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By Deirdre Bunyan, registered psychotherapist and counsellor, Ireland.
The World Health Organisation (WHO) (2014) has indicated that 8-12% of couples worldwide experience sub- or infertility and in recent years the number seeking treatment has dramatically increased. The diagnosis and therapy put a heavy psychological and physical burden on most patients.
Several variables have been identified as affecting or being associated with subfertility. It has been highlighted over the years that one of the most difficult emotional consequences is the loss of control over one’s life, as it marginalises other aspects of life (Cousineau & Domar, 2007). Subfertile women often experience a sense of loss of identity and feelings of defectiveness and incompetence (Deka & Sama, 2010). Rather than a medical issue issues with fertility are often depicted as a source of anxiety, fear, sadness and frustration.
The incidence of depression in couples presenting for fertility treatment is significantly higher than in comparable fertile couples. It is important to evaluate women at the beginning of their fertility diagnosis and treatment, as most studies have shown that the presence of depressive symptoms is associated with longer duration of treatment (Smeenk, Verhaak & Eugster 2001; Lok 2002).
Anxiety is significantly higher than in the general population.8-28% of subfertile couples report clinically significant anxiety and generalised anxiety disorder is the most common anxiety disorder diagnosed (Chen, Chang & Tsai, 2004). It is beyond dispute that a diagnosis of subfertility and therapy put a heavy psychological and physical burden on most patients (Greil, Slauson-Belvins & McQuillan, 2010).
Many women have reported finding treatment for subfertility stressful and a cause of relationship difficulties with their partners (Carter, Applegarth & Josephs, 2011). A systematic review of the literature (Verhaak, Smeenk & Evers, 2007) suggests that whilst women starting IVF were only slightly different emotionally from the general population, unsuccessful treatment raised the women’s levels of negative emotions which continued after consecutive unsuccessful cycles.
The psychological needs of patients can only be met by in-depth psychosocial interventions that are best delivered by mental health professionals. Latifnejad, Roudsari and Allan (2011) argue, as subfertility is multifaceted problem, professionals who are working with subfertile couples adopt a holistic approach incorporating counselling in which all psychological, social and cultural needs of an individual are considered.
Mood disorders may be associated with reduced fertility rates but the causality is still unclear and probably variable. A systematic review and meta-analysis (Maleki-Saghooni et al. 2017) acknowledge the role of counselling through stress reduction and thereby increasing the possible chance of pregnancy.
Conversely, in their meta-analysis of prospective psychosocial studies Boivin, Griffiths and Venetis (2011) found that emotional distress experienced as a result of fertility treatment or other co-occurring life events are unlikely to further reduce chances of pregnancy. They recognise, however, the abundant evidence of subclinical and clinical level of anxiety in women about to undergo these treatments. As such, patients may still want interventions to improve quality of life during treatment such as psychological support.
Deirdre Bunyan and team are available for online individual fertility counselling sessions. If you're interested in a no-obligation chat about how counsellling or therapy could help your baby journey, contact us.
References and Links
Boivin J, Griffiths E, Venetis CA (2011) Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies. British Medical Journal, Feb 23; 342:d223. doi: 10.1136/bmj.d223.
Carter J, Applegarth L, Josephs L (2011) A cross-sectional cohort of infertile women awaiting oocyte donation: the emotional, sexual and quality-of-life impact. Fertility and Sterility, 985: 711-716
Chen TH, Chang SP, Tsai CF (2004) Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic. Human Reproduction, 19: 2313-2318
Cousineau TM, Domar AD (2007) Psychological impact of infertility. Best Practice & Research: Clinical Obstetrics & Gynaecology, 2: 293-308
Deka PK, Sama S (2010) Psychological aspects of infertility. British Journal of Medical Practitioners, 3: a336
Greil AI, Slauson-Bevins K, McQuillan J (2010) The experience of infertility: a review of the recent literature. Sociology of Health & Illness, 32: 140-162
Latifnejad Roudsari R, Allan HT. Women's Experiences and Preferences in Relation to Infertility Counselling: A Multifaith Dialogue. Int J Fertil Steril. 2011 Oct; 5(3):158-67. Epub 2011 Dec 22. PMID: 25101160; PMCID: PMC4122831.
Lok IH, Cheung LP, Whung WS (2002) Psychiatric morbidity amongst infertile Chinese women undergoing treatment with assisted reproductive technology and the impact of treatment failure. Gynecologic and Obstetric Investigations, 53: 195-159
Saghooni NM, Amirian M, Sadeghi R, Latifnejad R (2017). Effectiveness of infertility counseling on pregnancy rate in infertile patients undergoing assisted reproductive technologies: A systematic review and meta-analysis. International Journal of Reproductive Biomedicine, 15 (7) 391-402
Smeenk JM, Verhaak CM, Eugster A (2001) The effect of anxiety and depression on the outcome of in-vitro fertilization. Human Reproduction, 16: 1420-1423 World Health Organization (2014) Global prevalence of infertility infecundity and childlessness. WHO.
Verhaak CM, Smeenk JM, Evers AWM (2007) Women’s emotional adjustment to IVF: a systematic review of 25 years of research. Human Reproductive Update, 13:27-36
World Health Organization (2014) Global prevalence of infertility, infecundity and childlessness. WHO.
