While it seems like a simple thing on the surface, for many couples, having a child is a difficult process. Infertility (defined as trying unsuccessfully to conceive for a 12-month period) affects nearly one in every six couples in the U.S. Life events not within one’s control are typically more stressful than others, and since having a child is such a momentous life event, the stress caused by infertility is substantial.

Around 35% of the time the problem lies with the woman, and 35% of the time, it’s down to the man. The remaining 30% percent can be related to both, what is known as “unexplained infertility.”

Although infertility usually has a physiological cause, the stress and anguish—often a result of both the emotional and physical effects of infertility treatments—can carry major psychological repercussions. In one study of 200 couples using a fertility clinic, about 50% of the women and 15% of the men said infertility was the most distressing thing they’d ever experienced in their lives. Another study surveyed nearly 500 women who filled out a questionnaire before participating in a stress-reduction program, and concluded that infertile women showed the same levels of depression and anxiety as people with high blood pressure or cancer, as well as those recovering from a heart attack.

Recent studies have shown that men generally don’t feel as distressed by infertility as women. However, one study found that a man’s reaction often depends on which partner has the fertility problem—men who discover that they are the infertile partner do tend to report the same degree of depression and low self-esteem as women.

Contributing factors to infertility-related depression and anxiety include the side effects of medication, financial worries and feeling uncertain about the outcome of treatment.

Signs and symptoms of emotional distress

  • Depression
  • Shock
  • Grief
  • Frustration
  • Lack of self-confidence
  • Low self-esteem
  • A sense of having no control over the future
  • Problems in relationships with partner, friends and family
  • Avoidance of friends or family who have children or are pregnant
  • Sexual dysfunction


While medical fertility treatments can improve the likelihood of conception, beginning therapy can help you work through the difficult emotions you’re experiencing—especially if fertility treatments aren’t working. You may also wish to seek counseling to cope with related social and practical issues, such as the grief of miscarriage or loss of a pregnancy, or the anxiety of pregnancy after infertility.

Therapy can give you an unbiased overview of your options, to help you make family-building decisions that take into account long-term implications. Every family is unique—and so is their idea of what constitutes a family. Among the options you might be considering are egg, sperm, or embryo donors, gestational carrier/surrogate, adoption, or even child-free living.

Cognitive behavior therapy for infertility stress and anxiety

Cognitive behavior therapy (CBT) can help you learn to respond more constructively to situations that trigger or exacerbate the stress caused by infertility, as well as change negative, unrealistic thoughts and interpretations. While it may not improve your chances of conception, it can improve your relationships and your ability to look at situations in a different way, and help you open your mind to new perceptions of motherhood and how to build a family.

CBT usually involves a combination of:

  • Education. Learn the cognitive, physical, and behavioral aspects of worry, and how helpful worry differs from unhelpful worry.
  • Self-monitoring. Track your anxiety and worry episodes (triggers, responses, thoughts, frequency, intensity and duration) to identify patterns and help direct your treatment plan.
  • Relaxation exercises. Deep breathing, progressive muscle relaxation, yoga, meditation, and similar techniques may relieve some physical symptoms of infertility-related stress. Practicing these relaxation exercises regularly can lower your “baseline state” of anxiety so when you do experience physical agitation, it feels less intense and easier to control.
  • Cognitive strategies. Control negative outcomes by recognizing and modifying thought patterns that perpetuate your anxiety, taking a more realistic view of situations, solving everyday problems, learning to deal with uncertainty, and reducing your dependence on worry.
  • Behavioral strategies. Gradually, in accordance with a timetable, start to confront your fears about infertility to become less afraid, and to allow yourself to experience your full range of emotions. Confronting your fears instead of avoiding or escaping them will actually help you gain some control over them, thus reducing your anxiety over time.