When Should Psychological Support Begin During Fertility Treatment?

About ten years ago, I founded and led a psychotherapy department at a hospital in Baku for people undergoing fertility treatment, including IVF. In collaboration with the medical team, we made psychological and psychosexual support part of treatment. During those years, I worked with hundreds of individuals and couples.

At the time, this kind of care was still new in local practice. Even so, it drew considerable interest from patients and colleagues alike. Through clinical supervision, I shared my experience with colleagues at the start of their careers and helped them develop their knowledge and skills in reproductive health.

I regard the years I spent leading the department as one of the most significant periods of my career. I’ll write about them in more detail another time. If I get carried away reminiscing, I could fill a whole book. For now, let’s return to our topic.

Living with uncertainty: the psychological burden of treatment

From diagnosis through treatment, infertility can bring a long period of uncertainty. Waiting for results, undergoing repeated procedures, deciding what to do after an unsuccessful attempt, and bearing the financial burden are all part of the process. Family expectations, questions from others, and the pressure to explain one’s private life add to the strain.

People experience this period differently. Alongside sadness and anxiety, some feel anger, guilt, or a loss of self-confidence. Struggling to have a child can also affect a person’s relationship with their body, their sense of self-worth, and how they imagine the future.

How does treatment affect relationships and sexual life?

Partners’ needs and reactions do not always align. One may want to talk about what they are going through, while the other needs to be quiet and withdraw into themselves. That difference can be interpreted as indifference or a lack of support. When both partners are struggling, it can be harder to understand each other.

Sexual life deserves attention in its own right. For some couples, sexual intimacy increasingly revolves around trying to conceive, while desire and pleasure fade into the background. If partners begin to pull away from intimacy or experience sexual difficulties, there is no need to wait until treatment ends to assess these concerns.

Psychotherapy is more than emotional support

Offering psychological support during fertility treatment does not imply that infertility has a psychological cause. The aim is to take a person’s emotional state, relationships, and everyday life into account throughout medical treatment.

When clinically indicated, this work also includes assessing mental disorders and treating them through psychotherapy. During those years, I provided psychotherapy to patients diagnosed with obsessive-compulsive disorder (OCD), generalized anxiety disorder, or depression. In such cases, the stress of fertility treatment alone does not fully explain what a person is experiencing. Planning psychotherapy involves considering their mental health history, current symptoms, and how those symptoms affect daily life. When needed, this work also involves collaboration with a psychiatrist.

Psychological work involves understanding what a person is feeling and what those feelings mean to them, working with anxiety and sadness, and helping partners express their needs and understand each other. Decisions about continuing, pausing, or stopping treatment are discussed in these sessions. With the patient’s consent, care is coordinated with the treating doctor.

Psychological support at different stages of treatment

There is no need to wait for a severe crisis before seeking support. Psychological needs should be considered from the diagnostic stage onward and reassessed during and after treatment. This does not mean everyone needs psychotherapy. The care a person receives should reflect their needs, the difficulties they are facing, and their own choices. The European Society of Human Reproduction and Embryology (ESHRE) recommends attending to psychosocial needs throughout the treatment process and referring patients for specialized support when needed.

The World Health Organization’s (WHO) 2025 infertility guideline also emphasizes discussing the need for psychological and social support with patients and either providing appropriate support or making a referral.

The value of psychological care is not measured by pregnancy

People going through treatment should not be expected to stay calm and optimistic throughout or to feel ready for every new step. Psychological support gives them space to talk about what they are struggling with, think through their decisions, and understand their needs. The value of that care is not measured by whether treatment results in pregnancy.

References

1. World Health Organization. (2025). Guideline for the prevention, diagnosis and treatment of infertility. Geneva: World Health Organization.

2. Gameiro, S., Boivin, J., Dancet, E., et al. (2015). ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction—a guide for fertility staff. Human Reproduction, 30(11), 2476–2485.

3. American Society for Reproductive Medicine, Mental Health Professional Group. Frequently Asked Questions About the Psychological Component of Infertility. ReproductiveFacts.org.

4. Niu, C., Gao, Y., Xu, Q., et al. (2026). Associations of anxiety and depression with sexual health among infertility patients: a systematic review. Frontiers in Psychology, 17, 1823084.

5. American Society for Reproductive Medicine. (2023). Stress and infertility. ReproductiveFacts.org.

© 2026 Shabnam Sadigova