So Many Unknowns! Uncertainty Compounds an Already Stressful Journey: Mental Health Resources for Fertility Patients during the COVID-19 Pandemic

Not surprisingly, fertility patients often report that the uncertainty surrounding when fertility treatment will resume is a primary stressor during the COVID-19 pandemic. Learning to cope with uncertainty has always been a central challenge for fertility patients. Now, the uncertainty of treatment success is compounded by all of the uncertainties created by the pandemic. Specifically, the time delay to re-initiation of treatment may feel catastrophic to an individual for whom it feels as if every month matters – whether because of increasing age, delayed conception, fear of future failure, or overall anxiety related to conception timing.

Many fertility patients are goal-oriented planners who like a roadmap and a timeline. Attempts to plan for the future which are thwarted by uncertainty may create feelings such as helplessness, anxiety, and anger. Our mental health colleagues suggest that SART member practices can use two strategies to assist patients in managing the uncertainty of the current treatment hiatus.

First, although we can’t give patients an exact timeline for reopening, we can offer a roadmap. We can communicate factors that will be considered in timing the re-opening and share strategies that will be used to protect patients once care resumes. Having a more concrete sense of a fertility clinic’s anticipated timeline and strategies may help alleviate some anxiety.

Second, we can highlight the importance of focusing on the present rather than the future. We can help develop a plan for the next treatment step. We can help patients notice when they get caught up in attempts to control the future and shift focus back to the present moment. One metaphor that resonates with many fertility patients is “The What If Tree”. Focusing on the present moment is like being on the trunk of the tree, where circumstances feel more manageable and grounded. Imagining multiple future scenarios which divide endlessly is like climbing out onto the spindly branches of the tree. Not only is their more “wind”, more opportunity to feel anxious when high up in the tree, but as soon as life moves in one direction (and not the other), all of time spent detailing that portion of the tree becomes wasted. Centering oneself in the present is a learned skill that improves with practice. Making the present moment as reassuring and comfortable as possible takes some thought. If patients are out of ideas or low in motivation, encourage them to reach out to mental health professionals with fertility expertise for support. Teletherapy has made accessing expert support easier than ever.

During this pandemic, many SART member clinics have strengthened their ties to qualified local mental health professionals who are skilled at helping care for patients’ emotional and psychological needs. The increased collaboration between fertility centers and mental health providers will benefit fertility patients not only during treatment disruptions, but also long after the COVID-19 pandemic is over.

This document was developed by members of the SART executive council of the American Society for Reproductive Medicine as an educational resource and service to its members and other practicing clinicians. While this document reflects the views of members of, it is not intended to be the only approved standard of practice or to dictate an exclusive course of treatment. Physicians and other healthcare providers should always use their best judgment in determining a course of action and be guided by the needs of the individual patient, available resources, and institutional or clinical practice limitations. This document was reviewed and approved by SART Executive Committee.
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National statistics from SART member clinics that reported their data through SART.