At age 19, Christina Paruag underwent her first surgery to diagnose and remove endometriosis. It was a laparoscopic ablation, and she woke up after the procedure in excruciating pain. Because her surgeon was also an OB/GYN, they were delivering a baby at the time, and Christina was sent home a few hours later without many answers at all.
She can still vividly remember the nerve-wracking follow-up appointment.
“I sat on the exam table, palms sweaty, chills running down my spine,” she says of that day, the day she received her official endometriosis diagnosis. The doctors told her she had about a thirty percent chance of getting pregnant in her lifetime, and that miscarriage was common for people like her.
Still a teenager, Christina couldn’t understand why this was happening, or what could have prevented it. She experienced a lot of grief, confusion, and fear about the future.
“I’d see new moms pushing strollers, wondering if that would ever be me. I’d skip baby-related ads online because they triggered a reaction in which I envisioned a future where I was not only childless, but without a partner, because how could someone be with me if I was possibly infertile?”
Christina’s diagnosis affected every part of her life, including her relationships. She felt she had to be upfront with partners about the realities and limitations of her fertility. Intimacy was often painful, and while she was encouraged by doctors to try to conceive a baby as early as twenty-one years old, she didn’t feel emotionally or financially ready for that.
Christina met her now-husband, who she calls a wonderful and supportive partner, a few years later. He assured her that while he did want to have children, being with her was even more important than this shared dream. After a complex excision surgery in the UK, it was confirmed that Christina had severe stage 4 endometriosis, and her doctor advised her to try for a baby before the age of thirty-two. She was twenty-five at the time.
After travelling, business building, healing, and getting married, Christina and her husband have recently begun to explore their fertility options. But after an overwhelming first clinical appointment, Christina says she broke down under the weight of it all.
For the approximately one million Canadians who, like Christina, have endometriosis, as well as the one in six couples who experience infertility in general, this isn’t merely a physical struggle. The mental health toll is huge, pressing, and often overlooked.
Dr. Vaneeta Sandhu is a clinical psychologist and the founder of the Fertility Wellness Collective. She works with people, including LGBTQ+ individuals and couples, who are going through their own fertility struggles. In her work, she offers affirming, practical, and deeply personal support.
She says fertility treatments aren’t just physically demanding, they can be emotionally exhausting as well.
“There’s a lot of waiting, a lot of unknowns, and for many people, a real sense of losing control over their lives.”
In fact, Dr. Sandhu says a recent study from the Patras University School of Medicine in Greece found that women going through infertility often feel like they’ve lost the ability to plan everything from big life decisions (like taking on a new job) to small things (like booking a vacation or having an honest work conversation). This uncertainty can cause a lot of stress and anxiety.
“It’s not just about getting through treatment,” she says. “It’s about managing the emotional rollercoaster that comes with it. That’s where mental health support plays such a big role. It gives people space to process all the complex feelings that come up—grief, hope, frustration—and to feel less alone. It also helps folks stay grounded and take care of themselves in the middle of something that can feel all-consuming.”
Sadly, our systems aren’t designed to approach infertility struggles with the nuanced care and focus on mental wellbeing that people desperately need.
Dr. Sandhu sees this firsthand. As she says, mental health coverage is already limited, and when you consider the high out-of-pocket costs of fertility treatments, the idea of paying additionally for counselling and therapy can feel overwhelming for many people. Even when someone is ready to accept mental health support, there are so many barriers in terms of access.
There is also an unspoken pressure to push through, she tells us. To be strong, to stay hopeful, to keep going.
“The emotional weight is real, and it deserves the same level of care and attention as the physical side of treatment. We need to shift the system to recognize that emotional support isn’t optional—it’s essential.”
In terms of systemic solutions, Dr. Sandhu says integrating mental health professionals directly into fertility clinics, so people don’t have to seek support externally, is an option. Another is building routine mental health screenings into the process, which would help normalize emotional check-ins throughout, and would allow caregivers to proactively offer support when needed.
More funding and policy changes that encourage mental health access alongside fertility care are also needed, she says.
“If we want to truly support people going through this experience, we have to recognize that their mental and emotional health are just as important as the medical interventions.”
For Christina, there are mixed emotions and hesitations that come along with the choices she must make on her fertility journey. The next step on her treatment path would be a sonohysterogram, a potentially painful procedure for those with endometriosis. She’d need sedation and antibiotics, but due to antibiotic resistance and a history of over twenty-five kidney infections, she’s reluctant to go that route.
She asked doctors if it was possible to skip directly to IVF, but they told her they need to assess her fallopian tubes first. Christina and her husband have considered IUI, IVF, surrogacy, and adoption, but before fully exploring these options, they will continue to try to conceive naturally for a few months.
The decisions and indecision and stress of these choices and what they might mean have forced Christina to take steps to protect her peace. She reminds herself of the many mental health challenges she has faced and survived thus far. And while it’s hard not to slip into comparison mode when friends and other couples are getting pregnant and posting about it online, she remains actively appreciative of the gifts life is offering her at this moment.
Beyond her professional experience, Dr. Sandhu is well-versed in this struggle on a personal level as well, and has been navigating her own infertility challenges since 2019, when she received the all-too-common and frustrating diagnosis of “unexplained fertility”. Since then, she’s gone through miscarriage, failed IUIs, IVF cycles, and transfers that didn’t work. She says that even with her clinical training, education, and financial resources, it has been the hardest journey of her life.
This has helped her notice a huge gap between what the healthcare system provides and what people actually need when navigating fertility, which is why she forged her own career path as a fertility wellness consultant. She considers her practice a one-stop-shop for people on fertility journeys navigating healthcare, advocating for themselves and trying to ask the right questions to insurance providers and doctors, all while taking on the emotional and relational toll that comes with it.
For readers and followers in the midst of their own fertility struggles, Christina recommends pouring into themselves more than they ever have. She says making time for movement, whether it’s a long walk or a full workout, really helps clear her mind and move from a low energy state to a higher energy state. She listens to positive affirmations in the morning, and lets her thoughts flow freely when she’s overwhelmed.
While not everyone has a partner beside them through this struggle, confiding in someone, whether it’s a family member, a friend, or a professional, can help you make some sense of it all. Seek out community, people who can encourage you to remind yourself how powerful you truly are.
“Even if you haven’t created life inside you yet, you’re capable of incredible things,” Christina says. “You’re worthy of love, joy, and a beautiful life, no matter the outcome.”
Dr. Sandhu stresses the importance of taking it one step at a time, because the journey can feel like a never-ending to-do list. She says to approach it “like a marathon, not a sprint”, always focusing on the right next step.
Secondly, she recommends making a game plan, just like you would for any other major life event.
“Think about your emotional bandwidth, your financial resources, and what kind of support you’ll need along the way,” she says. “A game plan won’t make the journey predictable, but it gives you a sense of direction and control.”
Finally, Dr. Sandhu suggests being kind to yourself. She says self-blame is an easy trap to fall into, especially for women.
“Infertility is a medical condition, not a personal failure. You are not broken, and you’re not alone. The more you treat yourself with compassion and reject that inner shame spiral, the more resilient you’ll be in facing what comes next.”
You can find Dr. Vaneeta Sandhu @fertilitywellnesscollective, and Christina Paruag at @christina.paruag on Instagram.