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The Emotional and Mental Health Aspects of Fertility Treatment

Life crises
Dr. Vered Bar, Director of the Hava Center, Reproductive Psychiatry Unit, Sheba Medical Center.
1 June 2026

Israel has one of the highest rates of fertility treatment use in the world and provides generous public funding for treatment up to age 45. However, despite this support, fertility treatment is a journey filled with physical and emotional challenges. Emotional responses vary from person to person and are influenced by personal and environmental factors. This article explores the emotional side of fertility treatment, common sources of stress, possible reactions, and effective coping strategies.

Before Treatment Begins

Emotional difficulties may begin with repeated disappointment after unsuccessful attempts to conceive naturally. Learning that medical assistance is needed can trigger feelings of vulnerability and being different from others, which may lead to secrecy and isolation. The medical evaluation process often involves numerous invasive and uncomfortable tests, which can further intensify these feelings.

An Emotional Roller Coaster: Between Hope and Despair

The emotional experience of fertility treatment is often marked by significant ups and downs. Hormonal treatments, which are adjusted based on each person's response, may cause sleep disturbances, low mood, irritability, and restlessness. It is important to discuss these side effects with your healthcare provider, as alternative treatment options may be available. In addition, repeated medical procedures and testing can affect self-confidence and contribute to emotional distress.

The Cycle of Hope and Disappointment

Many people expect treatment to succeed quickly, especially during IVF cycles. However, a negative result can bring profound disappointment. As treatment continues, the cycle of hope followed by disappointment can become exhausting. It is important to remember that the chance of pregnancy in any given treatment cycle is typically about 20% to 25%, and an unsuccessful cycle does not predict future outcomes. Emotional challenges may be amplified in a society that places a high value on parenthood. Social gatherings and questions about children can be painful, and keeping treatment private due to embarrassment may increase feelings of loneliness.

Relationship Stress

Fertility treatment can create stress within relationships. Timing sexual activity around fertility windows may make intimacy feel mechanical, and partners may sometimes blame one another. Many women report frustration when they feel that most of the physical and emotional burden falls on them. Additional challenges may include disagreements about sperm donation, egg donation, or surrogacy, as well as differences in the desire to become parents. Among female couples, unique questions may arise regarding which partner will carry the pregnancy.

Single Parenthood: Unique Challenges

Single women pursuing parenthood may face different challenges, including disappointment about not finding a partner, concerns about raising a child alone, and the responsibility of parenting without a partner. They often go through the treatment process independently and may rely heavily on support systems such as family members and friends.

Effective Strategies for Coping With Fertility Treatment

  • Knowledge is power: Understanding the treatment process and realistic success rates can reduce feelings of failure and improve coping.
  • Communication and sharing with others: Talking with trusted family members and friends can provide support, understanding, and prevent misunderstandings.
  • Support groups: Connecting with others in similar situations can reduce isolation and provide emotional support and practical advice.
  • Therapy groups: Professional group support can offer coping tools and emotional guidance.
  • Individual counseling: One-on-one support from professionals with expertise in fertility-related issues can be helpful.
  • Couples counseling: Counseling can strengthen communication and help partners manage relationship stress.
  • Medication when appropriate: For people experiencing depression or anxiety, medically supervised treatment can be a safe and important part of maintaining emotional well-being.

Women who are already managing mental health conditions may be at increased risk for emotional difficulties during fertility treatment. Maintaining emotional stability and consulting with their healthcare providers is especially important.

In summary, the journey to parenthood through fertility treatment can be emotionally challenging. Recognizing the complexity of the experience and ensuring access to effective coping tools are essential for women and couples navigating this process.

Israel is a global leader in the rate of fertility treatments per capita and maintains a policy that supports women’s desire to become mothers, including public funding for fertility treatments up to age 45. However, fertility treatments also come with a cost: they place many women on a journey filled with physical and emotional challenges. Every woman is a world unto herself, and her emotional response to fertility processes—like any other life experience—is shaped by a wide range of personal and environmental factors. Women respond differently, and there is a very broad spectrum of emotional reactions.

