We Need to Talk More About the Mental Health Toll of Fertility Treatments

When you're undergoing fertility treatments, it can affect every part of your life and well-being — and it's something more women than ever are doing. According to one 2023 survey from the Pew Research Center, 42 percent of adults have undergone fertility treatments or know someone who has. (And that doesn't account for egg freezing.) But while the physical symptoms are commonly known and often talked about, the effects on mental and emotional health remain much more taboo.

Yet the psychological impacts are equally, if not more, powerful than their physiological counterparts. We spoke with top experts (and real women who have been through the fertility treatment ringer) to learn how and why IUI, IVF, and egg freezing affect your mental health — and how to best handle this uniquely stressful time.

Experts Featured in This Article

Emily Heilman, MA, LCSW, BCD, PMH-C is a psychotherapist specializing in women's reproductive mental health and the founder of Flourish Counseling.

Joshua Klein, MD, FACOG, is a board-certified subspecialist in reproductive endocrinology and infertility, and the chief clinical officer and cofounder of Extend Fertility.

Why Do Fertility Treatments Affect Mental Health?

No matter whether it's IUI, IVF, or egg freezing, it's important to underscore that emotional impacts are normal. There's a very clear physical cause and effect at play. In the case of egg freezing and IVF, "We're overriding normal biology that allows women to only grow one egg at a time. To do that, we have to bring in hormones from outside the body," explains Joshua Klein, MD. "There's estrogen and progesterone circulating at levels that are five, 10, even 20 times higher than what occurs during a normal menstrual cycle. There's no doubt that those hormones have a connection to the brain."

More specifically, it's not just the intense amount of hormones that matter, but the rate at which they spike and drop. The abrupt change of going from low to high over the course of about a week, then having a retrieval and crashing back down to normal a few days later, is what really throws people, says Dr. Klein. The first part — the prep for egg retrieval (be it with egg freezing or IVF) — features an abrupt spike in estrogen. "This is associated with hypersensitivity, when every emotion is heightened. There's also a general sense of heaviness, both physically and mentally," Dr. Klein explains. Post-retrieval, there's a massive drop in progesterone, which can lead to a slew of negative emotions including feeling deeply moody, depressed, and anxious, he says.

Worth noting: during IUI, there's a similar pattern at play, but it's not quite as intense. This is because the amount of medication used is much lower, since the goal isn't to get the body to hyperovulate, per Dr. Klein. In the case of IVF, if there's an immediate embryo transfer that does result in a pregnancy, then the progesterone won't plummet. But if the transfer fails, then you're dealing with the physical effects, coupled with the psychological impact of not being pregnant, Dr. Klein says.

The Emotional Impact Can't Be Overstated

Moving through these treatments can be traumatic for many people, says Emily Heilman, MA, LCSW. "There's the psychological impact, the financial, the physical, the relational, it really is so pervasive in every area of life." As Kate*, who underwent egg freezing last year, puts it: "It's just . . . a lot. They tell you not to be stressed out because that will affect your body, but it's such a stressful experience. I get so annoyed when people say 'just freeze your eggs.' They're not considering the mental and the physical and the financial aspects."

Heilman is quick to note that people's background also plays an important role. It's not uncommon for the person undergoing fertility treatment to have a pre-existing mental health and/or trauma history, she says. Now, they're in the midst of one of the most important and influential life experiences one can have — building a family. Whether going this route was anticipated or not, the "before" has to be factored in when you talk about moving through these treatments. The past often exacerbates what's happening in the present, Heilman explains.

As for how all of this manifests? You name the emotion, it's probably on the list. "Some of the symptoms that most often show up are anxiety, depression, irritability, mood swings. Coupled with that is a loss of control, social isolation, financial strain, and strain on relationships with partners, family, and friends," Heilman says. So yeah, it's a lot.

Egg Freezing Comes With Some Unique Nuances

While we're adding egg freezing into this broader category of fertility treatment, both experts were quick to note that there are some key differentiating factors about the process and its impact. "When someone is electively freezing their eggs for fertility preservation, they're making the choice to be there. And that can feel empowering, like they're taking control and advocating for themselves and their future," Heilman says. "There's also this future orientation, in that they're not actively trying to get pregnant, but rather doing it like an insurance policy." Kate echoes these sentiments: "It was a very empowering feeling, especially because I paid for this all on my own. I spent around $20,000 all in. Taking control in this way did give me a sense of empowerment."

On the flip side, women who are freezing their eggs are sometimes single, and as such don't have the built-in support system of a partner, notes Dr. Klein. (Of course, there are partnered women going through egg freezing and single women undergoing IUI and IVF.) On top of that, women freezing their eggs are often younger and/or may not have had the same kind of medical experiences as women dealing with infertility, says Dr. Klein. He points out that for women undergoing IVF, there's sometimes a history of other conditions and/or surgeries or treatments. It can be a jolt to the system for these younger, and generally healthy, egg-freezing patients to suddenly be poked and prodded, Dr. Klein says.

