PSYCHOANALYSIS AND INFERTILITY MYTHS AND REALITIES

Psychoanalysis, long interested in infertility, and a valuable treatment for men and women suffering with this affliction, has also helped to create and support a myth of psychogenic infertility. Multiple causes of infertility exist across the physiological - psychological spectrum. There is no simple psychodynamic causality. Advances in assisted reproductive technologies provide treatments that create emotional stress and outpace psychological preparedness of patients and analysts. This paper is based on the experience of a unique study group in Boston. An analytic case illustrates some of the ways analysis can be a treatment of choice for people using assisted reproduction. In fact, analysis offers a unique opportunity to elaborate fully the complex realities and dilemmas faced by people and their therapists throughout the infertility experience. More generally, this study of the concept of psychogenic infertility explores a valuable role for psychoanalysis in the treatment of medical conditions.     

Intrusive and avoidant ideation among females pursuing infertility treatment

Abstract

It was shown that infertility and its treatment constitute a stressful experience for women, reflected particularly in disturbing intrusive ideation about the stress source. Infertility patients reported levels of intrusive ideation significantly higher than routine gynecologic patients and not significantly different from levels of psychiatric outpatients being treated for stress reactions to traumatic events. Intrusive ideation also predicted the degree of self-reported infertility-specific distress and dysfunction, further clarifying the key role of such ideation in the experience. Finally, as hypothesized, the frustration level of the treatment experience (as indexed by the number of infertility treatment methods attempted) predicted avoidant ideation. Implications for managing the psychological distress and disruption associated with the infertility treatment experience were discussed.     

Psychological characteristics of infertile couples: can they predict pregnancy and treatment persistence?

The paper describes an exploratory study of the relative importance of different psychological variables for the prediction of (a) pregnancies and (b) treatment continuation in a sample of 140 couples seeking specialized infertility treatment one year after their first contact with an infertility clinic. The couples filled out questionnaires dealing with psychological and interpersonal functioning, marital and life satisfaction, child-related attitudes, causal attribution of infertility and general expectations towards the treatment. It could be shown that the psychological variables explain a relatively small amount of the variance of the pregnancy criterion. Nevertheless, there were some indications supporting the hypothesis that psychological complaints can be seen as a ‘risk factor’ associated with a lower pregnancy rate. Couples who had terminated treatment after one year indicated a higher amount of psychological and interpersonal complaints (females) as well as partner problems (males and females), and a dominance of internal attributions of the fertility problem. This result—which might help to develop strategies for counselling couples making use of the new reproductive technologies—highlights the importance of attribution and cognitive appraisal in coping with infertility. © 1998 John Wiley & Sons, Ltd.     

Infertility treatment for postmenopausal patients: an equity-based approach

This article examines two questions pertaining to the extension of infertility treatment to postmenopausal women. First, what concepts and principles of infertility practice apply to assisted reproduction for the postmenopausal patient? Second, what role should these concepts play in the development of an ethical justification for extending women's reproductive lives past the menopausal boundary? The argument offered here supports their claim to infertility services on the basis of the formal principle of justice, which requires that similar cases be treated similarly. The cases of many postmenopausal patients are argued to be relevantly similar to classes of patients who already receive assistance in reproduction.     

宫颈癌普查与人文关怀

随着不育症患者的不断增多,不育症治疗技术的迅速发展及医学模式的转化,在不育症临床诊疗中应树立人文关怀的理念,强化人性化服务的意识。在工作中应遵循患者第一的原则并恪守心身统一原则、保密原则、最优化原则、知情同意等原则。在治疗过程对患者同情、鼓励以及进行心理治疗,体现人文关怀,构建和谐的诊疗气氛。     

男性不育症诊疗中的伦理学思考

男性不育症是影响男性身心健康的重要疾患。生殖医学,特别是辅助生殖技术突飞猛进的发展,给男性不育症患者带来了福音,同时也给社会带来了许多伦理学问题。在工作中,医生应将伦理学原则与诊疗规范相结合,思考遇到的伦理学问题,自觉遵守医学伦理学规范。唯有这样,才能使生殖医学健康发展,才能保证患者最大程度受益。     

