When to Seek Mental Health Support on Your TTC Journey
By Batya Novick, LCSW
In the United States, when it comes to women’s health, about 1 in 5 between the ages of 15 to 49 experience a problem with fertility. Within that group, the number jumps even higher to 1 in 4 when it comes to women having difficulty getting pregnant or carrying a pregnancy to term. At such a high rate, fertility challenges are something many people face, yet it is often seen as “just” a reproductive medical struggle connected to physical health, eliminating one of the most profound impacts of the fertility experience—the impact on mental health.
As a fertility therapist, my practice focuses exclusively on reproductive mental health. Almost all of the clients that come through our doors are somewhere on their journey of trying to conceive (TTC) and family building. They all say almost the same thing: they feel alone, isolated and overwhelmed, their friends and family do not understand their experience, work and relationships have become harder, and other parts of their life are on hold. All of these clients have experienced struggling and feeling alone, many not realizing that there are therapists that specialize in this very unique experience. Most importantly, they don’t realize that what they are experiencing is significant, and they have a right to ask for support.
In 2018, an important article about stress and infertility was published, finding that patients who experience infertility have the same rates of anxiety and depression as patients experiencing cancer. This validated what many people felt: that everyone has a right to feel their feelings if they are going through fertility struggles, and a right to recognize this experience as a significant, life-changing event that has happened to you and to your life.
First, it is important to identify if you are struggling with your mental health, and if so, it is very important to ensure you are consistent with your mental health care throughout your TTC journey. If you have been working with a mental health specialist, such as a therapist or psychiatrist, make sure you are continuing to do so throughout this time in your life. If you are taking medication, be sure to consult a reproductive psychiatrist, who is trained and specialized in medication management for women who are trying to conceive, pregnant, and postpartum.
With all of this in mind, let’s explore the stressors that many people experience on the fertility journey, and when you may want or need to seek professional support for your mental wellbeing.
Social Support
Many people feel that early on during their TTC journey, friends and family stop recognizing their grief and stress levels. Aspiring parents often feel that their loved ones may not say the right thing, or may dismiss their feelings altogether, suggesting that they should stop being so stressed out and trust that everything will happen in time. It can feel like a very lonely time of life.
Social support is one of the most important factors when it comes to resilience during this challenging period. This does not mean that you need a team of friends and family who are great at supporting you. Some friends are there for a good time and a laugh, while others may be better for deep conversation and advice. In this moment, you also likely need a friend or family member who can sit with you while you cry, someone who can hear what you need and honor that for you. You can feel free to say to this person something along the lines of, “Can you just do a checkup and ask me how I am? You do not need to try to fix or solve it, but just let me vent and cry.” This example could also be something you share with your partner. Remember that this is an important time for you and your partner to communicate with each other what you both need, so you can continue to support each other.
If you are finding yourself socially isolating—no longer seeing friends and family, no longer going out in social settings, no longer talking to others about how you are feeling—then it’s definitely time to find professional help from a licensed therapist, ideally one who focuses on reproductive mental health conditions. It is also a good time to explore talking to a fertility coach, and even joining a fertility support group, which can provide a wonderful way to connect with other people who are going through the fertility journey. This shared experience can make you feel less alone.
The Great Uncertainty
The journey of trying to conceive and growing your family can be a stressful and also very busy time. It often requires frequent visits to a fertility specialist (reproductive endocrinologist or RE), learning your own body and tracking your ovulation and menstrual cycles, managing medications, and asking yourself constant questions, likely with a feeling of uncertainty: “What will the results be this month? Will this work? Will I get a positive pregnancy test? Will I have a baby? What if this does not work?” Plus, this is all happening while your regular day-to-day life is also taking place. It’s no small feat, but instead a rollercoaster period during which many people feel overwhelmed.
Uncertainty is at the root of the TTC experience. People like certainty, and predictability—it makes us feel safe and secure. So what happens when we are in a perpetual state of uncertainty? We feel a loss of control, which is often one of the hardest things to experience. This can also lead to increased feelings of anxiety and depression.
When we do not feel safe and secure, our bodies respond by trying to protect ourselves and our sympathetic nervous system reacts, also known as “fight or flight.” While TTC, this often translates into a feeling of extreme overwhelm or even disconnection. People stop being able to focus on other parts of life outside of their fertility journey, making life feel very much on hold. Small self-care tasks such as scheduling an activity or cleaning your home, or even writing down questions to ask your healthcare provider, feel too overwhelming to handle. This is an important time to recognize that you are being impacted by a serious experience and you cannot do it alone. You must ask for help from your partner, family and friends.
Sometimes this can become too much to handle. Sometimes it starts to negatively impact your life. If you are not able to do every day tasks and activities on a regular basis, or eat and sleep the way you normally would, it is an important time to seek the support of a licensed therapist who focuses on reproductive mental health. Also, if you are experiencing feelings of anxiety or depression, it is a very important time to seek support from a licensed therapist.
Another sign that it’s time to seek professional support (ideally with a focus on reproductive mental health) is if you are feeling flooded with overwhelming thoughts, called “intrusive thinking,” which often looks like what ifs: “What if this happens? What if that happens?” These thoughts are things that are not actually happening, just things you fear could happen, such as “What if I do not get pregnant? What if I have a miscarriage? What if we cannot figure this out?” These thoughts can be very overwhelming and are often linked to anxiety.
Grief
We often think of grief as the death of a loved one. But grief can also be the loss of a hope and a dream, the loss of how we thought things would be, or the loss of trust in our bodies. This is often a more complicated form of grief, as it is unseen by society and often unnamed even by ourselves. When we do not allow grief to exist, it does not go away, but festers and seeps through the cracks of life. In my work as a therapist specializing in fertility issues, I find that all of my clients have experienced profound grief, yet most of the time they have not recognized it themselves or given themselves the permission to grieve.
When fertility and family building do not go the way it was “supposed” to go—when you do not get pregnant, when you lose a pregnancy, or when you have to explore forms of family building such as fertility treatments like in vitro fertilization (IVF) that were not part of your initial planning—there is an experience of profound grief and loss. It is important to know that when experiencing this, there is no clear path or steps to take to make it go away. It does not end, we just grow around it, and it becomes a story in our lives. But it is not your whole life.
If grief develops into feelings of ongoing sadness, intense emotional pain, avoidance and loneliness, it is an important time to seek the support of a licensed therapist. It is also an important time to name this grief for yourself and to your support system, as knowing you are experiencing that grief and giving yourself permission to feel it is part of the work to address it.
Finding Mental Health Supports
Wherever you are on this trying to conceive journey, remember that you are not alone, and you don’t have to go through this in isolation. Your mental wellness matters, and it’s important to seek out the support you want and need, from both your social network and a professional.
