Infertility

Psychological Factors

Psychological aspects of Infertility

Patients frequently ask if the cause of their infertility could be psychological (relating to the mind or its function). This raises many interesting points. Research is at present going on in this important field and essentially two main issues arise :-

1.Psychological factors causing Infertility

Either singly or in combination such factors include stress, tension, depression, guilt, lack of self-esteem, anger, resentment - in fact the whole gamut of human emotions.

For the male, psychological factors may work in one of two ways. Firstly, they can affect his performance of the sexual act, causing failure of erection (impotence) or reduction of sexual drive, thus decreasing the number of times intercourse occurs over the fertile period, if it occurs at all. Secondly, psychological factors may affect the pituitary gland and interfere with hormonal control of sperm production. This not only reduces sperm numbers but also may lead to adverse changes in sperm quality.

Adverse psychological factors may decrease the female's sex drive (libido) and so reduce the frequency of intercourse. They may also lead to painful spasm of the "vaginal" muscles, so preventing intercourse from taking place. These factors may also exert their influence on the woman's pituitary gland and interfere with ovulation. This in turn may lead to changes in her menstrual cycle such as absence of periods or irregular bleeding. Thus the question becomes not "if" pregnancy can occur, but rather "when"?

However, despite all the above, a very small group of patients who have been infertile for a number of years occasionally do conceive during the course of infertility investigations, after they stop treatment or when they change doctors. One wonders if these are cases of so called "psychological infertility"? These are definitely the exceptions rather than the rule.

In addition the fact that a couple achieve a child with treatment usually does not mean that their problem has been solved and so the majority will require additional treatment to achieve additional children.

2. Psychological factors resulting from Infertility

Pregnancy is part of the natural progression of a couple's relationship. In most societies, prevention of pregnancy, ie contraception, is far more topical than infertility. Infertility comes as a severe shock to couples who have probably taken their fertility for granted. It presents them with one of their first major crises together. This life crisis can lead to many reactions, often following a pattern, but varying in degree from person to person. Such reactions usually include surprise, denial, anger, isolation, guilt, grief, and sometimes resolution. Each member of the couple may be at a different stage in the sequence of reactions, and this difference will further affect the couple's inter-personal relationship and communication.

It is valuable to review these reactions in a little more detail. This may help to show you that such feelings and fears are not unusual or unnatural, no matter how strange they may seem.

Surprise

Their infertility obviously comes as a surprise to couples who have taken normal fertility for granted, have used birth control, and even planned their families. Ignorance of normal fertility and unrealistic expectations may well aggravate their surprise.

Denial

Although it may seem illogical, this mechanism does occur, and it seems necessary to allow the mind and body to adjust to the newly discovered infertility problem. Comments such as "1 don't really want a child anyway" are frequently made, even though the person really desperately desires to become pregnant.

Anger

Once a couple acknowledges infertility and goes for investigation and treatment, to a varying extent control of the couple emotional and physical wellbeing is surrendered to medical personnel. This may result in anger. Such anger can be real and directed towards family members who continually ask about the absence of children or offer inappropriate advice such as "Go away on holiday" or "Stop working". The anger may not appear rational and directed towards their partner, doctor or social groups.

It may be important to ventilate this anger with professional assistance. If this does not occur, frustration, mistrust and embarrassment will ensue, which can further aggravate the next reaction, viz. isolation.

Isolation

Infertile couples often feel alone. This is partly explained by the fact that sexuality is often equated with fertility. Thus the couple or one of the partners may feel too embarrassed to discuss the fertility problem. Isolation is thus further increased. Isolation may also lead to the indirect acceptance of advice, often inappropriate, or the use of alternative scientifically unproven non- medical options. Unfortunately this also makes them fair game for unscrupulous "non-medical practitioners". The isolation reaction also prevents the seeking of support so badly needed by the couple. To overcome this, fertility education and contact with infertility support groups may be helpful.

Guilt

A guilt reaction is common, and yet is often difficult to explain. It can follow the realisation that one partner is the cause of a couple's infertility problem, and thus is denying the other partner a child. Sometimes an infertile person will look for a guilty act to put his or her infertility into a cause and effect relationship, eg failure of religious observance, premarital sex, abortion, unkind wishes and so on.

Guilt is difficult to discuss and share. Furthermore, guilt can add to the already poor ego strength of an infertile person and increases the feeling of being bad. The guilt feeling may lead a person to try and "atone for his or her sins" and he or she may often seek some form of religious assistance. Guilt can also lead to self-destruction attempts through alcohol, drugs, apathy, weight loss or gain. Obviously, in reality there is no relationship between an individual's worthiness and fertility!

Grief

If a couple fails to have a child or gives up trying, grief is an inevitable result. For the non-grieving person, whether the other half of the couple, a close friend or a relative, it is exceedingly difficult to understand how one can grieve over a child who never existed. However, the grief is just as real and painful, possibly more so, than if a real loss had occurred. Real losses have various related rites that help overcome grief, whereas with infertility no such rites exist. It should be recognised that the grief expressed is real, and no attempt should be made to prevent the person from expressing it. Sometimes counselling may be needed to help work through the grief.

Resolution

Usually, a state of resolution and acceptance occurs, and the individual or couple are now able to cope with their respective fertility status, as well as the medical procedure(s) necessary to help them increase their fertility.

When considering psychological reactions arising from infertility, it should be Remembered that:-

• The reactions may affect each member of the couple to a different degree, in different combinations, and this may lead to serious effects on a couple's inter-personal communications.
  
• These reactions, often linked with poor communications, can easily affect the couple's sex life, which in turn can further aggravate their relationship, and so a vicious cycle is set in motion.
  
• The reactions may be aggravated by the fact that the couple may have to undergo numerous tests, many different forms of treatment, and eventually have to make rational choices regarding alternatives to treatment, eg adoption, artificial insemination by donor sperm, or the use of donor eggs, to mention a few.
  
• Thus, if a couple feels that they could use some help with problems associated with their infertility, the next step is to approach your doctor. The doctor will then refer you to an experienced counsellor such as a psychologist or social worker who has experience in helping people struggling with infertility. Initially it is possible that only one of the partners will be prepared to take this action. The comment is heard all too often that "... my husband would never go". If this applies to you, my advice is that initially you should seek help alone. The counsellor will usually find a way to assist you.