For couples going through in vitro fertilization, life gets measured in cycles. There are daily injections, early morning blood draws, ultrasounds and phone calls with results. Then comes the waiting, which many women describe as the hardest part of all.
When a round does not work, there is often little time to grieve before the next decision. Try again? Take a break? How much more can the budget, the body and the marriage take?
Through it all, many women keep going to work, answering questions from relatives and smiling at baby showers. Underneath, some are struggling with depression that the people around them may not see.
Why fertility treatment weighs so heavily
Infertility can touch nearly every part of a woman's life. It can strain finances and friendships. It can make holidays and family gatherings painful. It can leave her feeling that her body has let her down, or that she is failing at something everyone else seems to do easily.
The hormones used in treatment can affect mood, too. And each round carries its own cycle of hope and disappointment. When that cycle repeats again and again, it can wear down even the most determined person.
Many women also feel isolated. They may not want to tell friends about each attempt, which means they grieve each loss mostly in private.
Signs a loved one can notice
Some sadness during fertility treatment is expected. What deserves attention is a change that lasts. Watch for:
- A low or hopeless mood that holds for weeks, not just after a single bad result
- Avoiding friends, family events or anyone who is pregnant or has young children
- Saying she is worthless, broken or a disappointment to her partner
- Changes in sleep, appetite or energy that are not explained by treatment alone
- Losing interest in work, hobbies or things that once brought her joy
- Talking about being a burden, or about not wanting to go on
How to talk about it
Partners in fertility treatment are often so busy managing schedules and finances that they stop talking about feelings. Make time for it on purpose. Choose a calm evening, away from appointments and test results, and tell her what you have noticed. Say that you love her, that you are worried, and that you want to know how she is truly doing.
Family members can help too, but tread gently. Avoid advice about relaxing, adopting or trying a different doctor. Instead, ask how she is holding up and listen to the answer.
If she says things that sound hopeless, ask her plainly whether she is having thoughts of suicide. It can feel too blunt to say. But asking directly does not put the idea in her head. It shows her that she can tell you anything, and that you will not look away.
If she says yes, stay calm and stay close. Thank her for being honest, and help her get care that day.
Some couples find it useful to agree on a way to pause the conversation about treatment for a while. Setting aside an evening or a weekend where no one mentions cycles or results can give both partners space to breathe and simply be together.
Finding support
Fertility clinics see patients often, and many have counselors on staff or can refer patients to one. She can mention her mood at any appointment. A partner can offer to bring it up together, or to call ahead and ask what support is available.
The National Maternal Mental Health Hotline is open to women facing infertility as well as those who are pregnant or have recently given birth. She or a family member can call or text 1-833-852-6262, free, at any hour of the day or night, to talk with a counselor.
If treatment does lead to a pregnancy, keep watching. Women who have been through a long fertility journey can still face depression during pregnancy and after birth, sometimes because they feel they are not allowed to struggle after wanting a baby so badly. Her prenatal and postpartum visits will include questions about mood, and honest answers there matter.
Whatever the outcome of treatment, her well-being counts on its own. Asking how she is, and meaning it, is a good place to start.
If you or someone you know is thinking about suicide, call or text 988, the Suicide and Crisis Lifeline, any time. In an emergency, call 911.