Psychosocial aspect of infertility

We may describe fertility as a capacity to conceive and produce offspring[1].

In opposition, infertility is defined as a disease characterized by a failure to achieve a pregnancy after 12 months of regular unprotected sexual intercourse. Infertility in females may be classified as primary in females who have never been pregnant and secondary in females who have previously been pregnant. Factors connected with reduced fertility include a time of unwanted non-conception, the age of the woman, and some diseases affecting productivity.

Stress-related fertility issues

Frequently, it is difficult to verify the reason for infertility, and in this case, such dysfunction is named idiopathic infertility. Idiopathic infertility may be caused by mental disorders, for example, chronic stress, depression, insomnia, eating disorders, addictions, etc[2].

Physiological responses to stress are known to suppress reproductive function. Scientists explain that stress boosts levels of stress hormones such as catecholamines (adrenaline, noradrenaline, and dopamine) and the hypothalamic-pituitary-adrenal axis. They subsequently interact with hormones that are responsible for regular ovulatory cycles: gonadotropin-releasing hormone (GRH), prolactin, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). 

Different recent studies have proved the connection between women’s levels of stress and reduced pregnancy chances. For example, women who present high levels of stress markers take longer to become pregnant than those who have low. Abnormal levels of the stress hormone cortisol can create a state of infertility by suppressing ovulation. Corticotropin-releasing hormone (CRH), the key regulator of the hypothalamic-pituitary-adrenal axis, has been identified in most female reproductive tissue, including the uterus, ovary, and placenta[3]. Besides the regulatory role of CRH during pregnancy, high levels of glucocorticoids handle harmful effects on the uterus and fetus and decrease the secretion of sex hormones[4]. Such inhibitory impacts of stress on female reproductive organs also account for deficient progesterone levels during pregnancy, consequently appearing in fetal loss. Stress-related failure outcomes include failed implantation, placentation, spontaneous abortion, and stillbirth: each of which occurs at a specific time of the gestational period[5].

The influence of motherʼs psychological processes was discovered on fetal growth too. Prenatal stress was significantly associated with a decrease in baby birth weight[6].

A complete diagnosis and treatment of infertility must include analyzing the couple’s mental state desiring a child.

Psychological reactions to infertility

Infertility is a real challenge for family couples. The physical demands on a womanʼs body during fertility treatment are well-known, but the destructive influence on mental health is not always discussed.

Trying to have a baby is a significant life event for the majority of people. Some patients achieve pregnancy quickly, but it is rather a miracle or an exception. For many people, it may last years or not happen at all. Patients that are striving to get pregnant report having anxiety and depression episodes, feeling out of control. The problem can be significantly worse when the person is victorious in other fields of life and canʼt deal with this failure. Levels of depression in patients with sterility are comparable even with patients diagnosed with cancer[7]. The depression may match with phases of the treatment cycle. Statistical analyses show that women who stay at the beginning of treatment suffer from more severe anxiety than females who already repeat fertilization methods. 

People who had fertility problems said they felt frustrated, helpless, desperate, fearful, and worried all the time. For some couples, a defensive mechanism against the sense of helplessness may be constant control of every aspect of their treatment. Some of them experienced suicidal ideas. 

The reason for sterility is not always apparent. Women with unexplained infertility may demonstrate a colossal prevalence of obsession[8]. Obsessive thoughts about infertility infiltrate their everyday life and threaten their ability to work. Knowing the cause of the diagnosis can decrease the struggle for patients as they can place blame on “something.” However, self-blame and feeling betrayed by own body appear in women with the female-related cause of infertility[9].

It’s not weird to experience a wide range of emotions, especially when taking medications that affect hormone rates. But some of the mental reactions to infertility may harm health. These patients need to be surrounded with psychological support as they go through treatment. 

Mental health & fertility treatment outcome

One of the most questionable areas in reproductive medicine is the possible impact of mental factors on fertility treatment. The effect of distress on treatment results is hard to investigate for some reasons, including inexact self-report patterns and increased optimism at the start of therapy.

The correlation between mental health and in vitro fertilization outcome (IVF) is still inconclusive. Scientists found a significant negative relationship between a score of anxiety and IVF results[10]. Additionally, depression in women has been associated with higher ART dropout rates. Сouples with clinically depressed female partners are more likely to discontinue therapy than couples without signs of depression. However, the findings of the meta-analysis showed that emotional distress canʼt endanger treatment success[11].

Nevertheless, the scientists made conclusions that higher pregnancy rates are associated with greater decreases in anxiety. They proved statistically significant and overall solid effects of psychotherapy on both fertility rates and different mental conditions[12]. So, screening for depression and coping with it is vital for couples undergoing infertility treatment.

Infertility and relationship 

Infertility concerns an approximated 15% of couples globally[13]. This is a life crisis for them, which results in a lower life quality and marital struggles[14]. An infertile woman realizes that her husband could have children from another healthy woman and worry that the fertile partner will split. That’s why the relationship can be distorted or even lost.

Extra pressure on the relationship may be the couple’s sexual troubles[15]. Sex may remind a pair of failures in having a child. The enhanced invasion into the sexual habits of the couples by the medical team may transform sexual intercourse into duty. Sometimes, he or she may purposely avoid sex to bypass the depression that arises from repeated failure.

The pain associated with infertility may make it challenging for each individual to give the wanted emotional support for each other. Sadly, this happens at a time when both need it the most. One partner may also become irritated because he or she does not experience the same degree of emotional pain. The victim-partner may put unrealistic requirements on the other and become offended when he or she does not satisfy these expectations. 

Careless of which member of the couple has the disease, the solving of infertility must be partaken by both. In this way, they will have a better awareness of the demands made on the other and will be more likely to be a help and support for the partner.

