The desire to have children and the psyche: Why the emotional burden can become so great

An unfulfilled desire to have children can affect far more than just the question of whether a pregnancy occurs. Over time, hope and disappointment, medical examinations, decisions about treatments, and repeated waiting can take up more and more space in everyday life. Especially during fertility treatment with IVF or ICSI, many of those affected experience phases of severe emotional distress.

Sadness, anxiety, tension, envy, anger, or the feeling of losing control over one's own life are not unusual reactions in this situation. At the same time, an unfulfilled desire to have children does not automatically mean that a psychological disorder is present.

Above all, it is important to note that psychological stress is no longer generally considered a cause of infertility today. The older concept of so-called "psychogenic infertility" is scientifically untenable. Rather, the experience of infertility itself can become a source of significant psychological distress.

Why can an unfulfilled desire to have children be so psychologically distressing?

The desire to have children is often linked to a vision of the future: with family, partnership, identity, and an idea of what one's own life should look like.

When a pregnancy does not occur as expected, it does not just create a medical problem. Suddenly, something that may have previously seemed self-evident becomes uncertain.

The handout on gynecological psychology accordingly describes infertility as a drastic and stressful life experience, or a "critical life event." Possible consequences include stress reactions, uncertainty, anxiety and depressive symptoms, social withdrawal, feelings of stigmatization, self-esteem problems, loss of control, sexual problems, and an impairment of the quality of life.

At the same time, people differ significantly in how severely they are affected and what support they need. The AWMF guidelines therefore also view psychosocial aspects as a relevant component of comprehensive care for fertility disorders.

Hope, anxiety, grief, and envy can occur simultaneously

A unique aspect of an unfulfilled desire to have children is emotional ambivalence.

A friend gets pregnant – and you are happy for her. At the same time, her pregnancy can be a painful reminder of what you are missing yourself. An invitation to a baby shower can therefore trigger joy, grief, envy, anger, or anxiety all at once.

Some of those affected are startled by these feelings and additionally judge themselves negatively for them:

“Why can't I just be happy for her?”

“What is wrong with me?”

“I don't want to be envious.”

As a result, a second layer can develop on top of the original grief: shame, feelings of guilt, or self-deprecation.

From a gynecological psychology perspective, it can be helpful to distinguish between the immediate emotional reaction and these subsequent evaluations of one's own feelings. Feelings such as grief, anxiety, anger, or envy can initially be understandable reactions to a situation experienced as stressful or threatening.

The loss of control

Another common theme is the loss of control.

Many areas of life can be planned at least to some extent: education, career, place of residence, or travel. With the desire to have children, this principle works only to a limited extent.

You can have examinations carried out, organize appointments, use medications correctly, and follow medical recommendations – and yet the outcome of a treatment cannot be completely controlled.

In particular, people who are used to solving problems through planning, performance, and effort can find this experience particularly distressing.

Thoughts like

“What else can I do?”

“Did I do something wrong?”

or

“If I do everything right, it has to work eventually.”

can be expressions of this attempt to restore security in a situation that is difficult to control.

IVF and ICSI can further increase the burden

Reproductive medical treatment brings its own psychological demands.

The gynecological-psychological handout describes the treatment process as a sequence of recurring stress phases: the decision for treatment, examinations and diagnosis, hormonal stimulation, ultrasound checks, puncture, fertilization, transfer, and finally the waiting for the pregnancy test.

During this process, hope and uncertainty can repeatedly alternate.

How many follicles are developing? How many egg cells can be retrieved? Will fertilization occur? Can a transfer take place? Did the implantation work?

Especially the waiting times are experienced by some as particularly difficult. Physical sensations can suddenly be intensely observed and interpreted. Hope can alternate with the desire to protect oneself from further disappointment.

Studies confirm that fertility-related stress can be linked to general psychological distress. In a Swiss couple study involving 116 couples before fertility treatment, infertility-related distress was associated with psychological distress. The results also show how important it is to consider women and men, or both partners, individually.

When life revolves more and more around the desire to have children

With increasing duration, the desire to have children can begin to crowd out other areas of life.

Leisure activities may be reduced, trips planned around treatment cycles, and social situations involving pregnant women or families avoided. Some couples hardly speak of anything else; others increasingly avoid the topic.

Sexuality can also change. When sexual intercourse is linked to the menstrual cycle, ovulation, and the optimal time, intimacy can increasingly become a chore. The handout therefore explicitly names partnership, communication, and sexuality as relevant areas of psychological support during infertility.

Withdrawal or taking it easy can provide short-term relief. However, if this causes more and more positive activities, social contacts, and other sources of quality of life to fall away, the burden can continue to increase in the long term.

A look through consistency theory: When important needs are threatened

An additional psychotherapeutic perspective is offered by Klaus Grawe's consistency theory.

According to this, people strive to satisfy central psychological basic needs – in particular for attachment, orientation and control, self-esteem enhancement or self-esteem protection, and pleasure gain/pain avoidance.

An unfulfilled desire to have children can touch several of these areas at the same time.

Orientation and control can be impaired because the further course remains uncertain despite great personal effort.

Self-esteem can be affected if those concerned interpret the infertility as a personal failure or experience their body as not functioning.

Attachment can be affected when partners deal with the situation differently or when contact with friends and family becomes more difficult.

And positive experiences and joy of life can also increasingly recede into the background if the desire to have children takes up more and more space.

From this perspective, it is understandable why the burden can become so comprehensive: it is not just a single goal that is threatened. Several central areas of life and psychological needs can be affected at the same time.

However, this does not mean that every person with an unfulfilled desire to have children shows the exact same reactions. Personal experiences, existing resources, the partnership, the social environment, additional stressors, and the specific course of treatment significantly influence how the situation is experienced.

When can psychological support be useful for those wishing to have children?

Psychological support does not have to wait until a mental illness has developed.

It can be useful, for example, if the desire to have children increasingly dictates everyday life, severe anxiety or sadness occur, medical decisions overwhelm, social situations are increasingly avoided, the partnership or sexuality is strained, or repeated unsuccessful treatments are difficult to process.

The decision to continue, modify, or end a treatment can also be psychologically supported.

Depending on the distress and concern, psychological counseling or psychotherapy may be appropriate. A careful assessment helps to distinguish which form of support makes sense. This also corresponds to the needs-oriented approach described in the gynecological-psychological handout.

Psychotherapy for fertility concerns in Zurich

At FemCare in Zurich, we support women and couples experiencing psychological distress in connection with an unfulfilled desire to have children, as well as during reproductive medical treatments such as IVF and ICSI.

The focus is not on the idea that psychological distress is "to blame" for a pregnancy not occurring. Rather, psychotherapy can support dealing with uncertainty and loss of control, organizing distressing thoughts and emotions, preserving resources, and addressing the impact of the desire to have children on everyday life, partnership, and quality of life.

The support is tailored to the individual situation and can take place on-site in Zurich or online.