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Psychological Distress in Infertility: Comparable to Serious Illness
Evidence-based · Patient-centered

Psychological distress in infertility: comparable to serious illness

Studies show that stress and depression in people facing infertility can reach levels similar to patients coping with cancer and other serious illnesses.

anxiety & depression comparable to cancer IVF emotional burden screening & support evidence-based care

1 What to know (for patients & clinics)

  • Distress is common — and valid. Multiple studies report depression and anxiety levels among infertile patients comparable to those with cancer, HIV, or heart disease.
  • Symptoms fluctuate across the cycle. Distress often peaks around testing and after failed cycles; screening should be repeated.
  • Distress affects care. Higher depression scores are linked to lower treatment initiation/continuation and poorer quality of life.
  • Screening works. Use brief tools (e.g., PHQ-9, GAD-7, SCREENIVF) and offer stepped care: psychoeducation → groups → CBT/IPT → psychiatry as needed.
Action: Build mental-health-as-standard: normalize feelings, provide peer/community support, integrate a counselor, and create clear referral pathways.
Because the fear that life will end can feel similar to the fear that life (of your future baby) will not begin at all.

2 Key findings from the literature

Finding Estimate Notes
Depression in infertile vs. fertile women ~2× higher Classic cohort; replicated in meta-analyses
Equivalence to other serious illness Comparable Levels similar to cancer/HIV/heart disease cohorts
Peak distress during IVF Testing & post-failure Prospective studies and reviews
Depression & care engagement Lower initiation/continuation Patients screening positive are less likely to start treatment
Effect of psychosocial care Improves mood; may reduce dropout Group & CBT-based interventions show benefit

Figures are synthesized from the cited studies and reviews; individual experiences vary. Screening and tailored support are essential.

SOURCES
  • Domar, A.D., Zuttermeister, P.C., & Friedman, R. (1993). The psychological impact of infertility: a comparison with patients with other medical conditions. J Psychosom Obstet Gynaecol, 14(1), 45–52. PubMed: 8142988.
  • Domar, A.D., Broome, A., Zuttermeister, P., et al. (1992). The prevalence and predictability of depression in infertile women. Fertility and Sterility, 58(6), 1158–1163. PDF.
  • Domar, A.D., Clapp, D., Slawsby, E., et al. (2000). Impact of a group psychological intervention on distress, and comparisons with cancer/HIV/heart disease cohorts. PDF.
  • Rooney, K.L., & Domar, A.D. (2018). The relationship between stress and infertility. Dialogues in Clinical Neuroscience. PMCID: PMC6016043.
  • Verhaak, C.M., Smeenk, J.M.J., et al. (2010). Who is at risk of emotional problems and how do you know? Human Reproduction, 25(5), 1234–1240. SCREENIVF.
  • Pasch, L.A., Holley, S.R., et al. (2012). Psychological distress and IVF outcome. Fertil Steril. PMCID: PMC4781657.
  • Purewal, S., & van den Akker, O. (2018). Depression and state anxiety during ART: a meta-analysis. RBMO. Full text.
  • Kiani, Z., et al. (2021). Prevalence of depression symptoms among infertile women: systematic review and meta-analysis. FR&P.
  • Crawford, N.M., et al. (2017). Infertile women who screen positive for depression are less likely to initiate treatment. Human Reproduction. Full text.
  • Niedzwiedz, C.L., et al. (2019). Depression & anxiety among people with cancer. BMC Cancer. Open access.

Information is educational only and not a substitute for care. If you’re struggling, please reach out to a clinician or local support line.