Why is the IVF process so hard psychologically? Read about anxiety in infertility, the waiting period, couple relationships and coping with a negative result.
Wanting a child and finding that it does not happen as expected can be one of the quietest yet deepest pains a person goes through. Months, sometimes years, of trying, tests, hospital appointments, injections and days of waiting... Hope on one side, fear of disappointment on the other. Besides being a medical treatment, the IVF process is an intense emotional journey, and it can affect both the individual and the couple's relationship deeply. In this article I will look at the psychological side of infertility and IVF treatment, the feelings that commonly arise along the way, and ways that may help you protect yourself. I would like to say at the outset that for every decision about the medical side of treatment, you must consult the doctor who is managing your treatment.
The Psychological Dimension of Infertility and the IVF Process
Infertility refers to a situation in which pregnancy does not occur despite regular attempts. The diagnosis, its causes and the treatment options require a purely medical assessment. However, the emotional impact of this diagnosis is at least as important as its medical side.
For many people, having a child lies at the centre of their adult identity, their dream of a family and their plans for the future. Learning that something stands in the way of that dream can bring shock, denial, anger, sadness and a sense of loss. IVF treatment often intensifies these feelings, because the process is demanding both physically and mentally: frequent hospital visits, hormone treatments, procedures and uncertain days spent waiting for results.
Research shows that anxiety and depressive symptoms can be common in people experiencing infertility. This means that the difficulty you are going through is not exaggerated, and that you are not being "too emotional"; on the contrary, it is a perfectly understandable reaction.
What Feelings Are Common During the IVF Process?
Every couple and every individual has a different experience; however, the following feelings are frequently encountered during this process:
- Anxiety and uncertainty: Thoughts such as "Will it work? What will we do if it doesn't happen again?" constantly occupying the mind.
- A cycle of hope and disappointment: Hope rising with each attempt, followed by a deep crash when the result is negative.
- Guilt: Self-blaming thoughts such as "It's because of me", "We should have started earlier" or "It didn't work because I was stressed".
- Jealousy and anger: Feeling jealous in the face of pregnancy announcements, baby photos or questions from the people around you, and then feeling ashamed of that feeling.
- Loss of control: Feeling that your body, your calendar and your future are outside your control.
- Loneliness: Not being able to share the process with anyone, or feeling misunderstood when you do.
- Worthlessness and questioning of identity: Beliefs about womanhood, manhood or "being a complete family" being shaken.
- Grief: Feelings of mourning for the loss of the imagined pregnancy, the baby and the dream of parenthood.
None of these feelings is wrong. All of them show that something you care about deeply is hanging in uncertainty.
Which Stages of Treatment Are More Difficult?
Diagnosis and decision-making
Learning the diagnosis of infertility and deciding to start IVF treatment require an adjustment process in their own right. During this period, couples have to weigh up their financial circumstances, timing and the burden that treatment will bring together.
The treatment period
Hormone treatments, frequent check-ups and procedures can bring emotional ups and downs alongside physical tiredness. Trying to balance work with the treatment schedule, and having to explain at work why you take time off so often, are additional sources of stress.
The waiting period
The days between the embryo transfer and the pregnancy test are the period that many people describe as the hardest part of the process. During these days it is quite common to read every physical sensation as a sign, to spend hours searching online and to have trouble sleeping.
A negative result and afterwards
A negative result can be an experience of intense loss and grief. Some couples want to plan a new attempt straight away, while others need a break. Both reactions are understandable. When a pregnancy does occur and is followed by a loss, that experience brings a different process of grief; I have covered this subject in my article on grief after pregnancy loss.
After a positive result
Even when pregnancy occurs, anxiety may not go away immediately. After a long and difficult process, the fear of "What if I lose it?" is common in a pregnancy that has been achieved. This anxiety is also understandable and worth talking about.
The IVF Process in Turkey: Social Pressure and Privacy
In Turkey, having children is experienced as a strong social expectation. Being asked "When is the baby coming?" from the first months of marriage is usual for many couples. The fact that family and population issues have featured more often on the public agenda in recent years may also have made these questions more visible. For couples experiencing infertility, these questions can feel like a wound that is reopened every time.
Pressure from the extended family: Comments, advice and sometimes accusatory insinuations from older relatives can add to the couple's burden. Women in particular, whatever the source of the problem, may face more questioning and stigma.
Men's invisible grief: Men may suppress their feelings during this process with the thought "I must be strong". When the infertility is male-factor, shame and guilt can be even more intense and even harder to talk about.
The privacy dilemma: Many couples prefer to keep IVF treatment secret from family and friends. This choice can sometimes be protective; however, it can also make it harder to get support and increase loneliness.
Financial burden: In a period when the cost of living is felt keenly, treatment costs, medication and frequent hospital visits can create financial pressure. The conditions under social security coverage and the costs of private centres can directly affect couples' decisions and stress levels.
Treatment in another city: Some couples have to travel to another city for treatment. This brings extra burdens such as travel, accommodation and time off work.
Imagine a couple in their thirties visiting relatives during a religious holiday after their second IVF attempt has ended with a negative result. One of the relatives says, "You two should have a child by now." The woman smiles and changes the subject, but on the way home in the car she begins to cry; her husband does not know what to say and stays silent. This moment shows that the process is not only medical but also a relational and social burden.
