Each year, millions of people discover that they are unable to bear children. People diagnosed with infertility face an overwhelming amount of stressors associated with biological, psychological, and social factors related to the inability to conceive. The goal of this paper is to gather information on infertility and the resources available to people who suffer from this condition. After providing general information on infertility, and treatments associated with it, this paper will look at which factors underline people’s experiences and their psychological well-being.
Next, the hystorical background will be detailed. Finally, particular attention will be devoted to the role of advocacy what resources are already available and what therapeutic tools are needed to enhance the well-being of people dealing with the negative effects of infertility. While the stereotype of infertility may be an aging upper-class career woman, the reality is that infertility does not discriminate based on age, gender, race, religion, socioeconomic status or sexuality. Approximately one in five couples worldwide are infertile, one in eight American couples, with 7.3 million couples and 6.7 million (about 11 percent) women of reproductive age infertile in the U.S.
This statistic does not include women who are unmarried, but still wish to carry a child but are unable to do so. This subset of women, arounf 12%, is known as impaired fecundity. Moreover, 7.3 million women have received infertility treatment in their lifetime. Treatment is a broad term that can range from advice, medical help to prevent miscarriage, test on woman or man, ovulation drugs, and artificial insemination. These are listed in the order of popularity in which they are used with advice being the number one resource and artificial insemination being the less commonly used treatment. Infertility affects both women and men, and is defined as the inability to either conceive or to carry a pregnancy to a live birth after a year or more of unprotected intercourse.
Several steps need to occur in order to conceive. These include: the release of an egg from an ovary, a man’s sperm must fertilize the egg, the fertilized egg must travel down the fallopian tube and lastly it must inplant in the uterus. Infertility can result from any distruptions in any of the above specified steps or any issues in the reproductive sytems. One third of infertility is due to male factor, one third to a female factor, and one third of the time the problem lies with both individuals or cannot be identified. Disruption of testicular or ejaculatory function, hormonal disorders, and genetic disorders can all cause infertility in men. Women fertility can be affected by disruption of ovarian function, fallopian tube obstruction, and abnormal uterine contour. Lifestyle factors, age, drug and alcohol use, and obesity can also impact infertility in both men and women.
Infertility can be either primary or secondary. Primary infertility describes the inability to conceive a pregnancy, while secondary infertility is defined as the inability to become pregnant, or to carry a pregnancy to term, following the birth of biological children. Over the past couple of decades, the introduction of fertility treatments and the use of Assisted Reproductive Technology (ART), specifically In Vitro Fertilization (IVF), have become the means of choice by which individuals with infertility can make parenthood possible.
However, experiencing fertility issues, as well as going through increasingly aggressive fertility treatments can have a significant psychological impact on the affected people, both as individuals and as a couple. In fact, both women and men can be affected in their individual and social well-being, which are based off of unique psychosocial consequences (e.g. social welfare and public health issues), when diagnosed with infertility. There has been a fairly recent shift in how infertility is being perceived in that it is now considered a social and emotional condition in addition to a medical condition.
Infertility is ranked as one of the most stressful experiences in life along with death, divorce, and deadly diseases, such as HIV and cancer. Numerous studies point to the psychological impacts of infertility. Common emotional responses to infertility and its treatment are anger, hurt, fear, guilt, frustration, depression, and sadness. Anger, hurt, and fear are often among the strongest feelings experienced. Lack of control of the situation, pressure and remarks by others, feelings of anger toward people with children, or toward abusive parents, or even toward medical professionals, seem to be fueling some of the anguish experienced during such proving times.
Additionally, many also deal with guilt for delaying childbearing, previous abortions, birth control methods, STDs, premarital or extramarital sex, or other reasons they attribute to infertility. In a study of patients with long-standing medical conditions, Domar et al. (1992) found that the rate of depression among long-term infertility patients was the second highest after cancer, with one in four experiencing severe depression.
