Mental Health and IVF: Navigating The Terrain No One Warned You About

This blog post was written by Simone Tomasi, MD, PhD a consulting psychologist at CHR. Dr. Tomasi, is a board-certified psychiatrist with a background in academic medicine and a special interest in third-party reproduction. He is the consulting psychiatrist at CHR New York, providing psychological evaluations and psychiatric care for individuals pursuing IVF, egg donation, and gestational surrogacy, with a focus on ethical care and alignment with ASRM guidelines. His clinical work is grounded in empathy, precision, and a deep understanding of the emotional complexities of reproductive care.

In-vitro fertilization (IVF) can feel like a full-time job – with a heavy emotional toll and no guaranteed payoff. It demands time, energy, money and, above all, hope. Whether you’re preparing your first retrieval or your fifth, fertility treatment can leave you feeling isolated, anxious, and emotionally raw. The longer the journey, the more cumulative the stress. 

As a clinician focused on reproductive psychiatry – I often say that fertility medicine isn’t just the science of hormones. It’s a practice of emotional endurance. 

And yet, few clinics offer structured mental health support. CHR stands out for treating both mind and body – because anything less is just incomplete care. 

1. The Anxiety Loop: When Hope Feels Like a Threat

In IVF, waiting is constant—and brutal. You wait for hormones to rise, follicles to grow, embryos to divide, phone calls from the lab to come. And with each flicker of hope comes the looming threat of disappointment. 

This hypervigilance – tracking, testing, and interpreting every twinge – can mimic or trigger anxiety disorders, even in those without prior history. I’ve seen patients whose mental energy is consumed by ‘what ifs’ and microscopic shifts in sensation. The mind becomes a prediction machine with no off switch.

Classic anxiety symptoms include racing thoughts, muscle tension, insomnia, irritability, ‘brain fog’, or that nameless sense of dread. These symptoms often feel physical – and when misread as signs of treatment failure, they fuel even more stress. Anxiety produces sensations, sensations triggers worry, and the cycle tightens. 

Action step: Grounding strategies such as breathwork can help in the moment. But if anxiety is interfering with your daily functioning, it’s worth speaking a mental health professional who understands fertility. Sometimes, short-term medication can be a safe and effective tool. Fertility-aware psychiatric support isn’t indulgent; it’s responsible care.

2. Depression In Disguise: Fatigue, Numbness, And Identity Loss

Sometimes it’s not tears—it’s numbness. Detachment. Flatness. Shrinks to cycle calendars, injection schedules, and bad news. 

Patients often tell me that they feel like they’ve lost themselves. Joy feels distant. The future is on hold. A quiet guilt creeps in - as if your body’s struggle is your fault. But naming this feels risky, like it might crack the fragile shell of hope. And because the world expects you to stay brave and hopeful, this quiet depression often hides in plain sight.

What to watch for: pulling away from others, disrupted sleep, persistent irritability, or feeling like a stranger to yourself. If you feel lost, numb, or unable to experience joy -  these are soft-spoken warnings, but they carry weight. Listen closely. 

3. Relational Whiplash: When IVF Disrupts The Us

Here’s a truth many couples learn the hard way: you and your partner may not grieve, hope, or cope in the same way – and that’s entirely normal. But it doesn’t make it easy. 

One person may want to talk constantly; while the other goes silent. One dives into research; the other avoids the topic altogether. Intimacy may become functional, fraught, or vanish entirely. Communication itself can break down—not because love is gone, but because the emotional climate has changed.

What helps: Couples therapy isn’t just damage control – it’s maintenance. A space to realign and reconnect in a landscape that pulls you apart. 

4. Medical Trauma And The Body Disconnect

When your body becomes the constant site of monitoring and intervention, it can start to feel less like yours – and more like a project under surveillance.

Patients with a trauma history – medical, sexual, or otherwise – often describe a growing disconnection. Even those without prior trauma can start to feel like a walking lab report. This detachment can be subtle but can blunt emotion and quietly erode resilience over time. 

Clinical insight: Reclaiming a sense of agency starts with care that honors the whole person. Trauma-informed fertility care – attuned to past harm – and somatically focused therapy help rebuild the mind-body connection, not just compliance with a treatment plan.

5. Moral Fatigue and Existential Questions

IVF doesn’t just demand your body—it asks you to make choices most people can’t even imagine. How many embryos to create? What happens to the ones you don’t use? How far are you willing to go, and at what cost?

There’s no manual – just ethical, emotional, and financial complexity. Some patients question their values. Others question their future. For many, it’s the first time they’ve confronted the painful truth that wanting something deeply doesn’t mean you’ll get it.

This isn’t just grief. It’s a quiet, internal reckoning. An existential shift that reshapes how you see yourself, your future, and what it means to keep hoping anyway.

So What Helps?

Forget “self-care”. Here’s what makes the difference:

Fertility-competent mental health support. Not all therapists or psychiatrists understand this terrain. Find someone who does.

Targeted treatment. Anxiety and depression in IVF are real. Evidence-based meds can be used effectively and safely, with no shame.

Reclaiming control where possible. You can’t control embryo quality—but you can choosel your treatment team, your support network, and your mental health plan.

Real connection. You don’t need dozens of people – just one or two who can say, “I see you. This is hard. And you’re still standing.”

Final Word: It’s Not Just in Your Head

If IVF is weighing on your mind, you’re not broken—you’re human. The emotional toll is real, valid, and treatable. While you can’t always change the outcome, you can change how supported and equipped you feel along the way.

Mental health care in IVF isn’t optional. It’s strategic. It’s strength. And it may be one of the few things that makes a lasting difference – before, during, and long after the cycle ends.