Montgomery Fertility Center
3202 Tower Oaks Boulevard
Rockville, MD 20852
Mental Health and Fertility
The fertility journey has been described as being extremely stressful and can provoke anxiety and depression in many patients. Infertility stress has been related or likened to the stress felt with major life events.
The interesting thing is that stress itself can result in irregular menstrual cycles, which may ultimately lead to infertility. Researchers have been looking into the complex relationship between stress and fertility. Most women experience some level of discomfort prior to their menstrual cycle – premenstrual syndrome (PMS) – however patients who have anxiety or depression experience worsening symptoms. Of the women who seek treatment for PMS a majority complain of depression and anxiety.
Stress, depression, and anxiety are described as common consequences of infertility. Several studies have found that the incidence of depression in infertile couples presenting for infertility treatment is significantly higher than in fertile controls, with prevalence estimates of major depression in the range of 15-54%
Patients with anxiety disorder may also experience shorter menstrual cycles. Irregular menstrual cycles have also been associated with eating disorders and depression. Women with bipolar disorder are twice as likely to have irregular menstrual cycles.
Research has shown that psychological interventions that lower stress levels have been associated with significant increases in pregnancy rates.
Several studies suggest that cognitive behavioral group psychotherapy and support groups decrease stress and mood symptoms, as well as increase fertility rates. In a study by Domar and colleagues of 52 infertile women, a 10-week group behavioral treatment program significantly reduced anxiety, depression, and anger.
Having a precise diagnosis for the cause of infertility can reduce the psychological stress on patients. Patients who have unexplained infertility do not get a clear-cut answer as to why they’re not getting pregnant, and this further exacerbates their stress level.
Changes to lifestyle such as exercise, diet, caffeine intake, and sleep may be beneficial for some patients especially when combined with fertility treatment.
Group interventions have been shown to be more effective than counseling ones. Programs that include a mind/body approach have been shown to be beneficial. Such treatments include cognitive behavioral therapy that emphasizes the importance of thinking. It tries to increase positive thoughts and downplay negative thoughts such as “infertility is my fault.” Relaxation techniques are also widely used to help to induce anxiety. Such techniques include progressive muscle relaxation, yoga, meditation, imagery, and massage therapy. Other techniques include expressive writing.