Infertility and Emotional Wellness (“Sara’s* Story”)

Female Infertility and Emotional Wellness (“Sara’s* Story”)

After a woman begins to get her period regularly, the next major reproductive event in her life revolves around her childbearing years. Unfortunately, for many women, getting pregnant is not a routine event. The stress of realizing one’s inability to conceive, as well as the stress involved in the various treatments used to combat female infertility, may lead to drastic changes in mood. In fact, sometimes treatments for infertility and depression can have a cause and effect relationship. . Infertility in women during their childbearing years can lead to feelings of sadness, guilt, and inadequacy. Symptoms of depression and anxiety are common and are often exacerbated by the hormonal treatments used to induce ovulation, as well as the psychological impact of being informed of a negative pregnancy test cycle after cycle. Many studies have sought to establish a link between infertility and depression. While some studies have shown that depression may lead to higher rates of infertility in women, other studies have shown that infertility may lead to higher rates of depression. This puts women and their spouses in a “catch 22” situation, as they are left with little guidance as to how to manage their mood swings during this very exhausting and challenging time in their lives.

Sara is a 28 year old woman living in a community where many of her friends have children. She has been trying to conceive for the past 2 years. Despite medical intervention, however, she has not had a successful pregnancy. Sara did get pregnant once after IVF, but miscarried before the end of her first trimester. She has no one to confide in both about the pain of infertility or the loss she experienced with her miscarriage, as these issues are not openly discussed. Her infertility and depression are linked, it seems, since she often cries herself to sleep,feels alienated from her husband and her friends and avoids family get-togethers because they are too painful. She feels a sense of failure and that she has disappointed her husband, her parents and her in-laws. She no longer enjoys activities that she used to think were fun, and she structures her days around doctors’ appointments and medication administration. Each month she goes through mood swings as she takes hormonal injections to stimulate her ovaries. She then goes through the anxiety of invasive procedures to retrieve as many eggs as she can produce and hopes that she has good embryo quality. After having embryos transferred back into her uterus, she then has to wait 10 days to find out if all of this was successful. As hard as she tries not to think about this, it is an impossible task. The biggest disappointment comes when she gets a phone call that tells her that her pregnancy test was negative and that she should be getting her period within the next day or two. After receiving the bad news about the negative pregnancy test, Sara is no longer able to leave the house and spends her days in bed crying. Sara decides to seek help and finds that openly expressing her emotions in therapy allows her to find new ways of coping with her infertility and depression. In a relaxing and encouraging environment, she is able to grieve about her infertility and talk about the stress of her infertility program while maintaining hope for future cycles. As she and her husband start to communicate better, Sara’s marriage improves. She is also able to reintegrate socially and finds a source of strength in her family and friends.

Male and female infertility affects an estimated 10% to 15% of couples of reproductive age. The stress of infertility in women has been associated with emotional symptoms such as depression, anxiety, anger, marital problems, sexual dysfunction, and social isolation. Couples facing infertility suffer from a sense of loss, a social stigma and diminished self-esteem. Both men and women may experience a sense of loss of identity and may have pronounced feelings of defectiveness and incompetence. Whether these individuals had symptoms prior to dealing with their infertility, or if the symptoms are a direct consequence of their infertility program, it is crucial for couples to seek out help if they are having difficulty coping during this difficult time. Psychotherapy for couples or women experiencing female infertility can be a highly beneficial way of addressing feelings of guilt, loss and inadequacy and can help individuals develop coping skills. In addition, relaxation techniques to reduce anxiety are useful in getting through a very difficult time. Several studies have suggested that cognitive behavioral group psychotherapy and support groups decreased stress and mood symptoms and may increase the rate of fertility in women. In a study that followed 52 women going through infertility, successful pregnancy rates were shown to be 54% for women who were involved with support groups and 20% for controls who did not have any therapy during their infertility program.

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* Pseudonym