男性不育症临床工作的问题与思考

在临床工作中,不育越来越受到大家的重视,但仍然有许多问题困扰着我们的医疗工作者,多数医生能对男性不育症做出诊断,并给予治疗。但是由于生殖问题的复杂性和我们认识的局限性,不育症的治疗效果并不满意。在不育症诊断和治疗的思路、方法和方式中仍有许多值得探讨和改进之处。     

The Role of Dyadic Coping on the Marital and Emotional Adjustment of Couples With Infertility

Infertility is a challenging experience, affecting individual and couples’ adjustment. However, the way the members of the couple support each other may affect the experience of infertility and their adjustment. This study aimed to investigate the role of dyadic coping by oneself and by the partner in the association between the impact of infertility and dyadic and emotional adjustment (anxiety and depression) to infertility. In this cross‐sectional study, a total of 134 participants (67 couples with infertility) completed self‐report questionnaires assessing infertility‐related stress, dyadic coping, dyadic adjustment, and depression and anxiety symptoms. A path analysis examined the direct and indirect effects between the impact of infertility in one's life and dyadic and emotional adjustment. There is an indirect effect of the impact of infertility in one's life on dyadic adjustment through men's perceived dyadic coping efforts employed by the self (dyadic coping by oneself) and women's perceived dyadic coping efforts of the partner (dyadic coping by the partner). Regarding the emotional adjustment of infertile couples, infertility stress impact had an indirect effect only on depressive symptoms through men's dyadic coping by oneself. The results highlight the importance of men's dyadic coping strategies for the marital adjustment of couples as well as for men's emotional adjustment. Findings emphasize the importance of involving men in the fertility treatment process, reinforcing the dyadic nature of infertility processes.     

An Infertility Primer for Family Therapists: II. Working with Couples Who Struggle with Infertility

The distress of infertility and its medical treatments are profound, and the effects reverberate in each partner, the couple dyad, and the couple's relationships with family, friends, and medical systems. Yet family therapists, like others in our society, are often uninformed or misinformed about the experience of infertility. While the legacies of infertility may be painful and enduring, they often remain unspoken, and hence may be overlooked in standard interviews. This article describes the experiences of couples struggling with infertility, most of whom have sought medical intervention, and it provides treatment interventions for guiding couples through this difficult and often uncharted terrain. Case vignettes derived from 2 years of this clinical research study are included.     

Using Acceptance and Commitment Therapy to Treat Infertility Stress

Women and men diagnosed with infertility experience a variety of infertility-related stressors, including changes to their family and social networks, strain on their sexual relationship, and difficulties and unexpected challenges in their relationship. Infertility stress is linked with depression and psychological distress, and can lead to premature dropout from medical treatments and unresolved feelings of loss and grief. The current study examined the effectiveness of treating infertility stress using Acceptance and Commitment Therapy (ACT), a promising new behavior therapy that targets experiential avoidance through mindfulness, acceptance strategies, and value-directed action. This single-case study followed a couple experiencing infertility-related stress following a failed in vitro fertilization (IVF) procedure. The couple completed 6 self-report measures at 7 time points, including a second failed IVF attempt and a 1-year follow-up. Measures included both distress-focused instruments and therapy process-related questionnaires. The female participant reported higher pretreatment stress and depression scores compared to her partner. She reported significant decreases in global infertility stress, social infertility stress, sexual infertility stress, psychological distress, and depression from pretherapy to 1-year follow-up. She also reported a decrease in infertility stress following her second failed in vitro fertilization (IVF) attempt. The male participant reported significant decreases in sexual infertility stress. The study suggests that acceptance-based therapy shows promise in treating infertility stress in patients experiencing infertility who undergo medical treatments. The data from this preliminary case study also suggest that ACT may be helpful for couples following IVF treatment failure. Treatment gains were maintained 1-year posttherapy, indicating that an ACT approach to treating infertility has the potential to produce lasting change.     

