When Building a Family Doesn’t Come Easily

In honor of the Mental Health Awareness Month and the recent National Infertility Awareness Week, we asked our experts to discuss a very specific topic: the emotional challenges people have when trying to get pregnant but not succeeding. Meet Katherine (Ellie) Williams, MD, psychiatrist, director of the Stanford Women’s Wellness Clinic and an expert in women’s emotional well-being. We’ve asked her to shed light on the challenges some people/couples have when struggling with trying to get pregnant. We also spoke with Neda Kharrazi, PsyD, psychologist, and Brent Monseur, MD, ScM, reproductive endocrinologist and infertility fellow with Stanford Medicine Children’s Health, for a deeper perspective on the unique challenges faced by LGBTQ+ individuals when building families.

What emotions do people commonly experience when building a family or pregnancy doesn’t come easily?

KW, BM: People who try to get pregnant and cannot often feel betrayed and let down by their own bodies. This is especially true for those who are extremely goal-oriented and who usually experience successful rewards for their efforts. They do everything they can to get pregnant, so when it doesn’t happen, it can bring feelings of hopelessness, frustration, or a sense of failure. Also, for individuals who spend much of their lives avoiding pregnancy, not being able to get pregnant when they want to is a very strange and bizarre feeling. LGBTQ+ individuals can feel a loss of control or even detachment in situations where they must use donor sperm/egg and/or a surrogate.

Do people who struggle with infertility experience depression or anxiety?

KW: Yes. People in this situation can become depressed and anxious. There was a very important study in the 1990s that compared depression scores between fertility patients and patients with other conditions, such as cancer or heart disease. The two groups scored the same. That shows how seriously people experience infertility. And it’s important to remember that partners can also experience depression and anxiety.

Who is particularly at risk for mental health issues during this time?

KW: When infertility is unexplained, it can be very difficult for some people. When a reason is found and there is a possible solution, it’s easier than not knowing why. I also notice that when people have a history of mental health issues, such as anxiety or depression, the symptoms can recur or become much worse during the struggle of trying to get pregnant without expected success.

What’s the best way to support a friend or family member who is struggling with building a family?

KW: Hold the emotional space for them to express their feelings without judgment or advice. They are getting plenty of advice from other people and doctors, so advice from friends and family is not often appreciated. Also, resist using friendly phrases such as, “Relax, it will happen.” These can unintentionally put the blame on the person/couple trying to conceive or adopt. I often tell my patients that stress, depression, and anxiety are never the reason for not getting pregnant.

How do the emotions of people who are trying on their own versus those going through infertility treatments differ?

KW: When women are undergoing infertility treatments, they suddenly have many appointments, often for procedures. This busy new schedule can pose a challenge to balancing work and other commitments. Infertility treatments often involve hormonal treatments, which may themselves be associated with time-limited symptoms such as irritability and moodiness.

What positive shifts around infertility have you noticed through the years?

KW: For one, I don’t see women experiencing as much self-blame as I did 20 years ago. In the 1980s, a Stanford researcher studied how women talked to themselves. She discovered that it was often very self-blaming. That’s shifting. I do not hear young women today saying, “I should have known this would happen” or “If only I had done (or not done) something.” I think today women are more empowered. They feel like they have a voice. That’s wonderful to see. Another positive change is that we are seeing more resources for people trying to conceive or facing infertility. Also, employers are more supportive today when it comes to infertility treatments.

What resources would you recommend for those who are going through the journey of building their family and are seeking support?

KW: Stanford Medicine Children’s Health is expanding the mental health resources for people who need support all along their journey of building a family. For example, the Fertility and Reproductive Health care team now has a dedicated mental health provider, as does our obstetric clinic. Also, in our Stanford Women’s Wellness Clinic, besides offering individual and group support, we are offering mindfulness and relaxation classes for women trying to conceive. Finally, a great nonprofit organization that’s helping people cope with the challenges of building a family is Resolve—the National Infertility Association. It provides information on infertility, gives infertility options, and names financial resources for family building, along with in-person emotional support via a helpline and peer counselors who have experienced similar challenges.

Are there resources specifically tailored to LGBTQ+ couples that can be accessed if more emotional or mental support is needed while trying to grow a family?

NK, BM: LGBTQ+ people can experience anxiety, sadness, frustration, and depression when facing challenges as they try to build a family, and they also commonly experience stress and decision fatigue. Since every journey is unique, setbacks can leave couples feeling a loss of control. It’s best to find a supportive therapist and LGBTQ-affirming providers who can offer support through this personal and emotionally complex journey. As part of Stanford Medicine’s THRIVE (therapeutic, healing, resilience, inclusivity, values, empowerment) clinic, Dr. Kharrazi has started an LGBTQ+ Trying to Conceive Group, where couples meet other folks on the family-building journey, receive support, and learn basic mental health self-care skills. For more information, call (650) 498-9111.