Fertility, emotions and relationships

Your sexual health and fertility are some of the most personal but vital things in life. It’s not surprising that they have a big impact on your emotions.

It can feel lonely, but if you’re going through emotional difficulties, you’re not alone. Several million people around the world experience problems with their fertility that affects their physical and mental health.

How does your reproductive health affect your mental health?

The rise and fall of certain hormone levels during your menstrual cycle or period, affect how you think and feel mentally and physically.

You’ve probably heard of premenstrual syndrome (PMS), for many this causes mild mood swings or irritability.

What you may not know is that about five to eight per cent of people with periods have severe PMS or premenstrual dysphoric disorder (PMDD). This causes severe mood changes, feelings of hopelessness and even suicidal thoughts. If you’re living with PMDD this will have a huge impact on your quality of life.

There are treatments and support available - tracking your mood and cycle is a good first step. The charity has additional advice.

Problems with fertility

Aside from the ups and downs of your menstrual cycle, any changes or problems with your reproductive health adds a further burden.

For example, if you’re dealing with irregular menstrual cycles or certain conditions that affect fertility, like polycystic ovary syndrome (PCOS) then these could already be having an impact on your mental health.

If you have PCOS you’re more likely to also have anxiety and depression. Doctors are still not sure why this link exists, it’s likely that the stress of coping with PCOS symptoms or hormonal differences associated with the disorder play a part.

More generally, fertility problems are considered by psychologists to be a ‘life crisis’ with an emotional strain that matches other traumatic events.

Problems with your reproductive health can leave you with a sense of shame on top of loss, grief, anger and sadness. If you’re having difficulties conceiving then it’s common to also feel unhappy with your body and blame yourself.

Tackling what’s going on in your mind as well as your body will generally improve your daily life and help you feel more positive and relaxed.

Don’t suffer in silence

Reproductive health feels like a sensitive issue. Talking about your periods or fertility still carries a lot of stigma and shame. If you’re lesbian or trans then you may face extra societal barriers to discussing your feelings around pregnancy.

If you can’t talk about these issues they become hidden. Leaving you feeling isolated and making it harder to get the help you need.

It’s common to feel powerless. The good news is that finding ways to feel more in control, will positively impact on your mood and emotions.

A great place to start is by talking to your GP or another sympathetic health professional about what you’re going through. They may be able to help or refer you on for further support.

Getting psychological support can improve anxiety and depression for people with fertility issues. In particular cognitive behavioural therapy or CBT helps empower you to cope with difficult feelings and experiences during stressful life events.

Ask your GP, or self-refer online on the NHS website in England or through Breathing Space in Scotland.

Here are some other ways to feel more in control:

1. Express yourself

Avoiding difficult thoughts and feelings can actually make you more stressed. It’s easier said than done, but talking about your feelings often reduces distress.

Figure out what feels right for you: talking to a close friend or family member, writing in a journal or doing something creative that helps you work through your emotions.

2. Try mindfulness meditation

Mindfulness meditation aims to decrease worry or stress and help you relax. It can also help reduce depression and improve sleep for if you’re experiencing infertility.

Mindfulness it’s not about clearing your mind and you don’t need any special skills to give it a go. Look for a local class or teacher or try a mindfulness app

3. Look after your body

In general, leading an active lifestyle is linked to good mental health. Being kind to yourself by eating well, moving more and making time to relax boosts your self-esteem and body image. More specifically, if you have PCOS, then research shows that doing at least two and a half hours of moderate exercise a week helps reduce depression.

You don’t have to go to the gym to get more active, even gentler exercise like yoga is beneficial. Research has shown that yoga helps women with infertility manage stress and anxiety.

4. Get group support

Researchers have also found that getting support in a group is helpful. Talking about your fertility journey with likeminded people, who’ve been through similar things, means you’ll feel less isolated. The Fertility Network UK runs online and in-person support groups all over the country.

Fertility and relationships

On top of the regular highs and lows of your menstrual cycle and dealing with any fertility-related health conditions, pursuing fertility tests and treatment all add extra stress.

Hospital visits, examinations, medication, monitoring of your cycle and monthly pregnancy tests may put a strain you and your relationship.

Some couples find that they argue more: blaming each other, not getting on as well and drifting apart.

What you’re going through is normal, but these tensions can lead to greater emotional problems. About 20 per cent of all couples seeking fertility treatment show signs of anxiety, depression or distress.

The impact on intimacy

If getting pregnant is the sole focus of your sex life, then fun, pleasure and spontaneity often take a back seat.

For a small number of people problems with sex such as vaginismus, dyspareunia (pain during sex), lack of sexual desire, or erectile dysfunction for men, can be the main cause of fertility issues.

Either way, it’s a vicious cycle - emotional difficulties can make you feel less like sex in the first place. But having sex less often may, in turn, affect your chances of getting pregnant.

Taking the pressure off

If you are grappling with intimacy issues, try taking the focus off penetrative sex for a while. Instead, find other ways to express affection – what about mutual massage or different approaches to mixing up your

If this still feels like too much then start with non-sexual ways of rebuilding intimacy. It’s a cliché, but something as simple as regularly spending quality time together can make a big difference – a special meal, trying a new hobby or activity, or just going for a walk and holding hands.

If things are not getting better then sex and relationship therapy is available on the NHS in some areas. The College of Sexual and Relationship Therapists has more information.

Feeling differently about fertility

It’s likely that that you and your partner have different perspectives on fertility. If you’re the one with a reproductive health problem or the person trying to get pregnant, then you probably feel extra pressure on top of coping with the physical toll this takes. Equally, your partner may want to help but feel powerless.

If you’re in a heterosexual couple, then part of this might be that the expectations and pressures around fertility can be different for men and women.

If you have a male partner, it’s likely that he’s also going through anxiety and sadness too, but dealing with it in a different way. For example, research shows men tend to be more secretive about their feelings around fertility and react with denial and anger.

Communication is key

When things get stressful in a relationship it can actually be harder to talk to your partner. This is tricky at a time when open communication is really important.

Finding ways to improve how to explore your feelings together is vital, it can bring you closer and boost your confidence in dealing with challenges.

Here are three ways to open up the conversation:

1. Make the time and space for a chat. It’s harder to talk about difficult issues when you’re distracted, busy or preoccupied.

2. Start with explaining what you’re going through, using lots of ‘I feel’ statements. For example ‘I feel lonely’ rather than ‘you never spend any time with me.’ According to the charity Relate, using ‘I feel’ statements helps you take ownership of your feelings and avoids criticism or blame. This will be easier for them to hear and means they will be less likely to be on the defensive.

3. Reassure them that you also want to hear about their thoughts and feelings. Showing empathy and learning to accept each other viewpoints, even when you have a difference of opinion helps build bridges.

Relate have lots more useful communication tips.

Getting more support as a couple

Trying some of the tips above, as well as getting support for yourself is a great start. Look into getting help as a couple if you’re still struggling.

Getting some professional input from a relationship counsellor can make it easier to talk things through and give you the skills to help resolve conflicts.

According to the NHS, if you’re going through fertility treatment then you and your partner should have the opportunity to see a counsellor before, during and after any tests and treatment you have.

If you’re not going through fertility treatment then you could look for a relationship counselling service near you, Again, the charity Relate have a network of Centres across the UK and a group of licensed local counsellors that provide face-to-face counselling and support. They also provide phone, email and live chat counselling.

Ultimately, facing your problems together helps share the burden and strengthen your relationship. Many couples say that even though it’s difficult, coping with fertility issues as a couple has brought them closer together.