Fertility: The fear, grief and relief in accessing mental health support

As research shows that women with infertility experience similar levels of anxiety and depression to those with cancer, heart disease and HIV, we find out how to get the balance right when trying to conceive.

The relationship between stress and infertility has been repeatedly debated. Although the impact of distress on treatment outcome is unclear, stress, depression and anxiety are common consequences of infertility.

According to NICE, one in seven heterosexual couples in the UK may have difficulty conceiving. But despite the prevalence of infertility, research has shown that couples often shy away from sharing their story and “fake good” in order to appear mentally healthier than they are, thus increasing their psychological vulnerability.

“The lack of scientific knowledge has meant that the correlation between fertility and mental health support has been largely ignored,” says Mithi Thaya, CEO of the London-based health tech company Harper.

“Women who undergo fertility treatment are highly stressed. However, in most cases, nobody looks after their mental well-being because the clinicians and nurses either don’t have the time or are not well equipped to do so.”

A Fertility Network UK survey on the impact of fertility problems found that only 44 per cent of women received counselling with 54 per cent of them funding some of the sessions themselves.

Existing solutions are often too costly for clinics to implement, says Thaya. “In order to offer counselling, a clinic has to go through both a fertility and a reproductive medicine regulator.

“On top of that, self-reporting – the current gold standard in mental health assessment – can be unreliable simply because people may not be aware of certain mental health issues they might have.”

Along with the team behind Harper, Thaya aims to make mental healthcare more objective and affordable through molecular biology and technology for earlier accurate detection.

The practice, also known as precision medicine, looks at the genetics, environment, and lifestyle of a person and offers a personalised treatment, in contrast to the traditional one-size-fits-all approach to prevention and care.

Reports have shown that giving the right treatment to the right person at the right time leads to better outcomes for patients and can additionally reduce the costs and the risk of adverse effects.

“Your behaviour, your tone of voice, your eye pattern, some of the hormones you produce in your body and the way you feel could be indicators of your state of mental health,” the CEO explains.

“So, we aggregate all of these data points in a seamless, non-invasive manner through a number of clinically validated digital assessments, we give each patient a personalised plan and then we assign them a fertility-trained coach.”

Coaches help couples learn to express their feelings, navigate their IVF cycles and feel more in control. However, a coach is not a counsellor, says Thaya.

“There’s a big difference between our coaches and having a counsellor. Counselling often helps with serious issues, including severe mental health challenges and trauma. But although therapy has its place, when it comes to fertility treatment, we realised that the last thing a patient wants is somebody to open the Pandora’s box of everything that has been going wrong in their life.

“Coaching, on the other hand, is there to help them achieve their goal. The coaches are either IVF nurses or patient administrators who have previously worked in an IVF setting and are able to deal with patients on a human level.”

Demand for mental health support has significantly increased post pandemic. Reports have found that 90 per cent of those struggling with fertility are likely to experience depression symptoms of some kind while 42 per cent are likely to report suicidal thoughts.

However, the mental health sector remains unexplored. Meta analyses have shown that mental health has received “an inadequate proportion of health funding”, in comparison with the burden it causes while stigma, human resource shortages, fragmented service delivery models and a lack of research capacity for implementation and policy change contribute to the current treatment gap.

Thaya hopes that by working with scientists companies like Harper will drive more research and investment in solutions targeting mental health.

“We are very fortunate to partner with experts from the University of Chicago, Oxford, Cambridge and Imperial College London and our goal is to do a joint study with them to analyse the data from the clinics we work with and improve patient support.”

After in April it raised US$6.5m to address AI-based mental healthcare, the start-up is planning to expand geographically and explore other health sectors, including cardiovascular disease and oncology.

“We know that people who live with different mental health conditions, such as chronic stress, clinical anxiety or depression, have a two times higher rate of cardiovascular disease,” says Thaya.

“Our ambition is to be able to identify patients’ state of mental wellbeing at the right time and deliver the right interventions.”