By Dr Kedar Tilwe, Psychiatrist, Sexologist & Geriatric Psychiatrist,
Hiranandani Hospital, Vashi, Navi Mumbai, India.
Infertility usually refers to the inability of a person to reproduce normally. It is estimated that 1/6 couples worldwide and approximately 27.5 million couples in India experience Infertility. Probable cause is attributed to 50% female related factors, 35% male related factors and rest involving both partners. The reasons can vary from hormonal dysfunction (Polycystic Ovary Syndrome, Hypothalamic Amenorrhea, Hyperprolactinemia, etc.), Anatomical abnormalities in reproductive structures, problems with the count and morphology of the sperms, etc. Even now, a very high number of causes remain undetected or are attributable to psychosomatic causes. The experience of infertility can be emotionally draining and psychologically devastating. So significant is the mental burden that childlessness couldlead to mood and anxiety disorders in infertile couples.
Psychological impact on the person: In a woman infertility is associated with a sense of ‘feeling incomplete’. This leads to lowered self-esteem, self-loathing, self-reproach and steep decline in self-confidence which disturbs all facets of your life. Negative repetitive thoughts and preoccupation with the ‘condition’ starts becoming persistent, slowly occupying each minute of the day. As a result, the person prefers social avoidance and starts feeling lonly&helpless.
Psychological impact on the partner: There is a sense of being a bystander –‘unable to help’. This can lead to a lowering of frustration tolerance. Anxiety manifests and the partner finds himself oscillating between the extremes of over-involvement and indifference.
Impact on marital and family dynamics: Infertility puts a strain on marital bliss. Sex may become mechanical, with focus being exclusively on trying to conceive rather than enjoying physical intimacy. Obsession with the ‘calendar’ ruins quality personal time and activities are scheduled around the timetable of ‘conception days’. The increased stress may sometimes be responsible for complete breakdown of relationships. Couples also have to deal with a nightmarish, unrelenting but often well-meaning pressure from relatives. Constant comparisons are made and magic remedies bordering on inappropriate are thrust upon the couple. In some rigid cultures, the couple are at a risk of getting ostracised.
Impact of treatment: Initiation of infertility treatment is associated with an immediate improvement in depressive and anxiety features. However, by 2nd/ 3rd year of treatment, these conditions worsen significantly. Financial burden associated with it and the prolonged cyclical nature of treatment along with the uncertainty of a positive outcomes, further add to the burden. Sometimes adverse effects may also precipitate behavioural disturbances and Psychosis.
associated with infertility: After diagnosis, it is common to have denial, anger outbursts and crying spells. There is a higher chance of developing Depression and Anxiety, along-with adjustment disorders. Persistent stress may sometimes also lead to self-harm, and even Psychosis.
Coping with infertility:
Here are a few ways of managing the mental burden associated with infertility;
Acceptance: Acknowledging as a couple that you may have a problem is the first and often the most crucial step. It enables you to seek the right advise sooner and that may make all the difference.
Enlist help: You are not alone. Seek assistance of your support system including your parents and in-laws. They are usually happy to help and glad for being involved in the process.
Understand your condition: Consult your Obstetrician, understand the management plan and your options. Being fully aware of the process reduces the Anxiety significantly.
Involve your partner: Make your partner your accomplice and share your hopes and doubts with each other. Use this adversity to reinforce the commitment to your relationship.
Cover the calendar: Timetables are made for our convenience. Don’t become so mechanical that you become strangers to each other and lose your emotional connect. So, mark the calendars but remember to enjoy yourselves
Live your life: Ultimately being a parent is just one (but an important one) amongst the many roles you will essay during your lifetime. So, don’t make becoming one the only priority
Talk: Help is only available to those who ask for it. So, if you fill stressed or scared; share your concerns with a friend or acquaintance. Reach out to mental health professional if you feel the need to do so
Psychotherapy: Supportive counselling will enable you to navigate the troubled waters easily. Cognitive Behavioural Therapy or Inter Personal Therapy can also be immensely helpful.
Pharmacotherapy: When the distress experienced is so much that it becomes disabling, one should meet with a Physician at the earliest to understand the required medicines and their dosages.
Take stock: Sometimes we are faced with obstacles which can’t be overcome. In these situations, it helps to have a candid discussion with your spouse reviewing your priorities and considering your options. Remember that conception is but the first step in the journey of parenthood and you have the choice of adopting a child.
We are lucky to witness the colossal advances in medicine and technology which are enabling us to become better at handling the hurdles posed by infertility. So, if you are one of those approximately 27.5 million couples who have difficulties in conceiving, it is of paramount importance that you remain optimistic and hopeful during these testing and uncertain times; allowing the experience to strengthen your bond and not the other way around!