COPING STARTERGIES OF INFERTILE MARRIED COUPLES

          The term infertility refers to the inability to naturally conceive, carry or deliver a healthy child. Women who are able to get pregnant but have recurrent miscarriages are also said to be infertile.

In recent years, the number of couples seeking treatment for infertility has dramatically increased due to factors such as postponement of child bearing in women, development of newer and more successful techniques for infertility treatment and increasing awareness of available services.

Infertility can have a negative impact on marital and sexual relationships.

About 5% of couples living in developed world face primary infertility (inability to have any children) or secondary infertility (inability to conceive or carry a pregnancy after one or more children)

It is an issue that all the counsellors should be aware and understand if this growing client group is to receive therapeutic support they need and deserve.

My aim of being a counselling psychologist led me to reflect on the psychological and emotional impact of infertility on those couples and what role counselling and counsellors have to play.

IMPACT OF INFERTILITY:

The extent to which infertility exerts negative psychological impact can differ between individuals and couples and is likely to be due to many factors including their desire for child or family, past experience, family history, past and present relationship, cultural beliefs and outcome of the treatment.

IMPACT ON FEMALES:

• Females experience can be both complex and painful.   It is generally characterised by the feeling of isolation from her partner or other social groups.
• Females can feel unsupported and misunderstood throughout the experience, which adds to their despair and isolation.
• Pregnancy and motherhood is perceived as femininity, and so infertility can evoke a sense of failure as a woman, as a person and she can feel that her body has failed her. This in turn affects her self-esteem.
• For females, who desire a child, treatment can increase the possibility of having one and for some it becomes overwhelming, which creates a sense of urgency about finding a solution to the problem.
• Women with infertility feel anxious or depressed as those diagnosed with cancer, hypertension or receiving from heart attack.
• Changes in immune function associated with stress and adversely affect reproductive function.
• The infertility treatment itself can cause stress in females. Researchers found that women presenting for INVITRO FERTILIZATION (IVF) were more depressed, had lower self-esteem and were less confident than a control group of fertile woman and after a failed IVF cycle, they experienced a further lowering of self-esteem and an increase in depression relative to pre treatment levels.

IMPACT ON MALES:

• While many males have a strong desire for a child and a family, unlike many females they tend to have a pragmatic ambivalence towards fatherhood and children. That’s why they are happy if it happens and can accept it if it doesn’t.
• Males tend not to express their negative feeling about the treatment process or how they feel about having or not having children to their partner.
• Their partner may mistake them as not caring, but on the contrary, it is often because they care about their partner so much and that they adopt this position.
• The experience for males can be an anxiety filled one that poses a major threat to their masculinity. But it is not necessarily an experience they either want or feel able to share with their partner or anyone else.
•  Another feature of the experience for males is that they worry about the pressure on their partner, and their partners increasing desire for a child, and the prospect of what might happen in the future if they do not achieve their goal. So it can be a time of great insecurity for males.
• Men’s reactions may depend on whether they or their partners are diagnosed with infertility. When the problem is with their partners, men do not report being distressed as women’s do. But when men learn that they are the ones who are infertile, they experience the same level of low self-esteem, stigma and depression as infertile woman do.

IMPACT ON COUPLES:

• A combination of factors, including females sense of isolation, male pragmatic ambivalence, growing resentments, the medical, the emotional and financial pressure of treatment are uncertainly about what the future holds can exert extreme stress on the couple relationship. This normally manifests the distance between them.
• The result of this distance is the lack of communication, which results in separation.
• Throughout the experience, couples tend to oscillate between periods of distance and closeness and the nature and frequency of this distance is likely to be a key factor in whether couples stay together during beyond the experience.

