Fears about infertility—Is it OCD?

What are fears about infertility?

If someone experiences strong, persistent fear or worry about their ability to become pregnant or make a partner pregnant, these fears may be a sign of obsessive-compulsive disorder (OCD). In OCD, these fears are accompanied by behaviors known as compulsions, which are done in an attempt to relieve distress or anxiety related to one’s fears, or to prevent or reduce the chances of infertility. 

Unfortunately, studies have found that stress can also negatively affect fertility, and OCD can both be exacerbated by stress and produce great stress. In women, stress can cause irregular menses and a lack of ovulation. In men, sperm quality, motility, and even sexual functioning can be affected due to the hormone imbalances caused by stress. 

OCD research has uncovered a lot of understanding about the condition that was previously lacking. It is estimated that 2 in 100 people will meet the criteria for an OCD diagnosis. Once thought to only affect areas of contamination, taboo sexual themes, perfectionism, harm, and order is now showing itself in many different ways. While some subtypes and themes are more common than others, in the field of OCD treatment, the variety and reach of the condition is now being widely observed.

Let’s take a look at an example of someone experiencing OCD involving the fear of infertility:

Betsy and her husband have always talked about having a child. They are now in their third year of marriage, and they believe they are ready to begin trying to conceive. Betsy was diagnosed with OCD in her 20’s and underwent Exposure and Response Prevention (ERP) therapy supplemented with SSRI medication for contamination fears for about a year, with great success. She hasn’t dealt with any significant contamination fears in about 5 years and feels that her OCD is under control—she is excited about starting a family. 

Once Betsy and her husband start trying to conceive, Betsy has an intrusive thought that her OCD medication could have made her infertile. Afraid, Betsy decides to look it up online and finds mixed information about her SSRI medication. Some articles allude to problems with fertility, while others state there is no issue. She decides she probably should check with her primary care physician and gives him a call. Betsy goes in for an appointment the next day, and her doctor tells her there is no reason to fear she will struggle with infertility due to the fact that she took medication. Betsy feels better at first, but a month goes by without getting pregnant and she feels compelled to revisit the articles online to be sure. 

This time she spends more time and finds more articles about infertility and her medication. She also messages her doctor with some of her findings. Her doctor encourages her to stop researching online, reminds her that this is a compulsive behavior, and also reminds her that sometimes it can take up to a year for healthy couples to get pregnant. 

Betsy again feels reassured, but this doesn’t last. She starts asking her husband questions to get reassurance. She asks him his opinion on the medication she once took. She asks if he will leave her if she is unable to get pregnant. He always reassures her that whatever happens with their situation, he will be by her side, but she can’t shake the feeling that she will drive him away if she is infertile. Betsy starts to research ways to boost fertility, spending hundreds of dollars on supplements and holistic doctors, and she even looks into fertility specialists after 4 months of not getting pregnant. Betsy is starting to wonder if this fear of infertility is somehow related to OCD, so she decides to contact the ERP therapist she worked with in the past to discuss her symptoms. 

It could be OCD

In OCD, one’s repetitive fears about infertility will cause distress or anxiety, becoming obsessions. In response, they will feel a strong urge to engage in compulsions to feel better, such as repeatedly researching online, avoiding possible contributors to infertility at all costs, and reassurance-seeking.

Common obsessions experienced in someone with a fear of infertility are: 

• What if something is wrong with my reproductive system and I am physically unable to conceive?
• What if my drinking habits have made me infertile?
• Something in my environment is toxic and not allowing me to conceive
• My partner will leave me if I can’t give them a child
• My partner will cheat on me if I am infertile
• What if I’m sterile because of chemicals in my drinking water?
• I swallowed too much toothpaste as a child and now I am infertile
• My mental health struggles are making me infertile
• Antibiotics or other medications caused my infertility 

Common compulsions experienced by someone with a fear of infertility are: 

• Researching causes of infertility or ways to boost fertility
• Reassurance seeking from partner, family, friends, or other loved ones
• Excessively engaging in medication, relaxation, or other techniques to reduce stress and boost fertility
• Seeking reassurance from a doctor
• Avoiding stress or other things that could contribute to infertility at all costs
• Repeated texts, calls, or even visits to the doctor
• Unneeded medical testing to rule out all causes of infertility
• Visiting holistic or alternative doctors
• Spending excessive amounts of money on supplements to boost fertility

How can I tell if I have OCD or if my fears are reasonable and healthy?

To get a better sense of whether you’re struggling with OCD, you can ask yourself some questions that relate to the diagnostic criteria for OCD:

• Are you experiencing repeated, unwanted, intrusive thoughts, images, or urges? 
• How persistent are the thoughts and fears around the topic of fear of infertility? Are the thoughts about this fear distressing or disturbing? 
• Do you engage in behaviors in an attempt to reduce this distress or fears or prevent your fears from happening? 
• Do the thoughts and behaviors take up a significant amount of time? 
• Do these fears and behaviors interfere with other important areas of your life? 

If the answer to some or all of these questions is yes, you may be suffering from OCD. Even if a person does not meet the criteria for OCD, this does not mean that their fears are healthy or not a cause for concern; someone may be experiencing another mental health diagnosis like Generalized Anxiety Disorder or Major Depressive Disorder. Having an assessment with a trained OCD specialist can confirm whether you are experiencing OCD or another condition. 

How can I accept uncertainty about infertility?

OCD focused on a fear of infertility can be debilitating, but it is highly treatable. Doing exposure and response prevention (ERP) therapy with a trained ERP therapist is the best course of treatment, validated by decades of clinical research demonstrating its effectiveness for the majority of patients. 

People who struggle with OCD and the fear of infertility will work with their therapist to build an exposure hierarchy and begin being exposed to situations that trigger their fear and anxiety, one at a time. Usually an ERP therapist will start with an exposure that is predicted to elicit a low level of fear and work up to the harder exposures as confidence is built. Over time, people will build more tolerance for anxiety and worry when they are exposed to their triggers, accept the uncertainty that the intrusive thoughts bring, and experience a reduction in fear and anxiety as they resist engaging in compulsive behaviors. 

Example exposures done in ERP therapy for a person with a fear of infertility may include:

• Writing an imaginal script about never getting pregnant
• Looking at pictures of friends’ babies online
• Reading about stories of infertility and what caused them
• Writing a script about one’s partner leaving because of infertility
• Drinking tap water or confronting other actions with a feared connection to infertility

At each step in ERP, response prevention is absolutely necessary when fears are triggered. Response prevention techniques might involve not researching infertility anymore, letting thoughts about infertility exist without attempting to make them go away, not rinsing one’s mouth out more than one time after teeth brushing, or staying in the baby section of a store until anxiety about infertility passes. 

If you’re struggling with OCD, I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP

We look forward to working with you.