If pregnancy is unsuccessful after 6-12 months of trying, you may have infertility. Infertility is a common problem for many people. Statistics reveal that “about 9% of men and 11% of women of reproductive age in the United States have experienced fertility problems.”8 Infertility is traumatic; evoking a multitude of emotions including grief, anger, and shame.
Both women and men often find counseling helpful in navigating this new and uncertain landscape. Substantial progress can be made in about 9-12 sessions.1 Costs can vary depending on your insurance coverage and type of therapist you see.
What Is Infertility Counseling?
Infertility counseling is a form of psychotherapy used to help those struggling with infertility. Infertility can wreak havoc on your emotional, physical, mental, and financial state. Decisions made regarding infertility treatment have a major impact on how your future will be shaped.
Women tend to cope differently than men which creates relationship conflict.2 A major goal of infertility counseling is to help couples understand the differences in their reactions and the ways they cope with infertility. Counseling helps people to recognize these differences and communicate and support each other in more effective, compassionate ways.
Working with a therapist can be so important for individuals and couples as they struggle to understand all the ripple effects created by the crisis of infertility. The role of the therapist is providing “for individuals and couples to learn more efficient ways of addressing issues, make sense of them, reduce conflict and stress, and make wiser decisions regarding medical treatments.3
Challenges of Infertility
One of the more challenging consequences of infertility can be the necessary invasive, frequent, medical interventions. The intimacy of lovemaking can erode when it is carefully timed with the goal of creating a baby. Couples can disagree about whether to continue or stop treatment. These scenarios can create distance and stress between couples. Other relationships are jeopardized as well. Decisions need to be made about what to tell family and friends about your infertility and the resulting personal struggles.
Differences in opinions about this can create conflict. It can also be difficult to be around people who are pregnant and have children. They often don’t understand your reasons for not wanting to see them. Infertility counseling can help navigate these situations and offer insights about what you can do to manage them more effectively.
Research shows that half the women and 15% of the men said that infertility was the most upsetting experience of their lives.4 These types of major life traumas and the enormous losses associated with them can require longer term counseling to address ongoing issues of loss, grief, blame, and shame.
Timeline of Infertility Treatment
The timeline for infertility treatment can vary depending on the individual circumstances of the participants. It can be short term, however the length of treatment should be extended if a miscarriage or stillbirth occurs, or if information is revealed that it is not possible to achieve pregnancy and a live birth.
What Approaches Are Typically Used by Infertility Counselors?
For people battling infertility the psychological interventions and support can be as valuable as the indicated medical treatment. Martha Diamond, PhD, counsels infertility patients. She describes her treatment goals as helping her patients see “reproductive trauma is just one part of the story, and they can write the coming chapters.” She also encourages them to see that infertility is not their identity, but a medical condition.5 Cognitive Behavioral therapy is very effective in changing negative beliefs into positive ones, and is commonly used in infertility counseling.
Couples counseling is a common therapeutic technique used by infertility counselors. There is so much stress placed on couples when infertility occurs that tensions and conflicts can pull them apart. Lucille Keenan, PsyD, specializes in counseling couples with infertility. She observes “partners often respond differently to the stress and grief, which creates a negative cycle. One partner may avoid the pain by withdrawing from the relationship, while the other may cope by intensifying emotions to connect with their partner.”5 She helps couples to identify this cycle and appreciate each other’s feelings. This type of Emotion-based therapy is a key therapeutic technique in working with people with infertility.
When to See an Infertility Counselor
The American Society for Reproductive Medicine recommends you should seek counseling when “you are feeling depressed, anxious, or so preoccupied with your infertility that it is hard to live your life productively.”6 They go on to say if you are feeling “stuck” meaning uncertain about what the next step should be in terms of pursuing family building, counseling can be invaluable. The diagnosis of infertility and the ensuing treatment can bring on a heavy emotional and physical toll. Many react by isolating and withdrawing as the emotions like, shame, guilt, anger, and anxiety begin to emerge.
