Managing the psychological strain of physician infertility

Rebekah Bernard: ©Rebekah Bernard

In 2023, the Medical Student Section of the Florida Medical Association (FMA) submitted a resolution asking for recognition of physician infertility and more education on the topic. In response, the FMA hosted a webinar with experts on various aspects of physician fertility. This is part 4 in a series based on that webinar.

Twenty-five percent of women physicians will experience infertility, a rate twice as high as the average American. In addition to higher rates of infertility, women physicians may also be particularly vulnerable to the psychological impact of the condition. Stacy Greeter, MD, a reproductive psychiatrist who faced her own fertility struggles, shared insights on the topic during a webinar for the Florida Medical Association.

“As successful females, we are used to working hard, being strong, pushing through, and then being successful,” said Greeter. “When it comes to difficulty conceiving, we may believe, ‘Because I haven’t succeeded yet, I must be doing something wrong. I must be to blame.” In addition to feelings of inadequacy and self-blame, Greeter said that physicians may experience a range of emotions, including anger, fear, helplessness, defectiveness, and envy. “People may feel like they are going crazy, but these feelings are not crazy—they are human,” she said.

Greeter outlined some of the common experiences of physicians facing infertility and shared steps to optimize psychological health and to support colleagues.

Loss of identity

Psychiatrist Stacy Greeter frames the emotions associated with infertility in terms of a couple’s ‘reproductive story’—the vision, hopes, and dreams that they have for parenthood. Infertility struggles are more than just a disappointment,” Greeter said. “Because a reproductive story comprises a fundamental part of one’s identity, the loss of this story is experienced as a loss of identity and fragmentation of self.” For example, Greeter said that would-be parents sometimes feel psychologically stuck as neither a child nor a fully formed adult. “Women may feel less feminine, while men may feel less virile and competent.”

In addition, couples must come to terms with the loss of opportunities that come with parenthood, such as self-development, growth, or healing. “A person who is unable to become a parent may be grieving more than just the child they might have,” said Greeter. “They are mourning missed opportunities.”

Greeter said that it is important for couples facing infertility to recognize and acknowledge these feelings of loss. She also noted that a therapist can be very helpful to provide support, but also to help couples reframe the fertility journey. “By learning to rewrite their reproductive story, couples can experience posttraumatic growth.”

Feelings of inadequacy

Women experiencing infertility often report feelings of inadequacy, even when they have no control over the situation. “Our culture imagines that we as women are somehow in control of what is strictly a biological process of fertilization of an egg by sperm and then implantation,” said Stacy Greeter. “Rather than viewing infertility as a medical condition, we are prone to see it as a psychological failing of not wanting a baby enough or not trying hard enough.” Greeter noted that even some early psychiatrists shared this perspective. “Historically in psychiatry, infertility was thought to be caused by a woman’s ambivalence about becoming a mother or unresolved issues/conflict with her own mother.”

Greeter said that many couples receive messaging from society that infertility is their fault; that they either aren’t trying hard enough, or that they are trying ‘too hard.’ “People tell us, ‘Well, as soon as you stop trying so hard, then you’ll get pregnant,’” she said. Every failed treatment or negative pregnancy test may reinforce feelings of inadequacy. Greeter quoted Janet Jaffe, PhD’s book Reproductive Trauma: Psychotherapy with Clients Experiencing Infertility and Pregnancy Loss: “These patients are not unlike soldiers who repeatedly are sent back into battle to conquer the same ever-elusive hill.”

To treat feelings of inadequacy, Greeter urged couples to remember that fertility is a biological process, not a psychological one. “Remind yourself that infertility is not a skill that you just haven’t ‘mastered’ yet.”

Guilt and vulnerability

Psychiatrist Stacy Greeter said that women physicians often put enormous pressure on themselves to ‘do it all,’ noting that demands on time and emotional bandwidth become compounded during fertility treatments. “It's like we're trying to grow extra arms to keep all the plates in the air: Patients, fertility appointments, colleagues, our romantic partner, and our finances,” she said. “We think, ‘If I cancel my clinic, I'm a bad doctor. If I miss my fertility meds, I'm a bad patient. If I put off that doctor's appointment, I must not want a baby bad enough and don't deserve this.’” To manage these feelings, Greeter said that physicians must recognize that the idea that we can do everything is unrealistic and impossible. “We must relinquish the fantasy that we can do it all well, all of the time,” she said.

