The World Health Organization estimates that one in six people globally has experienced infertility. Counseling can be a valuable resource for people experiencing infertility, including those undergoing IVF or other medical treatment.

“The mental health impact of infertility is significant and multifaceted,” says Kristy Christopher-Holloway, NCC, ACS, BC-TMH, LPC, LCMHC, CPCS, PMH-C. “Many experience profound grief over the loss of anticipated parenthood or repeated pregnancy losses, which can feel like an ongoing cycle of mourning.”

According to Dr. Christopher-Holloway, infertility can contribute to depression and anxiety, trauma responses, identity and self-esteem struggles, feelings of shame or inadequacy, relationship strain, social isolation, and spiritual or existential distress.

In vitro fertilization (IVF) is a medical intervention for some of the most common causes of infertility. In IVF, eggs are fertilized outside the body before being placed directly in the uterus.

The use of IVF has continually grown since its introduction in 1978. According to the Society for Assisted Reproductive Technology (SART), 95,860 babies were born via IVF in the United States in 2023, accounting for 2.6% of all births. That same year, the Pew Research Center found that 42% of U.S. adults say they have used fertility treatments or personally know someone who has.

“Because infertility affects nearly 1 in 5 couples, it is likely that counselors will encounter clients navigating this experience,” says Dr. Christopher-Holloway. “Counselors interested in working with this population must be competent in understanding infertility, assisted reproductive technologies (ART), and the psychological toll they can carry. Clients deserve the opportunity to process their infertility journey without also bearing the responsibility of educating their provider.”

The decision of whether to undergo IVF is an important and personal one. Counselors should be prepared to help clients who are at this major decision stage, says Dr. Christopher-Holloway.

“Many individuals struggle with the idea of conceiving through medical intervention rather than ‘naturally.’ Counselors can help clients explore feelings of grief, loss, or disappointment about how they imagined their path to parenthood.”

Counselors can assist clients through this deeply personal decision-making process. They can facilitate emotional processing; normalize and validate emotional reactions such as shame, guilt, or ambivalence; empower clients; and educate clients about the mental health risks that come with infertility and treatments.

“Working with clients undergoing IVF requires not only therapeutic skills but also sensitivity, cultural humility, and specialized knowledge of reproductive health and its emotional complexities,” says Dr. Christopher-Holloway.

IVF offers treatment for individuals and couples experiencing infertility, but the process is not easy for patients and may layer additional stress on top of that initially caused by infertility.

“Counseling is a valuable resource for anyone undergoing IVF treatment,” says Dr. Chrisopher-Holloway. “IVF can be financially, physically, and emotionally demanding, and the process often involves repeated cycles of hope and disappointment. While some clients may enter treatment with optimism that IVF will be the ‘solution’ to infertility, the reality is that success is not guaranteed on the first attempt—and sometimes not at all.”

For couples pursuing IVF, couples counseling can provide valuable support for both individuals. IVF may impact a couple in different ways, and counselors can support open communication and help reduce conflict.

“For clients in partnered relationships, it’s important to recognize that infertility affects both partners—even when only one person has received a medical diagnosis,” explains Dr. Christopher-Holloway. “Infertility and IVF can strain communication, intimacy, and shared decision-making. Couples counseling can provide a supportive space to process these challenges together, strengthen the relationship, and navigate the stressors of treatment as a team.”

Couples counseling might seem like the obvious solution for an issue affecting both people. However, individual counseling may be equally valuable for one or both partners, explains Dr. Christopher-Holloway. The two are not exclusive, and couples might use both options.

“Some clients may want to explore personal emotions they are not ready to share in a couples session, such as guilt, shame, fear, or ambivalence,” she says. “Individual therapy also allows for deeper work around personal beliefs and expectations of parenthood, which may stem from cultural, religious, familial, or societal influences. Processing these beliefs individually can help clients engage in IVF from a place of clarity and empowerment.”

Counselors should also be aware of the unique concerns for individuals undergoing or considering IVF outside of a partnered relationship, says Dr. Christopher-Holloway.

“Counseling is also critical for those pursuing IVF as a single parent by choice, often with the use of donor eggs, sperm, or embryos,” she says. “Individual therapy provides space to explore identity, future parenting dynamics, and the emotional impact of creating a family outside of traditional expectations.”

Although counseling is beneficial for anyone going through IVF, explains Dr. Christopher-Holloway, some indicators suggest a greater need for professional support. These include:

• history of depression, anxiety, or trauma.
• difficulty coping with past infertility treatments or losses.
• significant relationship strain or conflict around family-building decisions.
• social isolation or avoidance of family/friend events related to children.
• perfectionism, high stress levels, or unrealistic expectations of IVF outcomes.

“In these situations, counseling can be especially critical in protecting mental health and strengthening coping capacity,” says Dr. Christopher-Holloway.

Understanding the medical causes of infertility and the technologies of IVF treatment is essential for a counselor helping clients through this journey, says Dr. Christopher-Holloway. Counselors can pursue training and professional development opportunities focused on infertility and assisted reproductive technologies such as IVF.

“Infertility and IVF are deeply personal journeys that extend beyond the medical process, touching every part of a client’s emotional, relational, social, and spiritual life,” says Dr. Chrstopher-Holloway. “Counselors play a vital role in creating safe, validating spaces where clients can process grief, explore values, and find resilience. It is important to approach this work with cultural humility, compassion, and up-to-date knowledge of reproductive health. Clients deserve care that honors their unique story, their hopes, and their choices.”

Dr. Kristy Christopher-Holloway is a counselor educator as well as the founder and director of New Vision Counseling Center, LLC, and of New Vision Consulting and Training, LLC, both located in Georgia, USA. She is a Licensed Professional Counselor (GA), a Licensed Clinical Mental Health Counselor (UT), a National Certified Counselor, a Board Certified-TeleMental Health Provider, an Approved Clinical Supervisor, and is certified in Perinatal Mental Health. Dr. Christopher-Holloway is the immediate past Co-Chair for the American Counseling Association of Georgia, the 2023-2026 Association for Multicultural Counseling and Development Southern Region Representative, and the 2025-2026 President-Elect for Association for Multicultural Counseling and Development. Additionally, she is a faculty trainer, curriculum manager, and subject matter expert for Postpartum Support International. She currently resides in Metro Atlanta with her husband and their three children. 

References

Goddard, I., & Aragão, C. (2023, September 14). A growing share of Americans say they’ve had fertility treatments or know someone who has. Pew Research Center. https://www.pewresearch.org/short-reads/2023/09/14/a-growing-share-of-americans-say-theyve-had-fertility-treatments-or-know-someone-who-has/

Society for Assisted Reproductive Technology. (n.d.). Preliminary national summary report for 2023. https://www.sartcorsonline.com/CSR/PublicSnapshotReport?ClinicPKID=&reportingYear=2023

World Health Organization. (2023). Infertility prevalence estimates, 1990–2021. https://www.who.int/publications/i/item/978920068315

**Opinions and thoughts expressed in NBCC Visions Newsletter articles belong to the interviewees and do not necessarily reflect the opinions or practices of NBCC and Affiliates.