Identifying Mental Health Issues Associated With Infertility

Published:November 03, 2022DOI:


      • Infertility crosses all races, ethnic groups, and educational levels.
      • Evidence supports that those experiencing infertility use assisted reproductive technology and experience a greater incidence of depression, anxiety, and stress.
      • The most prevalent psychiatric disorders seen in those experiencing infertility include anxiety disorder (23.2%), major depressive disorder (17%), and dysthymia (9.8%).
      • Validated psychiatric screening tools, including 3 specifically developed for use with infertility patients, may be useful for identifying mental health issues associated with infertility.


      Infertility is a significant health issue currently affecting up to 10% of the reproductive population in the United States. Current evidence indicates higher levels of depression, anxiety, and stress among individuals who are experiencing infertility, and those seeking assisted reproductive technologies often meet criteria for major psychiatric disorders, such as major depressive disorder, generalized anxiety disorder, and dysthymia. Financial stressors, rigorous testing, and treatment modalities, in the context of limited social support, can result in strained communication with providers and mental health symptoms being attributed to the circumstances. This report provides an overview of common mental health issues seen in those experiencing infertility and describes screening tools for clinical use in identifying psychiatric disorders.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal for Nurse Practitioners
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Greil A.L.
        • Slauson-Blevins K.S.
        • Tiermeyer S.
        • McQuillan J.
        • Shreffler K.M.
        A new way to estimate the potential unmet need for infertility services among women in the United States.
        J Womens Health. 2016; 25: 133-138
        • Gurunath S.
        • Pandian Z.
        • Anderson R.A.
        • Bhattacharya S.
        Defining infertility: a systematic review of prevalence studies.
        Hum Reprod. 2011; 17: 575-588
        • Mascarehas M.N.
        • Flaxman S.R.
        • Beorma T.
        • Vanderoel S.
        • Stevens G.A.
        National, regional and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys.
        PLoS Med. 2012; 9: 1-12
        • Centers for Disease Control and Prevention
        National Center for Health Statistics. Infertility.
        (Updated December 2)
        Date: 2019
        Date accessed: August 1, 2021
        • Lo W.
        • Campo-Engelstein L.
        Expanding the Clinical Definition of Infertility to Include Socially Infertile Individuals and Couples.
        in: Campo-Engelstein L. Burcher P. Reproductive Ethics II: New Ideas and Innovations. Springer, 2018: 71-83
        • Obeisat S.
        • Gharaibeh M.K.
        • Owels A.
        • Gharaibeh H.
        Adversities of being infertile: the experience of Jordanian women.
        Fertil Steril. 2012; 98: 444-449
        • Dancet E.A.
        • Van Empel I.W.
        • Rober P.
        • Kremer J.A.
        • D’Hooghe T.M.
        Patient-centered infertility care: a qualitative study to listen to the patient’s voice.
        Hum Reprod. 2011; 26: 827-833
        • Gameiro S.
        • Boivin J.
        • Domar A.
        Optimal in vitro fertilization in 2020 should reduce treatment burden and enhance care delivery for patients and staff.
        Fertil Steril. 2013; 100: 302-309
        • Grill E.
        Role of the mental health professional in education and support of the medical staff.
        Fertil Steril. 2015; 104: 271-276
        • Clark R.A.
        • Richard-Davis G.
        • Hayes J.
        • Murphy M.
        • Theall K.P.
        Planning Parenthood: Strategies for Success in Fertility Assistance, Adoption, and Surrogacy.
        The Johns Hopkins University Press, 2009
        • Missmer S.A.
        • Seifer D.B.
        • Jain T.
