2. Psychiatric Aspects of
infertility
Prof. Hani Hamed Dessoki, M.D.PsychiatryProf. Hani Hamed Dessoki, M.D.Psychiatry
Prof. PsychiatryProf. Psychiatry
Chairman of Psychiatry DepartmentChairman of Psychiatry Department
Beni Suef UniversityBeni Suef University
Supervisor of Psychiatry DepartmentSupervisor of Psychiatry Department
El-Fayoum UniversityEl-Fayoum University
APA memberAPA member
5. Introduction
• The inability to create a desired pregnancy
that culminates in the birth of a child is
likely to create a life crisis for women and
their partners.
• Women seeking fertility treatment look to
nurses for care, counsel and health teaching.
6. Introduction (Continued)
• Primary infertility: The inability to conceive
after 1 year of unprotected intercourse for a
woman younger than 35, or after 6 months
of unprotected intercourse for a woman 35
or older (Speroff & Fritz, 2005).
• Secondary infertility: The inability of a
woman to conceive who previously was
able to do so (Speroff & Fritz, 2005).
7. 1 in 7 couples will experience a problem
with conception in their reproductive
lifetime.
Size of the problem
8. In the study carried out by Freeman et al.
(1985), 48% of the women and 15 % of the
men stated that they regarded their
infertility as their worst life crisis.
Size of the problem
9. Infertility
• Infertility can be defined as a crisis with
cultural, religious, and class related aspects,
which coexists with medical, psychiatric,
psychological, and social problems.
• Relation between psychiatric and
psychological factors stem from a mutual
interaction of both
10. Psychogenic Infertility
• Psychogenic Infertility refers to the inability to
conceve without any physiological cause, in other
words there are no physical or organic reasons for
the infertility.It's estimated that approximately
17% of couples will experience psychogenic
infertility.
• The main reasons possibly being linked to
psychological stressors.
11. J Assist Reprod Genet. 2003 Dec;20(12):485-94.
Psychogenic infertility--myths and facts.
Wischmann TH.
Author information
Abstract
PURPOSE:
The hypothesis of this review is that the role of psychological factors as the sole cause of infertility is
generally overrated.
METHODS:
A review is given of studies concerning the influence of psychological factors on the development of
infertility.
RESULT:
A prevalence of psychogenic infertility of 10-15 per cent must be discussed critically. A value of
approximately 5 per cent is more realistic. Equating unexplained infertility with psychogenic
infertility is not justified. A definition of psychogenic infertility according to the German guidelines
Psychosomatics in Reproductive Medicine is presented. Spontaneous pregnancies following
adoption or the decision to remain childless are the absolute exception. The association of stress and
infertility in humans is still unclear. For many women the effect of infertility and notably of medical
therapy is a considerable emotional stress. This may make psychosocial counseling necessary in
certain cases.
CONCLUSIONS:
An exclusive psychological/psychodynamical point of view on the complexity
of infertility is as inadequate as a strictly somatic point of view. Infertility
should always be treated as a psychosomatic entirety.
14. Psychology of infertility
• Individuals who learn they are infertile often
experience the normal but nevertheless distressing
emotions common to those who are grieving any
significant loss — in this case the ability to
procreate.
• Typical reactions include shock, grief, depression,
anger, and frustration, as well as loss of self-
esteem, self-confidence, and a sense of control
over one's destiny.
15. Relationships
• Relationships may suffer — not only the primary
relationship with a spouse or partner, but also
those with friends and family members who may
cause pain by offering well-meaning but
misguided opinions and advice.
• Couples dealing with infertility may avoid social
interaction with friends who are pregnant and
families who have children.
• They may struggle with anxiety-related sexual
dysfunction and other marital conflicts.
16. Causes of Stress
- Medication side effects
• Drugs and hormones used to treat infertility may cause a variety of
psychological side effects. For example, the synthetic estrogen
clomiphene citrate (Clomid, Serophene), frequently prescribed
because it improves ovulation and increases sperm production, may
cause anxiety, sleep interruptions, mood swings, and irritability in
women.
• Other infertility medications may cause depression, mania, irritability,
and thinking problems.
• Patients and clinicians may find it hard to figure out which reactions
are psychological and which are caused by medications — yet
identifying causes is essential for determining next steps.
17. Causes of Stress
- Money worries
• For patients who do not have insurance coverage
or the means to pay for treatment, not being able
to obtain treatment may contribute to feeling
helpless and hopeless.
