that doesn't mean it should go ignored Multiple studies have showed that the psychological burden of infertility is high, comparable to that of a potentially terminal disease. Think about that. Women who are dealing with infertility have equivalent scores of psychological distress compared to women with cancer, heart disease, high blood pressure, and other illnesses that could kill them. Approximately half of women undergoing fertility treatment rate infertility as the most stressful experience of their lives. And again, these stress levels are measurably biochemically av- able to be tracked. This is part of why we always are looking at what are your adrenal glands doing? What is your stress doing? What is your sleep doing? This is not just emotional weakness or I can't handle it through it. This is a well-documented, physiologically grounded response to a serious medical experience Equally important is the impact that this has on men. Now, men are significantly less likely to be even asked about their emotional experience, and in some settings typically aren't even present. This is why we make it so important to try and involve the partners from the very start, because we know that this works as a unit. Having a baby, dealing with fertility struggles is so much more than just take this medication, check this lab. Research shows that men experience a pattern that's a little bit different than women. They are more likely to report depression after a failed cycle, so when a woman is starting their period. They are more likely to just withdraw as a coping strategy and more likely to feel a strong pressure to be the strong one throughout all of this. When men suppress that emotional distress, it can sometimes make it feel like he's becoming distant, and in some couples it can make it seem like he doesn't care, or maybe he doesn't want to get pregnant, and this can continue to drive that wedge further. When men feel as though they might be part of the problem, or if underlying things have been discovered that show there is an actual male factor, that can increase sexual dysfunction. It's a frequently under-reported complication of fertility treatment, but there is this pressure for on-demand performance, and that in and of itself can create a real and rarely discussed psychological strain. Interestingly, a study in the Netherlands found that men's emotional experience of infertility was significantly predicted by their female partner's distress level. So the couple's emotional systems are deeply interconnected. When one individual is not doing well, oftentimes the other is also not doing well. And again, if they're not talking about it or not on the same page, can continue to create problems. What this does, if it's not addressed, is that it can lead to additional distress in the long run. In a study of nearly 900 women, approximately 40% of women withdrew from fertility treatments because it was too stressful. Now, these were by and large individuals who were going through IVF, but still has significant relevance. 47% of them cited the reason for stopping as high levels of anxiety or depression. Another systematic review of over 21,000 patients found that psychological distress was a common reason for treatment discontinuation at every stage, whether it was just starting to get treatment, whether it was between cycles, or whether it was as they started their next period again. And most concerning, couples who do not conceive a child are three times more likely to divorce or split up. That is a big deal, and that is why we think it is so important in our line of work to make sure that we have a strong unit as a couple first and continue to put that at the forefront of all of our conversations. Because we can't always promise that we're going to end up with having a baby, but we can promise answers and hopefully help the couple to realize that they are in this together We wanna focus on replacing those feelings of loss and grief, and instead focus instead on how we can make your couple unit stronger. Some of the ways we can do this include psychological intervention, because this can improve outcomes. So there was a study back in 2011 where they enrolled women in a randomized control trial, and they put some women in a group where they worked on mind-body interventions. And then they put other women in a control group where they did kind of what they call sham treatment or placebo treatment. And the women who went through the mind-body interventions had a 52% pregnancy rate at the end of the trial, compared to the women in the control group who did not receive these interventions had a 20% pregnancy rate. Now, certainly there are other things that could be at play here, but that is a dramatic difference to say we can improve your pregnancy rates by 30% just by going through a program for infertility that focuses on your mind-body connection, on that psychological experience that you have. Other studies have shown similar outcomes. Studies in 2000 and in 2022 have all reported improved pregnancy outcomes in women after undergoing mind-body interventions or cognitive behavioral therapy or other support groups. Now, this doesn't mean just go to a support group and all of a sudden you'll get pregnant. But psychological support doesn't just improve your quality of life, it tends to help with, um, resilience and it tends to help with decreasing your dropout from treatment. Because if you have a supportive partner working with you, if your mind-body connection is doing well, it can make all the difference. And I would add working together with a healthcare team who understands that this is a big part of this process is a crucial and critical step. This is