By Marie Atallah, PhD

Though starting a family is an exciting time for many people, some women face challenges and societal pressures which can take an emotional toll and have an impact on their mental health and wellbeing. From the stigma of infertility to external pressure from friends and family, the prospect of starting a family can be both incredibly fulfilling and incredibly overwhelming. We sat down with Marie Atallah, Ph.D, Director of Therapy of Brightside, to talk about mental health and fertility. 

How does fertility, and infertility specifically, affect mental health?

Several studies show that women with infertility have higher rates of anxiety and depression compared to their fertile counterparts. Higher rates of distress and symptoms of depression can indirectly impact conception outcomes. For example, higher scores of depressive symptoms have been linked to early drop out of fertility treatment. Fertility treatments can put tremendous emotional, financial, and relational strain on a couple. More than half the women in an infertility study of 200 couples described the experience as the “most upsetting of their lives.” Similarly, a large study of women with various health conditions found that those struggling with infertility had similar amounts of distress compared to cancer and cardiac rehab patients.

Several studies show that women with infertility have higher rates of anxiety and depression. 

How can the stigma of infertility make it more difficult?

Trying to conceive and struggling with infertility can feel incredibly isolating. You may find it hard to share in others’ joy or feel alone in your emotional pain. Even today, when we know that so many different factors can impact fertility, many women still have internalized beliefs that they are “broken” or “inadequate” if their conception journey is not going as planned. When women do share their conception or fertility struggles, even seemingly innocuous comments, like being told to “just relax and it will happen,” can completely negate the financial, emotional, and relational strain someone may be feeling. Worse, it reinforces the false notion that infertility is solely a matter of a woman’s mind rather than a medical condition.

How can women handle pressure and uncomfortable conversations around fertility?

Women are often faced with overt and covert messaging from family, friends, media, and society at large about having children. It’s not uncommon for in-laws or extended family members to inquire about a woman’s timeline or even weigh-in with their own opinions. Even though it all can be well-intentioned or stem from excitement, it can also create a great deal of pressure on those trying to conceive.

Sharing where you are in the conception journey is a very vulnerable experience; it can make well-intentioned but poorly informed or poorly timed comments tough to endure. Use this as a time to find your voice around setting boundaries that work for you. These boundaries may include using humor, assertively communicating your needs, or recruiting others to assist in the conversation.

It is important to remember that this is your journey. By setting boundaries and communicating your needs, you can mitigate stressful or uncomfortable conversations, and set the tone for future questions from friends and family.

What tips do you have for managing mental health while trying to conceive?

  1. Communicate and create boundaries. Whenever possible, use assertive communication to establish your boundaries around what you do and do not want to discuss about your fertility and conception journey. If you are conceiving with a partner, you may rehearse together how you want to respond and who will respond in what circumstances. For example, your partner may take the lead in conversations with your in-laws. If assertive communication is not possible (or appropriate), there are ways to change the subject or divert the attention. Rehearse these different ways with a close friend or partner.
  2. Provide feedback. If you are open to giving someone feedback, focus on the specific thing that is said or the behavior, rather than making global remarks. For example, try saying something like, “I know you are invested in this journey with me, but when you continuously ask if I’m pregnant, it makes me feel overwhelmed and stressed.” Tying a specific statement or behavior to how it makes you feel allows the recipient to hone in on their language and behavior to (hopefully) make a change.
  3. Find your people. To the best of your ability, find a supportive community or group of friends. This community can be an online support group, a close friend, or a group of individuals. Stigma is primarily maintained by staying quiet. The more we can normalize this process and provide support for one another, the better the odds of reducing the stigma surrounding infertility and the conception journey.
  4. Practice self-care and compassion. As you go through physical and hormonal changes, it’s essential to practice self-care and self-compassion. Journaling, meditating, and gentle movement are all great ways to take care of yourself during this time.
  5. Connect (or reconnect) with a therapist. Begin researching therapy options. If you engaged in therapy in the past, this might be a great time to reach out to your therapist for a follow-up session or let them know that you may contact them to make space in their practice.
  6. Don’t try to change too many things at once. Your mind and body are going through a lot, and changing behavior is hard work. If you are working towards a healthier lifestyle, focus on progress over perfection.

This journey can weigh heavily on a person or couple. The conception journey can be a positive shared experience within a relationship. Still, it can be a significant source of distress. The emotional experience can vary depending on a couple’s emotional foundation, communication style, and overall relationship.

Don’t forget to ask for and accept help. As humans, we are tribal by nature. We were never meant to have these experiences alone. Ask family, friends, and your partner for support. Remember the adage, “It takes a village.”

Marie Atallah is the Director of Therapy at Brightside and a licensed psychologist specializing in treating anxiety and depression. Brightside makes it simple and affordable to get expert, personalized treatment for depression and anxiety from the comfort of home.