At some point in their lives, millions of Americans in the US will be affected by infertility. The pain of not having a child when you so desperately want one can be heartbreaking, which is why assisted reproductive technology (ART) procedures are so highly lauded. In vitro fertilization (IVF) is one of the most well-known ART procedures and has helped countless couples and individuals begin a biological family. However, despite the gains, the process is not without high cost. Specifically, the emotional toll the process takes on a woman can be overwhelming.
The emotional rollercoaster of IVF
Let’s discuss the various ways IVF takes a toll on a woman’s emotional health.
Hormonal Fluctuations
“I feel like I’m happy one minute and then bawling my eyes out for no reason the next. It’s crazy-making, I don’t know what’s going on!” Happy then sad…chilling then rage. These are everyday experiences during the IVF hormone treatment. Changes in emotional state can come on suddenly and may be more extreme than what you’re used to. Their difficult-to-control nature can amplify daily stressors and make life feel more overwhelming.
Stress and Anxiety
“We can’t afford to do another round… I don’t know what I’ll do if this doesn’t work. I just feel so stressed out and can’t think about anything else.” The process of IVF can create a stressful and anxious environment for a woman, from an uncertain outcome to financial stressors; there is so much to worry about when undergoing IVF:
- Uncertainty of Outcome: Despite medical advancements, the success of IVF isn’t guaranteed. Uncertainty about “will it work or won’t” can cause significant anxiety. Anxiety symptoms can build on each other, creating a vortex of worry.
- Financial Stress: The high costs associated with IVF can exacerbate other mood and anxiety symptoms. Unsurprisingly, higher financial worries correlate with higher psychological distress.
- Information Overload: The first treatment cycle can be one of the most stressful times for patients; the numerous stages of treatment, medical information to learn, new providers, and unfamiliar medications can be overwhelming!
- Conflicting Values: What if your values or beliefs (like religion) don’t mesh with IVF (or other infertility treatments)? The process of reconciling your values and IVF can increase stress, anxiety, and mood symptoms.
- Decision Fatigue: During the IVF process, couples are faced with a myriad of decisions – what protocol to use, paperwork to sign off on, how many eggs to take, which embryo(s) to transfer… Even though these decisions are made in conjunction with medical professionals, the mental fatigue of the decision-making process remains. Couples can also increase their psychological burden by placing pressure on themselves to make the “right” decision, even though there may not be a right answer.
Depression and Mood
“This whole thing has been too much. I just feel like I can’t do anything anymore – all I want to do is stay in bed and just not think or feel anything.” There are several ways the IVF process can cause depression and mood swings, especially if there have been repeated failed embryo transfers.
Repeated IVF failures can lead to feelings of hopelessness and depression. The toll of repeatedly hoping, anticipating, and being snatched away can cause anyone to despair. Research has shown that unsuccessful treatment raises women’s level of emotional impact, which continues after each successive unsuccessful cycle. Many women undergoing IVF also report feeling alone and find it challenging to get adequate support. The ups and downs can leave women feeling disheartened, causing difficulties in their current social support. It may also feel difficult for women to feel truly supported by friends and family who don’t fully understand the experience.
Unsuccessful cycles are more than failed medical treatments – they can feel like the death of a dream. For many women (and their partners), the grief from remaining childless can be unresolved or prolonged, having a huge emotional impact. Negative self-talk is an internal dialogue that reinforces negative beliefs and fears. With infertility, negative self-talk is common, with many people believing they are broken or defective. These thoughts can then trigger feelings of guilt, sadness, anger, or frustration.
The power of the mind-body connection
The connection between our mind and our bodies has been well documented; thoughts impact our bodies by initiating the release of neurotransmitters, and physical sensations can influence our mental state.
Physical Discomfort
“My abdomen is swollen and sore, and I’m so uncomfortable. As if the emotional pain wasn’t enough, I can’t even bend down and feel like I’m just waddling around.” There is a tremendous amount of physical pain and discomfort for a woman undergoing IVF. It’s not just a one-time embryo transfer into the uterus; there’s a lead-up of daily hormone injections, hormonal symptoms, and one painful egg retrieval.
- Hormonal Injections: Daily injections can cause physical discomfort, bruising, and fatigue, which just adds to the emotional distress. For women who have any medical anxieties (like fear of needles), this process can be even more tolling.
- Egg Retrieval: The egg retrieval process requires a thin needle and ultrasound and is a painful and unnerving process. For many women, anxiety can arise around the medical procedure or recovery process.
- Bloating and Weight Gain: The necessary hormone treatments often lead to bloating and weight gain, which can affect an individual’s energy levels, body image, or self-esteem. It can also impact and force you to change your coping strategies. For instance, if exercise is a coping strategy, these symptoms may make it challenging to engage with and then can exacerbate mood or anxiety symptoms.
Body Image
“As a nonbinary AFAB, I’m really worried about (permanent) breast growth from these hormones. I’m also petite, and I’m worried about gaining weight and just not looking like myself.” On top of the other millions of things someone undergoing IVF has to worry about, they may also have feelings of poor body image due to the side effects of the hormones.
Weight gain and bloating can change a person’s appearance and, in turn, how they view or feel about themselves. In an experience that already feels out of your control, losing control of your appearance can do a number on your self-esteem and emotional state. For anyone who has struggled or is struggling with body image or eating concerns, the physical changes during the IVF process can dredge up old fears and maladaptive behaviors. Relapse is a real concern for individuals who have a history of eating disorders.
