Coping with Fertility Concerns


Fertility Challenges and Potential Impact on Psychological Health:

Fertility challenges often raise a mix of difficult emotions, including frustration, sadness, and even shame, making this a particularly sensitive topic for many people. Infertility effects somewhere between 9%-15% of the adult population, with 55% of those facing infertility going on to seek medical advice in hopes of becoming a parent[1].

Fertility concerns impact all individuals uniquely. However, women typically experience greater amounts of infertility-related stress in comparison with men[2]. Women are more likely than men to experience depression and anxiety symptoms related to fertility challenges, and often are more significantly emotionally impacted by infertility treatment failure[3]. Due to fertility challenges, men and women also often experience a loss of control and confidence in their own bodies, along with a sense of failure, which can have a negative impact on self-esteem [4],5. Additionally, difficulties with becoming pregnant may come with stigma, and can contribute to individuals and couples feeling socially isolated[5]. Medical advances bring hope for many individuals/couples facing infertility, although infertility treatments can come with their own challenges, often being invasive, expensive, and time-consuming.

 Fertility Concerns and Their Potential Impact on Relationships:

Fertility challenges and infertility treatment can be a significant source of stress that impacts couples’ relational dynamics. When one or both members of the couple use avoidance coping strategies, this tends to increase psychological distress in cases of infertility-related difficulties[6]. Men more commonly respond to the pain of infertility through distancing and problem-solving strategies, which can affect the relationship as a whole5. The way one partner responds to fertility concerns can have a significant impact on the other partner and the relationship in general. Moreover, some ways of responding to fertility concerns have been associated with poorer relational outcomes. For example, responding to infertility and its contribution to marital distress with avoidance has been linked to increased psychological distress, whereas meaning-based coping has been linked to decreased marital distress5. Mean-based coping involves drawing upon personal beliefs, values, and existential goals (e.g., sense of purpose or guiding principles in life) to help sustain individuals and couples as they face challenges. Turning towards, exploring, and discussing beliefs, values, and existential goals with your partner as you face fertility challenges can help with managing distress and strengthening the bond between yourself and your partner.

Infertility can also have a significant impact on a couple’s sexual relationship. Under such circumstances, women may experience a decrease in sexual desire, lower levels of sexual satisfaction, and marital strain[7]. Men are more likely to experience a decreased ability to control ejaculation, lower levels of sexual satisfaction, decreased self-esteem, and increased anxiety7. Such changes to a couple’s sexual relationship can therefore represent an added layer of complexity to the infertility-related challenges that couples may face.
 

Navigating Other Fertility-Related Challenges:

Psychosocial care and psychological support is both common and helpful for many individuals and couples struggling with fertility concerns. Forms of care available may focus on assistance with decision-making, support through assisted reproduction transitions or crisis, and management of infertility-related emotional, psychological, or relational distress.

Fertility-related challenges often vary from one person to the next; however, there are a few simple tools that can be a helpful starting point for managing difficult thoughts and emotions. Practicing mindfulness and relaxation exercises can decrease stress and anxiety, which can be especially beneficial for women (and their partners) when navigating fertility challenges. Mindfulness has been defined as “intentional and nonjudgmental awareness, and paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally”[8]. Practicing intentional and nonjudgmental awareness can increase unconditional acceptance. Research has shown that mindfulness-based approaches to coping with fertility challenges can bring about significant improvements in women’s psychological well-being[9]. Linked to mindfulness, developing and exercising self-compassion can also be especially beneficial for women facing fertility challenges. Self-compassion can take many forms, from compassionate self-talk, to working through guided self-compassion exercises (see the resources below), to engaging in activities that are aimed at self-care.

Research has indicated that hope can also play a significant role in the well-being of women receiving fertility treatment. Rumination (the tendency to focus on distressing situations or experiences) has been linked to increased distress, while increased hope has been linked to greater well-being during fertility treatment[10]. Counselling may be especially helpful in helping individuals and couples experiencing fertility challenges and treatment develop strategies to manage distress and foster hope amidst uncertainty. Counselling can also be helpful for supporting couples through marital distress, concerns with sexual functioning and intimacy, and addressing depression, anxiety, and other mental health concerns related to fertility challenges.