Couples can grow apart as a result of infertility. They see their dreams of building a family in jeopardy and are not equipped to cope with the ramifications. The AAMFT describes the resulting dynamics and relationship challenges for them because “they can feel more emotionally distant or needing to withdraw from intimacy. Feelings of guilt and self- blame may also arise, particularly if one of the partners is identified as being the primary cause of the infertility. Additionally the unfertile partner may fear the other person might leave the relationship.”3
Infertility treatment requires ongoing decisions as new information is received or the status of the patient changes. Results from ongoing testing must be absorbed and understood. All of these combined factors can create hurdles in terms of stable mental health.
Additional reasons to seek mental health counseling support include:
- Guidance deciding about moving to a new infertility treatment
- Decisions about ending infertility treatment
- Coming to terms with choosing to remain childless
- Help responding to unwanted or inappropriate comments regarding your infertility from family members or friends.
- Letting go of the idea that you will have a biological connection to your child and coming to a place of understanding and acceptance.
How Is Infertility Counseling Helpful for Couples?
Infertility counseling is an excellent way for couples to help understand and process their emotional reactions to having problems with reproduction. It can help them talk candidly about their feelings, learn coping mechanisms, and together make decisions about where and how they want to move forward. A counselor can help couples cope individually and as a couple with the emotional pain and grief that inevitably stem from an infertility diagnosis. Couples can emerge with relationships that are deeper and stronger than before.
Many people assume that when they are ready to begin a family it will go smoothly. Couples share future dreams about parenting and raising children together. There are societal expectations about having children when people marry. It is considered the norm. It is devastating for people when these dreams do not materialize or the path to making it happen is longer or different than they imagined. Embarking on infertility treatment can quickly overtake or alter the marital relationship in negative ways. The reasons you fell in love and got married can become distant memories. Counseling can help a couple refocus on their marital relationship and help make it a priority again.
Counselors can help process information and ensure an understanding of remaining options and what is involved in each step. There are many questions that arise for people that are new to infertility treatment. Decisions must be made on a regular basis regarding treatment goals. That is difficult to do for people that are unfamiliar with infertility. They may not know the questions to ask or understand what is involved or the consequences of their choices. Infertility counselors can guide people through this maze of uncertainty and unfamiliarity. Terms like IVF, surrogate, embryo, or home study adoption, can feel foreign. A counselor can make these terms more understandable and help the couple move forward.
Infertility Counseling Example
In the initial session of infertility counseling your therapist will inquire about your medical history relating to family building and how and where you acquired the diagnosis of infertility. Prior to the session the counselor will determine with you if you should be seen as an individual or a couple if you have a partner.
Dr. Connie Shapiro, PhD explains in her early session she asks each individual “their own unique take on their infertility, so I will be encouraging both of them to clarify for me the dimensions of this experience that are important to them.”1 This information helps the counselor understand how infertility is impacting each person and what their ways of coping are. An agreed upon treatment plan can evolve from this discussion.
A frequent area of concern for people experiencing infertility is the question of third-party conception. This can involve donor eggs, sperm, or embryos, when the patient’s eggs or sperm are not viable. It is also used with couples whose medical workups reveal genetic disorders. It means there won’t be a biological connection for one or both prospective parents. Individuals and couples can initially be reluctant to consider this as a treatment option.
Infertility counselors recognize “these reservations are related to the unusual family composition, the mixture of social and biological parenthood, the fear that bonding between the child and the social parent will be less secure, and the stigma associated with gamete donation with many countries in the world.”7
Counseling focuses on looking at other family building options. It entails coming to terms with the loss of that biological connection, and helping the patient and partner discuss feelings of loss while looking at the desired next family building step or the choice to end the dream to build a family.
How to Find an Infertility Counselor
If you are a patient at an infertility clinic ask if they have counselors on staff or can recommend an infertility counselor. Therapists specializing in infertility can be found through an online directory. Another option available is Internet Health Resources’ list of infertility counselors across the country. Finally, RESOLVE, the national infertility association, offers a website to help find infertility counseling professionals in your area.
Who Is Able to Offer Infertility Counseling?
There is not a special licensure associated with infertility counseling. It can be done by people with an assortment of credentials including MA, LCPC, MSW, PhD, PsyD, psychiatric nurses,(RN), or pastoral counselors. This also includes Psychiatrists who are medical doctors.
The most important thing to know is people who identify themselves as infertility counselors should have training in the medical and psychological aspects of infertility. Always ask a potential mental health professional about their training and experience, their expertise with your mental health issue, and their philosophy about how they do treatment.
