Infertility affects millions of individuals and couples—and takes a heavy toll on their mental health.

"For some women and couples, there can be this expectation, a dream or plan that they had about having children, and they feel robbed of that dream," says Dr. Eynav Accortt, clinical psychologist and director of the Reproductive Psychology Program at Cedars-Sinai.

Studies have shown that infertile couples experience significant anxiety and emotional distress. When a round of fertility treatments proves to be unsuccessful, for instance, women and couples can experience deep feelings of grief and loss. 

In fact, one study of 200 couples who visited a fertility clinic found that half of the women and 15% of the men said that infertility was the most upsetting experience of their lives.

"Today, men are much more involved in the family and may feel a perinatal loss just as deeply," says Dr. Accortt. "Even if men don't experience the physical pain of that loss, the emotional pain they feel is very real."

Compared to white women, women of color are more likely to experience infertility, says Dr. Sinmi Bamgbose, reproductive psychiatrist at Cedars-Sinai.

Furthermore, women of color might be more likely to be blamed for their own infertility or have their emotional pain and valid medical concerns dismissed or ignored by a physician.

"In communities of color, there's this general idea that women are naturally fertile, and there's a lot of importance placed on childbearing and being a strong mother," Dr. Bamgbose says.

"When a woman of color can't fulfill that duty, it may be harder to seek treatment for infertility or her mental health because she's not getting support from her family."

It's not just infertility itself that can cause distress: The hormone therapy some women need to treat the condition can have a mental health impact.

"The hormones you are given will have an effect on your mood, but it's not the same for everyone," says Dr. Bamgbose.

Dr. Bamgbose says these effects can include sleep disturbances, disruptions in sex drive, hot flashes, depressed mood or anxiety, among other symptoms.

Drs. Accortt and Bamgbose have compiled a list of things that someone should not say to a woman or couple who are infertile, have recently suffered a miscarriage or are having difficulty getting pregnant.

"Let's reduce the stigma so that couples feel more comfortable talking about miscarriage, perinatal loss and infertility in general," Dr. Accortt says.

Avoid making comments like:

• "Enjoy this time, trying is the fun part."
• "Just relax and it will happen."
• "Everything happens for a reason."
• "If you have more faith in God, it will happen."
• "At least you know you can get pregnant (after a miscarriage)."

Instead, offer words of support. If you don't know what to say to someone in these instances, Dr. Accortt suggests making these compassionate statements:

• "Infertility is so challenging, do you want to talk about it?"
• "I wish you didn't have to go through this."
• "How are you doing? I am always here for you."
• "I'm so sorry for your loss. I am bringing dinner over."

You can also "say nothing, just hug them and listen," advises Dr. Accortt.

Read: Pregnancy, New Motherhood and Mental Health—What You Should Know

There are multiple ways to seek support for those who are experiencing infertility and also struggling with their mental health.

The Reproductive Psychology Program at Cedars-Sinai offers a variety of family planning support groups for individuals and couples. 

"The support group helps you feel that you're in a community with others who understand what you're going through," Dr. Accortt says. 

Both Drs. Bamgbose and Accortt agree that mental health screenings should be incorporated at the beginning of the infertility treatment process.

"Even though it's well known that the incidence of depression and anxiety are higher in those experiencing infertility, many are not being offered mental health resources during clinical appointments," says Dr. Bamgbose.

Being aware of the impact infertility could have on your mental health and how to get support is key, Dr. Accortt says.

"Sometimes people are blindsided, they didn't realize they were going to feel this way," Dr. Accortt says. "If you already have the phone number to call and know the resources available, we can intervene sooner."

Read: Pregnancy, New Motherhood and Mental Health—What You Should Know