Psychosocial and psychosexual factors of infertility
Psychosocial aspects of infertility
The psychological impact of infertility on a couple can be considerable. Commonly reported feelings include guilt, anger, depression, anxiety, inadequacy, grief, loss of control and low self esteem. Men and women relate differently to the diagnosis of infertility. Women are reported to suffer greater psychosocial stress and higher levels of depression where as men are more likely to adapt to childlessness with less distress. Only when male factors are diagnosed as the source of infertility, do men start reacting negatively. There are increased feelings of depression, social isolation and failure. Feelings of despair, anger and helplessness can be profound, particularly when infertility is prolonged. Problems may arise in the relationship due to various factors. Women may feel angry, antagonistic or resentful towards an infertile partner or where conception has been delayed because of career aspirations or when one partner did not feel ready for parenthood. The couple may also have poor communication skills, hence they might not be able to disclose and share their feelings with each other.
However infertility can also have positive effects with couple feeling closer, improved communication, increased sensitivity to partner’s feelings and a sense of closeness.
Most fertility clinics try to address the psychosocial impact of infertility in addition to the medical aspects. They have appropriately trained counsellors who form a vital link in the management of infertile couples.
Any counselling session will include three agendas, the primary inability of the couple to have children, the interests of the child to be conceived and finally the treatment process involves different therapies and may be unsuccessful. This may lead to further stress and disappointment.
One of the most difficult aspects of infertility treatment for a couple is deciding when to stop. The range of treatments available means that another treatment can be started following failure of one mode of treatment, thus creating an endless cycle of treatments. This leads to disillusionment and despair at the end of these cycles. Many couples are driven by the fact that the next treatment might be successful and making the decision to remain childless or apply for adoption is something that they will need help with.
Psychosexual aspects of infertility
The sexual demands that are placed on a couple are considerable particularly when the pressure to have intercourse around the fertile days or at the culmination of an intense regimen of ovulation induction. The recreational aspect of sexual relationship is often lost in the necessity for men to ejaculate at these key times, leading to the abandonment of sexual intimacy during non fertile times of the month. The same applies when the male partner has to produce a semen specimen as required for various assisted reproductive techniques.
Men can suffer from various sexual problems such as erectile problems, sexual apathy and avoidance of sexual intercourse particularly if they are the source of the fertility problem.
Although infertility is the source of these sexual problems, the couple’s infertility could be associated with these problems. It is rare that sexual problems are the primary or single cause of reproductive failure but it is important that sexual competency of both partners be assessed to ensure that the couple are engaging in full sexual intercourse in relation to frequency and timing.