not just soft and squishy care. This is evidence-based medicine. This is why we put it as a clinical priority, not an optional add-on. So let's go through a couple of common questions we get asked because, again, with everything in medicine, this is absolutely a spectrum. So some people will ask, "Well, is it normal to feel depressed or does it mean something is wrong with me?" And again, we answer this as we answer so many things. Although it is common, it does not have to be normal. Again, remember the statistics from earlier in this episode. About half of women in fertility treatment are experiencing anxiety and more than a third are experiencing some levels of depression. It doesn't mean that something is wrong with you, but it means that you're having a normal human response to a profoundly difficult experience. Again, common doesn't mean we can't treat it and you deserve support We also oftentimes will get asked, "Well, I am falling apart, but my husband seems fine. Should I be worried he's not dealing with this, or what else might be going on?" And again, men process infertility differently. They typically don't have the crazy hormone adjustments that we're dealing with for women oftentimes, and oftentimes they are suppressing that distress in order to s- appear supportive or strong. Research shows that men are also significantly impacted, but they're less likely to seek help or talk about it. So if your partner seems emotionally distant, it's more likely withdrawal than indifference. Invite him into the conversation. Make sure that your healthcare professional you're working with is inviting him into the conversation, and realize that he is an integral part of making sure that this couple unit is well-supported. Another tough question we often get asked is, "Well, is my anxiety or depression actually the thing that's impacting my ability to get pregnant?" Although this relationship is complex and the research is still ongoing, evidence does suggest that chronic psychological stress can have measurable impacts on your hormone environment. However, what we know with more certainty is that addressing that psychological distress can reduce your symptoms and does seem to have some apparent improvement in outcomes, and that alone makes it worth treating. This is also why we always will talk with our patients, especially those that have been in care for longer term, about giving them the option to take a break. This, for some individuals, can be a month or a couple months or a year or sometimes more. Sometimes it looks different and we'll say, "Hey, why don't you just try and not do your charting for a cycle," or, "Let's skip a cycle of doing labs. Maybe we can back off on the intensity of some of the medications." It doesn't have to mean it's all or nothing. We don't have to bring everything to a screeching halt, but sometimes taking the intensity off of everything being on and go all the time can really give your body permission to just relax, to just take a break, and then pick up again if and when it feels right to do so. And finally, how do we know when we should seek mental health support? Should we wait until we've been trying a certain amount of time, or what makes the most sense? And for us, we actually talk about trying to seek help from the beginning, especially if you're already identifying symptoms. Proactive support is far more effective than crisis management, and sometimes people will look at this as one more thing they need to do on top of everything else we hear. And again, this is one of the most honest questions we hear. I don't want to do one more thing. I don't have time. I don't have bandwidth, or I don't have brain space to do one more thing. However, we know that couples who can participate in support groups, in mind-body programs, in individual or in couples therapy consistently report that it helps them to have a better understanding of what's going on, gives them tools they need in order to move in the right direction, and probably most importantly, helps them to connect again together as a couple. The investment is real, but the outcomes are real also. Imagine if the first appointment at your fertility clinic included a genuine question about how both partners were doing emotionally. Imagine if that psychological burden of infertility was treated with the same clinical seriousness as the hormonal and medical side of things because the research tells us it deserves to have attention paid to it. Men also need to be asked about their grief and their withdrawal and quiet suffering and met with support rather than silence. And couples going through one of the hardest experience of their lives should and can have access, not just to the best clinical care, but to an emotional support system that keeps them intact as individuals, as partners, and as a team working together. That is what comprehensive fertility care looks like, and that is what it means to truly improve health and promote fertility

Speaker 2 19:58

If you're ready to work with our elite team of healthcare professionals, go to our website radiantclinic.com to schedule a free discovery call and learn more about our package-based pricing for comprehensive care. We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa clinic or can arrange for a telehealth visit if you live in many different states across the US. Check out our website for current states that we can serve medical clients and let us know if your state is not listed to see if we can still cover you there as we are constantly expanding our reach. Please note that our fertility educators are able to take care of clients no matter where they live. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom