Roughly 15 percent of American couples are considered infertile, according to the National Institutes of Health. Infertility, the inability to conceive after a year of trying, affects both men and women equally, about a third of the time for each, with the remaining third left to unknown causes. For those who are unable to have children, even after fertility treatments, the psychological impact can affect every part of life, causing depression, anger, and frustration. For women, these effects only worsen if they’re unable to come to terms with not having a biological child.

“It was already known that people who have infertility treatment and remain childless have worse mental health than those who do manage to conceive with treatment,” said Dr. Sofia Gameiro, lead author of a new study on the matter, in a press release. “However, most previous research assumed that this was due exclusively to having children or not, and did not consider the role of other factors.”

Gameiro and her colleagues found that women who were unable to have children, and who couldn’t accept that fact, were 2.8 times “more likely to develop clinically significant mental health problems” than those who just let it go. Women who already had children, but longed for more, were 1.5 times more likely to have mental health issues. Women’s mental health was also less likely to suffer if the source of infertility were the men in their lives, if they started fertility treatment at an older age — they probably assumed it was just their age that rendered them infertile — if they lived or cohabitated with a partner, and if they were more educated.

“Our study improves our understanding of why childless people have poorer adjustment,” said Gameiro, a lecturer at the School of Psychology at Cardiff University in the UK. “It shows that it is more strongly associated with their inability to let go of the desire to have children.” She said that women who focused their attention on other life goals, such as a career, could alleviate some of their distress.

The study was conducted in the Netherlands, among 7,148 women who started fertility treatment between 1995 and 2000. They answered questionnaires between 2011 and 2012, which asked about various factors, such as their age, marital status, infertility between them and their partners, and various forms of treatment. Their mental health was also assessed, based on how they felt over the month prior to questioning. Six percent of women still wanted children at the time of being surveyed, a finding associated with worse mental health.

Gameiro said that “there is a moment when letting go of unachievable goals is a necessary and adaptive process for wellbeing.” In these cases, it might be better to adopt a child in the interest of not only bettering their own mental and physical health but also enriching the life of a parentless kid. A 2012 study published in the Journal of Epidemiology & Community Health found that childless couples who adopted children cut their risk of early death by about 50 percent. Adopted children are also more likely to benefit since they’re afforded educational and financial resources, as well as the emotional support needed to grow up healthily.

Source: Gameiro S, van den Belt-Dusebout AW, Bleiker E, Braat D, van Leeuwen FE, Verhaak CM. Do children make you happier? Sustained child-wish and mental health in women 11-17 years after fertility treatment. Human Reproduction. 2014.