Introduction

Dealing with infertility is a painful journey for many people. The World Health Organization (WHO) defines infertility as a disease of the male or female reproductive tracts wherein a couple cannot get pregnant after 12 months of regular, unprotected intercourse. Approximately 1 in 6 people of reproductive age experience infertility in their lifetime. This article discusses the emotional toll infertility may take on people and suggests strategies for coping. 

The emotional impact of infertility

The American Psychiatric Association (APA) finds that individuals who struggle with infertility experience feelings of profound loss and experience a significant life crisis. These feelings include anger, sadness, grief, and/or shame. Couples may feel stigmatised in addition to these feelings and may find it difficult to be around other couples with children or children in general. 

The stress associated with infertility can impact other areas of life , such as work, family, and relationships. Having anxiety and depression may contribute to infertility, or struggling with infertility may lead to anxiety and depression. 

Approximately 40% of women are diagnosed with a psychiatric condition, often depression or anxiety, after dealing with infertility. Moreover, higher levels of depression and anxiety are found in both men and women undergoing In Vitro Fertilization (IVF) or other treatments when compared to the general population. Reports indicate that women are more likely to report feeling greater psychological distress than men, but very few seek help. Medications can be prescribed to treat infertility, which may also contribute to worsening mood and emotions. This is due to the hormonal changes induced by medications used to increase fertility, however,the reasons are unclear. 

Common emotions experienced

Grief

Grief is an expected emotion when dealing with a failed pregnancy and has devastating effects on the psychological wellbeing of the couple. Many complicated reactions may arise leading to further issues such as substance abuse and an increased risk of suicide. Moreover, the individual, male or female, may feel worthless, like their life is meaningless, and they might struggle with their self identity. They may also find it difficult to continue with their regular activities, even ones that used to bring them joy. This cycle of grief can be very hard to escape. 

Coping with grief

Grief from infertility should be treated the same as grief from losing a loved one. It affects how a person feels, acts, thinks, and interacts with their surroundings. Cultural beliefs and traditions also impact how a person expresses their grief and cope with it. Each individual should be allowed to grieve in their own way and in their own time. 

For some people, talking about their feelings with another person, whether that is a close friend/relative or a professional, helps them process the experience. However, some people struggle with talking about their emotions and may prefer creative activities such as writing or painting. The key feature when dealing with grief is accepting the loss, letting go and learning to live with it. Asking for help is the first step in the process and it is often the hardest one⁴. The Centre for Addiction and Mental Health lists a few strategies/guidelines for people experiencing grief and/or loss:

• Connecting with others and seeking social support
• Some people turn to their faith or seek spiritual guidance 
• Searching for a foundation by working/volunteering with a charity has helped some people
• Joining a support group to talk about the pain and complicated emotions that are difficult to speak of with your loved ones
• Engaging in self-care activities; this includes proper nutrition, and engaging in daily exercise even if it is just for 15 minutes a day
• Proper sleep schedules and routines are beneficial 
• Refrain from negative coping mechanisms such as resorting to substance use (this includes alcohol, nicotine, and caffeine usage)

Relationship strain

Furthermore, a  topic of concern with couples, dealing with infertility, is the large strain it places on their relationship. Couples that struggle with infertility sometimes experience marital problems and conflicts as a result. One party may blame the other, consciously or subconsciously, which can lead to negative feelings towards one another. 

Some couples report that they end up much closer after the shared grief if they can rely on one another for emotional support. In cases where infertility places a large amount of marital strain, other factors also impact the couples’ experiences. Factors such as socio-economic status, personality types, mental health, communication, and the duration of the marriage are likely to impact whether a couple can handle the extra strain. Individual and couples counseling is recommended, toovercome their negative emotions.  

Coping strategies

Creative activities and outlets

While it may seem difficult (or unconventional) to initiate, creative activities provide many benefits for the brain, especially in times of emotional distress. Whether done individually or as a couple, there are various creative activities that can  help to cope with infertility. Painting, writing, making music, and other similar activities, which require the person to think outside the box, helps to relax and reduce stress levels. They can also be quite amusing. Creative activities help process complex emotions and provide an outlet for them. It provides a break from trying to conceive,allowing the mind to reset.  A break from the normal routine, also helps reset the brain and can be used as a distraction from all the negative feelings.  

Journaling and expressive writing

Journaling can be a creative activity, but it also focuses directly on the traumatic event. Which in this instance would be the inability to conceive. The main focus of journaling is to dump all the thoughts in your mind onto paper, as a method of emptying them from your brain. Some people find that writing them down, and having them in a physical form, makes it easier to understand. Allowing them to address these feelings. 

While journaling, it is helpful to write the date, and time and list things that you are grateful for. Writing down any feelings (positive, negative, or neutral) that may exist, then write your affirmations and intentions. This advice taken from Fertility Avenues is helpful for people who have never journaled before. here are many other resources to guide you in expressive writing.  

Mindfulness meditation: coping strategy and fertility booster

Mindfulness meditation has been widely used to reduce stress and improve overall wellbeing for daily life. Especially in people who are struggling with psychiatric conditions. It can also be used for people struggling with the negative emotions relating to infertility. If done properly, mindfulness meditation relieves the body of stress and improves overall cognition. It involves focusing on the present moment;observing one’s thoughts and emotions without judgement. This allows the individual to release negative thoughts and emotions from their mind in a healthy way. 

Some research has shown that, because of its stress-relieving effects, mindfulness meditation can improve fertility rates, reducing pregnancy-related anxiety and depression. While meditating, a relaxed state is achieved, which changes hormone levels in the body. DHEA is one hormone that is released during meditation, which is an essential hormone relating to fertility in both men and women. As a result, mindfulness meditation may improve the ability to conceive a child. The Reproductive Care Center of Ontario, Canada has listed 5 key strategies for mindfulness meditation relating to infertility: 

1. Focus on the present moment and let go of any negative thoughts or fears regarding conception
2. Be open and receptive to the possibility of becoming pregnant 
3. Mindfulness meditation may boost the DHEA hormone levels which may improve the chances of becoming pregnant; DHEA is critical for the ovulation cycle 
4. Choose quality over quantity when deciding on a mindfulness meditation practice 
5. Using a holistic approach balances the needs of the mind and body to yield optimal results 

Summary

Infertility is a challenging topic since it encompasses the physical condition of being unable to conceive as well as the psychological toll it takes on a couple. The main thing to remember is that infertility affects both men and women. Stress, anxiety, depression, and grief are common emotions experienced by people struggling with infertility. It often impacts a person’s daily life and relationships. Grief is a common emotion that infertile couples experience.the grief of infertility is similar to the grief of losing a loved one. Strategies for coping with this grief are different for every individual. While some people prefer to talk about their feelings through counseling and support groups, others may struggle with that, preferring creative outlets such as journaling, painting, or music. 

However, there is no wrong way to grieve and it is a process which requires time. It is important to discuss these feelings with your partner and to address any strain this places on the relationship. Individual and couples therapy is recommended if the strain on the relationship becomes too severe. Overall, there are many ways of coping with infertility and it is best to seek help as soon as possible.