How to Cope with Mental Health Challenges During Fertility Treatments

So, how do you handle this wild emotional roller coaster? Heilman says she thinks about coping mechanisms through a three-part lens, noting that there should be biological, psychological, and social strategies at play. Here's what she and Dr. Klein suggest — plus helpful advice from women who have been through it.

1. Incorporate daily movement.

This is admittedly a bit tricky, because there are exercise restrictions and you likely will have to modify your normal routine, but there are ways you can still be physically active, says Dr. Klein. Caroline*, who has undergone four rounds of IVF medication and eight embryo transfers, underscores how important this is. "When I couldn't go for a run or ride the Peloton, I'd just walk. I'd take my dog for these monster walks around our neighborhood and get fresh air and get my body moving. That was tremendously helpful for my mental health," she says, adding that it helped her feel calmer and less anxious.

2. Listen to your body.

There's so much that's out of your control when undergoing fertility treatments (like, everything). It's why Heilman says it's imperative to focus on and really think about what is in your control and will help set you up to feel as good as possible. Tune into your body; if you know that having coffee after noon keeps you up at night, then don't drink it, she says. Eat food that feels nourishing for you, and drink water. Prioritize sleep as much as possible; it's a tremendous protective factor when it comes to mental health, Heilman says. Kate focused on doing all of the above during her egg freezing journey. "I really listened to my body. If it was 2:00 on a Tuesday and I felt tired, I'd lay down and take a nap," she says.

3. Find a support system.

This may just be the biggest one on the list. Be it a partner, a friend, or a family member, everyone needs at least one person to lean on during this time. Kate says her boyfriend was invaluable (particularly when it came to alleviating her stress around giving herself injections). She also had a friend who checked in daily. Caroline echoes a similar feeling. "I started to get to a point where I was really struggling with the lack of control [when things weren't working]," she says. "My husband helped me realize that even though we couldn't control the situation, there were still other options, and we had so much to be grateful for. He'd bring me back down when I got really worked up."

Heilman adds that fertility support groups are also hugely beneficial. "It's a shared identification and alleviates the social isolation. You feel less alone because everyone is speaking the same language."

4. Talk about it, if it feels good.

This one is pretty personal. For some, holding the experience close to the chest feels more comfortable; Kate chose not to share what she was going through, with the exception of a few close friends. Caroline, on the other hand, found that it helped to talk about her experience in real time. "There's a lot of weird behavior when you're going through these treatments," she says. "I'd have to give myself shots at night. So if someone wanted to make dinner plans, I'd say 'sure, but I have to be home by 8:00 to give myself an injection,' or ask if we could do dinner at my house. It alleviates the secrecy, which can be another added level of stress," she says. "And I've also found that people show up in more meaningful ways when they know what's up. The more you let people in, the more they can be supportive."

5. Be cautious with social media.

Social media can be a great place for connection and community — or for anxiety-inducing comparison. For many people, it's both. "I found a lot of comfort in hearing about other women's journeys and stories. But I also got jealous or annoyed when people would say they had no symptoms and got 20 eggs," Kate says. Her tip: stay away from all of the "what to do and what not to do" content because that only added to the stress and overwhelmed her. Heilman also encourages setting boundaries around how much content you consume.

6. Embrace the idea of a break.

Pausing on fertility treatments when experiencing difficulties can be refreshing. Caroline (who has had two successful pregnancies over the course of all her IVF treatments) says that she was ready to put things on hold right before she got pregnant both times. "Taking a break is not giving up. It can be a good thing. When we felt like we were running into a wall, we really got comfortable with the idea of pause. If that transfer didn't work, we were going to take a beat and just enjoy life for six months. We even planned a whole trip in our heads. That let me breathe a little easier," she says. Kate, whose egg freezing journey didn't go the way she had hoped (she was never able to do a retrieval), says she's been coping with the outcome by simply taking a step back from it all. "As soon as I got the call that I wasn't going to be able to do the retrieval, my boyfriend and I went away for the weekend," she says. "I had that glass of wine I'd been wanting to have. I really let myself feel my feelings. But as far as going back to the doctor and making another game plan, I just stepped away. It was too overwhelming."

7. Enlist the help of a mental health professional.

When in doubt, call on the pros. Talk therapy is hugely beneficial during any life experience, but particularly one like this, Heilman says. Medication (for example, anxiety meds) can also be useful. And while you can go to your GP for a prescription, this might be the time to seek out a provider who really specializes in this arena; for example, in Heilman's practice, the psychiatrists who can prescribe medication are also midwives. Dr. Klein says he urges patients to enlist the help of a mental health provider who understands the context of what they're going through. Finally, Heilman notes that somatic training is a very effective treatment approach in these types of scenarios, particularly if you feel like your stress and anxiety are manifesting physiologically. "There are lots of different options for therapies, and they're all good. It's about finding what feels right for you," she says.

Melanie Rud is a freelance beauty and lifestyle writer and editor based in Chicago. Along with her work for PS, she also writes for Byrdie, InStyle, Real Simple, Women's Health, and more.