Progyny is one of Castlight’s newest ecosystem partners.

Infertility affects about one in eight couples in the U.S.—that’s more prevalent than asthma or diabetes. Why, if infertility is so common, aren’t more people talking about it? 

Infertility is what many call a “silent disease,” which means you wouldn’t be able to tell if someone’s suffering from it just by looking at them or having a brief conversation. Rather, people who deal with infertility often do so in private—likely because, despite its prevalence, it’s still fairly stigmatized. Because of this, those with infertility often deal with the physical and emotional toll of trying to build a family through assisted reproductive technology (ART) alone or solely with the help of their partner. 

Those who haven’t gone through fertility treatment may never realize the mental health impact it can have on those who have. The thing is, a person’s fertility journey doesn’t pause when they clock into work every morning. In between meetings, a colleague might be injecting herself with hormones to prepare for an IVF cycle. Another might put a hold on her calendar to check in with her therapist as she struggles with how this journey has affected her emotionally. 

To better understand how infertility affects mental health, we spoke with clinical psychologist Dr. Georgia Witkin, head of Member Services Development at Progyny, assistant professor of OB-GYN and Reproductive Sciences at Mount Sinai, and assistant clinical professor of Psychiatry at Mount Sinai. 

How can infertility impact one’s mental health?

Dr. Witkin: The shock of an unexpected infertility diagnosis, or the confirmation of one, can be emotionally overwhelming. It can make people feel as though they’ve lost control over their life plans. But the thing to remember when it comes to mental health and infertility is that there are always ways to help one manage their feelings. Here are three tips one can use if they find themselves struggling with the emotional toll of infertility:

Reframe the narrative. 

Try thinking of yourself in “pre-parenthood” rather than in a state of infertility. There are now so many options for treatment and family building (IUI, IVF, genetic testing, donor egg, donor sperm, surrogacy, gestational carriers, adoption, foster care), that if you want to experience parenting, there will be a way.

Expect emotions to come in waves. 

The initial shock may subside after a few days, but the emotional pain can ebb and flow, over and over. Observe them with interest rather than alarm, and think about how those feelings are impacting you.

Focus on the Future. 

Remind yourself that you had the problem before you had the diagnosis. The diagnosis just marked the beginning of treatment to try to make the problem better!

Does stress cause infertility?

Dr. Witkin: Here’s some good news: Psychological stress does not cause infertility. According to Dr. Alan Copperman, director of Reproductive Medicine Associates (RMA) of NY, “There’s no evidence that the anxiety we all experience in our day-to-day lives either increases or decreases fertility.” Although a Celmatix study found that more than 70% of women believe mental health problems can have a negative effect on fertility, it seems to only be the case when there’s a pre-existing problem, an age factor, or when the stress changes our behaviors enough to temporarily lower our chances of conceiving (e.g., drinking, smoking, depression, etc.). And, even when a female’s menstrual cycle is affected by physical or emotional stress, the disturbance is generally time-limited and self-correcting.

However, although daily stress alone doesn’t cause infertility, infertility often causes stress. Multiple studies have found that infertility in both women and men often increases stress, depression, and anxiety. In fact, recurrent pregnancy loss (RPL) can lead to symptoms of post-traumatic stress disorder (PTSD).

What are signs or symptoms one should be aware of when they may need to take a break or really check in with their mental health?

Dr. Witkin: Being a strong fertility patient requires some “training.” Like running a marathon, we must learn to pace and nourish ourselves, recognize signs of overload and emotional fatigue, and know how to repair and replace our energy. Being “strong” doesn’t mean running on empty, physically and emotionally. Below is a questionnaire people can use to reassess their stress.

Check all of the following statements that are often or lately true for you:

• I smile less frequently than I used to, even in situations I’d typically find funny.
• My senses seem dulled; food tastes flat, music doesn’t move me.
• I’m having trouble with sleep. I can’t fall asleep, stay asleep, or all I want to do is sleep.
• I get startled easily, and I’ve been feeling jumpier and more jittery than normal.
• I’m more irritable than I used to be.
• My anxiety level is higher than usual.
• I cry more easily, even in situations that wouldn’t usually bother me.
• Socializing is difficult.  When I’m with friends or family, I feel disconnected and have a hard time paying attention to what they say.

If you answer “yes” to even one of the statements, it’s time for more self-care and to think about sharing your feelings with your support team or a trained professional.

How can someone manage their fertility treatments, mental health, and work?

Dr. Witkin: Because fertility treatments are so regimented and can be fairly tough both physically and emotionally, it can sometimes feel impossible to juggle everything. Work, friends, family, mental health, and fertility treatments? It feels like a lot! 

But those dealing with fertility treatments shouldn’t rush to quit their job unless they were planning to leave anyway. Drastic changes and unstructured free time usually increase stress levels. Working, on the other hand, can help in many ways during this process, as it can be a great distraction from the stress of treatment, provide a routine, and serve as a reminder that there’s more to one’s life than worrying, waiting, and watching for treatment results. Plus, work achievements can boost one’s sense of control and self-esteem. Also, most workplaces now offer some sort of mental health benefit and other resources that will help employees deal with the emotional toll of fertility treatment. 

What advice do you have for managers and/or HR teams for supporting employees struggling with infertility?

Dr. Witkin: There are many things managers and HR teams can do to help their employees during their fertility journey.

Firstly, all employers should consider providing fertility and family building benefits that are accessible to every employee and robust and inclusive to all paths to parenthood. Often, traditional fertility insurance coverage will only cover a heteronormative definition of infertility, so LGBTQ+ patients and single parents by choice cannot even access the coverage. Providers like Progyny are great because they offer incredibly inclusive coverage, and they also provide all of their members with a dedicated Patient Care Advocate (PCA) that acts as a guide throughout the entire fertility journey. Furthermore, leveraging a navigation solution like Castlight that promotes the right programs to the right people at the right time helps make initiating and maintaining engagement much easier for members and leads to increased engagement—and thus cost savings—for employers and health plans.

Second, recognize that fertility treatments often take a huge toll on a patient both physically and mentally. Fostering an open environment between managers and direct reports may encourage an employee to speak about their journey, which can then turn into better communication and better enable you to give the employee the support they need. Of course, it’s up to the employee to disclose this information. If they’re open about their journey, try not to overload them with excessive work, and don’t berate them for taking more PTO than they usually would.

Another thing HR teams can do is organize an employee resource group (ERG) for expectant or trying parents. Many companies put together ERGs so people can bond with their colleagues and come up with solutions for specific situations. An ERG could prove incredibly beneficial for employees who are struggling with infertility.

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Castlight ecosystem partner Progyny is a leading benefits management company that specializes in fertility and family building benefits solutions, empowers patients with concierge member support, and provides access to a premier network of fertility specialists to drive optimal clinical outcomes for members and reduce healthcare costs for the nation’s leading employers.