Supportive Hope: Help During Reproductive Treatments
Nicholas A. Natale, PhD

The lingering childhood fear from the recesses of her mind now manifested as Emily stared with anticipated horror at the results of her tests.  Standing in a half-painted nursery, her voice cracked, “I can’t conceive,” while her distant fantasy of excitedly surprising Dan with the “blue+” sign of a home pregnancy test now contorted into the nightmare of disclosing her inability to naturally conceive a child.  Trembling hands and a tearstained report greeted him, and in a long embrace, they held each other with the assurance of their unfailing love. 

Ensuing days of consultations with fertility specialists provided hope for Dan and Emily. Their dream of conceiving a child remained alive, but they faced many daunting obstacles: high costs, moderate probability of success, maintaining a positive attitude, and intrusive procedures.  The most difficult hurdle, however, dawdled below the surface – the growing strain on their relationship.

Slight hints of blame periodically surfaced in Dan’s tone that were almost undetectable at first but unmistakable in a moment of disagreement and frustration.  Deep regret of past decisions from Emily’s past unwittingly affirmed her mounting guilt.  Stress and anxiety coalesced into an inescapable and ever-present fear, more dangerous than the challenge in front of them. Unfathomable thoughts crept into Emily’s mind, “What kind of parents will we make for a child anyway?  Is this God’s judgment on me for what I did?  Does Dan really love me at all?  Are we making a mistake?”

Anxiety and Depression

Couples who struggle with infertility often suffer in ways unaware to most people and professionals.  The complications, uncertainty, and rigidity common among fertility treatments can be overwhelming all to themselves, and experts now recognize how the emotional state of the individuals involved impacts the success rate of the treatment.[1]  That is in contrast to previously held assumptions that fertility treatments were largely a medical procedure with little or no dependence of a woman’s overall mental state.  The potentially devastating role of stress and anxiety on the process is receiving closer consideration than before. 

It is widely accepted that anxiety, stress, and depression negatively influence the efficacy of conception naturally or with fertility treatments.[2]  Researchers suggest a link between anxiety–depression dynamics involving the hypothalamic–pituitary–adrenal axis (HPA) and failure to conceive.[3]  Furthermore, they propose that psychological interventions aimed at reducing anxiety might increase the likelihood of conception in couples engaged in vitro-fertilization.  We now know that counseling and supportive psychotherapy can be very effective in reducing high levels of anxiety in couples undergoing a variety of reproductive treatments.[4]

Back to Emily.  Tension between her and Dan continued to grow, making it harder to quell the raging questions and fears within her.  Each failed attempt led to intense disappointment, greater insecurity, and heightened anxiety.  She began to question everything, doubting herself, her marriage, and her sanity.  The long process was taking its toll, and she needed help sifting through the increasingly negative, intruding thoughts. 

Supportive Hope

Many couples, like Emily and Dan, undergo stress in their relationship that calls into question the validity of their efforts.  The strain on the relationship produces a cycle of anxious thoughts that can be perpetuated by deeper insecurities, eroding their relational satisfaction in general, their sexual satisfaction specifically, and ultimately interfering with the reproductive treatments.  However, there is strength found in support. 

A well-qualified counselor or therapist can provide much needed help:

·       Teaching relaxation techniques, mindfulness, and meditation can greatly alleviate stress and depressive symptoms.[5] 

·       Educating about the reproductive treatment can normalize the process for the couple.

·       Helping process emotions throughout treatment can reduce intrusive, negative thought patterns that begin to take their toll.

·       Addressing relational issues as they arise between the couple can help prevent problems from deteriorating too quickly.

Emily and Dan argued more and enjoyed the company of the other less.  Both privately began to toy around with the idea of ending the treatment and moving on.  In these difficult moments, they both needed someone who could understand their struggle.  Someone who would listen.  Someone who could help them preserve perspective and gently guide them back to what they both once held so dear.  They found help in their counselor. 

Pink Nursery

There was a moment following the devastating news when Emily and Dan held each other in the embrace of their unfailing love.  Their dream of having a child together was alive because of their love.  And now, through the amazing support of someone who was a “friend of their dream,” they held their sleeping daughter. 





Dr. Nic Natale is a sex therapist practicing in Columbia, SC.  His practice focuses on helping couples flourish in their intimacy.  Leading research, cultural trends, and a spiritual perspective informs his work.  For information about Dr. Natale, go to or contact him at



[1] Freeman, E. W., Boxer, A. S., Rickels, K., Tureck, R. & Mastroianni, L., Jr Psychological evaluation and support in a program of in vitro fertilization and embryo transfer. Fertil Steril. 43, 48–53 (1985).

[2] Newton, C. R., Sherrard, W. & Glavac, I. The Fertility Problem Inventory: measuring perceived infertility-related stress. Fertil Steril. 72, 54–62 (1999).

[3] Merari, D., Feldberg, D., Elizur, A., Goldman, J. & Modan, B. Psychological and hormonal changes in the course of in vitro fertilization. J Assist Reprod Genet. 9, 161–169 (1992).

[4] Tarlatzis, I. et al. Psychosocial impacts of infertility on Greek couples. Hum Reprod. 8, 396–401 (1993).

[5] Carmody, J. & Baer, R. A. Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J Behav Med. 31, 23–33 (2008).