When you’re struggling with infertility, some days you can’t help but ask yourself: will this ever get any easier? Sometimes that question can turn into: is this even worth it?

While you know, deep down, that you want a child, the process of becoming pregnant can take a toll on every aspect of your life. Day after day, you fall into the routine of checking your basal body temperature, timing intercourse for when you’re ovulating, and hoping against all hope that the pregnancy test reads positive this time. You’re constantly finding the balance between being open about your fertility issues with friends and family and preserving your emotional reserve for those days when you don’t think you can keep trying.

On top of the often grueling emotional challenges, financial considerations run on a feedback loop in your mind. Between fertility testing, treatments, and everyday living expenses, your mind can become just as strained as your bank account.

In honor of World Mental Health Day, we’re addressing a topic that so often gets left in the shadows of the fertility narrative — how infertility can impact your mental health.

According to an article in Vice earlier this year, “many fertility patients may not be getting the mental health treatment they need. A survey of patients at five California fertility clinics published in the July 2016 issue of Fertility and Sterility shows that few were offered counseling. Despite more than half of the women and one-third of men displaying clinical-level depression symptoms and 76 percent of women and 61 percent of men displaying anxiety symptoms, only one-quarter of patients said their clinic offered them information on mental health resources.

This points to the truth that fertility is not just a physical process but an emotional and psychological one, as well. And the longer you have to try to get pregnant, the more intense the experience can become.

However, the mental health conversation can’t stop once a woman becomes pregnant. A study published in Oxford Academic’s Human Reproduction journal found that 1 in 10 women struggled with anxiety and depression up to 17 years after completing IVF treatments. The good news is that fertility healthcare providers can “profile different groups of at-risk women at the start of the treatment and tailor psychological support…to promote [mental] health adjustment during and after treatment.”

Additionally, research published in the journal ACTA Obstetricia et Gynecologica Scandinavica found that “women who received the fertility treatment and then gave birth were five times more likely to develop [postpartum] depression than women who go the treatment but never gave birth.”

It’s a catch-22 then; not only are women who have a hard time getting pregnant more susceptible to mental health issues but women who have successful fertility treatments are more likely to have them, as well. Another facet of this is that stress (emotional, physical, and psychological) can impact your hormones and, subsequently, your fertility.

What, then, can be done to help address the complexities of mental health and fertility? Mental health prevention and awareness should start before you begin trying to get pregnant and must continue on even after you have your child.

Begin counseling before you start trying to conceive

At the time you start trying to get pregnant, invest in talk therapy. While the beginning stages of starting a family can be joyful, it’s always a good idea to have support from a professional. Not only will you have someone to help you navigate through your own emotions during this time, you’ll have an advocate who can walk you through relational challenges, fertility ups and downs, and help you identify any depressive or anxious behavior before it gets worse.

Even if you’re past the beginning stages and in the thick of infertility, seeking out counseling can do a lot to alleviate some of the emotional burden you may feel.

Join an infertility support group

There are many support groups available for people who are trying to conceive. Find one in your area and be intentional about attending events and engaging in conversation with others who have been or are going through similar issues. Sometimes simply feeling like you’re not alone can do a world of good.

Talk openly about your fertility

Talking about your fertility with friends, family, and strangers can feel overwhelming. You never know how they’ll respond and you aren’t always sure how to answer uncomfortable questions. Still, sharing the process with those closest to you can help you feel supported. In fact, many people may not know how to support you and opening up a dialogue about what’s happening can lead to a stronger social support system.

Share your mental health struggles, too

Mental health has always been a taboo topic, despite how common it is for people to struggle with it. The best way to break through that veil of shame placed on mental health issues is to drag it into the light. You can do this by sharing with someone you trust when you feel depressed or anxious and allowing them to support you. 

Mental health and fertility are not talked about together as often as they need to be. If we want to see more clinical and social support, that has to change. While it’s never easy to talk about these difficult and often convoluted issues, doing so is the first step toward helping you — and others struggling with the same things — receive support.