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April 11, 2022


FACTS Infertility Awareness Series

The Mental Health Effects of Infertility: A Review of Research Findings

By Dulce Maria Miller De McCoy, DO


Executive Director’s Note: In anticipation of National Infertility Awareness Week, we continue our research series on infertility with a summary of a systematic review on mental health and infertility. This piece was written by Dulce Maria Miller De McCoy, DO as part of the FACTS elective taught by Dr. Marguerite Duane through the Georgetown University School of Medicine.

Infertility can lead to stress, isolation, anxiety and hopelessness, but with fertility awareness-based methods (FABMs), couples may feel more empowered. FABMs facilitate conversation about the female cycle; for some women, using FABMs enabled them to view life beyond the lens of infertility and propelled them forward in their relationship. This research summary highlights how FABMs may potentially mitigate some of the negative mental health effects commonly associated with infertility.

Our upcoming conference, For the Future of Women’s Health will also feature a presentation by Dr. Paul Carpentier on the latest research in treating infertility with restorative reproductive medicine. Join us for our August session with Dr. Carpentier either virtually or in-person in Lancaster, PA! Registration for all four sessions is now open!



The effects of infertility on mental health for couples who are trying to conceive are immense and life-changing. Social and cultural expectations, the financial cost of treatments, and possible loss of pregnancy are some of the many factors that can directly impact a couple’s psychological health. It is a subject that is not readily discussed in mainstream society, further relegating the topic as taboo and making it difficult to address. Qualitative research done by Hasanpoor-Azghdy et al. details the psychological consequences of infertility, specifically among infertile Iranian women seeking treatment.[1]


This study was conducted using a qualitative content analysis on 25 women with no living children presenting with primary and secondary infertility. A qualitative content analysis is a method used to quantify, organize, and analyze subjective interviews with participants. Participants who were exceptionally knowledgeable about, or had experienced, infertility and infertility treatments were selected with maximum sample variation from a large fertility health research center in Tehran, Iran. Data was collected using 32 semi-structured interviews and analyzed with the conventional content analysis method. Researchers were able to codify themes revealed during the participants’ interviews. This data can ultimately help create categories and subcategories for a topic with limited prior research.


A total of 25 women, aged 21 to 48 years old, with histories of primary and secondary infertility without living children were interviewed. Education levels ranged from elementary school to doctoral degrees. Duration of marriage and period of infertility treatment ranged from 3 to 22 years and 1 to 14 years, respectively. Participants had maximum sample variation, which increased the validity and transferability of the findings to similar groups and settings. As interviews were collected and analyzed, data revealed that infertility and the treatment process were both associated with cognitive and emotional reactions. The researchers identified four main themes, each with respective sub-categories.

Main Themes Sub-Categories
Cognitive reactions to infertility Mental engagement; Psychological turmoil
Cognitive reactions to the treatment process Psychological turmoil; being difficult to control in some situations; reduced self-esteem; feelings of failure
Emotional-affective reactions to infertility Fear, anxiety, and worry; loneliness and guilt; grief and depression; regret
Emotional-affective reactions to the treatment process Fear, anxiety, and worry; fatigue and helplessness; grief and depression; hopelessness


This study found that Iranian women with infertility seeking treatment face numerous psychological and emotional obstacles, which negatively impact their mental health and well-being. While infertility or being labeled “infertile” is often treated as a biomedical issue, there is much less attention to its impact on the mental-emotional, social, and cultural aspects of a woman’s life. Fertility, particularly in Eastern cultures, is upheld as one of the highest values and the inability to bear children has severe psychological consequences. The study demonstrated that one of the major causes of psychological distress is the social pressure by community members.

While infertility or being labeled “infertile” is often treated as a biomedical issue, there is much less attention to its impact on the mental-emotional, social, and cultural aspects of a woman’s life.

It is important to note that in every geographical region, the concept of infertility is shaped by culture and societal expectations. In Western countries, where women continue to pursue careers and financial independence, the culture surrounding infertility is different than in other geographical regions. Although the socio-cultural influences of Iran heavily influence the results of this study, it highlights an issue in mental health that is often overlooked: women and couples struggling to conceive can become clinically depressed and anxious, further affecting overall health.

Having the proper language to assess, diagnose and treat psychological issues related to infertility and its treatment is crucial in tackling this problem. This study is a step towards collecting the emotional language and categorical subsets around fertility-related depression and anxiety that can help unveil the struggle that women and couples undergo during infertility and treatment, normalize the psychological hardships, and integrate findings into medical training and treatments.


[1] Hasanpoor-Azghdy SB, Simbar M, Vedadhir A. The emotional-psychological consequences of infertility among infertile women seeking treatment: Results of a qualitative study. Iran J Reprod Med. 2014;12(2):131-138.

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About the Author

Dulce Maria Miller De McCoy, DO

Dulce Maria Miller De McCoy is a 4th year at the Philadelphia College of Osteopathic Medicine who has matched into the Psychiatry Residency Program at Allegheny General Hospital. She has an interest in reproductive psychiatry and the psychological issues surrounding infertility. As a future psychiatrist, she believes learning about FABMs increases her scope and understanding of women’s health and will broaden the assessment and treatment plans offered to patients.

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