Relationship challenges
The IVF process does more than just affect the emotional and physical body; it also impacts your relationship–whether good or bad, there is going to be some sort of impact.
Strain on Marriage
“I feel like all the IVF posts on social media are these happy couples going through IVF, but my marriage feels like it’s holding on by a thread through this wild rollercoaster.” IVF can cause strain on a couple’s marriage because of the emotional and physical toll the process takes on one or both partners.
- Communication Struggles: With each partner bearing the logistical, emotional, and physical burden of the IVF process, it’s easy for communication between partners to take a hit. Less time to speak with one another, not wanting to burden the other, misunderstandings, and outright conflicts can break down the emotional connection between partners.
- Intimacy Impacts: The pressure surrounding infertility and conception can turn intimacy into a chore or job. The pressure can make intimacy unenjoyable or make it difficult to engage, especially if their anxiety levels are high. That lack of physical connection can then impact the emotional connection between partners, exacerbating all the other impacts.
- Coping Styles: We each cope in different ways. During the IVF process, couples may find they approach the stress in different ways – sometimes in ways that are at odds with one another. One partner finds support by talking it out, while the other person may need alone time to process. Unhealthy coping strategies like self-medication (increased alcohol or substance use) can occur and, in the long run, cause more harm than good.
Impact on other relationships
“I feel like everyone around me is getting pregnant. I’m happy for them, but it feels so unfair. And I know they mean well, but all the questions about our status and what’s next make me feel even more anxious because I feel like I’m jinxing it. Why can’t it just be easier?” Whether it’s your BFF, cousin, Mom, or neighbor, someone is always curious or giving their two cents on your journey, which can be especially difficult.
- Strained Friendships: Friendships may be tested. No matter the good intentions, it may be difficult for a friend to truly understand the process (unless they have gone through it themselves). Friends may also, inadvertently, say things that are hurtful—never intentionally! But with the strain of the IVF process, the crazy hormone levels, and the fear of whether this will work or not… comments that would not be taken to heart can truly wound a person at this time.
- Family Expectations: Family members, with all their love, can add to the stress and pressure by adding their own hopes and opinions. Without meaning to, their desires can add pressure and intensify feelings of fear, guilt, and frustration. Comments such as, “It’ll happen when it happens,” or “Don’t worry, this won’t fail!” to “Don’t get your hopes up” or a statistic repeated to you, just don’t help, no matter how good the intention. For some, family members may place unrealistic goals (“I can’t wait to be a grandparent!”) and responsibility on the individual and couple.
- Stigma and Judgment: Whether it’s due to love, comfort, or poor social insight… people feel entitled to their opinions and to share them even when it can hurt others. For many people going through infertility and the IVF process, this can be a common occurrence – stigma and judgment can cause self-isolation and increase anxiety and depression symptoms.
What can help the emotional toll IVF takes on a woman?
While there’s no magic pill or wand that can make the pain go away, there are some things that may help ease the pain a bit and provide someone with the strength to keep going.
- Counseling: Support from a therapist who specializes in fertility issues can provide a safe space to express feelings and develop coping strategies.
- Support Groups: Not only is support key to making it through this journey, but it’s also about finding the right support during this time. Organizations like Resolve, Infertility Unfiltered, and the Fertility Forum offer resources and support groups to help build connections with others going through the process.
- Protect Yourself: Limit exposure to stressors, such as social media or conversations that may trigger anxiety. With so much on your plate, give yourself grace during this time to really focus on yourself. Maybe you have a friend who recently gave birth, and you have to be honest that you love them and their new baby, but with your own journey, it’s difficult to see them right now. It’s not easy, but prioritizing yourself (and asking for help in doing so) can really protect your mental health!
- Ask For Help: Let friends and family know how they can best support you. This includes what you need more or less of during this time, which can help reduce the pressure of social obligations. Resolve has a whole page for family and friends, and how they can help! RESOLVE provides advice on talking to family and friends here.
Don’t worry; the emotional toll is not likely to affect the odds of pregnancy
Worry Is Natural. All this talk about the emotional toll may cause… well, more emotional toll. But let me be clear – worry, depression, and heightened tension are normal in this process and unlikely to further reduce a woman’s chances of pregnancy.
A special note acknowledging our partners through IVF
We don’t want to forget our partners–the men, women, and non-binary individuals. While their experiences are different, it doesn’t mean they don’t experience an emotional toll as well. Their experience is valid and important to recognize and support; both partners’ mental health is paramount throughout the process.
Conclusion on the emotional toll of IVF
The emotional toll of IVF on the individual undergoing the treatment is undeniable. It’s real, profound, and multifaceted, affecting your psychological, emotional, financial, and relational well-being. For many individuals, these challenges are significant but manageable.
However, for some, when combined with other life stressors or mental health histories, the emotional strain can become a barrier too difficult to overcome. Regardless of where you are in the process, education and preparation can only help at any stage of the IVF process. Surround yourself with support and find a community that can help guide you through this journey. Remember, you’re not alone, and seeking help is a strength!
Dr. Vivian Oberling is a licensed clinical psychologist with degrees from UCLA, Harvard, and Stanford. In her private telehealth practice, she works with adults navigating anxiety, identity shifts, and relationship dynamics—whether they’re dating, partnered, or parenting. She also provides executive coaching and behavioral health advisory support to tech startups and legal tools reshaping how we think about love, marriage, and psychological safety. Dr. Oberling combines 10+ years of clinical expertise with modern, real-world insight to help people move through uncertainty with clarity and connection.
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