Two Weeks of Hope, Then Start Again

You know the shape of the month better than you know most things. The days when it matters. The two weeks of holding still. The morning you test, or the morning your body tells you first. Then a day or two of flatness that you mostly hide, and then the whole thing starts again.

Infertility is usually described as a medical problem, and it is. It is also a calendar that delivers hope and loss on a schedule, over and over, with no end date announced in advance.

How Many People Are In This

More than the silence suggests. The World Health Organization reported in April 2023 that about 17.5 percent of adults, roughly one in six, experience infertility at some point in their lives, with little difference between high income countries at 17.8 percent and low and middle income countries at 16.5 percent. WHO defines it as not achieving pregnancy after twelve months or more of regular unprotected intercourse, and names distress, stigma and financial strain as part of its ordinary consequences rather than as side notes.

No, Your Stress Is Not the Reason

This deserves to be said early, because almost everyone carrying this has quietly wondered.

A meta-analysis published in the BMJ in 2011 pooled 14 prospective studies covering 3,583 women, each going through one cycle of assisted reproduction, and compared anxiety and depression before treatment with whether a pregnancy followed. Pretreatment emotional distress was not associated with the outcome of that cycle. Women who became pregnant had been about as anxious and as low beforehand as women who did not.

That is one specific question answered well, not the whole of human reproduction settled. But it is the question people torture themselves with. The implication is worth stating without hedging: there is no good evidence that your worry is what stood in the way, and the advice to just relax is not supported by the research it is usually delivered with.

The Emotional Load Still Matters, for a Different Reason

Here is the part that gets missed when people hear the finding above and conclude that the emotional side is irrelevant.

A systematic review of 22 studies covering 21,453 patients across eight countries looked at why people stop fertility treatment. Psychological burden accounted for about 14 percent of the reasons given, and physical plus psychological burden together about 19 percent, making it one of the most commonly cited reasons for stopping, even in settings where treatment was funded. Postponement was the single largest category at around 39 percent.

Put the two findings side by side and something useful appears. Distress does not appear to reduce your chances within a cycle. What it does is shape how many cycles you can stand. That is the pathway that actually matters, and it means attending to the emotional side is not self indulgence or magical thinking. It is the part of this you have some influence over.

Why Nobody Around You Knows What Month It Is

The other distinctive thing about this grief is how private the calendar is.

A loss that nobody knew to expect is a loss nobody marks. There is no announcement, so there is no acknowledgment, and the day you find out is frequently a Tuesday with meetings on it. People ask about holidays and promotions. Occasionally somebody asks whether you are planning to have children, in a friendly voice, at a party.

So you are running a monthly cycle of anticipation and disappointment that is invisible to almost everyone, including sometimes your own doctor, who is looking at the clinical side rather than the two weeks.

What Tends to Help

Not a method. A few things people find make the months more survivable.

• Plan the two week wait before you are in it. Decide in advance what you will do with those days, including how much reading you will allow yourself, because the suspense is the part that reliably eats everything.
• Decide how testing day works. Who is there, what happens afterward, whether you take the morning off. Making the decision early means not making it while you are upset.
• Keep the circle small and brief them properly. Two or three people who know what is happening and know what not to say is better than a wide group who ask at the wrong moment.
• Agree on review points with your partner rather than drifting. Deciding together to reassess after a set number of attempts is different from an open ended grind, and it gives the two of you a shared horizon.
• Protect one thing a week that has nothing to do with this. When fertility becomes the organizing fact of a life, the rest of the life gets thin, and the thinness makes every month harder.

When It Has Become More Than Hard

Hard is expected. Some signs suggest it would be worth having someone alongside you: the low mood no longer lifts between cycles, the dread of the test is taking over the weeks before it, you are avoiding friends with children or avoiding friends in general, you and your partner have stopped being able to talk about it, or the thought of stopping and the thought of continuing both feel unbearable.

Therapy does not change the medicine. What it can do is reduce the cost of carrying this, help the two of you talk about it without either having to protect the other, and help with the decisions that have no right answer. If the waiting itself is the hardest part, The Anxiety of Waiting for Something Bad to Happen may be a useful companion piece, and if the grief of it has surprised you, When Grief Doesn't Look the Way You Expected covers losses that come without a funeral.

Where to Start in Arizona

You do not need to be at a breaking point, and you do not need to have decided anything about treatment.

The Healing Effect works with clients across Arizona, in person and by telehealth for clients located in the state. You can get in touch through our contact form, and there is more about this work on our perinatal mental health page.

And whatever happens with the next cycle, the hoping was not a mistake. It is what makes this worth wanting.

Does stress cause infertility, or stop treatment working?

The best available evidence on the treatment question says no. A 2011 BMJ meta-analysis of 14 prospective studies covering 3,583 women found that anxiety and depression before a cycle of assisted reproduction were not associated with whether that cycle resulted in pregnancy. That addresses one cycle rather than every question about stress and fertility, but it does mean the advice to relax is not supported in the way people usually mean it.

Then why does everyone say to manage stress?

Because the emotional load matters through a different route. In a review of 22 studies and 21,453 patients, psychological burden was among the most commonly cited reasons people discontinue fertility treatment, including where it was funded. Distress does not seem to change the odds within a cycle, but it does affect how many cycles are bearable.

How common is infertility?

The World Health Organization estimated in 2023 that about 17.5 percent of adults, roughly one in six, experience infertility during their lifetime, with similar rates in richer and poorer countries. WHO defines it as not achieving pregnancy after twelve months or more of regular unprotected intercourse.

How do we stop this taking over our relationship?

Two things people find help: deciding together in advance how testing days and the two week wait will be handled, and agreeing on review points rather than drifting from cycle to cycle. Couples often also find it easier to talk honestly with a third person in the room, because neither has to manage the other's reaction while speaking.

The Healing Effect is not a crisis service. If you are in crisis or thinking about harming yourself, call or text 988 to reach the Suicide and Crisis Lifeline, available 24 hours a day, 7 days a week.

Sources:

World Health Organization. 1 in 6 people globally affected by infertility, 4 April 2023 (about 17.5 percent of adults, roughly 1 in 6, affected over their lifetime; 17.8 percent in high income countries and 16.5 percent in low and middle income countries; infertility defined as the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse; WHO noting significant distress, stigma and financial hardship, with most treatment paid out of pocket).

Boivin J, Griffiths E, Venetis CA. Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies. BMJ. 2011;342:d223 (14 prospective studies, 3,583 infertile women each undergoing one cycle of assisted reproductive technology; pretreatment emotional distress not associated with treatment outcome after a single cycle), as summarized by the Massachusetts General Hospital Center for Women's Mental Health.

Gameiro S, Boivin J, Peronace L, Verhaak CM. Why do patients discontinue fertility treatment? A systematic review of reasons and predictors of discontinuation in fertility treatment. Human Reproduction Update. 2012;18(6):652 to 669 (22 studies, 21,453 patients across eight countries; postponement of treatment the largest category at 39.18 percent of selections; physical and psychological burden together 19.07 percent, with psychological burden alone 14 percent; relational and personal problems 16.67 percent; treatment rejection 13.23 percent; organizational problems 11.68 percent; clinic problems 7.71 percent; no predictors consistently associated with discontinuation).