        Cultural factors contributing to health care disparities among patients with infertility in Midwestern United States.
        Fertil Steril. 2011; 95: 1943-1949
        • Quinn M.
        • Fujimoto V.
        Racial and ethnic disparities in assisted reproductive technology access and outcomes.
        Fertil Steril. 2016; 105: 1119-1123
        • Gamerio S.
        • Boivin J.
        • Peronace L.
        • Verhaak C.M.
        Why do patients discontinue fertility treatment? A systematic review of reasons and predictors of discontinuation of fertility treatment.
        Hum Reprod Update. 2012; 18: 652-669
        • Domar A.
        Creating a collaborative model of mental health counseling for the future.
        Fertil Steril. 2015; 104: 277-280
        • Rooney K.L.
        • Domar A.
        The relationship between stress and infertility.
        Dialogues Clin Neurosci. 2018; 20: 41-47
        • Domar A.D.
        • Prince L.B.
        Impact of psychosocial interventions on IVF outcomes.
        Sex Reprod Menopause. 2011; 9: 26-32
        • Holley S.R.
        • Pasch L.A.
        • Bliel M.E.
        • Gregorich S.
        • Katz P.
        • Adler N.
        Prevalence and predictors of major depressive disorder for fertility treatment patients and their partners.
        Fertil Steril. 2015; 103: 1332-1339
        • Pasch L.A.
        • Holley S.R.
        • Bliel M.E.
        • Shehab D.
        • Katz P.P.
        • Adler N.E.
        Addressing the needs of fertility treatment patients and their partners: are they informed and do they receive mental health services?.
        Fertil Steril. 2016; 106: 209-215
        • Vo T.M.
        • Quynh T.T.
        • Le C.V.
        • Do T.T.
        • Le T.M.
        Depression and associated factors among infertile women at Tu Du hospital, Vietnam: a cross-sectional study.
        Int J Womens Health. 2019; 11: 343-351
        • Crawford N.M.
        • Hoff H.S.
        • Mersereau J.E.
        Infertile women who screen positive for depression are less likely to initiate fertility treatments.
        Hum Reprod. 2017; 32: 582-587
        • Shani C.
        • Yelena S.
        • Ruet B.K.
        • Adrian S.
        • Sami H.
        Suicidal risk among infertile women undergoing in-vitro fertilization: incidence and risk factors.
        Psychiatry Res. 2016; 30: 53-59
        • De Beradis D.
        • Mazza M.
        • Marini S.
        • et al.
        Psychopathology, emotional aspects and psychological counselling in infertility: a review.
        Clin Ter. 2014; 165: 163-169
        • Cousins A.
        • Freizinger M.
        • Duffy M.E.
        • Gregas M.
        • Wolfe B.E.
        Self-report of eating disorder symptoms among women with and without infertility.
        J Obstet Gynecol Neonatal Nurs. 2015; 44: 380-388
        • Hoek H.W.
        • van Hoeken D.
        Review of the prevalence of incidence of eating disorders.
        Int J Eat Disord. 2003; 34: 2084-2091
        • Hudson J.I.
        • Hiripi E.
        • Pope H.G.
        • Kessler R.C.
        The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication.
        Biol Psychiatry. 2007; 61: 348-358
        • World Health Organization (WHO)
        International Classification of Diseases.
        WHO, 2018 (11th Revision (ICD 11))
        • Fernandez A.
        • Moreno-Peral P.
        • Zabaleta-del-Olmo E.
        • et al.
        Is there a case for mental health promotion in the primary care setting? A systematic review.
        Prev Med. 2015; 76: S5-S11
        • Mulvaney-Day N.
        • Marshall T.
        • Downey Piscopo K.
        • et al.
        Screening for behavioral health conditions in primary care settings: a systematic review of the literature.
        J Gen Intern Med. 2017; 33: 335-346
        • Beckmann C.
        • Ling F.W.
        • Herbert W.
        • et al.
        • American College of Obstetricians and Gynecologists (ACOG)
        Obstetrics and Gynecology.