Mother–infant communication can be enhanced after conception by in‐vitro fertilization

To determine if stress associated with artificial pregnancy treatment might affect early communication, video microanalysis was applied to examine face‐to‐face play between infants and their mothers in the first 5 months. Three groups of infants participated: 8 born after in‐vitro fertilization (IVF) treatment employing parental gametes; 8 born after standard infertility treatment (INF), which did not include IVF; and 8 infants whose parents had experienced no infertility problems (Control group: C). All were videotaped at home in free play with their mothers at 4, 7, 13, and 21 weeks of age. A 3‐min extract of each video was reviewed in detail by means of an objective coding system, to define the style of communication. Data from this analysis was subjected to two separate repeated measures of analyses of variance. We found no evidence of detrimental effects of infertility treatment on mother–infant communication, but there were “positive” differences in behavior in the pairs where the mother had been so treated. Thus, while maternal “caretaking” episodes had become infrequent in the control group by the age of 21 weeks, in the two treatment groups the mothers continued to show many caretaking behaviors with infants of this age. Furthermore, infants of both the IVF and INF groups showed significantly higher frequencies of “play” episodes than those in the control group (p = 0.018 and p = 0.004, respectively). Apart from these differences, mother–infant interactions were generally the same in the three groups. The results indicate that communication between mothers and infants is likely to develop along the normal path after IVF or INF treatment, but that mothers who have had these infertility treatments may be more attentive to their infants, and their infants are significantly more playful. Since the IVF and the INF groups were similar, it would appear that these differences from the control group are related to the experience of a successful treatment for infertility, and not related to any particular stresses that may be associated with IVF treatment. ©2001 Michigan Association for Infant Mental Health.     

Perceived control over the medical procedure and its association with adjustment to a low-control situation: the case of infertility

Illness perceptions were shown to be related to emotional and physical outcomes, as proposed by Leventhal’s self-regulation model. These perceptions include the illness identity, its timeline, consequences, causes, and controllability, which later research found to include self-control and treatment control. The current study aimed to examine the role of a third type of perceived control: Control over the treatment procedures. We hypothesized that this type of control would be important for women undergoing infertility treatments, which are characterized by high uncertainty and low personal control. The sample included 194 Israeli women who were undergoing infertility treatments, 70% recruited in hospitals and the remainder in a fertility counseling center and website. All participants were married religious Jewish women, which added to the stress inherent in infertility. Study measures included the Illness Perception Questionnaire-Revised (IPQ-R), adapted to infertility, with an additional subscale assessing control over the procedure, and infertility-specific distress and well-being scales. Exploratory and confirmatory factor analyses supported the factor structure, including the distinct new subscale. A structural equations model showed that perceived consequences were most strongly related to distress and well-being. The three types of control were positively intercorrelated but differed in their associations with distress and well-being: Self-control over the problem and treatment control were unrelated to either measure while self-control over the procedure was related to greater well-being. These findings suggest that when control over the condition or the treatment outcomes is impossible, individuals may still benefit from control over external factors such as their health care. Healthcare providers can support them by seeking ways to increase their control over their treatment procedures, which may contribute to better psychological adjustment. Future studies should examine the role of perceived control over the procedures in other low-control situations (e.g., newly diagnosed cancer; aging-related declines).     

Psychoanalysis and the regulation of society

Multiple losses can be associated with both infertility and child sexual abuse. This work seeks to explore the ways in which such connections can affect a survivor who subsequently experiences infertility and who may choose to pursue medical treatment. The potential consequences of such mirroring are explored from the perspective of counselling practice under the provisions of the Human Fertilisation and Embryology Act (1990).     

Exploring the lived experiences of infertility treatment and care by involuntarily childless women

This study explored the lived experiences of fertility treatment and care by South African women with infertility. A total of 21 women from different age and ethnic groups (age range = 26 to 41; whites = 53%, coloured = 47%) were interviewed for the study. The women responded to semi-structured interviews on their lived experiences of fertility treatment and care whilst undergoing treatment. The data were analysed using thematic analysis. Four main themes were identified in the study; including: lack of compassionate care from treatment care providers, the need for infertility clinics to integrate psychosocial support care, a need for continuing education for fertility staff, as well as financial support resourcing. Participants expressed a need for health care staff at fertility clinics to be more attentive to their emotional and psychological needs. In addition, participants perceived a need for psychosocial care as a result of the distressing nature of the treatment process. The women also felt that some health care staff lacked technical knowledge about the fertility treatments and this left them deprived of crucial information. The costly nature of fertility treatment presented as an added burden for participants. Overall, participants seemed to require a more individualised and patient centred form of fertility care.     

