Friday, 11 October 2013

The psychosomatic impacts and effects of infertility on infertile couples

It is a widely held expectation that if and when we choose to, we will be able to have a family. We do not challenge this assumption until difficulties in conceiving are encountered and for some this presents a major life crisis. The pain and loss can be immense. And, not surprisingly, infertility can have a significant negative impact on marital and sexual relationships. It is a multilayered and complex phenomenon and a number of issues are involved for the individual and couple going through it, as it spans the biological, emotional, physical, relational, social, financial and psychological domains.

The Impact and effects of infertility
This differs between males and females, regardless of the cause. It is the nature of these different experiences, in addition to the actual infertility issue, that can exert a significant strain on the couple relationship. The extent to which infertility exerts a negative psychological impact can differ between individuals and couples and is likely to be due to a number of factors, including: their desire for a child/family; past experience; family history; relationships past and present; diagnosis; cultural beliefs; and treatment outcome. These factors are also likely to contribute to whether infertility becomes an experience that prompts individuals and/or couples to seek counseling, at what stage and for how long.

The impact of infertility in females and males outlined below describes the key characteristics that are experienced by each member of the couple regardless of the cause of infertility; like male factor, female factor or unexplained. The experience is doubtless more complex than the descriptions suggest and each individual and couple will have their own unique experiences – not to mention diagnosis or lack of one – that feed into their responses to infertility, and which ideally need to be established and explored in the course of counseling.

Impact and effects on females
The female experience can be both complex and painful. It is generally characterized by periods of intense feelings of isolation – from her partner, her social circle and society. As more than one female client has reflected, it can feel as if they are ‘on the outside looking in on the rest of the world’. Females can feel unsupported and misunderstood throughout the experience, which adds to their despair and isolation. Pregnancy and motherhood is inextricably wrapped up in perceptions of femininity, and infertility can evoke a pervasive sense of failure as a woman, a person, and, in cases of unexplained and female factor infertility, she can feel that her body has failed her. 

All of which can have a devastating effect on self esteem. For those females who desire a child, this desire can increase as the possibility of having one reduces and for some it can become overwhelming, which creates a sense of urgency about finding a ‘solution’ to the problem. The result of this can be that treatment is pursued without pausing to consider the impact of this route on them, their body, their partner and their relationship. Treatment can be an unpredictable, long drawn-out rollercoaster of hoping, waiting and disappointment, which may or may not result in the birth of a child, and which can take a serious toll on females in a number of ways. Ultimately the experience for females can be one of grief.

Impact and effects on males
Whilst many males have a strong desire for a child and a family, unlike many females they tend to have a ‘pragmatic ambivalence’ towards fatherhood and children. That is, they will be happy if it happens; yet can come to accept if it does not. A symptom of their pragmatic ambivalence is that they consciously adopt a compliant position in relation to treatment. One consequence of this and their inability to ‘fix the problem’ – as perhaps they can in other situations – is that they tend not to express their negative feelings about the treatment process or how they feel about having/not having children, to their partner. This can be mistaken by their partner as ‘not caring’, but, on the contrary, it is often because they care about their partner so much that they adopt this position. This, in combination with the medical focus on the female, can leave males feeling marginalized and inadequate throughout the experience, and this is further compounded in cases of male-factor infertility. It can also lead to a build-up of resentment, which is mirrored by their partner.

The experience for males can be an anxiety-filled one that poses a major threat to their masculinity. However, it is not necessarily an experience they either want or feel able to share with their partner, or anyone else. And unfortunately, this can lead people around them to make the assumption that they are ‘OK’ and ‘coping fine’. This is often not the case and, moreover, it can add to their anxiety and sense of inadequacy. Another feature of the experience for males is that they worry about the pressure on their partner, and their partner’s increasing desire for a child, and the prospect of what might happen in the future if they do not achieve their goal. So it can be a time of great insecurity for males.

