When It's Time to See an Infertility Counselor

From Helping You Cope to Sorting Out Your Options

Unhappy couple on couch
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There are a variety of reasons for seeking out a therapist to work through your 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 egg or sperm donor. Egg and sperm donors themselves are required to see a mental health counselor before they are allowed to donate.

Or, you might be thinking that seeing a therapist could help you cope with the emotional struggle of infertility.

Research shows that the emotional pain women experience when going through infertility is similar to those dealing with cancer, HIV, and chronic pain. Coping with infertility is hard, and needing help is 100 percent normal.

I spoke to Penny Joss Fletcher about why a couple might seek counseling for infertility. Fletcher is a marriage and family therapist based in Tustin, Calif., specializing 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.

Here is what she had to say about infertility counseling:

Reason #1: When Infertility Takes Over Your Life

As mentioned above, infertility can really overwhelm you. 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 hopefully 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: When Infertility Is Hurting Your Relationship

Our relationships are put under tremendous stress when going through infertility. 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 or spouse. Sometimes, your partner is the only one who can really understand what you're going through. Counseling can help you better understand and support each other.

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

A counselor who is specially trained in working with couples with infertility 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 desire help. In fact, some reproductive endocrinologists strong suggest patients to 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: When 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 to 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.

Fletch 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: When Considering a Child-Free 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.

“When a couple feels they are at the end of treatment options, they have two choices—either live childfree or adopt. Neither decision is an easy one,” says Fletcher. “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. It is an extremely difficult, but empowering, decision.”

Reason #6: Because 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, per se. 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 considered a sign of weakness by some people. 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. In my opinion, strong people know when they need extra help. Seeing a therapist is nothing to be ashamed of. I started seeing a psychologist after my second miscarriage, and her support and input has helped me tremendously as I am going through infertility.

Whatever your reason, or non-reason is, you should know that you don’t have to go through this infertility journey alone and without help. Counselors out there who are trained to help you. And if you could use the extra support, reach out for it.

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