fertility news

The psychological response to the infertility experience is eloquently described in the following piece written by a patient and published in a Resolve newsletter.

“My infertility is a blow to my self-esteem, a violation of my privacy, an assault on my sexuality, a final exam on my ability to cope, an affront to my sense of justice, a painful reminder that nothing can be taken for granted. My infertility is a break in the continuity of life. It is above all, a wound- to my body, to my psyche, to my soul.”

Loss comes in many forms for those struggling with infertility. The ability to conceive a child the “natural way” is something we take for granted and the inability to do so takes an emotional toll that has been likened to getting a fatal diagnosis. Consider the following losses that have been described in the literature.

Loss of a relationship: the infertile often isolate themselves from family or friends and may secretly fear losing their spouse if they are unable to conceive.

Loss of health / loss of acceptable body image: the perception of many patients is that they are defective. Sex for procreation rather than love, lack of spontaneity and the constant intrusion into the most intimate aspects of the couple’s life are contributing factors. Furthermore, the otherwise healthy infertile patient is often asked to have surgery and take medications that reinforce the concept of being sick.

Loss of status or prestige: Biblical references to “Be fruitful and multiply,” underscore the great value society places on procreation. The inability to achieve this goal can impact the couple’s sexual identities and lessen their perceived value to society. This is often described by patients as “Feeling as if they don’t belong,” or “Like a second-class citizen.”

Loss of self-esteem: This is likened to making the decision to consult with a psychiatrist or psychologist; the patient must admit there is a problem. Self-esteem is often derived from accomplishing basic goals and validated by how a person is perceived by others but for many patients the most important goal is getting pregnant. This desire may become so painful that it evokes intense feelings of jealousy or resentment toward other pregnant women, feelings that are upsetting to them and which tend to reinforce their already negative self-esteem.

Loss of security: the time and cost of infertility treatments can strain a couple. On a deeper level, the insecurity they experience regarding the fairness and predictability of life increases their insecurity.

Loss of the hope of fulfilling a fantasy: the dream of parenthood and the accompanying “psychological passage to adulthood” that is implied may never be realized.

Loss of something or someone of great symbolic value: the loss of the child that never was and the sense of family that the child embodies.

The emotional response to loss is grief however a syndrome of feelings has been described by Barbara Eck Menning, an infertility counselor and founder of Resolve, and is based on Elizabeth Kubler-Ross’ five stages of death and dying. These are

Denial and Isolation: Most people use this coping mechanism in some form. It is a short term shock response to bad news that some return to when there are new developments or they can no longer cope with the situation.

Anger: People express anger in many different ways. It might be anger at God: "Why me?" It may be envy of others: Some people get pregnant when they don’t want a child and I can’t conceive.” Finally, the anger may be projected on their caregivers- doctors and nurses, or their spouse or families.

Bargaining: This stage is typically short-lived and involves a deal made between the patient and God.

Depression: Mourning for the many losses described above and often past losses as well.

Acceptance: This is not necessarily a "happy" stage and may be void of feelings. Moreover, not everyone reaches this stage.

Part of what makes infertility different and more difficult to grieve is that some of the loss is abstract. These losses include the loss of a dream and all the hopes this dream represents, children, genetic continuity and the experience of pregnancy. There are no accepted common societal rituals, such as wakes or funerals, to comfort the infertile patient or couple. Additionally, those closest to the couple may never know and, therefore, be unavailable to offer support to the couple during these difficult times. Confiding in family or friends may still not be helpful, since infertility may be considered “off limits.” Because of this, family and friends may feel it is inappropriate to offer comfort or support.

The grief process is often delayed or never completed, since the moment of certainty never comes. Alternative treatment options may be recommended by the physician keeping the couple in a state of emotional limbo. Finally and most importantly, the couple may not recognize the loss as such and therefore may not feel entitled to grieve.

Grief work is painful, especially in the initial stages. It is commonly associated with crying, loss of appetite, and exhaustion among other symptoms, but it is doesn’t last forever. This is important to remember if you are experiencing this kind of emotional crisis. Only when you acknowledge and work through these feelings can you achieve any resolution. The feelings may never go away totally; however, their return is usually brief. For healing to occur It is crucial to put infertility in the greater context of life and to separate it from self-esteem and self-image.

Support groups can be very helpful if you are experiencing the emotional effects of infertility. Groups provide opportunities for support from one’s peers, learning, personal insight and stress reduction. Infertility groups may be tailored to a specific diagnosis or treatment option such as egg donation, recurrent pregnancy loss, or PCOS. The themes that are commonly addressed in infertility groups might include loss, anger, grief, powerlessness and the feeling of being out of control.

References:
Burns L. Sexual counseling and infertility. In: Burns L, Covington S editors. Infertility counseling. New York: The Parthenon Publishing Group; 1999. p.149-75.

Mahlstedt P. The psychological component of infertility. Fertil Steril. 1985; 43: 335-46.

Menning B. The emotional needs of infertile couples. Fertil Steril. 1980; 34: 313-19.

RESOLVE Newsletter. Available at: http://www.resolve.org/main/national/magazine/index.jsp?name=magazine