• Even patients with insurance coverage may find
limitations on coverage mean they must pay
significant amounts out of pocket.
18. Causes of Stress
- Choices and outcomes.
• Over all, infertility interventions help about half of patients become
parents, with the likelihood of success decreasing with age.
• Patients who learn they are to become parents may be overjoyed, but
also must learn to adjust to new roles and pressures — both during
pregnancy and after childbirth.
• Women who have suffered multiple miscarriages, for example, are
likely to feel anxious about whether they will be able to carry to term.
• Older couples may debate whether to undergo prenatal testing such as
amniocentesis.
19. Causes of Stress
• Treatment failure, on the other hand, may
trigger a renewed cycle of grieving and
distress.
20. Maximum Stress
The psychological stress during the waiting
period following embryo transfer is more of
a strain for many women than all the
medical procedures involved in IVF
therapy, and, for example, also more
stressful than the routine abdominal
laparoscopy
21. The burden
Reproductive medical treatment, which is
time-consuming and emotionally and
financially demanding, is an additional
psychological burden for many women
(Boivin et al. 1995; Olivius et al. 2004).
22. Male Factor
Men who exhibit an andrological factor
describe themselves as being more anxious
and interpersonal sensitive compared with
the norm.
23. Male Menopause/Adrenopause?
– Decreased
• Testosterone levels
• Libido
• Hair
• Muscle mass
• Strength
– Increased
• Weight
• Erectile dysfunction
• Infertility
• Depression
• Cholesterol
As men age:As men age:
24. Female Factor
• Even though not being able to have a child affects
both sexes emotionally, women feel greater
amounts of stress, pressure, anxiety, and
depression.
• Consequences of infertility arise from short and
long-term devastating effects on both
individual’s physical and mental health, and
marital system.
25. The problem
It is probably for this reason that over half of
the couples, despite the lack of success, do
not complete all the treatment cycles
26. Causes of discontinuation
When questioned in retrospect,many couples
say that emotional strain is the main
reason for abandoning treatment
27. Difficulties
• It's also difficult to know when to stop seeking
treatment.
• Frequently one partner wants to end treatment
before another, which can strain the relationship.
• Most patients need to gradually, and with great
difficulty, make the transition from wanting
biological children to accepting that they will
have to pursue adoption or come to terms with
being childless.
30. Therapies that may help
• Counseling. Referrals for short-term counseling are common —
especially to increase coping strategies, or to provide help with
making decisions (as patients face many choices during treatment).
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.
• Ideally, counseling should begin before patients start infertility
treatment, as some studies — though not all — suggest that addressing
psychological factors such as depression, anxiety, and stress may help
increase the chances of giving birth to a child.
• Clinicians working with infertile patients can provide information on
how to manage fatigue, reduce stress and anxiety, and improve
communication with others.
31. Infertility Counseling
• Infertility counseling, whether provided by a
psychiatrist or another health care professional,
involves the treatment and care of patients, not
simply when they are undergoing fertility
treatment but also with their long-term emotional
well-being, and that of their children.
• They can educate patients about the side effects of
infertility treatment medications and the impact of
hormone shifts on psychologic well-being.
32. Other persons
• Many patients find a way to cope on their
own, or they seek support from friends,
family, or one of the many infertility
support groups now available in person and
online. But others need additional help.
33. Therapies that may help
• Psychotherapy. Specific types of therapy may also be
useful. For example, studies have concluded that
interpersonal therapy (which focuses on improving
relationships or resolving conflicts with others) and
cognitive behavioral therapy (which identifies and tries to
change unhealthy patterns of thought or behavior) 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.
34. Therapies that may help
• Relaxation techniques. Given that infertility and
its treatment often cause considerable stress,
experts recommend various relaxation techniques.
For example, mindfulness meditation, deep
breathing, guided imagery, and yoga promote
stress management. (See our online stress resource
center for additional information and tools:
www.health.harvard.edu/stress.)
35. Therapies that may help
• Medications. Antidepressants and anti-anxiety medications are useful
when symptoms are moderate to severe. However, it's wise for women
taking psychiatric medication to consider the risks to the developing
fetus. Further complicating treatment, some infertility medications can
interact with psychiatric drugs.
• For example, birth control pills prescribed to regulate ovulation may
decrease blood levels of certain benzodiazepines, including lorazepam
(Ativan), while increasing blood levels of other medications, such as
alprazolam (Xanax) and imipramine (Tofranil). It is important for
patients and clinicians to weigh all these factors when making
medication decisions.