Key Questions to Ask an Infertility Counselor
If you are in need of infertility counseling find out what training the counselor has had in relation to working with people who are experiencing infertility. You want to work with someone you feel comfortable with. Some women with infertility issues may prefer to work with a female mental health professional.
Here are some key questions to raise with your infertility counselor:
- What experience have you had working with someone with my infertility diagnosis and history?
- Will you see me individually or would you want to work with my partner?
- What would be your treatment goal in working with me?
- How often and how long would we be meeting?
- Will you need to have any contact with members of my infertility treatment team? If so what would that involve?
- Can I continue working with you if there are problems with my treatment or things that arise that create more stress or increase my mental health symptoms?
- What do you charge and do you take my insurance?
Cost of Infertility Counseling
Client costs for seeing an infertility counselor can be contingent on mental health insurance benefits. You need to consult your insurance provider to determine your mental health coverage. Costs for counseling vary depending on the licensure and credentials of the practitioner. Marriage and Family therapists, mental health practitioners with a Master’s Degree in Counseling fees, including Psychiatric Nurses, Licensed Clinical Professional Counselors, (LCPC), and Social workers charges, can range from $75 to approximately $150 an hour.
Psychologists may charge between $150 to $200 a session. Finally, psychiatrists fees can range between $250 to $300 per session. Some mental health practitioners are willing to negotiate their rates on a sliding scale fee based on what clients can pay. These fees can vary between practitioners and can also be impacted by the geographical location of the mental health professional. Fees can be higher in larger cities.
Additionally, some fertility clinics may recommend or require prospective parents undergo a psychological evaluation to help assess and prepare them for using donors or surrogates. This evaluation includes information on the nature of the procedures, discussions on disclosure, the loss of the biological connection, and how to cope with the potential failure of the procedures. They also address fears, concerns, and questions that prospective parents want to raise. The costs of an assessment like this can range from $350-$600 depending on how extensive and long the interview is and the required contents for the final written report.
A few fertility clinics may have staff members who offer psychological counseling and support. In a few instances the cost of an initial evaluation can be included in the fees for in vitro fertilization (IVF) costs. If you are going to a fertility clinic, inquire to see if this service is available to you.
Other Supports for Those Dealing With Infertility
Our society has come a long way in terms of people being more comfortable about discussing their infertility in a more open and candid way. There are many arenas you can turn to if you need additional support as you create your own path to parenthood. There are support groups available online and in person. Some are done through RESOLVE. Your infertility doctor or clinic may have information about support groups.
In addition to individual and couples counseling there are therapeutic groups to help people cope with infertility. Consult your infertility clinic. Local infertility counselors should also have information about therapeutic groups that meet in your area. They may be group leaders. Be sure and ask your fertility doctor about support groups meeting in your area. Some fertility clinics may have programming available.
You can also do your own personal networking. Consult friends you know who may have knowledge about people or places you can contact to give you information on local sources of infertility support. There are also websites, Twitter, and Facebook pages offering a wealth of information regarding infertility topics. You can chat with people on line and there is a rich assortment of articles and information on a variety of infertility related topics.
Additional Resources for Those Dealing With Infertility
Infertility is a common problem for many people. Statistics reveal that “about 9% of men and 11% of women of reproductive age in the United States have experienced fertility problems.”8
Because so many people are impacted there are abundant resources available. Here are some good places to begin if you need additional information and support:
- RESOLVE: A national support organization which sponsors many seminars and self-help groups. Local chapters are located in many areas. RESOLVE offers many useful publications, resources, and counseling information about the medical and psychological aspects of infertility.
- Adoptive Families of America: A national organization specializing in adoption issues. They offer resources, education, peer support, and resources.
- Single Mothers by Choice: Offering support and information to single women who are considering motherhood and to single mothers who have chosen this path to parenthood.
- Parents Via Egg Donation: An organization created to provide information to parents and parents-to-be and to share information about all facets of the egg donation process.
- International Council on Infertility Information Dissemination: They offer education, information, a chat room, and professional referrals on family building topics.
- Family Equality: They offer financial grants, education, resource, support, and advocacy information for members of LGBTQ communities who wish to build their families.
