Strategies for coping with infertility and infertility depression

Even scientific literature has described infertility as “the most upsetting experience” of a person’s life. This seems to be more true for women than men, since their minds and bodies usually bear the greater burden of infertility treatment. It’s pretty clear how culture, biology, and identity can all align to make infertile couples feel crushed when children don’t come easily. If you’re reading this, maybe you’ve felt the weight of those expectations. 

Infertility can be experienced as grief, trauma, a life crisis, and a stress equivalent to having cancer. Recent data suggests that the prevalence of depression among infertile women may be as high as 52% (the global rate for adults is 5%). A woman with depression is half as likely to initiate fertility treatment, and couples with a depressed female partner are five times more likely to end treatment. But the mental agony of infertility and pregnancy loss can be addressed without letting go of hope for successful reproduction. Where there’s acute stress, there are coping strategies. Here are the ones that work best—and worst—for infertility.   

Emotion-Focused Strategies

Emotion-focused coping strategies take a direct route to tackling negative feelings like stress, depression, and anxiety. They face the feeling itself, not what’s causing it. When someone is struggling with infertility, the effects of these inside-out coping strategies can be broad, from life-saving to profoundly unhelpful. 

First, the helpful:

• Positive/active distraction. Although disengagement and avoidance have bad reputations as coping strategies in general, studies show that certain kinds of active-distraction can induce positive emotions and therefore reduce stress. It might sound too simplistic, but you can draw your attention away from reproductive issues by exercising, working on a crossword puzzle, getting out in nature, or doing something creative. You can maintain daily routines. You can work. Mindfulness practices can also divert your thoughts temporarily, then send you back into the fray somewhat restored. These kinds of positive-distractive coping strategies are associated with lower psychological distress in infertile women. 
• Positive reframing. A positive reinterpretation of one’s infertility struggles is associated with lower anxiety in women, even when it’s their only coping strategy. You don’t have to be all sunshine and rainbows, seeing the bright side of everything. You can just observe a single good element and see where that takes you. For example, you can identify a lesson that you’ve learned during your struggle, or find one thing to be grateful for. One study showed that women who found hidden meaning in their fertility struggles had lower stress.
• Humor. Humor can always help. For example, the comedian Mierav Zur, who wrote a one-woman show called “Inconceivable” about her 11 years of infertility struggles, said, “If infertility is nature’s bad joke, humor became my coping mechanism.”
• Emotional support. Seeking support from friends and family can occasionally backfire, because the people closest to you may say the wrong thing and inadvertently deepen your distress. It’s okay to be careful about who you share your journey with. Be clear to your chosen few about what’s truly supportive and what’s not. For example, you can ask your friends not to mention your infertility treatments unless you bring them up. If you have a partner, allow them to share your emotional burden. 

The emotion-focused strategies that tend to be unhelpful are denial (associated with higher stress levels in people experiencing infertility), substance abuse (women are more likely than men to drink as a maladaptive coping strategy), self-blame (don’t contribute to the robust historical tradition of stereotyping, blaming, and micro-managing women who don’t produce biological children), and venting (recognizing your negative emotions is healthy, but passively dwelling in the negativity might make you feel helpless and anxious). 

Problem-Focused Strategies

In reproductive psychology studies, women undergoing fertility treatment tend to benefit more from problem-focused coping strategies than emotion-focused strategies. Problem-focused coping aims to remove or reduce the cause of distress, not the feeling itself. These outside-in strategies are associated with a more pronounced feeling of control and lower stress levels. 

In general, engagement strategies tend to have a more positive impact on well-being than disengagement strategies (like passivity, avoidance, numbness, or “wallowing”). That may be because avoidance coping is associated with a perception of low controllability. 

Here are some measures you can take to exert more agency over the infertility treatment process and your individual experience of infertility:

• Manage your time, fatigue, and money. Some people find it helpful to set limits on the time and money they will spend on fertility interventions like in vitro fertilization (IVF). Treatment can require so many complex factors: medication schedules, recovery times, mood swings, the infamous two-week wait. Conscientious planning can be a helpful coping strategy. How will you prepare for important moments on the fertility rollercoaster?  
• Seek information and options. Many women find that getting the best information about fertility drugs, doctors, and treatment can help them regain control and reduce stress. Organizations like the Society for Assisted Reproductive Technology (SART) can direct you to the best labs and clinics. In addition, you can find out if your job offers any hidden infertility benefits. Educate yourself on the emotional dimensions of infertility, not just the medical aspects. Websites and internet forums can be extremely helpful in your hunt for information, but you should also seek the best medical advice in-person as quickly as possible. Read up on your sisterhood, all the amazing women in history who dealt with infertility and depression symptoms. And don’t wait until the end of the line to research alternative ways of starting a family.
• Get psychotherapy or counseling. Find a licensed therapist and/or support groups that address the mind/body connection in reproductive struggles. You can do cognitive behavioral therapy (CBT) individually or in a group. Women seem to be more emotionally affected by infertility when they first begin medical procedures, thus it’s ideal to start talking to a therapist before seeking treatment for infertility. This can teach you adaptive coping strategies to enlist if you experience depression and/or anxiety.
• Pursue active acceptance. Unlike resignation acceptance, active acceptance can enhance well-being. You can grieve your infertility and still try to improve your circumstances, balancing realism and optimism. Reproduction is a medical issue, not your identity or your failure. Control what you can control and work to accept the remainder.

You’re Not Alone in Feeling Sad

Infertility can feel like the loss of the future you always anticipated. It might be the hardest thing you ever go through, and the pain may never go away. There should be an inspiring “but” here, but there’s really not. There is only the marvel of your own existence and what you make of it. It’s incredible that you’re here on Earth after 3.5 million years of evolution, disease, war, famine, and giant meteors. Remember that you were also someone’s beautiful baby, and you deserve to be happy whether there are biological children in your future or not.