Ways to Protect Your Mental Health During IVF Treatment
1. Allow your feelings
Sadness, jealousy, anger and hope can follow one another within the same day. Noticing and naming these feelings, rather than suppressing them, can reduce their intensity. Keeping a journal can also help you regulate your emotions.
2. Question guilty thoughts
Thoughts such as "It didn't work because I was stressed" are extremely common and place a heavy burden on a person. Asking your doctor your questions about the medical factors that affect treatment outcomes can help you ground such thoughts in reality.
3. Make a plan for the waiting period
Making small plans in advance for the waiting days after the transfer can help: short walks, watching a series you like, quiet get-togethers or light activities that will distract you. Limiting online searches for symptoms can stop anxiety from growing.
4. Be prepared for questions
Preparing a short, clear answer to the question "When is the baby coming?" protects you: "This is our private matter; we'll share it when the time comes." You do not have to give anyone a detailed explanation.
5. Manage social media
Pregnancy and baby posts can be difficult during this period. Muting some accounts for a while or cutting down on social media use is a perfectly legitimate form of self-protection. I have looked in more detail at the effects of comparing your life with other people's curated moments in my article on comparison on social media.
6. Protect your bond with your partner
During IVF treatment, couples may show different ways of coping: one may want to talk while the other prefers to stay silent. This difference may not be indifference, but different ways of regulating emotions. Planning time once a week, away from treatment, when you can talk and enjoy yourselves together, protects your relationship.
7. Do not tie your whole life to the treatment
The treatment process can be long. During this time, try not to put the other areas of your life completely on hold: your work, your friendships, your hobbies and your moments for yourself. These areas are resources you can hold on to in difficult times.
8. Set your limits
It is important to make decisions such as how many attempts you will make, when you will take a break or when you will consider other options in the light of medical information and together with your doctor, but also with your own emotional capacity in mind.
9. Approach your body with compassion
During treatment, the body can become an object that is constantly measured, monitored and assessed. Many people say that at this time they feel hurt or angry with their body and think, "It let me down." These feelings are understandable; however, remembering that your body is currently carrying a demanding treatment can help you develop a more compassionate attitude towards it. Gentle movement within the limits your doctor recommends, enough rest and small self-care rituals that soothe you can be ways of making peace with your body again at this time.
Hoping, getting tired and taking a break are all legitimate parts of this journey.
When Should You Seek Professional Support?
Emotional strain is to be expected throughout treatment. However, it can be useful to seek support from a mental health professional in the following situations:
- If anxiety, hopelessness or a low mood has continued for weeks
- If your sleep, appetite and daily functioning have noticeably deteriorated
- If you are struggling to recover after a negative result
- If you are in constant conflict as a couple or feel you are drifting apart
- If you have withdrawn completely from your social relationships
- If you feel stuck over the decision to continue with or pause treatment
- If thoughts of harming yourself or ending your life cross your mind
Thoughts of harming yourself are an emergency; without delay, call 112 (Turkey's emergency services) or go to the nearest emergency department. In cases of severe depressive symptoms, an assessment by a psychiatrist may also be important; for any medication or medical question related to the treatment process, you should talk to the doctor managing your treatment.
How Is the IVF Process Approached in Therapy?
Psychological support does not replace medical treatment; however, it can help you walk this journey feeling less alone and more balanced. The topics frequently worked on in therapy are as follows:
- Normalising feelings and acknowledging grief: Expressing feelings such as disappointment, loss and anger without judgement.
- Anxiety management: Within the framework of cognitive behavioural therapy, noticing and balancing thought patterns such as catastrophising, self-blame and fortune-telling; creating concrete coping plans for the waiting period.
- Relaxation and mindfulness techniques: Breathing exercises and skills for bringing attention to the present moment.
- Values and identity: Work on how a person defines themselves beyond the dream of parenthood and on the other areas that give their life meaning.
- Couple communication: Understanding different ways of coping, being able to talk without blaming each other, and making shared decisions.
- Setting boundaries: Building healthy boundaries in the face of questions and pressure from family and friends.
When a couple needs support together, the couples therapy process can help strengthen the relationship during this difficult period. For couples going through a busy time because of their treatment schedule, or receiving treatment in another city, sessions can also be held online.
Frequently Asked Questions
Does stress affect the outcome of IVF treatment?
This question leads many people to blame themselves. It is healthier to ask the doctor managing your treatment your questions about the relationship between stress and treatment outcomes. Psychological support is important not to guarantee a result, but so that you can bear the process better and protect your quality of life.
Should I share my IVF treatment with the people around me?
There is no single right answer. Some couples prefer to share it only with a few people they trust; this both protects privacy and ensures support. It is important that you and your partner decide together whom you will share it with, and how much.
How long should I wait after a negative result?
The medically appropriate timing for a new attempt is determined by your doctor. Emotionally, it is important to give yourself time to grieve and recover. Starting a new attempt without feeling ready can increase the emotional burden.
Are men psychologically affected by the IVF process?
Yes. Men can also experience anxiety, guilt, helplessness and grief; however, they may find it harder to express these feelings. Making room for the feelings of both partners makes it easier for the couple to carry the process together.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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