Before Treatment Begins

Emotional difficulties in the fertility journey may begin with the experience of repeated unsuccessful attempts to conceive naturally and ongoing disappointment. The realization that medical assistance is needed to achieve pregnancy and fulfill the natural desire to become a mother may lead to feelings of vulnerability and being different. These feelings may lead to secrecy and avoidance of sharing with close surroundings, which can contribute to loneliness and intensify the sense of being different.

When a woman experiences difficulty conceiving naturally, a medical workup is usually initiated to identify the cause. This process involves many tests that take time and require careful coordination of appointments based on the menstrual cycle. These tests can be invasive and uncomfortable and may involve repeated exposure, which can further intensify feelings of vulnerability and difference.

An Emotional Roller Coaster: Between Despair and Hope

The emotional experience during fertility treatment is characterized by sharp ups and downs. Fertility specialists manage treatment in order to achieve the desired pregnancy, usually in a stepwise approach—from minimal interventions, such as adjusting hormone dosages as part of a treatment protocol. These interventions may change depending on the woman’s response. Women vary in their sensitivity to hormones and may experience different physical and emotional reactions.

In general, women who are sensitive to hormonal changes—such as those who experience premenstrual syndrome or emotional changes while taking oral contraceptives—may also be more sensitive to hormones used during fertility treatments.

Hormonal treatments may lead to sleep disturbances, low mood, depression, irritability, and restlessness. It is important to inform the treating physician, as there are many alternatives. A different medication or dosage may lead to different physical and emotional effects.

In addition to hormonal interventions, the medical procedures and frequent tests—often requiring time off work and disruption of daily routines—can undermine a woman’s sense of stability and self-confidence, contributing to negative emotional experiences.

Contrary to the common intuitive expectation that fertility treatment should lead to quick success, the reality is more complex. The expectation of immediate success, especially in IVF cycles where maximal effort is made, is often replaced by profound disappointment when a negative pregnancy result is received. As treatments continue, the cycle of hope and disappointment can become a draining and destabilizing routine. Along the way, women may also experience “near pregnancies,” such as chemical pregnancies, miscarriages, and early pregnancy losses.

Important to know

Important to know

While spontaneous pregnancy rates among couples without fertility issues reach approximately 80% within one year, the chance of achieving pregnancy in any single fertility treatment cycle ranges between 20% and 25%. Most women undergoing these treatments, along with their close support systems, experience an emotional roller coaster: starting treatment, taking hormones, repeated testing, medical procedures (egg retrieval, embryo transfer), expectations and disappointments, and so on in a continuous cycle. Each treatment cycle increases the risk of emotional symptoms, especially depression and anxiety, and can undermine a person’s sense of security and self-efficacy. It is important to remember that a cycle that ends without pregnancy or birth does not predict the outcome of the next cycle.

In Israel, a society that strongly encourages parenthood, emotional challenges are often intensified. Encounters with pregnant friends or women with infants can be painful, and dealing with questions about having children may sometimes be very difficult. Many women choose to avoid social gatherings and reduce their activities, which can worsen feelings of loneliness and being different. These behaviors can also amplify the sense of lack. Women who do not share their experience due to shame, feelings of inadequacy, or discomfort often feel even more isolated in coping with these emotional challenges.

Relationship stress: from intimacy to issues

Fertility processes can create significant strain within a relationship. Timing sexual intercourse around ovulation or treatment cycles adds another layer of stress. Sexual activity, which was once spontaneous and intimate, often becomes mechanical and technical, and at times even somewhat “public” in nature, or loses intimacy altogether when it takes place in a laboratory setting rather than in bed. Sometimes partners experience self-blame or mutual blame related to male or female fertility factors, which can gradually erode the relationship. Many women feel frustrated when they perceive that most of the treatment burden falls on them.

Additional relationship challenges in fertility treatment:

Conflicts

Conflicts around the option of sperm or egg donation or surrogacy, which involve significant complexities and costs.