Verhaak et al. (2005) found that more than 20% of the women in their study showed clinical forms of anxiety and/or depression six months after the last unsuccessful treatment and Wischmann, Stammer, Gerhard, & Verres (2002) found that 15 to 20 percent of individuals attending infertility clinics were in need of psychiatric help and over 60% intended to take up counseling. One of the major and most controversial feelings associated with infertility is loss. Infertility involves many types of losses such as loss of potential children, loss of self-esteem, loss of control over one's body, the devastating loss of having one or more miscarriages, and loss of a potential relationship with a child and hence acceptance of ones’ condition and coming to terms with the reality of permanent infertility.
Even though losses associated with infertility do not always relate to death, they often endure over a long period of time, and in most cases, many types of loss occur simultaneously. These complicated losses might cause feelings of grief, depression, disappointment, and sadness over a long period of time that often spans over years. A major criticism to the early infertility research was that most of the studies focused solely on women and grossly underestimated, or simply excluded men’s reaction to this painful life event. To fill this gap, some studies have examined the dyad’s response to infertility.
A study of 200 couples who went through IVF revealed that 15% of men and 49% of women identified infertility as the most stressful time in their lives (Freeman et al., 1985). Wichman et al. (2011) also concluded that both women and men experienced significant psychological distress in the context of IVF. In sum, for many couples, infertility is a major life crisis and psychologically stressful. As couples learn about their condition, they first need to make a series of difficult decisions regarding family bulding options, whether to pursue treatment, the type of treatment to undergo, when to terminate treatments and economic considerations associated with the high costs of treatments.
The cost of treatment is significant, ranging between 12,000 and 15,000 excluding medication, and in most states is not covered by medical insurance. According to Resolve, the national infertility association, only sixteen states are mandated to offer or cover some infertility treatment (Resolve, 2018). In Texas for instance no coverage is required. Insurers are only required to offer fertility treatments coverage and employers may choose whether or not to include it as part of their employee health benefit package.
Couples’ emotional, monetary, and physical resources are likely to weaken or even become depleted by the time they terminate treatment. To achieve a positive outcome, the majority may have endured years of costly and invasive medical procedures that have proved extremely challenging. Also, infertility affects couples’ relationships and poses serious stress on intimacy. Both partners report a loss of sexual desire due to the pressure to conceive, diminished privacy, and lower self-esteem. Sexual relations become tied to the ultimate goal of childbearing and less associated with a desire for closeness. Intimacy becomes tied to schedules and charts, which turn into public knowledge of doctors and medical staff.
Finally, since sexual relations are associated with reproduction, infertility can make people feel “damaged or defective.” Despite the large evidence of suffering among the couples who undergo fertility issues and treatments, very little, if any, counseling is provided by the fertility clinics to address the emotional needs of these individuals. Additionally, Boivin (2003) points to the lack of studies examining the effectiveness of psychological interventions as a means to treat infertility-related distress. Donnis (1984) believes helping individuals learn compassion and forgiveness for themselves is one way for them to learn to deal with guilt.
In a study conducted by Domar et al. (2000) where 184 women were assigned to three groups - a cognitive-behavioral therapy (CBT) group, a support group, and a control group, - it was found that the women in the CBT group significantly experienced decreased levels of anxiety, depression, and marital distress both at 6-month and 1-year follow-up as compared to the women in the other groups. Additionally Faramarzi et al. (2008) found that CBT therapies as compared to pharmacotherapy are most effective in reducing depression and anxiety in women.
Because individuals who experience infertility can feel an array of different negative emotions, because their well-being is affected negatively, and because those who wish to seek medical treatment such as different types of medication, artificial insemination, or assisted reproductive technology, can be affected financially, it is essential to make a collaborative effort in the medical, social and emotional aspects of infertility to foster the person’s well-being. It is also imperative to establish collaborative alliances between medical and mental health practitioners.
This type of alliance can help people build copying skills to face the infertility roller coaster while going trough treatments and it can help coordinate medications. For example, people who take medication for mental health related issues can work closely with all health providers involved as some medications, like antidepressants can increase the risk of infertility or affect the baby. A collaborative effort would be beneficial to safely take the person off of medication while undergoing counseling.