It's really hard to stay upbeat and feel normal while going through infertility. Even if you don't feel depressed all the time, after a year of infertility you've probably noticed some thoughts and feelings that may not be typical of your normal even-keel self. It might start with intense sadness the fourth month in a row that your period comes, while knowing it doesn't "count" as infertility until it's been over a year for women over 35. But you start to get the sense that something might be wrong. You might notice yourself avoiding your friends with babies and small children, opting out of more and more outings as to not magnify your pain. Your spouse or a loved one tells you that you seem to have changed, seem down more often, or are acting more aggressive toward them, and they think something might be wrong with you.
As a committed infertility therapist, I recently participated in a training by the American Society of Reproductive Medicine about Antidepressant Therapy for Depression and Anxiety During Assisted Reproductive Technology and Pregnancy. The statistics I quote in this post came from that training based on peer reviewed research of published journal articles. I'm happy to give anyone citations who wants them. Of course I know infertility can cause symptoms of depression and anxiety. I experienced it myself, and I see it in every one of the women I counsel each week. But these are the unique women who have decided to get help. Depression is already prevalent in 16.1% of the general adult population (Anxiety is 12.1%) and 12% of women have difficult achieving pregnancy or carrying a pregnancy to term. Naturally there is going to be overlap. The prevalence of depression and anxiety for women experiencing infertility is 30.8%. For men it's 10.2%.
Firstly it is important for a woman enduring assisted reproductive technology or experiencing her first year or two of infertility to understand that infertility is a stressful life event, a significant life challenge. It negatively affects many aspects of life - relationships, job, social functioning, identity, experience of shame, difficulty in spousal relationship, social isolation. All of these are also risk factors for depression.
If the fertility journey lasts more than even six months, it's rife with strife. A woman may experience shame, guilt, worthlessness, anxiety, depression, fear, pessimism, helplessness, grief, loneliness, jealousy, physical burdens, stress on their relationships, feeling selfish or guilty about their feelings of anger and inability to celebrate pregnancies for others. The partner relationship suffers because the partner that is not the intended carrier doesn't feel like they can express their feelings as to not make things worse. Additionally couples have more issues to argue over such as opinions about the use of interventions of reproductive technologies, finances, and changes in sex and drive.
Your personal mental health history is an important part of how you might be fairing through your infertility struggle. This is not a fact to go down the shame slide on, just one that will inform the importance of how you enhance your coping skills during this extra stressful time. If you've experienced significant periods of depression and anxiety in the past, this time of infertility will be a time you'll want to commit to achieving and maintaining mental health.
Let's not forget the intense hormonal fluctuations women can experience during their normal menstrual cycles. Some women are naturally more sensitive to hormone shifts, and I'm reading more about women taking that information to heart, to the point of planning parts of their lives around their cycles. Functional nutritionist Alisa Vitti coined the term Cycle Syncing, which is paying attention to the unique hormonal fluctuations during the cycle and planning ahead for your body and mind's optimum functioning. I recommend getting to know how your hormonal changes effect your mood, appetite, energy, sleep, and thought processes throughout your cycle. This will prepare you for how medications for fertility may enhance these impacts throughout the month. While hormones definitely impact mood, not all depression during this stressful reproductive time can be blamed on them.
Unfortunately if you're experiencing pre-IVF distress, you're more likely to experience post-IVF distress. And if a depressed woman is enduring IVF and it fails, she'll have higher levels of depression and anxiety. However, we still have no clear evidence of the association between stress and IVF outcomes. One study shows lower birthrates among depressed women compared those with no psychiatric diagnosis, but depression doesn't necessarily make you less likely to conceive, it just makes you less likely to cope well with all the treatment demands and therefore want to quit treatment sooner.
If you are experiencing symptoms of anxiety and depression during infertility, the first line of defense is talking to a psychotherapist who is well versed in the psychological impact of trying to conceive. Your therapist will help you develop coping skills, enhance communication with your partner and loved ones, and learn to take the best care of yourself through this stressful time. And the skills you learn will ultimately be the ones you rely on when you're experiencing the stress of parenthood, or future life endeavors. We have limited information on the impact of psychotropic medications, or SSRI (selective serotonin reuptake inhibitors) during the ART process. Depending on your history of medication use for anxiety or depression, your current situation, your symptom severity and impact on daily functioning, and your access to regular psychotherapy may impact your doctor's recommendation for pharmacologic treatment.
Allison Ramsey is a licensed clinical mental health counselor and fertility counseling specialist seeing clients online throughout North Carolina, Washington State, and internationally. She’s a member of Resolve, The Infertility Association and the American Society for Reproductive Medicine. Contact her to start feeling better.