COUNSELLING ON INFERTILITY ISSUES
Infertility: hope whispers…
A desire for a child is a result of an individual development. It does not exist from birth. The intensity of the desire is a result of many factors which include upbringing, biological and psychosocial factors. The condition of infertility in women can have a powerful impact on a couples and individuals life. There is a great danger in the fact that female infertility is usually treated as a medical issue and the emotional aspect of it is left unattended. Counselling needs of an individual – and more often than not couple therapy – should be a continuous process and not just a single event of catharsis. People experience a great deal of distress which eventually manifests itself into depression or anxiety. When distress reaches a significant level and starts effecting your day-to-day functioning, is when you seek help.
Difficult patterns that requires care and attention:
• Viewing parenting as a central adult life goal or wish and experiencing a sense of loss: Infertility in women can be seen as a critical life event which raises existential concerns. Apart from the biological dimension of childlessness you are confronted with the human dimension of procreation and its emotional impact. The probability of living a life without a child raises concerns about purpose of life and several emotional reactions. The lack of fulfilment is realised usually after repeated unsuccessful cycles of trying to conceive naturally. This repetitive futile effort leads to the disappointment, desperation and knowledge of the fact that their wish of having a child naturally will most probably not yield results. They need to acknowledge and address that the feelings of anxiety, hopelessness or frustration is a result of an unfulfilled wish. With the help of counselling clients will be able to find other ways of wish fulfilment and goal attainment. There is difference in each person’s subjective suffering that needs to be addressed keeping in mind their personal features. Facilitating and accompanying the mourning process related to the repetitive experience of non-fulfilment of the wish for a child is sometimes pertinent. Cognitive behaviour counselling is helpful in accepting the situation and seeing the possibility and positivity in a child free life. You need to develop skills for coping with stress and dealing with failure. Relaxation techniques further help in this regard along with other counselling techniques.
• You should be able to have opportunities to express the narrative of your infertility crisis and the emotional social problems associated with it: At times you may be directing anger or irritation towards yourself or others, venting out disappointment without realising it. It is important to acknowledge the triggers of your emotional reaction and the deeper meanings encompassed with your infertility issues. You should get help in identifying the exact causes for the distress you are going through. Further to you would need intervention in challenging your thoughts and developing coping skills to minimise the same. You also need assistance in looking ahead with the help of alternative thought and behaviour patterns to be able to live a stress free life. You should be able to feel understood, respected and accepted. There is also a need to have intermittent talks to express your emotions at different stages of your treatment, in order to explore the emotional reactions and the experience. Unmet needs of psychosocial nature will also add as a reason to unexplained infertility. You should be able to deal with negative reactions socially on pregnancy issues. There is a lot of avoidant coping skills like fantasy or hopefulness that one day you will certainly have a child. This could be dangerous as it builds up a fake self esteem. Reducing stress and anxiety levels, helps you to deal with your feelings of guilt and restore feelings of self-efficacy in order to help you feel in control over your life and a possible pregnancy. Motivational therapy is required for reassurance, coping, stress relief and to provide a hope for resolution. Grief, fears, doubt and sense of failure should be identified, expressed and dealt with.
• Some women experience social isolation: Psychosocial care is necessary in terms of relational as well as emotional domains. You should obtain a comprehensive picture of female infertility with its psychosocial background and consequences. Impoverished social network and situations or people which remind you of your infertility issues for e.g. family reunions, pregnant women are risk factors which could lead to your mood fluctuations and guilt.
• Infertility in women runs with a risk of poor adjustment as a result of repeated and chronic distress: This could further lead to poor marital relationship. Very often the partners end up having divergent and even opposing priorities and objectives: for example, one partner may want intensive infertility treatment, while the other is hesitant, and the wish for a child is therefore asymmetric. Further to the distress ends up lack on of empathy and self control which takes away from the deep relationship bond. Communication patterns become impulsive and one starts feeling isolated. Therefore, the couple’s relationship dynamics, sexuality, ability to cope with the psychological and emotional effects caused by this process must be determined apart from the biological causes and treatment options.
