When it comes to infertility, the struggle goes well beyond the physical. Up to 60% of those struggling with infertility experience significantly higher levels of anxiety and depression than their counterparts. In fact, folks grappling with infertility often have the same levels of anxiety and depression as those dealing with cancer, heart disease, and HIV. And it’s not only infertility itself that stirs up this phycological storm. The medications used to treat infertility are associated with psychological symptoms like anxiety, depression, and irritability, as well.

Research has shown that most couples struggling with infertility express a need for psychological support during their journey, but less than 25% wind up seeking help from a professional. One of the reasons: More than 70% of female fertility patients are given zero information about—or referrals to—mental health services from their fertility clinics, according to another study

To shed light on this important issue, we turned to Sarah Oreck, MD, a reproductive psychiatrist in Brentwood, California. Here, Dr. Oreck shares what a reproductive psychiatrist does—and how adding one to your own medical team can make a world of difference in your own fertility journey.

Happiest Baby: What is a reproductive psychiatrist?
Sarah Oreck, MD: A reproductive psychiatrist is a physician with a specialization in female reproductive hormones and their impact on mental wellness. Reproductive psychiatrists typically work with patients throughout their reproductive lives—from the first menstrual period, pregnancy, postpartum, breastfeeding to menopause. [A reproductive psychologist offers similar help but cannot prescribe or regulate psychiatric medication.] I primarily work with patients who are trying to conceive, those who are pregnant, and during the postpartum period. Many of my patients experience trauma from pregnancy loss and a variety of different challenges conceiving. My first step in treatment is to provide education and normalization around the many difficult emotions that come up around the diagnosis of infertility. In terms of treatment, I take a whole-body approach which combines the most up-to-date medical treatments, vitamins and herbal remedies with talk therapy, and mindfulness-based approaches.

HB: Does the mental health aspect of infertility get the attention it deserves? 
SO: Mental wellness is absolutely neglected as part of the fertility journey. Most fertility practitioners are trained to focus on outcomes and not enough are checking in with patients to see how they’re doing emotionally. Fertility treatments can be grueling from a physical, psychological, and financial perspective. Studies indicate that women who experience infertility report higher levels of anxiety and depression. There’s also the concern that increased levels of stress and mental health issues could themselves impact fertility. [For instance, research suggests that moderate to severe depressions may delay conception.]

HB: When it comes to infertility, who should consider seeking out a reproductive psychiatrist?
SO: I think just about everyone who’s struggling with fertility issues would benefit from connecting with a therapist, as there are mental health implications to facing this diagnosis as well as moving forward with treatments—which can themselves impact mental health. [For example, research has shown that 41% of those on Clomid, a widely used fertility drug, experience depressed mood and 45% experience mood swings.] If you have a history of mental health issues or are already in high-quality therapy and find that you need more support to achieve mental wellness, it might be time to consider reaching out to a reproductive psychiatrist.

HB: What are the most common issues you see with those who are trying to conceive and those undergoing fertility treatments?
SO: I see a lot of anxiety and depression in individuals who are struggling to conceive. So many have succeeded in purposefully not becoming pregnant for so many years, that it feels unexpected to struggle to conceive once they actually start trying. I see high levels of anxiety and depression with those going through treatment, too. Plus, there are the mood symptoms that can result from fertility treatment themselves. It's also often the first time that patients have interacted with the medical system with such frequency, which can often feel a bit scary itself. 

HB: What’s your best piece of advice for those who’ve just gotten an infertility diagnosis?
SO: You are not alone! It’s also okay to feel like it isn’t fair and wonder why you’re struggling but three of your closest friends just got pregnant without even trying. Checking in with how you feel and leaving judgment out of it is hugely important.

Support is hugely important in maintaining mental wellness through this process. If you’re going to appointments alone—as has been required during COVID—tell your partner or loved ones about them. And if your immediate support system isn’t enough, know that there’s a big fertility community out there, so check that out. If it provides support, wonderful. But tune it out if it doesn’t feel helpful for you. If you don’t feel like your support system is providing what you need—or if you are struggling and it’s starting to impact your quality of life—please reach out to a professional specialized in reproductive mental health.

HB: Any additional advice for those who’ve recently started fertility treatments?
SO: Go at your own pace. I know the fertility clock may be running, but if your body needs a break, please take it! You can take a few months off before doing another cycle. Clearing your head and reducing stress levels can often make a difference in success rates. Another big piece of advice is to remember that families can be formed in a multitude of different ways and the bond between a parent and a child is not dependent on being biologically related or carrying a pregnancy.

HB: Why is National Infertility Awareness Week (NIAW) important?
SO: It’s a week to highlight what sometimes seems like a silent epidemic, yet [almost 20%*] of women in the U.S. have difficulty getting or staying pregnant. It’s a time to combat the stigma around fertility so those individuals can seek out support and treatment without shame.

For help finding a reproductive psychiatrist or psychologist in your area, consult your fertility specialist. You can also do a search on Psychology Today, filtering by “Infertility” under “Issues” to find a professional who specializes in infertility.

* This statistic only includes cis heterosexual women, leaving out the fertility struggles of queer, trans, nonbinary folks, and men.


image of Dr. Oreck who is a psychiatrist

Dr. Oreck is a Columbia University-trained psychiatrist focusing on women’s mental wellness. Shes also a founding medical advisor for Perelel, a doctor-founded pre and postnatal vitamin brand that offers targeted nutrition for each stage of a woman’s reproductive journey—from preconception to postpartum.



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Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions and concerns about your child or yourself, please contact your health provider.