In addition to concerns about the impact on patient care and work colleagues, Greeter said that feelings of guilt can negatively impact relationships. “There is a lot of relationship stress in the infertility journey,” she said. “It is very common for women to feel guilty about their infertility—to feel that they are disadvantaging or somehow harming their partner.” Greeter noted that women may also worry about still being wanted by their partners. “Patients facing infertility often wonder if their partner will continue to love them if they cannot produce a child.”

Feelings of guilt and vulnerability are not unique to women. “During fertility challenges, men often feel helpless because they want to ‘fix’ things for their partners,” said Greeter. ‘This includes a desire to fix their partner’s feelings, which is a problem because feelings are not there to be fixed.” Instead, Greeter said that acknowledging and normalizing feelings is powerfully therapeutic. “It's really important that we support our partners, our colleagues, and ourselves by normalizing insecurity and vulnerability in the infertility journey,” she said, something that she noted physicians struggle with. “We are not always very good at doing this in the culture of medicine.”

Frustration, anger, and sadness

Facing infertility while others around you are becoming pregnant and raising children can illicit powerful emotions including frustration, anger, and sadness. Stacy Greeter shared a quote from a patient coping with infertility: “I want people to know that every pregnancy announcement is devastating. Not because you're not happy for them. Because you're sad for you.”

Greeter noted that infertility can be isolating for women physicians. “Many events include children, and women may be faced with the choice ‘do I go to that?’” she said. “On the one hand, it’s you and everybody else with kids, so you may choose not to go because it is going to hurt. On the other hand, I don’t want to miss it,” she said. “These are tough choices.”

Friends and colleagues can help by showing understanding and offering support, said Greeter. “If your friend needs to avoid a baby shower or family gathering full of kids, reassure them that they're not a bad friend for making that choice.” Greeter added that it helps to give others permission and space to not be ‘okay.’ “Infertility treatment is a big emotional roller coaster of hope and disappointment,” she said. “I may be doing great today until I find myself in the baby aisle of the grocery store, and now I’m sobbing.”

Greeter noted that it can feel uncomfortable to allow silence and space when people share painful experiences. “It is very tempting to respond by giving advice,” she said, which is generally not helpful. “It’s up to that person to decide what their next steps are—whether it’s adoption, egg donation, or living a childless life.”

Another common response is to offer consolation or to tell a story. “I call it, ‘put a silver lining on it,’” said Greeter, who discourages this practice.“Please avoid telling someone who is facing infertility a story about someone else who magically got pregnant,” she said, noting that she has experienced this scenario personally. “When people ask if I have children and I explain that IVF failed, they’ll try to reassure me that I’ll get pregnant as soon as I stop trying,” Greeter said. “But in my case, that’s not true. Hearing stories of others who ‘suddenly fell pregnant’ doesn’t make me feel better.”

Instead, Greeter urges others to validate and normalize painful feelings associated with infertility struggles. “Give people permission to be human.” As a psychiatrist, Greeter noted that resisting the temptation to give advice or consolation is not easy. “It takes a lot of self-control to just lean into that person's suffering,” she said, “To be with them and say ‘Hey, wow, this is really painful. Let me know what you need.’”

Getting help

While women physicians already face high rates of burnout and psychological distress, Stacy Greeter noted that infertility challenges can increase the risk of depression, anxiety, and post-traumatic stress disorder, and urged physicians to seek help. Even if a woman achieves a successful pregnancy after struggling with infertility, the trauma of experiencing infertility does not disappear and these women may feel even more ashamed for needing support once they become mothers because everyone expects them to be overjoyed.“Really lean on the supportive people in your life,” she said. “Ask for support from your institution and consider getting support from a trained mental health professional.” In fact, Greeter told the audience that as a psychiatrist, she attends therapy regularly.

Most importantly, Greeter said that physicians need to recognize our own humanity. “The culture of medicine tells us that we should just power through, that we should not have needs, not be vulnerable, and not need help,” she said, “But we need to remember that we are ultimately human.” In fact, Greeter said that our humanity, vulnerability, and flaws are essential to the practice of medicine. “These qualities are what connect us to our patients.”

Rebekah Bernard, MD is a Family physician in Fort Myers, FL. She is the author of four books on healthcare, most recently Imposter Doctors: Patients at Risk.