ABSTRACT: Infertility is a life crisis that affects all aspects of a couple's life. When they enter an in-vitro fertilization program the trauma and emotional stress becomes intensified.
The first section of this paper will review the psychological components of infertility. The second section shall focus on the psychological issues which apply specifically to in-vitro patients. In the last section, suggestions for primary care physicians who are directly involved in IVF programs will be made.
INFERTILITY: A LIFE CRISIS
A life crisis is a stressful event or situation that poses a problem that is insolvable in the immediate future. The problem over-taxes an individual's inner reserves because its resolution goes beyond traditional ways of solving problems.
Infertility is a life crisis, not merely a transitory state of stress and anxiety. One's body has betrayed one, and throughout the diagnosis and treatment profound feelings of despair, hopelessness and self-hatred are experienced. One woman described it this way (Menning, 1977, p. 122):
It is more than I can bear to think of myself as barren. It's like having leprosy. I feel . . . "unclean" and defective . . . empty, less than dead.
Men often feel robbed of their masculinity and sexual identity. One husband described his feelings in these words (Menning, 1977, p. 120):
I feel emasculated, I can make love to my wife 10 times a week, but she and I both know I'm only shooting blanks. I'm sterile and that makes me feel impotent.
In addition to feelings of being damaged, infertility is viewed as a threat to one of life's most important goals, parenthood.
Infertility profoundly affects a couple's relationship in the bedroom. Temperature charts, recording moments of intimacy for the doctor's scrutiny affects a couple's sexual spontaneity and pleasure.
Even outside the bedroom a couple's ability to communicate is often severely impaired. Infertility affects them differently. Men are usually more optimistic about the outcome and cope with their pain by keeping it to themselves and focusing on practical, daily activities. Women, on the other hand, frequently cope with their anguish by constantly talking about it to their husbands. The men feel powerless to take away the pain and stop listening. The stress escalates and they retreat further from each other. Now in addition to their despondency over their inability to conceive they have lost their friendship and compassion for each other.
Infertility affects a couple's peer relationships. In the initial stages, baby showers and birth announcements become painful reminders of their failures. Whether or not to go visit a friend who has just had a baby becomes a major trauma for an infertile couple. They must constantly juggle the loss of their social relationships vis a vis their anguish and jealousy. As the infertility progresses into years couples find themselves increasingly isolated from their friends who are busy with Little League games and Brownies.
Infertility raises concerns about how their own families perceive them. One couple felt that their parents were angry because they robbed them of the privilege of becoming grandparents. They even felt their neighborhood was angry at them because their home was childless and didn't provide kids for the other children on the block to play with.
Years of infertility places a couple's life on hold. Job security and advancements are affected by infertility treatments. Promotions are turned down because it might mean moving to another city and leaving their specialist. Women, in particular, experience stressful relations with their employers as they leave repeatedly for medical appointments. Financial burdens escalate as the costs for repeated appointments, inseminations, surgeries and medications soar. Future plans for trips and remodeling are put aside as couples save for further infertility work. …