Saturday, March 7, 2009

Psychological Issues Faced by Infertile Couples

The following article presents the many issues that are faced by couples who have been diagnosed with infertility. The issues are many and include loss of control, helplessness, depression, financial loss, and marital discord. Couples often forget the importance of communication and what brought them to the point of wanting to have a child. It is important for couples to remember that they are going through this process together, not individually and that there is support available for them.

The Emotional Complexity of Infertility

MADISON - When a couple is diagnosed with infertility, it can be an unexpected crisis in their lives.

"It's not a challenge most couples expect to face," comments Julianne Zweifel, PhD, clinical psychologist with UW Health's Infertility and Reproductive Endocrinology Program.

The uncertainty of the situation is one of the reasons why fertility challenges are so difficult to manage emotionally. Is there truly a problem? If there is, how do you proceed? When do you stop? How do you manage the social and emotional issues related to infertility?

"You just don't know what the outcome is going to be," Dr. Zweifel says. "And that's the most difficult part of all of this."

Because the outcome is uncertain, couples may actually put off vacations, or not look for new jobs because of the possibility of becoming pregnant. As a result, their lives get put on hold indefinitely.

"It can be easy for couples to become immobilized because of the potential for kids," continues Dr. Zweifel.

People can forget what they enjoy doing because they're so focused on the next treatment, or the next step.

Counseling can help couples identify and discuss the significant emotional issues they face, as well as any different perspective they may hold.

Infertility Doesn't Have to Be Isolating

Infertility affects individuals differently, and each member of the couple can often feel as if he or she is going through it alone.

It is common for women to feel somehow defective because they are having difficulty conceiving naturally.

"A woman will be interacting with a group of women at a party, and inevitably the stories come up about being pregnant, or breast feeding, or giving birth, and suddenly she's no longer a member of the group," explains Dr. Zweifel, illustrating how it can affect women even in an innocuous setting. "She can feel like less of a woman, or somehow defective. Many women even fear for the stability of their marriage because they can't readily bear a child."

Men, according to Dr. Zweifel, often deny their difficulties - perhaps because they feel the need to be the "rock" of the family, or that their wives will somehow do better or be stronger if they don't see their husbands' emotional struggles. And if the cause of the couple's infertility has to do with the male partner, the emotional impact can be significant for the husband.

Both partners may feel as if they have to shield the other from their experiences, faking how they're really doing to protect the other. The problem is that not being honest can end up contributing to a sense of isolation.

Complicating the issue even further is the cost of fertility treatments. Many of the treatments are not covered by insurance, leaving couples to face the difficult decision of when to conclude treatment. And often, couples themselves don't always agree.

"Men often feel they have to be the fiscal manager, and set a limit on just how much they'll spend," says Dr. Zweifel. And, faced with mounting bills, there can be significant differences in how far each person is willing to go.

"It's a classic dilemma," comments Dr. Zweifel. "Just how much time and money is each individual willing to commit to treatment? When faced with treatments, couples can discover they’re on very different pages."

Dr. Zweifel encourages couples to examine such topics as the stability of their marriage, any religious concerns over assisted reproductive treatments, the acceptance of the extended families, the reality that the treatments may not work and the implications of that fact.

Regardless of what treatments patients are undergoing, however, Dr. Zweifel encourages all of them to remember that life is multi-faceted. While the challenges may seem overwhelming, there are a lot of good things going on in every life.

"There are common pitfalls for couples facing fertility challenges," Dr. Zweifel concludes, "and getting through them requires a lot of little steps. But in the end, it really can bring couples together and make their marriages even stronger."

Dr. Zweifel is a member of the American Society of Reproductive Medicine (ASRM) and serves on the executive board for the Mental Health Professional Group. The Group is helping to establish guidelines for egg donors, gestational carriers and oocyte preservation. UW Health’s Reproductive Endocrinology and Infertility Program operates within the guidelines established by ASRM.

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