If you are reading this in the midst of a healthy pregnancy, you should take some time to be grateful, and some time to think about couples who would like to have children but can’t. In 2017, the birth rate in the United States hit its lowest point in 30 years. 
Some of the decline is due to Millennials choosing not to have children and some of it is due to women putting off pregnancy to later years. Some of it is due to the fact that 10 to 15 percent of couples who want to have children struggle with infertility. There are many reasons for infertility. Men and women contribute about equally to infertility and in many cases, the cause is shared or unknown. [2,3]
Despite the fact that men are as likely to be responsible for infertility as women, women often feel the stigma of being childless more deeply. Historically, motherhood was so closely linked to being a woman that women who were childless were openly ostracized. In some primitive cultures, a man is still free to leave a childless wife. In America, we are beyond that level of stigma, but for many women, never experiencing being a mother is a loss that is hard to accept. 
For some of these women, and men, being childless can be devastating. Studies show very high rates of depression and anxiety. In studies of women starting infertility treatment, rates of depression can reach 50 percent and rates of anxiety can reach 25 percent. Loss of interest in sex and relationship problems are also frequent. This can happen when the act of having sex becomes associated with failure. 
Being childless can also make you feel angry and frustrated. Becoming a parent is one of the most important milestones in a person’s life. Being deprived of this experience can make you feel abandoned, and can put a big dent in your self-esteem. [2-4]
Finally, there is the feeling of isolation. Imagine how it feels to be childless when your friends and relatives have entered child-world with birthday parties, play dates, school plays, and soccer games. Do you dive in and try to be part of other people’s child-world, or do you drift away and feel isolated? 
For many childless couples, assisted reproductive technologies become a source of hope and for many, these technologies are successful, but there may be added financial stress and a roller coaster ride of emotions ranging from hope, to joy, to despair. 
Infertility can be vicious cycle. Being anxious and depressed about not being pregnant can actually make it harder to get pregnant. One study found double the rate of infertility in depressed women. In another study, women who were trying to become pregnant and participated in group therapy or a support group, had successful pregnancies over 50 percent of the time. Women in the study who did not have therapy or support only become pregnant 20 percent of the time. 
There is a positive side to this story. Medicine has gotten a lot better at treating infertility. There are many options and many success stories. There are also good treatments for men and women suffering with anxiety, depression, and relationship problems due to infertility. Help is available. [2-4]
If you have friends who want to have children but are struggling, or just can’t, think about how that might feel. Make sure to include them, encourage them, and support them. You should also take some time to be thankful for the milestone you are about to experience. Don’t take it for granted. It is not a gift given to everyone. [2-4]
- USA Today, U.S. birth rate plummets to lowest point in 30 years.
- MGH Center for Women’s Health, Stress, depression, and anxiety with in fertility and its treatment.
- North Carolina Medical Journal, The Impact of Infertility on Women’s Mental Health.
- Facts, Views & Vision, Issues in Obstetrics, Gynecology and Reproductive Health, The social and cultural consequences of being childless in poor-resource area.