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Overcoming Stress İn The Infertility Problem
MAKALE #10074 © Yazan Dr.İbrahim ATEŞ | Yayın Aralık 2012 | 2,293 Okuyucu

Introduction to the Infertility Problem


Infertility is a stressful and debilitating medical condition and many couples suffering from infertility seek rigorous help to deal with it as soon as possible. As is well-known, assisted reproductive technology (ART) is used to overcome this -lifelong dream threatining- situation. Couples with infertility problem can not evitate also the stress problem. Therefore, stress must be overcome at first in order to increase the chance of fertility.

Love Concept of Arthur Schopenhauer

To understand better the importance of fertility to couples, one might listen to what Schopenhauer had written about the actual aim of love:

“The ultimate aim of all love affairs…
is more important than all other aims
in man’s life; and therefore it is quite
worthy of the profound seriousness
with which everyone pursues it.

What is decided by it is nothing less
than the composition of the next
generation…”

Schopenhauer actually uses love as a trick. By trick, he means in this suffering and difficult life full of stress, we need a reason to go on. Otherwise, it would be easier than thought to end everything with the stroke of a dagger (Hamlet, Shakespeare). Therefore, we can come to the conclusion that love affairs serve to the continuation of human species. In my opinion, love is one of the few situations in which someone is quite far from the reality.

What is Stress?

Stress refers to the consequences of the failure of an organism to respond appropriately to emotional or to physical threats. The threat may be actual or imagined. For example, exposure to an earthquake is an actual threat and an examination coming closer day by day is an imagined threat. The threat that causes stress is also called a stressor. An acute stressor affects the organism in the short term when a chronic stressor exhibits long term pressure. In most of the cases of infertility, couples are exposed to chronic stressor. Stress signs and symptoms include irritability, muscular tension, concentration difficulties, forgetfulness, elevated heart rate, headache, overproduction of adrenaline and cortisole, exhaustion. If the stressor persists for a long period, the adrenal gland and the immune system are exhausted resulting in the manifestation of various physical and mental disorders.

Does Stress Conribute to the Infertility Problem?

We can easily conclude that when unconscious desires and motives of having a biological child were disrupted by the reality of infertility, feeling stress is inevitable for each of the partners. As a matter of fact, people are dictated to have a biological child since childhood and it is unquestionable. The process is totally unconscious. Also, stress itself is going to be one of the major contributers to the ongoing infertility problem in some particular cases.

What causes stress during ART applications?

There are several reasons of stress during ART applications: Fear of probable unsuccessful outcome of the application, financial consequences of the procedures and especially financial burden which recurrent failing applications cause, uncertain nature of the situation, feelings of inadequacy, tension between partners, producing a semen sample in a room of a hospital, possibility of development of a sexual dysfunction such as erectile disorder or sexual desire disorder and much more.

Considering psychodynamics when it is the male factor

In some instances, when male factor is responsible for infertility, this situation may change the dynamics of the relationship: Woman might begin to dominate the relationship, with the help of the feelings of inadequacy of man, and she –unconsciously- would never want to give up this secondary gain and would sabotage the ART applications. What the woman is thinking at this moment –always unconsciously- is “It is better to be a powerful Princess than being a normal Queen!” This is a metaphor: In our society, woman becomes a Queen after having a baby, but she remains a Princess without a baby. This effect might be strong especially when it is the male responsibility. The woman would never want to loose the power she eventually possessed and would keep on sabotating the process.
Actually, when this factor is responsible for the unexplained unsuccessful applications, the ART team –if not considering the psychiatric dynamics- shall never be able to truely understand the underlying psychological reason. We –mental health professionals- know that every single mental process definitely alters the physical state of the human being. Therefore, any dilemma or any low desire of having a baby shall decrease the possibility of pregnancy.

What might be done in order to reduce stress during ART applications and increase pregnancy rates?

At first, psychological aspects of infertility should always be considered and kept in mind. Whether it is one of the main causes of infertility or is developed as a result; stress has to be reduced with the appropriate approaches.
As a rule, couples have to be clearly informed about infertility and ART applications. Further, they should be given the detailed information about the tests and the procedures which they are undergoing. They should be prepared to the feelings of stress. Always, the chance of expressing their ideas about the treatment plan has to be given. Realistic expectations about the treatment process and outcome will prevent disappointments and is obligatory for the couple to move with healthy defense mechanisms. Otherwise, every failure is going to result in the weakening of the Ego (the major component of the human mental structure). Further, it is going to work if the partners are helped to express their feelings concerning infertility, its treatment and the probable outcome.
Encouraging the couple to join an infertility support group shall help them share their feelings with other infertile couples. They shall see that they are not alone. Trying to help couple release their emotions, not to represss their feelings of anger, sorrow, or guilt, will work for the reduction of stress intensity.
We can never ignore the role of religion about stress management. A strong belief of the reflection of God on human life may relief the psychic pain caused by infertility and its consequences. With the help of an omnipotent power, one shall reduce his/her feelings of helplessness and shall control negative thoughts and emotions. Deep religious belief will establish an optimistic attitude which might increase the possibility of pregnancy.
Infertility faces both man and woman to considerable pressure. Therefore, sometimes it may be the main reason of divorce. In order to reduce the pressure, taking some measures would work: Since infertility is a problem involving two people, presence of the one that does not need medical help, shall help the other overcome the feelings of loneliness and helplessness. Pointing out the significance of the presence of both husband and wife at the medical appointments is going to be very helpful and the realistic and the optimistic stance of the medical doctor, as an omnipotent figure, shall reduce the conflict between the partners.
In order to achieve the goal, the couple has to be appropriately prepared and mentally motivated for the ART application. Encouraging the couple to be optimistic is the most effective approach. Hoping for the best is an appropriate attitude and expectation, only if the couple is also prepared for the worst outcome.
When the time is passing by without a child, some periods may be especially difficult for the couple: Weddings, birthdays, holidays, news of a friend’s pregnancy. Conversations on pregnancy and children at the weddings and birthdays, remembering that the time is passing by at the holidays, complex feelings that the couple can have in that moment such as sorrow and happiness at the same time. Sorrow, because of ongoing infertility problem they still experience and happiness, because a loved friend is pregnant. The couple must be prepared for the probable difficult times and situations. Questions from other people can be boring and frustrating. The couple should think how to respond the questions and how to overcome such unwanted situations.

Conclusion

I have to point out the fact that any ART application ignoring the psychic components shall have the fate of less than expected success rate. Therefore, it is obligatory to consider the mental state of the couples and –moreover- the psychic structure and the dynamics might be used as an effective weapon to deal with the infertility problem.

İbrahim Ateş, MD
Psychiatrist
March 24, 2010
Yazan
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