Hmm, depression, lethargy, lost libido and fertility issues... sounds like a hormone problem, perhaps low cortisol or low thyroid. Most drs don't test thoroughly and if they do they view the results too casually (I had a Dr who left me feeling half dead nearly a decade without telling me my thyroid was off or medicating me for that, because the test result was "only a bit over range" meanwhile on that test it's actually ideal to be in the lower half of the range, so I was actually really far off of ideal). My point is, most drs will be lazy and call something "good enough" when it isn't. But if you find a doctor who is thorough (they tend to call themselves functional or integrative practitioners- that's a philosophy not a specialty), I bet they can find some hormone issue, and medication for such issues is fairly low risk and effective. Good luck!

if there is no improvement after a year of counseling, you need to cut your losses.

I could tell you a very long story about someone I know but the punch line is. 1: Those were your babies too 2: Staying because she is depressed won't fix this 3: Trying for another baby won't fix this 4: Succeeding and having a healthy baby won't fix this. .... because that's not how depression works. Only she can fix that and it sounds like she isn't willing to make the effort.

There's at least 2-3 issues here. There's the physical issue of the miscarriage and all the physical and hormonal things that can go wrong after one. There's her depression after the miscarriage which sounds like she needs more than just taking to a therapist twice a month. And there's also y'alls relationship. If you want to save it I'd highly recommend talking to a couples therapist who specializes in either partners with depression or post miscarriage / medical issues. There's also support groups both for people who have lost pregnancies/ children and for people with depression. But clearly this isn't working for you and at this point it doesn't sound like it's getting better on its own.

Twice a month is not enough. I never had a miscarriage but have been a cutter since I was 13, and I'm 31 now, and know from experience that 2 times a month for depression that extreme isn't enough. For the longest time, I was going 8 times a month, twice a week every week. Depression is a monster of a disorder but saying such things to be suggestive of one thing to be another is messed. As for trying a 4th time may have the same results. She needs out patient therapy. Where she is forced to leave the house for therapy. Your local hospital can direct you to the resources needed for that. My last piece of advice: take care of yourself too. Do not let her depression drag you down. Good luck OP.

Do. Not. Have. Kids.

I wish I could give you a thousand upvotes.

I would recommend adding a 3rd counselling meeting, one for the two of you. She had trauma, but you're part and parcel of the (what should be) cohesive unit. I really think both of you would benefit from couples counselling to get the communication and feelings out there. She might be blaming herself and feeling alone because of what happened, and in turn pushing you away and feel like you're drifting. Working that much is also not a very good thing, especially re: communication. A text or whatsapp doesn't cut it. Good luck bro

Whatever happened to "for better or for worse"?

You're probably right