The Silent Struggle: One in Six and the Need for Reproductive Mental Health Training

If you didn’t know already, infertility affects one in every six couples globally at some point in their lives, according to the Centers for Disease Control and Prevention (2024). Infertility is described as the failure to achieve pregnancy after 12 months or more of unprotected sexual intercourse, while affecting both men, women, and couples. The minimal research that is currently out there predominantly focuses on the person, traditionally female, who is doing the child-rearing as the amount of stress, mental strain, depression, anxiety, grief and loss is known to affect the individual doing the child rearing as well as the partnership as well. The call to providers and mental health professionals getting more training in this area is essential as there are not many providers that specialize in fertility and reproductive concerns – which I will highlight after I share a little more about my personal story with infertility.

My interest in this topic is a professional and personal one as I have personally struggled with infertility prior to seeking Artificial Reproductive Technology (ART) via In-Vitro Fertilization (IVF). My journey started in 2021 where my partner and I decided that we wanted to begin family planning. After a year of trying to conceive (TTC), MANY negative tests, blood work and labs, and multiple failed attempts at trying to get pregnant on her own, we had to resort to higher level, fertility treatment options, In-Vitro Fertilization (IVF).

Dr. Ashley Waddington, PhD, LPC, LPCS

Everyone’s journey with facility treatments are very different and require a combination of evaluation, diagnosis, and then recommendations for treatment options. During the evaluation phase, there are male factor, evaluations, and screenings, female, factor, evaluations, and screenings, as well as diagnostic tests to identify what is the proper diagnosis and course of treatment. In some cases, it is not strictly male factor or female factor in fertility however, some cases it can be known as unknown or unexplained in fertility. In mine and my partner‘s case, we had unexplained infertility after undergoing a number of diagnostic tests that did not point to any particular issues with either of us leaving us with a lot of uncertainty.

When it comes to the diagnosis portion of fertility treatments, there’s a range of issues that could be occurring such as poor motility within sperm, menstrual abnormalities, thyroid abnormalities, additional bloodwork testing and follow up, as well as different procedures to correct any anatomical issues that could be causing supporting an embryo issues. This process can take weeks, to months, to years to identify the issue and stall the process of family planning, which is so exhausting for individuals and couples to go through as it can feel like a checklist leading to answers or another thing to try as a next step.

And finally, once the diagnosis is decided, individuals and couples may have to move to intrauterine insemination (IUI) or in vitro fertilization (IVF). Sometimes the treatment options can involve IUI or donor insemination, Intra Cytoplasmic Sperm Injection (ICSI), ovarian simulation with oral medication or injections, diagnostic laparoscopy, or a combination of all of these things in hopes it will lead to a successful embryo creation or transfer.

When I think back to our personal journey, my partner and I had a combination of months of timed intercourse (not sexy AT ALL - lol) in hopes that if we had intercourse at the ‘right time’ it would lead to a child, medicated cycles where we took a number of injections to stimulate the ovaries to drop more eggs than normal in hopes they could be found by the sperm, one cycle of IUI, and prepped for IVF with an egg retrieval – the literal worst part of the entire process in my opinion (where we had to stimulate my ovaries EVEN MORE to drop as many eggs as possible from my follicles and then retrieve them all and inject them with fresh sperm to freeze and see which eggs mature and turn into a viable embryo), and finally moving onto a frozen embryo transfer (FET). The entire process of treatments started in December 2022 and spanned through our first FET in February of 2024. The continuous letdown chips away at the Hope each month and the negative test invite the elongated grief process to continue as my partner and I tried to keep our eyes on the goal of being parents eventually someday.

It sounds wild to even say that we feel privileged that we were able to have a child on our first IVF- FET that resulted in our daughter being born in October 2024. After all the tears, grief and loss, dread, jealousy and resentment, excitement, cautious hope, frustration, and inadequacy it truly brought my partner and I closer together and we can totally see how it can drive a couple completely apart. Knowing we have viable embryos frozen for when we are ready to expand our family is relieving and also terrifying as the changes my body has gone through in trying to make, sustain, and birth a child is WILD. Mom’s and women’s bodies truly are amazing and one of a kind.

If this seems like an area of focus that you would like to get into, please look into additional continuing education credits through Postpartum Support International South Carolina (PSI SC) to get certified or trained in support this area or American Society for Reproductive Medicine (ASRM) mental health specialized trainings in reproductive psychology. Both offer live, in-person CEUs as well as self-paced webinars leading to advanced training and certificates.

Those going through the process personally, I see you and send hugs. Those supporting people they know or clients going through the process, I also see you, send hugs, and wish there were more of you. Fertility invites discussion with mental health providers on grief, loss, hope, grace, endurance, encouragement and continued research in how to best support individuals and their families through the process.

Ashley F. Waddington is a graduate from the Counselor Education and Supervision PhD program at the University of South Carolina. She is a Licensed Professional Counselor and Licensed Professional Counselor Supervisor in SC and currently owns a private practice, Ashley Waddington Therapy and Consulting, LLC. Ashley also provides supervision services and is an Adjunct Instructor at the University of South Carolina and Bellevue University. Her research interests include anti-racist pedagogies, fertility issues, and assessment and diagnosis skill development in new counselors.