Trying to Conceive, When Hope and Fear Exist Together: The Quiet Work of Fertility Counseling

«There's this really huge sense that they're sharing their most innermost thoughts and feelings with me. They're at their most vulnerable moment» says Angela Pericleous-Smith about her patients. As a psychologist who specializes in fertility counseling, she often feels caught between two strong emotions: «that hope of the family that they want to build» and «that fear that they're not going to achieve that». When she accepted a career award a few months ago, she wrote online that she feels privileged to help patients find «strength, clarity, and hope while hope and fear coexist». She says this still sums up what fertility treatment means for many people.

In her experience, IVF «really kind of knocks [people's] core identity of who they are». Infertility can affect how people see themselves, their confidence, and their relationships with partners, family, and friends, especially in a culture where so much is centered around family life. For the past twenty years, Pericleous-Smith has worked to make sure people do not have to face this burden alone. She is Chair of the British Infertility Counseling Association (BICA) and counselor representative of the British Fertility Society. She holds an MA in Psychoanalytical studies and a postgraduate certificate in Counseling and supervision. Since 2004, she has specialized in fertility counseling, supporting individuals and couples dealing with infertility, loss, and grief. At Eshre 2025 in Paris, she was named Best Fertility Counselor at the Fertility Care Awards, which the European Fertility Society started in 2021 to honor leading figures in global fertility care.

Eleonora Voltolina, a journalist and founder of The Why Wait Agenda, met Angela Pericleous-Smith in Paris during Eshre 2025 to record a special episode. As the Eshre 2026 annual meeting is now happening in London (until July 8th), we are sharing this and other episodes recorded in Paris.

A stigma that has not disappeared

Despite growing awareness, Pericleous-Smith says many patients still hesitate to ask for support. «Sometimes there is a little bit of stigma that it's a weakness, [as if] they're not coping, or what will people think of them?», if others find out. Patients also worry that asking for counseling might make clinicians think they cannot cope, or that their treatment could be stopped because they are seen as «a mad patient, or a bad patient».

Men, she notes, have become much more present in her practice since counseling sessions moved online during the pandemic. She credits this partly to privacy: «they're not having to come into a clinic where people can see them». Coping styles, she adds, still tend to differ by gender. She describes men's more practical approach as a «flowchart process»: «we're in this box, so we don't need to worry about that until we get to that box».

Working quietly, relentlessly

Pericleous-Smith says fertility counselors are often the least visible members of the clinical team. «People recognize the doctors, the nurses, the embryologists, but the counselors are quite often tucked away down the corridor somewhere». Becoming a fertility counselor takes years. A counseling diploma is just the start. BICA's accreditation pathway, the first of its kind in the world, then requires at least two more years of specialized training.

Would she ever suggest a patient stop treatment? «I think it would be really unethical of me to suggest to people to stop treatment», she says: that decision belongs to the patient alone. Patients often ask her when enough is enough, though. Her answer: «Enough is enough, when it's enough». When Eleonora Voltolina asked whether Joyce Harper's description, in another episode of the podcast, of seven years of IVF as a trauma is accurate or an exaggeration, Pericleous-Smith agrees it is valid, but not universal. «It's not what the trauma is for us [the counselors, the journalists], it's what the trauma is for the individual in front of you», she says.

Secrecy, privacy, and the children born from treatment

Families often keep fertility treatment hidden, even from the children conceived through it. Pericleous-Smith makes a distinction between privacy and secrecy: she rarely meets parents who are unwilling to tell their children how they were conceived. What worries her more is the message secrecy sends to the next generation, who may one day face their own fertility struggles. With donor conception and surrogacy, new fears come up, especially the fear of not being «the real mum, the real dad». In surrogacy, one main worry stands out: «What if my surrogate doesn't give up our baby?» Pericleous-Smith says this is extremely rare in her experience.

No harm in asking

To anyone about to start fertility treatment who thinks they can manage alone, Pericleous-Smith's message is simple: «There's no harm in going to see the counsellor». Having a space to talk, free of the emotional stakes of family or friends, she says, «is not a sign that you're not coping on your own». She encourages patients to give it a try.