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Sometimes it can seem like you are the only couple in the world struggling with fertility issues. As you watch friends, coworkers, and family members announce pregnancies and show off gender reveals on social media, you might start to wonder what's wrong with you. For many couples, the stress and challenges of trying to conceive puts a strain on a relationship. Here are some ways infertility could affect you and your partner, and how to find help when you need it.

The truth about conception and pregnancy loss

Getting pregnant is not easy for everyone. There are a lot of things that have to go just right in the process of ovulation, fertilization, and implantation for a pregnancy to even begin—and that doesn't account for the challenges your body will face in trying to carry a pregnancy to full term.

Only about trying to conceive can do it in any given ovulation cycle—a number that declines as women get into their mid-30s and 40s. An estimated also end in miscarriage, meaning that the baby does not make it past 20 weeks. About one in 6 to 8 women have difficulty getting pregnant or carrying a pregnancy to term, so you are definitely not alone.

Emotional challenges and stress

Studies show that women who experience pregnancy loss suffer from higher rates of anxiety and depression and that infertility can cause stress. What has not been studied as much is whether stress itself can affect your ability to conceive. An published in Dialogues in Clinical Neuroscience found that many women and couples experiencing infertility do not share their story with friends or family and feel isolated, ashamed, and guilty. These feelings can lead to higher levels of stress, anxiety, and depression, and treating these conditions to lower psychological distress results in increases in pregnancy rates.

Couples trying to conceive can experience a range of emotions and stress when:

• One partner focuses all their energy and effort to become pregnant and perceives that their spouse isn't as focused on it.
• One partner feels hurt or as though their relationship is 'not enough' because their spouse wants to have a ÑÇÖÞ×ÔοÊÓƵ.
• One or both partners feel personally responsible for not being able to conceive or have a successful pregnancy.
• Both partners feel like sex is structured and regimented (rather than spontaneous and enjoyable) because it has to be done at certain times in a menstrual cycle.

There are also ways that fertility treatment can increase stress levels in a relationship. For example, one partner might want to aggressively pursue fertility through methods like intrauterine insemination (IUI) or in-vitro fertilization (IVF) while the other has reservations about these treatment options.

Financial stress

For couples who decide to pursue fertility treatment, the high cost can add another layer of stress to an already difficult situation. Fertility treatment ranges from a few hundred dollars to tens of thousands of dollars, and it is not covered by insurance. The cost of treatment may require putting off other big financial decisions, such as buying a home, saving for retirement, or going on vacation.

The stress of fertility treatment costs is also influenced by the unknown—doctors often cannot give you an exact treatment cost at the beginning, since infertility has many different factors with varying costs to treat each issue. Couples might be comfortable spending a certain amount only to find out they need a more expensive option.

How to cope with infertility together

One of the most important things couples can do through their fertility journey, says Erica Johnstone, MD, chief of the at ÑÇÖÞ×ÔοÊÓƵ of Utah ÑÇÖÞ×ÔοÊÓƵ, is to spend time together as a couple in ways that are not related to fertility and conception. Plan date nights, cook meals together, and continue to pursue the extracurricular things that interest you.

"Some couples think stepping back from work, hobbies, family, and friends can help them focus on fertility, but in many situations that can make you feel more isolated and depressed," Johnstone says. Continuing the things that bring you happiness can relieve stress in a difficult time. It may not help you conceive, but it can provide a psychological benefit at a time when you need it.

You can also seek help from a therapist or counselor. Some focus exclusively on fertility issues, but seeing a counselor that specializes in general relationships can help. Seeking help earlier in your fertility journey is often better, but there's never a bad time to start. Sometimes it is difficult to navigate the mental health landscape along with fertility treatment, so ask your doctor for recommendations if you need help.

Finding available resources

One of the biggest challenges for many couples is not knowing what resources are available, whether you can qualify, and how to take advantage of what is out there. Johnstone recommends talking to a patient advocate or social worker at your reproductive endocrinologist's office. They may be able to help you find:

• Therapists or counselors who specialize in fertility
• Financial loans, grants, or programs to help alleviate the cost of fertility treatments
• Local non-profits like the , where you can find support groups, mental health services, and relationship support, along with individual counseling services

Preparing for your fertility journey

Couples often neglect to prepare properly for their fertility journey, which can increase stress and make things more challenging. Just like you wouldn't try to run a marathon or climb a mountain without preparing, you shouldn't go into the fertility process without having honest conversations about it together as a couple. Discuss your expectations and how you want to approach things like:

• Insurance benefits and out-of-pocket costs
• Personal and religious feelings about treatment options—IUI, IVF, donor eggs, surrogacy, and others
• Stress management
• Support (within your relationship and from external sources like a counselor)

You don't need to make all the decisions up front, and you can always pause to reevaluate your options before taking the next steps. Coming into the journey with an open mind and a strong foundation as a couple can help you navigate through this challenging time.