SOCIAL IMPACT:

• Infertility is a problem of global proportions. The WHO estimates that 8-12% of couples around the world experience difficulty conceiving a child. In developing countries, over fertility rather than infertility has been the focus of family planning programs.
• The consequences of infertility in these countries range from economic hardship , to social isolation, violence and denial of proper death rights
• .Many families depend on children for economic survival, especially in old age.
• In oriental cultures reproduction is one of the highest valued factors.
• A psychological crisis may occur when reproduction appears impossible. The way in which people deal with infertility is at least partly affected by the values and socio- cultural norms of the community in which they live.
• The experienced social sufferings of women due to childlessness are difficulties concerning integration into the family-in-law and their powerless status in the community without children

THERAPIES THAT MAY HELP:

COUNSELLING:

• ·    Referrals for short term counselling are common, especially to increase coping strategies, or to provide help with making decisions.
• ·  Patients who experience prolonged changes in mood or sleep patterns or who have relationship problems should seek a more comprehensive evaluation as these may be signs of anxiety or depression.
• ·    Counselling should begin before patients start infertility treatment, as some studies suggest that depression, anxiety, and stress may help to increase the chances of not giving birth to a child.
• ·    Infertility impacts on males and females in distinct ways and that they tend to deal with it in their own way. It follows that they lack have distinct counselling needs.
• Counselling Females:
• · Females experience a sense of high level of negative emotion. Here long term counselling can be of great benefit as they feel and need support.
• ·    In addition some points which can be particularly difficult for females, where counselling can help. These include time around treatment. E.g. at critical points such as miscarriage, anniversaries of due dates of lost pregnancies, when friends or relatives fall pregnant.
• Counselling Males:
• · Many males who do access counselling will reflect that if they had known what counselling was would probably gone for it sooner, especially in cases of male factor infertility.
• ·  They also express their concerns about confidentiality that their partner might find out how they really felt. This can act as a deterrent.
• ·   Yet many males felt that they want to talk in private to someone outside the family about the trauma of the experience.
• ·    Males also talk about their feelings trend to want to gain some kind of understanding about infertility and its impact.
• ·   This includes a desire to understand the medical diagnosis and procedures and what the females experience emotionally and physically, so that they know how to help their partner.

Counselling Couples:

• ·  Couples can benefit from counselling at each stage of infertility journey, chiefly through the facilitation of communication and understanding between them.
• ·  Couples can also make use of counselling to solve various issues like such as decision making around treatment options, miscarriages, failed cycles and when they achieve a pregnancy for instance.

Limitations of Counselling:

• There are feelings of failure (females) and inadequacy (males) which contribute to the low uptake. But, unlike medical intervention, counselling cannot provide a solution to the problem of infertility and so it is often not considered or offered.
• Counselling often tends to focus on realistic goals and objectives which clients do not always find useful and some can find counterproductive.
• At the time of treatment, couples feel a need to be optimistic and strong cope and are full of hope for the outcome of the treatment cycle and their future. They may not wish to discuss the painful options at this stage.
• Counsellors working with this client group need to be aware of this and be able to work with clients in a way they find beneficial.

 PSYCHOTHERAPY:

·              Specific types of therapies such as interpersonal therapy which focuses on improving relationships or resolving conflicts with others, cognitive behavioural therapy which identifies and tries to change unhealthy patterns of thought or behaviour can give relief to infertile patients suffering from mild to moderate depression. Researchers have shown that psychotherapy can be helpful for anxiety or depression whether delivered individually, to couples or in a group.

RELAXATION TECHNIQUES:

·         Given that infertility and its treatment often cause considerable stress, experts recommend various relaxation techniques.For e.g. mindfulness meditation, deep breathing guided imaginary and yoga promote stress management.

MEDICATIONS:

·          Antidepressants and anti anxiety medications are useful when symptoms are moderate to severe.

CONCLUSION:

          In light of all the data suggesting that psychological symptoms may interfere with fertility, success of infertility treatment and the ability to tolerate ongoing treatment; interest in addressing these issue during infertility treatment has grown.

Since psychological factors play an important role in the pathogens of infertility, exploration of this is also an important task to manage this divesting problem, which has cultural and social impact.