While infertility may be a problem affecting nearly 7.3 million women in the United States between the ages of 15-44, it is a topic that women often don’t discuss. Rather, they suffer from the emotional pain that accompanies hormone injections, multiple procedures, and sometimes miscarriage. How is it best to treat this vulnerable population that rarely gets the attention it deserves? The answer lies in a team approach to medicine.

According to Dr. Michael Jacobs, reproductive endocrinologist and infertility expert, who is director of Fertility and IVF Center of Miami, “The best way to treat couples challenged with infertility is to develop a good understanding of the reasons why a couple may be struggling. Infertility can be secondary to problems with a man, a woman or a combination of both the man and the woman. The key is to treat the couple as a whole.”

But the layperson may not understand how you can treat couples as a whole, when often times some people assume that fertility struggles result from problems with only the woman? Dr. Jacobs describes several reasons for infertility. He states that there are “medications to restore natural ovulation or to induce ovulation. In some cases, there are surgical options for problems like endometriosis. Male factor problems can be treated with fertility medications and insemination or in-vitro fertilization (IVF). IVF is not necessarily the first treatment, but can be effective for several different etiologies of infertility.”

Many people have limited knowledge of infertility and the mental health complications that can result. Consider that a woman who is currently undergoing treatment for infertility may be at her fertility center every 2-3 days. Women often need to give themselves injections several times a day, and some require vaginal suppositories. It’s a huge emotional commitment, and time commitment. It requires frequently missing work and often trying to explain reasons for frequent absence.

But why is it that so many couples are so reluctant to discuss their fertility journey? Perhaps it’s because it’s something a couple assumes they will always be able to have. The emotional shock of struggling with infertility may cause a couple shame, confusion, and some may even question their faith. Until one experiences a personal struggle, they often don’t think about how much of a blessing having a child is.

As a mental health professional, I am aware of research that suggests that problems with fertility may contribute to mental health pathology like depression and poor self-esteem. Couples who suffer from infertility need to have an ability to be resilient — a true gift, which only some can push through.

Why is resilience so important? It’s because of the emotional roller coaster that accompanies infertility. Consider a woman who may have had multiple failed IVF embryo transfers, yet she continues to inject hormones into herself on a daily basis.

Consider other couples that can’t even produce their own embryo and need donor eggs or sperm. The potential fear of using someone else’s DNA may be accompanied by hope for having their own child.

And then, there are other couples that do end up successfully getting pregnant. They start envisioning their life with their future son or daughter. Later, they are shocked by miscarriage.

As if the news of miscarriage itself wasn’t enough, a couple soon learns that they need to figure out ways to expel the fetus. Medications, like misoprostol, can be given vaginally or orally to induce uterine contractions. It’s a physically painful experience that can be visually daunting and beyond traumatic, despite the fact that it is relatively common affecting 10 to 20 percent of known pregnancies.

For this reason, the relationship that a couple has with the fertility clinic is critical. Dr. Jacobs only works with nurses, technicians and specialists who are 100 percent committed to their patients and are willing to support couples through the emotional journey. People who work with infertility couples need to have patience, dedication and bedside manners that are beyond incredible.

It is also helpful to seek mental health counseling. While some couples may benefit from medication, others can utilize therapy and more holistic approaches. Learning how to engage in mindfulness exercises, proper breathing techniques and exercise can help a couple through the fertility challenge.  Ultimately, if a patient chooses to see a therapist, the therapeutic relationship is the most important prognostic factor in the patient doing well. There are some psychiatrists and therapists who specialize in women’s mental health and specifically infertility.

Dr. Jacobs also explains that surrogacy is an option for those who are unable to carry a child. This can be a good alternative for homosexual men or women who are unable carry the pregnancy. He states that the carrier has “no biological relationship with the egg or sperm used to carry the pregnancy.” Surrogates can create families for those who only can dream of them.

So, who can be involved in the fertility process? It’s not just the fertility clinic. It’s the clinic, the nurses, the technicians, the mental health professionals, the primary care physicians, the psychiatrists, the future pediatricians, the surrogacy agencies, the lawyers to handle the surrogacy, the couple, the friends, and the family. It’s a whole community.

They say that it takes a village to raise a child. With infertility struggles, it takes a village to hold one. Never lose hope and remember that every life is a blessing.

Samantha Saltz is a psychiatrist and can be reached at Doctor Sam.  A version of this article originally appeared in the Miami Herald.

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