Infertility, New Reproductive Technologies, and Women’s Mental Health

Most women want to have children, but for some achieving a pregnancy when it is desired is either difficult and prolonged or impossible. Estimating the population prevalence of fertility difficulties or involuntary childlessness is hampered by varied definitions, but in all nations, a proportion of adults of reproductive age will experience infertility. It is a heterogeneous group of reproductive health problems usually defined as the failure to achieve a clinical pregnancy after at least a year of regular unprotected sexual intercourse. Some fertility difficulties are attributable to female, some to male, and some to shared causes, and some are regarded as idiopathic or unexplained. In high-income countries, it is estimated that about 15% of people of reproductive age will seek medical assistance to conceive. Inability to conceive is highly emotionally distressing. The distress is variously conceptualized as an existential crisis, disenfranchised grief, or an adjustment reaction. The nature and intensity of emotional distress varies over the course of infertility treatment. At diagnosis, acute symptoms of distress may increase, but the initiation of treatment arouses optimism that the condition may be assisted or ultimately alleviated. Treatments with assisted reproductive technologies are physically demanding and can be experienced as invasive and accompanied by successive feelings of hope and despair, which are exacerbated when several treatment cycles are undertaken. Couples can experience isolation from the “fertile world” and experience envy when learning of other women’s pregnancies or celebrations of births. Among those who conceive, idealization of parenthood might prevent consideration of the inevitable losses associated with having a baby, and might limit support seeking. After treatment has ceased, those who have not conceived are less satisfied overall with their lives than those who had a baby.