Impact and effects on the couple
A combination of factors, including female sense of isolation, male pragmatic ambivalence, growing resentments, the medical, emotional and financial pressures of treatment and uncertainty about what the future holds, can exert extreme stress on the couple relationship. This normally manifests in a distance between them. The result of this distance is at best a lack of communication and at worst a breakdown of communication, which for many couples can result in separation. Throughout the experience, couples tend to oscillate between periods of distance and closeness, and the nature and frequency of these distances is likely to be a key factor in whether couples stay together during and beyond the experience.

How can counseling helpful for infertile couples?
Given that infertility impacts on males and females in distinct ways and that they tend to deal with it in their own way, it follows that they each have distinct counseling needs. The couple unit also has its own distinct counseling needs. So there is a role for both individual and couple counseling, and, where there are older children involved, there is a case for family therapy.

How counseling helpful for females partner
The sense of extreme isolation in females can be a distressing time, during which they experience high levels of negative emotion and often feel unsupported and not understood. Here, counseling can be of great benefit, and a long-term counseling relationship may be of benefit throughout their journey, as and when they feel they need support. In addition, there are points which can be particularly difficult for females, where counseling can help. These include: the time around treatment eg immediately prior to, during and following, regardless of outcome; at critical points such as a miscarriage, anniversaries of due dates of lost pregnancies; when friends/family fall pregnant; and on being told treatment is not a viable option with their own eggs.

Following treatment, and regardless of whether they become mothers or not, females can experience a ‘delayed’ reaction in which they may be confronted with a host of issues that have been unresolved due to being on the ‘treatment treadmill’. Counseling can play an important role in terms of minimizing or preventing this reaction, which may also have a negative effect on the bonding process with a child or children.

How counseling helpful for males partner
As mentioned above, many males do not necessarily have a desire or need to discuss their feelings with anyone, let alone a ‘counselor’, and may run in the opposite direction if it is suggested, particularly in cases of male-factor infertility. However, this reaction is not as straightforward as it appears. Many males who do access counseling will reflect that if they had known ‘what counseling was’ they would probably have gone for it sooner, particularly in cases of male factor infertility. They also expressed their concerns about confidentiality – which their partner might ‘find out’ how they really felt. This can act as a deterrent. Yet many males say they do feel the need to talk, in private, to someone outside of their relationship about the trauma of the experience but that they did not necessarily know how to find a counselor or what to expect when they got there. 

Males who do access counseling, in addition to talking about their feelings, tend to want to gain some kind of understanding about infertility and its impact. This includes a desire to understand the medical diagnosis and procedures and what the female experiences emotionally and physically, so that they know how to help their partner. Males also have a desire for their partner to understand what they may be experiencing emotionally and psychologically so that they are not perceived as ‘not caring’ and ‘being fine’, when often they are not, despite outward appearances.

How counseling helpful for couples
Couples can benefit from counseling at each stage of the infertility journey, chiefly through the facilitation of communication and understanding between them. In addition, couples can use counseling to help them deal with a number of specific issues as they arise – such as decision-making around treatment options, miscarriages, failed cycles and when they achieve a pregnancy, for instance.

What are the limitations of counseling?
Given the distressing nature of infertility, it is not surprising that many individuals and couples express a desire to receive psychological support. Yet what is perhaps surprising is that less than 25 per cent tend to access it. There are the feelings of failure (females) and inadequacy (males) which contribute to the low uptake. But part of the explanation is that, unlike medical intervention, counseling cannot provide a ‘solution’ to the problem of infertility and so it is often not considered or offered.

Furthermore, counseling often tends to focus on realistic goals and objectives, which clients do not always find useful, and some can find this counterproductive. At the time of treatment, couples feel a need to be optimistic and strong to cope with the rigorous demands of it. They are also likely to be full of hope for the outcome of the treatment cycle and their future. They may not wish to discuss the more bleak and painful options at this stage. Counselors working with this client group need to be aware of this and be able to work with clients in a way they find beneficial.

1 comment:

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