There are no symptoms that denote infertility but the absence of a child (Peterson, 2015).
The World Health Organization define infertility as ‘a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after twelve months or more of regular unprotected sexual intercourse.’ (WHO, 2019).
I have completed a research project titled ‘An Exploration of the possibility of Holistic Counselling being a Core Component of IVF Treatment.’ and wanted to share my findings with you. Unfortunately, because of the limitations of the scope and time for the project I could only focus on heterosexual couples going through IVF treatment which excludes other form of artificial reproductive technology and demographics such as the LGBTIQ+ community, single people, egg or sperm donation and surrogacy.
Infertility has been increasingly defined as a medical condition. But couples present for treatment because they want to become parents as a sought-after social role and biologically driven need.
The couple view infertility as affecting them both rather than an individual diagnosis. That is, irrespective of the cause of infertility. For example, low sperm count, or immobility, endometritis, fibroids or low egg count. The couple experience infertility and IVF treatment together.
The primary themes that emerged in the research....
1. The effects of Infertility on the individual and the couple
Infertility is experienced as a life crisis.
Some of the primary causes of the psychological distress experienced due to infertility can be attributed to anxiety, depression, stress, limited control, stigma, shame, isolation, sexual problems, guilt, lack of empathy, reduced sense of self-worth, disconnection from support networks, uncertain outcome of treatment and the cost associated with treatment.
Most of the studies showed a high prevalence of depression amongst women who also experience more fertility related stress than men. Women may perceive themselves as incomplete or to blame and have a sense of loss of gender identity due to cultural and societal norms about conception
There can be a negative effect on the relationship too and how the couple communicates, connects and infertility can impede their overall intimacy. Marital and sexual dissatisfaction is reported by both genders experiencing fertility issues and treatment. Unfortunately, the stress associate with the inability to conceive can endanger some couple’s relationship.
Couples who do not have children can appear to function in their everyday lives, but they have to manage feelings of isolation, sadness and loneliness. The loss of being a mother or a father, their ability to produce and genetic continuity. Loss plays a significant role in the couple’s infertility journey and can be overwhelming. For example, the loss of support networks including family, loss of sexual satisfaction and their ability to conceive naturally and potential other losses in treatment like a disruption to a cycle or a miscarriage.
2. The impact of IVF treatment
There are many dimensions to seeking parenthood like the emotional, cultural, spiritual, moral, psychological, and ethical aspects. But, these can often get overlooked due to the focus on the biological reasons for infertility. Research found that common psychological concerns for both men and women undergoing infertility treatment are present particularly at the stages of egg retrieval, the fourteen day wait and pregnancy testing.
The emotional distress experienced because of treatment may not be the cause of reduced IVF success rates but rather this strain impacts the couple’s ability to complete the ideal number of cycles.
The research found that thirty percent of couples stop treatment early because of the psychological burden.
3. Counselling as an intervention for infertility and IVF treatment
Worldwide guidelines and legislation state that the provision of counselling and psychosocial intervention is necessary due to the emotional distress couples experience in infertility and should be provided throughout the process of treatment along with recommending that clinics have a patient-centered care approach.
The importance lies with ensuring the woman’s body and self-identity are recognised while undergoing medical interventions. Because adaptation and creating meaning in infertility is identified as being an important cognitive process that needs to be undertaken which could be facilitated by a counsellor.
Counselling is often sought when the relationship is already presenting signs of infertility-induced distress, problems and concerns.
4. Influence of counselling on emotional, psychological, physical and spiritual wellbeing
A holistic approach of counselling as part of the care for infertile individuals and couples is strongly recommended. By employing a strength-based approach, the counsellor needs to remain aware of the multifaceted impact of treatment on the couple’s life and roles as they must cope with infertility and treatment. Core spirituality is stated to assist in coping with negative life circumstance and thus improves adjustment and wellbeing. The appraisal of infertility from a spiritual or religious perceptive could encourage acceptance and positive perception of infertility.
It is essential the counsellor adapts a tailored intervention for the couples emotional, psychological, physical, and spiritual wellbeing while considering their culture and traditions.
I carried out interviews with accredited counsellors who specialise in the area of infertility and spoke to both men and women who experienced infertility and sought IVF. The research and data collected in the interviews validated the existential, psychological, emotional, and physical impact of IVF treatment on the individual and the couple.
The emotional distress experienced by both genders during IVF treatment is unequivocal both in the literature reviewed and the findings.
Women appear to internalize the process and approach it from an emotive level versus men who appear to play the “strong, supportive, silent role”. The literature reviewed did not capture the social exclusion experienced by some women because they do not have children or the religious stigma which can still exist for some people who opt for IVF. The interviewees who experienced IVF reported “not getting the support that I thought I should have got from my family and friends”.
The emphasis in the interview findings was on the enrichment that can take place in the couple's relationship by going through this crisis together, which was not mentioned in the literature reviewed.
Couples appear to believe in the benefit of counselling and that it should be optional, accessible, and affordable providing support, psychoeducation, coping strategies and available throughout the process.
I found in the literature along with the data findings that psychological and psychosocial distress is part of the process of infertility and treatment, particularly for women.
The medical intervention and the desire to have a child cannot be disconnected.
The couple face infertility and treatment together, it is not experienced as a medical diagnosis but the absence of a child. Moreover, the impact on the relationship, gender differences in the roles, stereotypes and coping styles were validated in the literature reviewed and the data analysed.
Research indicated that early cessation of treatment is common due to the inability to manage the stress of the physical and psychological impact of treatment and it is this that can impact on the successful outcome of pregnancy after multiple cycles.
The findings of the research and data is that counselling may be sought when there are symptoms of infertility-induced distress, the levels of loss are mounting, and burnout is present. Barriers exist to seeking counselling and were named in the research as, having adequate support and ability to manage stress, and not knowing where to seek support from and the cost.
Counselling can assist the individual and couple manage their distress by tailoring the approach to meet their needs providing physical, emotional, psychological and spiritual support.
The research project has discovered that the impact of the stigma and medicalization on men is lacking in research available and further research needs to be carried out on their sense of isolation, the stereotyped norms, and the impact the support role has on their sense of self and well-being.
Each couple make a choice to embark on treatment however they do not choose childlessness. The distress that the treatment can bring is all encompassing and without adequate support in place can lead to psychological and psychosocial issues.
I believe that counselling can support you from the outset when you embark on IVF treatment. The experience of seeking out parenthood with the support of medical intervention might be new for you and the coping strategies you might have used in the past may not be adequate to support you now. Remember you are a whole person experiencing infertility on all levels of your being, not just your body. Take care you yourself and each other on this journey to parenthood.
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