Infertility and society

In addition to marital crises, the infertile pair may also experience tension in relationships with parents, friends, colleagues, and the whole community. They are tired of social pressure[16]. Those partners separate themselves from their surroundings because they consider infertility a private difficulty and feel uncomfortable sharing it. They assume that no one else can know the proper depth of their emotional wound. The infertile couples don’t want to hear repeatedly that all they need is relaxing to be able to сonceive a kid. They may discontinue attending family parties, such as baby showers, christenings, or others when relatives come with their children. The infertile partners may feel acute depression caused by the announcement of a family member’s or friend’s pregnancy. The couple stops connecting with those who have kids. 

Sometimes during infertility treatment, pairs may feel extreme anger. They can always be claiming that their condition is unfair. These partners may become strongly disturbed with individuals who accomplish pregnancy with little or no effort. They become furious when they see unhappy pregnant women or women asking for an abortion. 

Despite the prevalence of infertility, infertile couples do not always share their story with family or friends. The incapacity to reproduce normally can breed feelings of shame, guilt, and low self-respect[17]. The woman’s parents may give more attention to her siblings with children.

It is needed to focus on normalizing and validating the life of infertile couples.

It’s important to understand that a good and rewarding existence without children is possible.

References:

  1. Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R, et al. . The International Glossary on Infertility and Fertility Care, 2017. Fertil Steril (2017) 108(3):393–406. 10.1016/j.fertnstert.2017.06.005 – DOI – PubMed
  2. Vander BM, Wyns C (2018): Fertility and infertility: definition and epidemiology. Clin Biochem 62: 2-10. – PubMed
  3. Mastorakos G, Ilias I (2003) Maternal and fetal hypothalamic-pituitary-adrenal axes during pregnancy and postpartum. Ann N Y Acad Sci 997:136–149. https://doi.org/10.1196/annals.1290.016 – DOI – PubMed
  4. Magiakou MA, Mastorakos G, Webster E, Chrousos GP: The hypothalamic-pituitary-adrenal axis and the female reproductive system. In: Adolescent Gynecology and Endocrinology: Basic and Clinical Aspects. Volume 816, edn. Edited by Creatsas G, Mastorakos G, Chrousos GP; 1997: 42–56. – PubMed
  5. Nakamura K., Sheps S., Arck P.C. Stress and reproductive failure: Past notions, present insights and future directions. J. Assist. Reprod. Genet. 2008;25:47–62. DOI: 10.1007/s10815-008-9206-5. – PubMed Google Scholar
  6. Joseph G. Schenker, Dror Meirow and Eran Schenker. European Journal of Obstetrics & Gynecology and Reproductive Biology, 45 (1992) 1-8 – Elsevier 
  7. Domar AD, Zuttermeister PC, Friedman R. The psychological impact of infertility: A comparison with patients with other medical conditions. J Psychosom Obstet Gynaecol 1993;14 Suppl:45–52 – PubMed
  8. Karimzadeh M., Salsabili N., Akbari Asbagh F., Teymouri R., Pourmand G., Soleimanieh Naeini T. Psychological disorders among iranian infertile couples undergoing Assisted Reproductive Technology (ART) Iran J. Public Health. 2017;46:333–341. – PMC – PubMed
  9. ordăchescu DA, Paica CI, Boca AE, Gică C, Panaitescu AM, Peltecu G, Veduță A, Gică N. Anxiety, Difficulties, and Coping of Infertile Women. Healthcare (Basel). 2021 Apr 15;9(4):466. DOI: 10.3390/healthcare9040466. – PubMed
  10.  Smeenk JM, Verhaak CM, Eugster A, van Minnen A, Zielhuis GA, Braat DD. The effect of anxiety and depression on the outcome of in-vitro fertilization. Hum Reprod. 2001;16(7):1420–1423. DOI: 10.1093/humrep/16.7.1420. – DOI – PubMed
  11.  Boivin J, Griffiths E, Venetis CA. Emotional distress in infertile women and failure of assisted reproductive technologies: Meta-analysis of prospective psychosocial studies. BMJ. 2011;342:d223. DOI: 10.1136/BMJ.d223. – DOI – PMC – PubMed
  12.  Frederiksen Y, et al. Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: A systematic review and meta-analysis. BMJ Open. 2015;5(1):e006592. DOI: 10.1136/BMJ open-2014-006592. – DOI – PMC – PubMed
  13.  Agarwal A., Mulgund A., Hamada A., Chyatte M.R. A unique view on male infertility around the globe. Reprod. Biol. Endocrinol. 2015;13:37. DOI: 10.1186/s12958-015-0032-1. PMC free article PubMed CrossRef Google Scholar
  14.  Onat, G., Beji, N.K. Marital Relationship and Quality of Life Among Couples with Infertility. Sex Disabil 30, 39–52 (2012). https://doi.org/10.1007/s11195-011-9233-5
  15.  Tao, P., Coates, R., & Maycock, B. (2011). The impact of infertility on sexuality: A literature review. The Australasian Medical Journal, 4(11), 620–627. 10.4066/AMJ.2011.105 PMC free article PubMed CrossRef Google Scholar
  16.  Ross R, Hess RF. Social Pressure for Pregnancy Scale: Its Development, Psychometric Properties, and Potential Contributions to Infertility and Depression Research. J Nurs Meas. 2019 Apr 1;27(1):5-15. DOI: 10.1891/1061-3749.27.1.5. PubMed
  17.  A. Galhardo, J. Pinto-Gouveia, M. Cunha, M. Matos, The impact of shame and self-judgment on psychopathology in infertile patients, Human Reproduction, Volume 26, Issue 9, September 2011, Pages 2408–2414, https://doi.org/10.1093/humrep/der209