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Psychological counseling for infertile individuals

It is a widely held expectation that if and when we choose to, we will be able to have a family. This assumption isn’t challenged until difficulties in conceiving are encountered and for some this presents a major life crisis. It is a multilayered and complex phenomenon and a number of issues are involved for the individual and couple going through it, as it spans the biological, emotional, physical, relational, social, financial and psychological domains. Therefore, infertility is therefore an issue that all counsellors need to be aware of therapeutic support they need.

The psychological impact of infertility


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This differs between males and females, regardless of the cause. It is the nature of these different experiences, in addition to the actual infertility issue, that can exert a significant strain on the couple relationship. The extent to which infertility exerts a negative psychological impact can differ between individuals and couples. These factors are also likely to contribute to whether infertility becomes an experience that prompts individuals and/or couples to seek counseling.

The impact of infertility on females
The female experience can be both complex and painful. It is generally characterized by periods of intense feelings of isolation – from her partner, her social circle and society. Females can feel unsupported and misunderstood throughout the experience, which adds to their despair and isolation. Pregnancy and motherhood is inextricably wrapped up in perceptions of femininity. All of which can have a devastating effect on self-esteems. For those females who desire a child, this desire creates a sense of urgency about finding a ‘solution’ to the problem. The result of this can be that treatment is pursued without pausing to consider the impact of this route on them, their body, their partner and their relationship.
The impact of infertility on males
Whilst many males have a strong desire for a child and a family, unlike many females they tend to have a ‘pragmatic ambivalence’ towards fatherhood and children. That is, they will be happy if it happens; yet can come to accept if it does not. A symptom of their pragmatic ambivalence is that they consciously adopt a compliant position in relation to treatment. One consequence of this is that they tend not to express their negative feelings about the treatment process or how they feel about having/not having children, to their partner. This can be mistaken by their partner as ‘not caring’. The experience for males can be an anxiety-filled one that poses a major threat to their masculinity2. However, it is not necessarily an experience they either want or feel able to share with their partner, or anyone else, and unfortunately, this can lead people around them to make the assumption that they are ‘OK’ and ‘coping fine’.
The impact of infertility on the couple
A combination of factors, including female sense of isolation, male pragmatic ambivalence, growing resentments, the medical, emotional and financial pressures of treatment and uncertainty about what the future holds, can exert extreme stress on the couple relationship. This normally manifests in a distance between them. The result of this distance is at best a lack of communication and at worst a breakdown of communication, which for many couples can result in separation.


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How can counseling help?

Given that infertility impacts on males and females in distinct ways and that they tend to deal with it in their own way, it follows that they each have distinct counseling needs. The couple unit also has its own distinct counseling needs.

Infertility counseling for females
The sense of extreme isolation in females can be a distressing time, during which they experience high levels of negative emotion and often feel unsupported and not understood. Here, counseling can be of great benefit. In addition, there are points which can be particularly difficult for females, where counseling can help. These include the time around treatment immediately prior to, during and following, regardless of outcome; at critical points such as a miscarriage, anniversaries of due dates of lost pregnancies; and on being told treatment is not a viable option with their own eggs.
Infertility counseling for males
As mentioned above, many males do not necessarily have a desire or need to discuss their feelings with anyone and may run in the opposite direction if it is suggested, particularly in cases of male-factor infertility. Yet many males say they do feel the need to talk, in private, to someone outside of their relationship about the trauma of the experience. Males who do access counseling, in addition to talking about their feelings, tend to want to gain some kind of understanding about infertility and its impact. This includes a desire to understand the medical diagnosis and procedures and what the female experiences emotionally and physically, so that they know how to help their partner. Males also have a desire for their partner to understand what they may be experiencing emotionally and psychologically so that they are not perceived as ‘not caring’.
Infertility counseling for couples
Couples can benefit from counseling at each stage of the infertility journey, chiefly through the facilitation of communication and understanding between them. In addition, couples can use counseling to help them deal with a number of specific issues as they arise – such as decision-making around treatment options, miscarriages, and failed cycles and when they achieve a pregnancy, for instance. A recent study shows that psychological interventions to increase reproductive and infertility treatment success is related to stress reduction and treatment of psychiatric disorders (including anxiety and depression), and this approach tends to improve the quality of life in the infertile couples. Thus, psychological intervention prior to infertility treatment was useful in infertile couples.


1. Burns LH, Convington SH. (Eds) Infertility counselling: a comprehensive handbook for clinicians. New York: Parthenon Publishing; 1999. 2. Gannon K, Glover L, Abel P. Masculinity, stigma and media reports. Social Science & Medicine. 2004; 59(6):1169–1175. 3. Sundby J, Olsen A, Schei B. Quality of care for infertility patients. An evaluation of a plan for a hospital investigation. Scandinavian Journal of Social Medicine. 1994; 22:139–144. 4. ‘Stephanie’. When therapy cannot help. CPJ. Rugby: BACP. 2005; 16(1):10-11. 5. FatemehRamezanzadehet. al. Psychiatric Intervention Improved Pregnancy Rates in Infertile Couples. Malaysian J Med Sci Jan-Mar 2011

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