精原干细胞移植治疗男性不育症的伦理学问题

精原干细胞是精子发生的起始,精原干细胞既能分化产生成熟精子又具有自我更新能力以维持自身数量的恒定。精原干细胞移植技术应用于治疗男性不育症,只需将一定数量的供体干细胞植入到受体睾丸的精曲小管内,就能重新建立生精功能。显然,精原干细胞移植在治疗男性不育症有广阔的前景,同时使传统的道德伦理面临着前所未有的困惑。     

The effects of anxiety and depression on in vitro fertilisation outcomes of infertile Chinese women

The object was to assess anxiety and depression during in vitro fertilisation (IVF) treatment and determine IVF-related psychological factors in infertile Chinese women. The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate anxiety and depression among 842 patients, respectively. A univariate analysis was used to compare variables among three SAS groups and three SDS groups. Anxiety and depression were both represented in 21.3% of the cases. Patients <35 years tended to be more anxious. In women <35 years, the SDS scores were higher with lower educational backgrounds and female or couple’s infertility, while the SAS scores were higher in female or couple’s infertility. In older ones, the SDS scores were higher in those with lower educational backgrounds and longer time for infertility, while the SAS scores were higher in those with lower educational backgrounds. In SAS groups 1–3, the embryo availability was 5.0 (3.0–8.0), 5.0 (3.0–8.0), and 3.0 (2.0–4.5) (p = .013); and the fertilisation rate was 91.9, 90.4, and 81.8% (p < .001), respectively. We concluded that infertile women experience anxiety and depression during IVF treatment, especially in women <35 years. Younger women with female infertility would be more anxious and depressive while higher education can protect them from depression. In older ones, they would experience more depressive with longer time for infertility and be less anxious and depressive with higher education. Anxiety affects the fertilisation rate and embryo availability.     

Letting go of your dreams—Adjustment of child-related goal appraisals and depressive symptoms during infertility treatment

To examine the adjustment of child-related goal appraisals during infertility treatment and whether such adjustment contributes to depressive symptoms 178 (86 men, 92 women; age for women M = 33.92, SD = 0.34, for men M = 35.68, SD = 0.45) patients at an Infertility Clinic filled in child-related goal appraisal questionnaires six times: (1) before starting the hormone injections, (2) before the oocytes were retrieved, (3) after embryo transfer, (4) the day when the pregnancy test was done, and (5) two and (6) six months after the infertility treatment. At the first and last measurement times they filled in questionnaire on depressive symptoms. Appraisals concerning child-related goal changed in tandem with the treatment result, and goal adjustment had an effect on depressive symptoms.     

Evaluating Psychosocial Factors and Psychological Reactions to Infertility Treatment

Abstract

This study presents preliminary findings evaluating the relationship between marital cohesion, pregnancy outcome, and gender and the level of stress and depression experienced by individuals pursuing infertility treatment. Women exhibited more stress and depression than men prior to treatment did, yet the level of change (pre-post) in depression and stress after treatment did not differ by gender. Pregnancy outcome helped predict post-treatment depression in women and men, and post-treatment stress for women. Clinical suggestions for preand post-cycle consultations are presented.     

Valuing the invaluable: Do emotional experiences during fertility treatments affect the willingness to pay for them?

Introduction

This paper extends the accepted economic method of valuation by taking psychological factors into consideration.

The Meaning of Childbearing Among IVF Service Users Assessed via Laddering Technique

The psychosocial issues related to infertility have been widely researched. However, the meaning a couple gives to childbearing remains a relatively unexplored area. This study explores the meaning making of Hong Kong Chinese couples who had received in-vitro fertilization (IVF). Eleven IVF-successful and seven IVF-unsuccessful informants were assessed using two complementary constructivist methods: laddering technique and constructivist-grounded theory analysis of in-depth interviews. Findings revealed four aspects of symbolic meaning of childbearing focused on the informant's sense of self, cultural values, existential purpose, and relations with others. The results also depicted infertility as a form of disenfranchised grief, following ambiguous loss, underscoring the need for counselors to explore the meaning of childbearing among IVF service users and the impact on their self-narratives as a function of treatment outcome.