reviewed by Tatiana A. ROMANOVA

Psychological infertility and success of IVF

While many couples presenting for infertility treatment have high levels of psychological distress associated with infertility, the process of assisted reproduction itself is also associated with increased levels of anxiety, depression and stress. A growing number of research studies have examined the impact of infertility treatment at different stages, with most focusing on the impact of failed IVF trials. Comparisons between women undergoing repeated IVF cycles and first-time participants have also suggested that ongoing treatment may lead to an increase in depressive symptoms. The outcome of infertility treatment may also be influenced by psychological factors. A number of studies have examined stress and mood state as predictors of outcome in assisted reproduction. The majority of these studies support the theory that distress is associated with lower pregnancy rates among women pursuing infertility treatment. Since psychological factors play an important role in the pathogenesis of infertility, exploration of this is also an important task to manage this devastating problem, which has cultural and social impact (Prasanta Kumar Deka, Swarnali Sarma, 2010).   

Some research said that couples who enter IVF treatment are generally psychologically adjusted, probably because this self-selection process into IVF treatment occurs as a result of the trials and emotional burdens of confronting infertility. Couples entering treatment are highly motivated. However, infertility treatment programs can be physically and psychologically demanding for each partner and on their marriage. Their sexual relationship becomes governed by the calendar and temperature charting. For some couples, infertility can become a major obsession in their lives. The couple, especially the female, often verbalizes feelings of confusion, depression, and guilt with unexplained infertility.
Sperm problems provoke feelings of shame in the male. Secrecy and isolation often accompany the discovery and management of sperm deficiencies for the male. Anxiety and depression are common psychological reactions concurrent with entry into infertility programs. Increased anxiety and depression have been shown to decrease pregnancy rates after IVF procedures.
Couples report moderate levels of stress during the IVF process. Tension often builds as the phases progress. A high anxiety state in the female before oocyte retrieval can stimulate cortisol secretion and negatively affect pregnancy outcome.
Awaiting embryo transfer outcomes has been identified as the most stressful period during the IVF process. During this critical time, the couple often maintains isolation from family and friends to avoid discussion about the IVF outcome (Reed, Susan A., 2001).

Anxiety and depression escalate with repeated IVF cycles if the couple has experienced one or more previous IVF failures, financial costs are mounting, and the dreams of parenthood are becoming more distant. A failed WF cycle imparts profound loss and grief (Reed, Susan A., 2001).
Unsuccessful IVF forces the couple to face infertility. Sadness, anger, and depression are common responses in both partners (see hereinbefore). Helplessness, loss, and guilt are more pronounced in female partners. Studies show depression to peak between 18 and 36 months after unsuccessful IVF. Unsuccessful IVF can generate a complex range of emotions. The unusually high emotional, financial, and time investment can affect the individual's self-esteem, sexual self, and other adult developmental tasks such as career, marriage, family, and friendships. Each subsequent menstrual period can serve as a reminder of what was lost (Reed, Susan A., 2001).
The grief from unsuccessful IVF affects marital and sexual relations. A high rate of divorce/separation occurs in the IVF failure group. Often, one partner, usually the female, is overtly expressive about her grief, whereas the other partner, the male, does not show grief. The stoicism may be interpreted as aloofness, and the emotionalism may be viewed as excessive. The couple may have extreme difficulty accepting each other's expression of grief, and this can affect other areas of their relationship. (Reed, Susan A., 2001)

Relaxation response training has been shown to decrease anxiety and depression and increase conception rates in IVF couples. However, stress management strategies are seldom recommended as part of the IVF treatment plan.

Treatment ways

The emotional impact affects everyone before and during treatment. There is no longer any disagreement that infertility is a distressing experience. Indeed some studies have suggested that it is one of the most distressing medical conditions treated in the health service, especially where infertility lasts for a long period and is never resolved. This distress extends not just to those who have never had children, but those who have had children in previous relationships, or fewer children than they hoped for.
Following unsuccessful treatment, all of the above feelings are still very commonly reported and also: poor coping skills, sense of helplessness, increased marital/partner tensions, heightened anger, sense of loss or bereavement (Jim Monach).
Infertility treatment can place a heavy burden on couples who at times must adhere to timed lovemaking to fulfill medical protocol requirements. This can leave men feeling like “sperm donors,” in part because women often lose their libido during treatment and are therefore often not interested in sexual intimacy at spontaneous times. Diagnostic and treatment procedures will often require more effort on the part of the woman who may be experiencing physical discomforts, as well as hormonal changes. The treatment for infertility is often referred to as an “emotional roller coaster,” because of the inherent ups and downs associated with the process. For every month that does not result in a pregnancy there will have been many hours of hopefulness, followed by, at best, disappointment or, at worst, despair. (Pamela Fawcett Pressman, www.pressmanandassociates.com)

Following previous information about physiological causes of infertility and emotional difficulties of IVF there are two approaches should be included in infertility treatment program. Besides and during medical procedures, patients need to learn stress management techniques, such as self-relaxation, deep breathing, and meditation.
As we described in other page, the Self-relaxation practice with Shikyu-chan, could be recommended as one of infertility treatment approach. This practice is able to prepare female body to become more acceptable for foreign materials such as a sperm or an embryo in IVF case. Based on touch therapy and mental direct imagination, practice with Shikyu-chan leads to:

1. psychological tolerance and acceptance foreign or a new;

2. mental self-imaging as a womb is able to prepare a connection between mother and future baby mentally and physically as well;

3. practice to contact physically with a foreign object is able to reduce possible body’s discomfort during IVT and pregnancy changes;

4. an expansion of inner space helps to be patient for other, including a sexual partner.              

 
Acknowledgment
Thanks for Dr. Takeuchi Masato for beneficial discussion.

Reference

Prasanta Kumar Deka, Swarnali Sarma, Psychological aspects of infertility, BJMP, 2010;
Pamela Fawcett Pressman, Psychological Aspects of Infertility, www.pressmanandassociates.com;
Reed, Susan A, Medical and psychological aspects of infertility and assisted reproductive technology for the primary care provider. Military Medicine, Nov 2001;

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