RESEARCH_FILE
The Science of Trying to Conceive
Trying to conceive turns a private hope into a monthly pass/fail test, and the data says the toll is real, not dramatics: infertility produces psychological distress on par with a cancer diagnosis, envy of pregnant friends is one of the most commonly documented feelings in the research.
Not a personality flaw — and scheduling sex around ovulation strains couples in measurable ways no matter how 'relaxed' they try to be about it. Here's what several decades of research on infertility distress actually found, and why the shame that gets attached to it doesn't hold up.
How the science changed
- 1993
Domar and colleagues give infertile women the same psychological symptom checklist (SCL-90R) used with cancer, cardiac-rehab, and hypertension patients — and find infertility distress statistically indistinguishable from all three, higher than only chronic-pain and HIV-positive patients. ↗
- 2003
Peterson, Newton and Rosen show it's not how distressed each partner is alone that predicts trouble — it's the gap between partners: couples where one partner's perceived stress far outpaces the other's report worse marital adjustment and more depression. ↗
- 2005
Schmidt, Holstein, Christensen and Boivin follow 2,250 people starting fertility treatment and find that how couples communicate and cope — not their diagnosis or treatment outcome — predicts who is still struggling with fertility-problem stress a year later, among the 816 who hadn't had a baby. ↗
- 2006
In the largest coping study of its kind — 1,026 patients — Peterson and colleagues find women use proportionately more confrontive coping, responsibility-taking, and support-seeking, while men use more distancing and self-control: a patterned gender difference, not a difference in how much either partner cares. ↗
- 2007
Cousineau and Domar's review names what infertility does beyond sadness: distress, loss of control, stigma, and a derailed sense of adult life-timing — arguing that the medical framing of infertility had, for decades, let clinicians overlook the emotional load. ↗
- 2010
Greil, Slauson-Blevins and McQuillan's review of the field documents envy of other mothers and grief as recurring themes in infertile women's own accounts, and finds the evidence on relationships mixed — some studies find no added strain, others find real damage, especially where parenthood is central to identity. ↗
- 2022
In a 12-month randomized trial of 450 people trying to conceive, Martins and colleagues find no timing strategy — every-other-day sex, fertile-window monitoring, or no instructions at all — protects against rising depression symptoms or declining sexual wellbeing: the toll shows up regardless of the plan. ↗
What people believe vs. what the data shows
The belief“Being this wrecked about not getting pregnant means something's wrong with you — it's not a real medical crisis.”
The dataDomar's comparison study measured infertile women's psychological symptoms against cancer, cardiac-rehab, and hypertension patients using the same standardized checklist — and found the distress statistically equivalent, not exaggerated. ↗
The belief“Feeling jealous when a friend announces she's pregnant makes you a bad, petty person.”
The dataGreil and colleagues' review of the literature documents envy of other mothers and jealousy of the fertile as recurring, well-documented themes in infertile women's own accounts of their experience — not evidence of a flawed character. ↗
The belief“If a couple just stayed relaxed about it, timing sex around ovulation wouldn't really hurt anything.”
The dataMartins and colleagues' 12-month randomized trial found depression symptoms worsened and female sexual functioning declined across every group — every-other-day sex, fertile-window monitoring, and no instructions at all. No approach protected wellbeing. ↗
The belief“Infertility is really the woman's problem — she's the one under pressure, so the strain lands mostly on her.”
The dataPeterson's studies show both partners are affected — just differently: women lean toward confrontive coping and support-seeking, men toward distancing and self-control, and it's the mismatch between partners' stress levels, not either partner's stress alone, that predicts worse marital outcomes. ↗
The belief“If your partner isn't as visibly upset as you are about a failed cycle, it means they don't care as much.”
The dataSchmidt and colleagues' cohort study found that differences in communication and coping style — not differences in how much a partner cares — are what predict who is still struggling with fertility-problem stress a year in. ↗
TEST_YOURSELF · How well do you know this science?
01 How did infertile women's psychological symptom scores compare with those of cancer, cardiac-rehab, and hypertension patients in Domar and colleagues' comparison study?
Domar's team found infertile women's SCL-90R scores statistically indistinguishable from cancer, cardiac-rehab, and hypertension patients — and higher than only chronic-pain and HIV-positive patients. source ↗
02 According to Greil and colleagues' review of the infertility literature, how common is envy of other mothers among women experiencing infertility?
The review documents envy of other mothers and jealousy of the fertile as recurring themes across multiple qualitative studies of women's own accounts of infertility — a common response, not a rare or shameful one. source ↗
03 In Martins and colleagues' 12-month randomized trial, which intercourse-timing strategy protected couples from worsening depression symptoms and declining sexual wellbeing?
None of the three arms — every-other-day sex, fertile-window monitoring, or no instructions — protected wellbeing. Depression symptoms rose and female sexual functioning declined regardless of strategy. source ↗
04 What did Peterson, Newton and Rosen find predicted worse marital adjustment and more depression in couples facing infertility?
Congruence — or its absence — mattered more than either partner's individual distress: couples with a wide gap between how stressed each partner felt reported worse marital adjustment and more depression. source ↗
05 In the largest study comparing how men and women cope with infertility (Peterson and colleagues, 2006), what pattern emerged?
Across 1,026 patients, women showed proportionately more confrontive coping, responsibility-taking, and support-seeking, while men showed more distancing and self-control — a gendered pattern in style, not in how much either partner cared. source ↗