When It's Time to See an Infertility Counselor

How Fertility Counseling Can Help You Cope & Sort Out Your Options

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There are a variety of reasons for seeking out a therapist to work through infertility challenges. It may be that your reproductive endocrinologist recommends or requires you to see a counselor before certain treatments, like when deciding to use an sperm or egg donor. Egg and sperm donors themselves are required to see a mental health counselor before they are allowed to donate.

For LGBTQ couples, counseling can help you consider your options for building a family and how different choices might affect your relationship. While you may not be facing a medical diagnosis of infertility, a counselor can help you with the process of assisted reproduction or adoption.

The emotional pain women experience when going through infertility can be severe and traumatic. (A research study from 1993 found that women with infertility experienced anxiety and depression at rates similar to those with cancer, heart conditions, and high blood pressure.) Coping with infertility is hard, and needing help is 100 percent normal. Seeing a therapist could help you cope with the emotional struggle of infertility.

Penny Joss Fletcher is a marriage and family therapist based in Tustin, California, who specializes in infertility and adoption counseling. She understands infertility not only from a professional standpoint, but also a personal one. After five years of infertility treatments, including failed IVF treatment, she and her husband decided to adopt.

Fletcher recommends infertility counseling in the following situations.

Reason #1: Infertility Is Taking Over Your Life

While infertility isn't easy for anyone, some cope all right on their own. However, if you're finding that infertility is taking over your life, you might consider counseling.

"If your sadness, depression, worrying, or anxiety is prolonged and affecting many areas of your daily life, then it is important to seek professional help," explains Fletcher. "A therapist can teach you coping skills and strategies to alleviate some of the depression or anxiety."

Also, medication for anxiety or depression may be helpful, which is something a psychiatrist could help you with. "Some medications are allowed even when trying to conceive, but it is important that you check this out with your physician," says Fletcher.

Reason #2: Infertility Is Hurting Your Relationship

Our relationships are put under tremendous stress when going through fertility treatments. It's the kind of stress that can bring you closer together at times, and at other times pull you apart. The effect infertility can have on your sex life also adds strain to a relationship.

On top of all this, misunderstandings between each other can make things more difficult. "Often couples handle stress in different ways," explains Fletcher. "Stereotypically, women express emotions more freely and need to talk out their thoughts. Men often focus on problem solving and may not let themselves feel each monthly loss."

Infertility is hard, but it's even harder if you don't have the support of your partner. Sometimes, your partner is the only one who really knows what you're going through. Counseling can help you better understand and support each other.

Reason #3: You're Not Sure What to Do

A counselor who is specially trained in working with couples with fertility challenges (including LGBTQ couples) can help you sort through your options. The counselor can help you make a truly informed choice and help you consider what your treatment options may involve, including the financial and emotional stresses of those choices.

"I think that any time a couple is at a crossroad in terms of treatment decisions, it can be helpful to speak with a mental health professional," says Fletcher. "Especially when there is disagreement about what to do next, having an objective third party can help."

Beginning IVF treatment is a common time that couples seek help. Some reproductive endocrinologists strongly suggest patients see a counselor before or during treatment. "Many people are not prepared for the additional stress that is often experienced doing IVF," explains Fletcher. "Speaking with a therapist before beginning the IVF cycle can also be productive."

Reason #4: You're Considering Gamete Donations, Surrogacy, or Adoption

"The most important time to obtain a consultation with a therapist familiar with infertility issues is when a couple or individual is considering using third party reproduction or adoption to create their family," explains Fletcher.

Especially when considering the use of an egg donor, sperm donor, or embryo donation, counseling is a must and often required before treatment. The same goes for surrogacy and adoption. The emotional impact of making choices like these can be intense, something that some couples may underestimate.

"There are significant losses that must be acknowledged and grieved when moving from IVF using your own gametes to third party donors, surrogates or adoption," says Fletcher.

When talking about gamete donation or surrogacy, some topics that a counselor will speak to you and your partner about include:

  • Clarifying why you're making the choice.
  • Confirming that it's a joint decision, something both you and your partner agree on.
  • Talking about whether you'll tell friends and family about your decision, and if yes, how and when you might do that.
  • Talking about the effect of donation on your relationship with the donor, if you know the donor.
  • Considering what it might mean to you and your future child if you choose a closed or open adoption or gamete donation. (In other words, will the donor have any contact with your family later, or not?)
  • If a donor or surrogate hasn't been chosen, discussion of the criteria you're looking for in a donor, and why.
  • Considering when, how, and whether you’ll tell any resulting child conceived with the help of a third party. (Pretty much all professionals recommend telling the child. But how and when to do so isn’t as clear-cut.)

Fletcher explains, "Overall, I view this consultation as one more part of the 'informed consent' that the couple is being asked to give to proceed with third-party treatment. I want couples to feel good about themselves and the treatment cycle as they move forward. This is the time to acknowledge and work through any grief, fear, or shame in forming a family in this manner."

Reason #5: You're Considering a Childfree Life

Whether it comes after years of treatments, or early on with a realization that the available options aren’t right for you, realizing that you’re not going to have kids is extremely difficult. For some, counseling can help with processing the emotions that come with this realization.

Making an actual decision to be childfree isn’t the same as deciding to “not prevent but not try” to have a baby. It’s also not the same as deciding that you’ll consider adoption “sometime in the future.” Or deciding that you “might try treatments again one day.”

While there is room for all of these paths, they don’t allow closure. The possibility of having a child still exists in the minds of the couple. That makes it much harder to grieve their losses.

“When a couple feels they are at the end of treatment options, I think it is imperative that they come to an actual decision to live childfree and not just let time pass without doing any more treatment or adopting," says Penny Joss Fletcher. "It is an extremely difficult, but empowering, decision.”

Reason #6: You’d Like More Support

Maybe you’re not feeling particularly depressed or anxious, and you don’t fall within any of the above groups. But you feel like you could use more support, someone to talk to, who can give you more tools for coping. Counseling can be a good choice for you, too.

You don’t have to have a reason. You don’t have to wait until you’re feeling so overwhelmed that you truly are depressed and having anxiety attacks.

Unfortunately, seeing a mental health counselor is sometimes considered a sign of weakness. The thinking goes that if only you were strong enough (whatever that means), then you wouldn’t need help with coping.

This just isn’t true. Strong people know when they need extra help. Seeing a therapist is nothing to be ashamed of. In fact, having the courage to ask for help is a sign of strength itself.

A Word From Verywell

Fertility counseling can be beneficial in many ways—from helping you sort through your options to helping you cope with the stress of infertility. Sometimes, you need a therapist who is familiar with infertility and fertility treatment options. This is especially true if you’re trying to sort through your options. But if you mainly need support for emotional challenges, any qualified, compassionate counselor can help. 

You don’t have to go through this infertility journey without help. Counselors out there are trained to help you. If you could use extra support, reach out for it.

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  1. Domar AD, Zuttermeister PC, Friedman R. The psychological impact of infertility: a comparison with patients with other medical conditions. J Psychosom Obstet Gynaecol. 1993;14 Suppl:45-52.

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