Gaps

Differences in the desire to become a parent and in willingness to invest time and money in testing and treatment.

Disagreements

Disagreements at various decision points.

All of these factors place the relationship under significant strain. At times, partners may express feelings of guilt toward a partner who strongly wants to become a parent and experience the sense that the relationship and fertility challenges are delaying that goal, saying things like: “Leave me, find someone else.” Among female couples, the challenges are similar but include unique complexities, such as deciding which partner will carry the pregnancy and when.

Unique challenges of single parenthood

Women who choose single parenthood through fertility treatment face a different set of challenges. Alongside disappointment and a sense of failure related to not finding a partner, concerns often arise about raising a child alone, addressing questions about the child’s father, and bearing sole responsibility. The decision to undergo fertility treatment is also more complex, as it is experienced without a partner to provide support at each stage. The experience of fertility treatment itself is similar to that of women in relationships, except that the woman must cope with everything on her own. The overall experience is more complex because it includes the broader meaning of single parenthood—raising a child alone—not only the treatments themselves. Alternative support systems, such as parents, sisters, and friends, can help compensate for the absence of a partner. Even after becoming pregnant, concerns and fears about raising a child alone may still arise.

Effective tools for emotional coping during fertility treatment

Understanding the process, becoming familiar with the data, and recognizing its implications can help reduce feelings of failure and endless disappointment, while providing practical coping tools. For example, when a woman understands that each IVF cycle has a pregnancy success rate of around 20%–25%, she can prepare for the possibility of a negative outcome and avoid interpreting it as a personal failure or the end of her chances for parenthood. This knowledge can help moderate the intense emotional response following a negative result.

Sharing with one’s close support system can provide understanding and emotional support. For example, if it is difficult for a woman or couple undergoing treatment to attend family celebrations where pregnant women or babies are present, sharing their feelings and challenges can help others understand. This understanding can prevent misinterpretations and provide emotional support. In addition, the support system can offer practical help—for instance, if a partner is unable to attend a specific appointment, support from a sister or close friend can be meaningful.

Meeting other women who are going through similar experiences and understand one another can reduce feelings of loneliness. A group setting allows women to share their experiences, benefit from mutual support within the group, and receive advice from others in the same situation. Support can come from in-person groups or virtual support groups, such as those on social media.

Participation in therapeutic groups within fertility clinics at medical centers or elsewhere allows women to receive support from others who understand the process firsthand, under the guidance of a professional who is highly familiar with the field and provides effective coping tools. These groups have significant value. For example, a woman who feels “not okay” because she is struggling to conceive naturally may find comfort and validation in a group where she meets others facing similar challenges. In some cases, women form lifelong friendships in support and therapeutic groups, which can ease emotional challenges throughout the life journey.

Reaching out to professionals, especially those who specialize in the complexities of fertility treatment, can provide tools for effective emotional coping.

A couple experiencing stress due to fertility treatment, such as arguments or a sense that sexual intimacy has become mechanical, can seek couples therapy to improve communication, address tensions and difficulties, and maintain intimacy.

In cases where depression or anxiety develops, it is appropriate to consider medication treatment during fertility care. It is important to know that properly chosen medication, under medical supervision, is safe and does not reduce the chances of success in fertility treatment. In fact, it is important to enter fertility treatment in a stable emotional state. A woman’s mental health is very important during fertility treatment, during pregnancy, and after childbirth.

Women who are living with pre-existing mental health conditions

Women who are living with pre-existing mental health conditions prior to entering fertility treatment, such as eating disorders, anxiety, depression, and others, are at increased risk of emotional difficulties during fertility treatment. In some cases, women may independently stop taking their medications, which can lead to poorer management of their mental health condition and a worsening of symptoms. For these women, it is especially important to maintain emotional stability and balance, in consultation with their care providers, such as a physician, psychiatrist, or psychologist.

The journey to parenthood through fertility treatment is emotionally challenging and requires resilience and support. Recognizing the emotional complexity and providing accessible coping tools are essential for women and couples going through this process.