Infertility and perinatal mental health

Guest blog by Anya Sizer, Regional Organiser for Fertility Network UK

With one in six couples facing problems conceiving, infertility will be part of the story for many parents. It is therefore vital that we look at the implications of this and what best practice might look like when offering mental health support.

Facts about infertility and perinatal mental health

Although infertility is a relatively common experience, with 3.5 million people affected per year in the UK, and one which cuts across ethnicities and socio-economic backgrounds, it is nevertheless one of the biggest emotional challenges a person will face.

Fertility Network UK conducted research with Middlesex University which showed that 90% of people facing long-term infertility stated that they had experienced depression, and 42% had reported feeling suicidal. The reality is that for many people this will be a source of long-term stress and anxiety, and sadly one that will impact even after the hugely desired outcome of a pregnancy is achieved.

What is the mental health impact of infertility on pregnancy, birth and beyond?

Pregnant patients we speak to report an inability to switch off from the concept of infertility and to simply “enjoy” the pregnancy, even if those around them may pressure them to do so. Instead, for many, it is seen almost as a continuation of the fertility process with levels of anxiety in early pregnancy especially high. The distress experienced during treatment, especially when over a long period of time can certainly have a negative impact on the experience of pregnancy and parenting. There is often also a huge disparity between the image and the actual experience of motherhood which can also cause considerable upset to the new parent.

In addition, there is often an unwillingness to reach out for help during this time. Patients report a perception that they ought to be grateful that treatment has worked alongside the isolation experienced during infertility. This potentially combines to cause an inability to ask for help or support at this crucial stage.

It is reassuring, however, to note that despite this level of anxiety attachment issues with pregnancy itself tend to occur only in the early stages with little difference postnatally between fertility treatment and those with natural conception. There is also little difference in terms of warmth and empathy between the two sets of parents. However, one area that is of note is the increase in a more controlling style of parenting after treatment. Again, as a charity, this finding is of little surprise to us as so much of the experience of those struggling to conceive is framed as a “loss of control” for the individual.

Three tips for health professionals, friends and family members supporting loved ones experiencing infertility

1. I would say that a background awareness of the emotional and physical toll of infertility is essential in framing the reality of the new parent before you. They have already been on a gruelling and complex journey and the inevitability is that some of this will impact the experience going forward.
2. Be aware of likely triggers and complexities such as the potential anxieties around asking for help or the mistrust of what a new mother’s body may be capable of. These all follow on from the experience of years of infertility and can lead to a much more anxious experience of new parenting.
3. Try not to assume what help looks like to the individual before you. Ask and then don’t be afraid to ask again. What does support mean to the individual specifically and who can be there to help? Again, it is key to remember that for this group asking for help may not come easily and therefore gentle exploratory questions may be needed to unlock some of the realities being faced.

Complimentary support for people experiencing infertility

There are some wonderful support structures out there from the Donor Conception Network, which provides support at all stages of donor assisted conception, to Saying Goodbye charity, which supports after baby loss no matter when that has occurred, and finally via Fertility Network UK. Amongst many other services, we support new parents during and after fertility treatment.

With support, care and understanding, our hope is that the experience of parenting for those following successful treatment can finally be a positive one.

Resources

1. Journal of nursing research meta analysis
2. Fertility Network UK Survey on the Impact of Fertility Problems (2016)
3. Knowledge, attitudes and practices relating to fertility among nurses working in primary health care, Karin Hammarberg

More perinatal mental health resources can be found in the MMHA Resource Hub. However, the MMHA recognises that literature on infertility and its impact on parental mental health is currently lacking in our Hub. We are working with Fertility Network UK, one of our newest members, to rectify this and continue to raise awareness of mental health before, during and after pregnancy, whatever the outcome.

If you know of any resources we should feature, please email amyt@maternalmentalhealthalliance.org.