Written by Lizanne van Waart
Director & Founder of Wijnland Fertility Clinic / ART Counselling
MA. (Psychology) University of Stellenbosch


During these times, one of the greatest challenges facing the health care industry is the fight against mental illness. Perhaps the most daunting obstacle to overcome in the treatment of mental health disorders is the stigma attached to the diseases. Studies in the US focusing on mental illnesses like anxiety, depression, and bipolar disorder, have found that the percentage of women being treated for mental illness was almost 50% higher than men (Everyday Health, “State of Women’s Wellness”. 2017).

Mental health risk factors also increase when a woman goes through fertility treatment due largely to the impact that infertility medication has on the patient’s mental status.  While fertility medication cannot cause mental health disorders, such as depression, it can cause similar symptoms to these disorders.

From a study I did, “The Psychological Aspects of Infertility Patients” (Lizanne van Waart, University of Stellenbosch, 2011-03), I quote the following:

“From the literature review, it appears that infertility is a general and increasing health problem worldwide. This has been confirmed by the World Health Organisation (1999).

The high dropout rate of infertility patients during the different phases of treatment, and also shortly after the diagnosis of infertility, means that most research results are not based on reliable figures. Findings can, therefore, in general, not provide an accurate image of infertility as a health problem (Wischmann et al., 2009).

It would appear from the literature that psychological interventions can, in fact, make a significant difference in infertility treatment, but as a result of the uncertainty about which psychological aspects are important, there is not yet clarity on what types of intervention are the most suitable. It is also still unclear which psychological characteristics are present before clinical interventions, and therefore psychological interventions cannot be done optimally.

The emotions experienced during treatment are similar to those experienced during the process of mourning. However, this is also still a grey area because of the uncertainty regarding how the phases of infertility differ from each other with regard to the patient’s emotional aspects. In the case of psychiatric disorders, there are also a number of contradictions on the occurrence of anxiety and depression in infertility patients. It appears that there are clear differences between the psychological aspects of infertility treatment. The side effects of medication do, in fact, affect the morbidity of patients, which makes the evaluation of patients difficult.

Finally, it is clear from the literature review that the studies concentrated mainly on psychological risk factors and not so much on protective factors, such as resilience for example. How the patients experience infertility can differ from person to person and may even depend on the type of infertility intervention. In the present study, the focus is on the general state of health, satisfaction with life, happiness, hope, thought processes, and the psychological well-being of the patient.

This study has provided an overview of psychological factors in infertility treatment. It has also provided an overview of the literature on international statistics regarding infertility, and also statistics from Africa and South Africa and how infertility has become a public health problem. Attention, furthermore, was paid to the psychological state of the infertile patient, which included psychiatric disorders and resilience characteristics. As a result of the controversy about important psychological aspects affecting infertility patients, good justification was found for carrying out the present study.

It follows from the findings of this study that the diagnosis of infertility should be made from within the framework of the biopsychosocial model and the Psychosocial Resilience Model to Account for Medical Well-Being (Hart et al., 2006). Because of the complexity of infertility, emphasis cannot only be placed on certain phases of infertility, and also not only on the risk factors at play in infertility. It is important that infertility should be viewed globally/holistically. The HP/OI patient really experiences problems with the diagnosis of infertility and it is essential that these patients receive more guidance to prevent emotional problems from developing in the individual and the couple. If the manner in which the diagnosis of infertility is conveyed is approached properly, it can lead to more cost-effective treatment for the South African infertile community.

In the present study, it was found that high-risk factors before the start of treatment do not necessarily mean high protective factors. Therefore, all infertility patients should be assessed for risk factors, thought control, and protective factors, before the start of the different phases of treatment. The study confirms the risk of mood disorders, more specifically depression and anxiety, to be present in patients undergoing infertility treatment. It is clear that the general psychological well-being of the patient before the start of treatment is an important factor for successful treatment.

It was furthermore found that, before the start of treatment, the patients in the HP/OI group ran the risk of developing depression and/or anxiety, along with associated uncontrolled worry and punishment thoughts. These patients also run the risk of having reduced protective factors. ICSI/IVF patients, on the other hand, are a risk group for the presence of anxiety and intrusive thoughts. AI/OI patients might have unrealistic expectations before the start of their first treatment, with risk factors, thought-control processes, and protective factors coming to the fore strongly in this group.

The type of cause of infertility does, in fact, influence the psychological aspects at the start of treatment and must not be viewed in isolation. Infertility must be diagnosed in totality and in context with the biological aspects (the causes of infertility), along with the psychological aspects of the infertility patient. Infertile women experience male factors negatively from a psychological point of view, while infertile men experience it more positively. In order to be able to make an optimal diagnosis of infertility and to optimise the prognosis, infertility patients should be assessed psychologically before the start of treatment.

It would appear from the present study that when female and male causes are the reason for infertility, the patient has fewer protective factors. The profile study of the psychological aspects of infertility patients offers the physician an opportunity to make a more complete diagnosis of infertility in order to compile an optimal treatment plan. The profile study of the psychological aspects offers a further foundation for the compilation of a better psychological intervention plan. Most of the psychological aspects and the effect of the types of causes on the infertility patient are generally underestimated and left untreated during infertility treatments. It should be an important task of the reproductive biological team to identify these aspects and to prescribe the correct treatment.

Written by Lizanne van Waart

Director & Founder of Wijnland Fertility Clinic / ART Counselling
MA. (Psychology) University of Stellenbosch