        Wolters Kluwer Health/Lippincott Williams & Wilkins, 2014
        • Hoff H.S.
        • Crawford N.M.
        • Mersereau J.E.
        Screening for psychological conditions in infertile women: provider perspectives.
        J Womens Health. 2018; 27: 503-509
        • Ockhujjsen D.L.
        • Smeden M.
        • Den Hoogen A.
        • Boivin J.
        Validation study of the SCREENIVF: an instrument to screen women or men on risk for emotional maladjustment before the start of a fertility treatment.
        Fertil Steril. 2017; 107: 1370-1379
        • Boivin J.
        • Takefman J.
        • Braverman A.
        The fertility quality of life (FertiQoL) tool: development and general psychometric properties.
        Hum Reprod. 2011; 26: 2084-2091
        • Newton C.R.
        • Sherrard W.
        • Glavac I.
        The fertility problem inventory: measuring perceived infertility-related stress.
        Fertil Steril. 1999; 72: 54-62
        • Na P.J.
        • Yaramala-Jihoon R.
        • Kim A.
        • et al.
        The PHQ-9 item 9 based screening for suicide risk: a validation study of the Patient Health Questionnaire (PHQ)-9 item 9 with the Columbia Suicide Severity Rating Scale (C-SSRS).
        J Affect Disord. 2018; 232: 34-40
        • Duckett K.
        Home Healthc Now. 2015; 33: 56
        • Spitzer R.L.
        • Kroenke K.
        • Williams J.B.W.
        • Lowe B.
        A brief measure for assessing generalized anxiety disorder: the GAD-7.
        Arch Intern Med. 2006; 166: 1092-1097
        • Williams N.
        The GAD-7 questionnaire.
        Occup Med. 2014; 64: 224
        • Koenke K.
        • Spitzer R.L.
        • Williams J.B.W.
        • Lowe B.
        An ultra-brief screening scale for anxiety and depression: the PHQ-4.
        Psycosomatics. 2009; 50: 613-621
        • Posner K.
        • Brown G.K.
        • Stanley D.A.
        • et al.
        The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults.
        Am J Psychiatry. 2011; 168: 1266-1277
        • Dahlgren C.L.
        • Stedal K.
        • Ro O.
        Eating Disorder Examination Questionnaire (EDE-Q) and clinical impaired assessment (CIA): clinical norms and functional impairment in male and female adults with eating disorders.
        Nord J Psychiatry. 2017; 71: 582-587
        • Mond J.M.
        • Phillipa J.H.
        • Rodgers B.
        • Owen C.
        • Beaumont P.J.V.
        Validity of eating disorder examination questionnaire (EDE-Q) in screening for eating disorders in community samples.
        Behav Res Ther. 2004; 42: 551-567
        • McDowell S.
        • Murray A.
        Barriers to continuing in vitro fertilization: why do patients exit fertility treatment?.
        Aust N Z J Obstet Gynaecol. 2011; 51: 84-90
        • Clifton J.
        • Parent J.
        • Seehuus M.
        • Worrall G.
        • Forehand R.
        • Domar A.
        An internet-based mind/body intervention to mitigate distress in women experiencing infertility: a randomized pilot trial.
        PLoS One. 2020; 15e0229379
        • Aarts J.W.M.
        • van den Haak P.
        • Melen W.L.
        • Tuil W.S.
        • Faber M.J.
        • Kremer J.A.
        Patient-focused internet interventions in reproductive medicine: a scoping review.
        Hum Reprod. 2011; 18: 211-227
        • Grunberg P.H.
        • Dennis C.
        • Da Costa D.
        • Zelkowitz P.
        Patients experiencing infertility’ need and preferences for online peer support.
        Reprod Biomed Soc Online. 2018; 6: 80-88


      Michele Martens, DNP, PMHCNS-BC, is an Instructor at Vanderbilt University School of Nursing, Nashville, TN, and can be reached at [email protected] .


      Matt Schroer, DNP, PMHNP-BC, is an Assistant Professor at Vanderbilt University School of Nursing, Nashville, TN,. Ty Williams, DNP, is an Assistant Professor at Vanderbilt University School of Nursing, Nashville, TN.


      Betsy Kennedy, PhD, is a Professor at Vanderbilt University School of Nursing, Nashville, TN .