“The pressure of scheduled sex and intercourse being played as a goal directed activity serves as a constant reminder of infertility as well as takes the natural pleasure and intimacy away from a couples’ life”
• Infertility can lead to an important impact on a couples’ sexual life: Prior sexual behaviour might start feeling different, while the sexual relationships begin to change. Women might experience a loss in sexual interest, satisfaction or desire. Similarly men might face lack of control on ejaculation, lower libido and satisfaction. This further leads to higher levels of anxiety, depression, marital strain, lower self esteem, feel of insufficiency, negative body image. This could further impair the sexual life. The pressure of scheduled sex and intercourse being played as a goal directed activity serves as a constant reminder of infertility as well as takes the natural pleasure and intimacy away from a couples’ life. It is important that sexual problems which could be defined as erectile dysfunction, vaginismus, sexually transmitted diseases should be explored. These can play a salient role in infertility. But usually sexual problems are hidden as a lot of people are uncomfortable with these questions and end up providing socially desirable answers. Counselling would help people express their sexual difficulties and assist them in developing coping skills as well as restoring normalcy and intimacy which would in turn help in pleasure building, confidence and loosening up the marital strain. Counselling can preventatively bring into notice aspects of sexuality. People being aware of the various sexual difficulties that would be challenged during the course of their infertility would also be therapeutic in itself.
• Infertility in women can lead to stressful waiting periods: hence possible emotional reactions to the consequences should be discussed and you should minutely take part in the decision making process. You should plan to be able to deal with uncertainty. With the help of counselling you will feel empowered to make sense of your own experiences, while increasing your competence for decision-making. You should be enabled to make choices and be prepared to cope with difficulties and losses. There are diverse medical options available for female infertility today; as a result your choice is pertinent to your condition. Naturally you need to invest a lot of time, effort, emotions and other resources at each stage of your treatment. Hence it becomes very important that your feelings at every stage be ascertained and expressed. Your endurance should be judged before and after a stage so that you do not get into further emotional complexes. Every failure with the help of counselling can be considered as a situation where you can regain your choices, derive independence and privacy from your decisions. It is also important that you get rid of family social pressure and choose in accordance with your emotional and physical limits. There could be differences in perspective between you and your partner on when the treatment should come to an end. These dynamics need to be confronted and counselling helps you make these choices. You might require pauses in your treatment, exploring childlessness, looking at other alternatives to have a child or intensifying your medical treatment.
• There are other choices available like donor insemination, egg donation, embryo donation, surrogacy, adoption, foster care or perhaps living a childless life: In case your infertility treatment has failed, you decide to end it or you have a genetic disease that you do not wish to pass on to your child or also if you want to choose to be a single parent then you have to go through the task of choosing from these third party options. Usually there are many reservations in these choices due to social vs. biological parenting, family composition, culture, the future child’s physical, mental characteristics, lack of information of the donor and most importantly fear of insecure attachment of the child with you. Due to the above sometimes there is a sense of alienation from the to born child. Various family building options must be explored with the help of a counsellor as these can have long term psycho-socio-emotional impact on your life.
• Infertility causes women to put in tremendous effort in achieving pregnancy due to which even after a woman is pregnant there are increased anxieties and fears: There could be feelings of denial in a woman as she is not able to attach herself to her foetus due to fears of miscarriage or other fatal pregnancy complications. This particularly happens with the experience of prior reproductive loss. Secondly there could be excessive abnormal worries even in course of regular pregnancy complications experienced by others. Couples loose there naturalness in becoming a parent and feel incompetent as would be parents. This leads to feelings of guilt, shame, sadness etc. All of the above affects negatively the experience of pregnancy, future marital and social life, health of both the mother and the child. Hence counselling eases a lot of strain and helps gain control over one’s life and perspective.
Counselling helps you express your ideas and emotions alongside gaining perspective and developing coping skills. It further helps you explore pertinent questions like what are you ready to do to fulfil your wish of having a child, at what point will you consider it is enough and terminate your medical treatment, how do you imagine your life post unsuccessful treatment perhaps in the next five years; etc… It helps you make the right choices for yourself, improve your social and marital life, build up intimacy and seek pleasure in your goal oriented sexual life, manage your anxieties while you are pregnant or going through a reproductive loss, also help you test your endurance.