Background: Infertility-defined as failure to achieve a clinical pregnancy after 12 months or more of regular unprotected intercourse-affects millions globally and carries profound psychosocial sequelae for couples. Objective: To synthesize current evidence on (1) public and patient knowledge and perceptions of infertility, and (2) the psychosocial impact on couples, including mental health, relationship quality, stigma, and financial toxicity; and to outline implications for clinical practice and policy. Methods: Narrative review of international guidelines and peer-reviewed research (1997–2025). Results: Knowledge gaps and misconceptions remain common across regions; stigma is pervasive and gendered. Infertility is associated with elevated depression, anxiety, stress, impaired quality of life, sexual difficulties, and relationship strain. Dyadic coping and evidence-based psychosocial care mitigate adverse outcomes. Financial barriers amplify distress and inequities in access to care. Conclusion: Integrating routine psychosocial care, strengthening couple-focused interventions, and addressing affordability and stigma are crucial to improve outcomes.