Resources:

[1] Boivin, J., Bunting, L., Collins, J. A., & Nygren, K. (2007). An international estimate of infertility prevalence and treatment-seeking: Potential need and demand for infertility medical care. Human Reproduction, 22, 1506-1512

[2] Greil, A. L., Slauson-Blevins, K., & McQuillan, J. (2010). The experience of infertility: A review of recent literature. Sociology of Health & Illness, 32, 140-162.

[3] Fatoye, F. O., Owolabi, A. T., Eeguranti, B. A., & Fatoye, G. K. (2008). Unfulfilled desire for pregnancy: Gender and family differences in emotional burden among a Nigerian sample. Journal of Obstetrics and Gynecology, 28, 408-209.

Newton, C. R., & Houle, M. (1993). Gender differences in psychological response to infertility treatment. Canadian Journal of Human Sexuality, 2, 129-139.

Newton, C. R., Sherand, M. A., & Glavac, I. (1999). The fertility problem inventory: Measuring perceived infertility-related stress. Fertility and Sterility, 7, 54-62.

[4] Petok, W. (2006). The psychology of gender-specific infertility diagnoses. In S. H. Covington & L. H. Burns (Eds.), Infertility counseling. A comprehensive handbook for clinicians. Cambridge: University Press.

[5] Daly, K. (1999). Crisis of genealogy: Facing the challenges of infertility. In H. I. McCubbin, E. A. Thompson, A. I. Thompson, & J. Futrell (Eds.), The dynamics of resilient families. Thousand Oaks, CA: Sage.

Greil, A. L. (1991a). Not yet pregnant: infertile couples in contemporary America. New Brunswick, NJ: Rutgers University Press.

Miall, C. E. (1986). The stigma of involuntary childlessness. Social Problems, 33, 268-282.

[6] Jordan, C., & Revenson, T. A. (1999). Gender differences in coping with infertility: A meta-analysis. Journal of Behavioral Medicine, 22, 341-158.

Peterson, B. D., Newton, C. R., Rosen K. H., & Skaggs, G. E. Gender differences in how men and women referred with in vetro fertilization cope with infertility stress. Human Reproduction, 21, 2443-2449.

Peterson, B. D., Pirritano, M., Christensen, U., Boivin, J., Block, J., & Schmidt, L. (2009). The longitudinal impact of partner coping in couples following 5 years of unsuccessful fertility treatment. Human Reproduction, 24, 1656-1664.

[7] Burns, L. H. (2006). Sexual counseling and infertility. In S. N. Covington & L. H. Burns (Eds.), Infertility counseling. A comprehensive handbook for clinicians. Cambridge: University Press.

Wischmann, T. (2010). Sexual disorders in infertile couples. Journal of Sexual Medicine, 7, 1868-1876.

[8] Kabat-Zinn, J. (1994). Wherever you go, there you are. Mindfulness medication in everyday life. Hyperion: New York.

[9] Abedi Shargh, N., Bakhshani, N. M., Mohebbi, M. D., Mahmudian, K., Ahovan, M., Mokhtari, M., ^ Gangali, A. (2016). The effectiveness of mindfulness-based cognitive group therapy on marital satisfaction and general health in women with infertility. Global Journal of Health Science, 8, 230-235.

[10] Shlomo, S. B., Skvirsky, V., Taubman – Ben-Ari, O., Azuri, Y., & Horowitz, E. (2017). Mental health of women entering fertility treatment: What role do age and internal resources play? Stress and Health, 33, 470-476. doi:1-.1002.smi.2733

About the Author
Chelsea Beyer

Chelsea Beyer

Counsellor with ThriveLife Counselling & Wellness. Find out more about her counselling work here.

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