Center for Infertility and Reproductive Surgery

Emotional Aspects of Infertility Treatments Infertility treatment is a physically and emotionally bewildering experience for most patients, who often encounter feelings of depression, grief, anxiety, and chronic stress throughout the process. Frequent visits, administrative obstacles (including, and especially, approval by their insurance company), the need to orchestrate work life with doctors’ appointments, and the strain on the couple’s relationship all contribute to making infertility treatment among the most stressful experiences that patients can face. The primary care clinician or the obstetrician-gynecologist can play an important role by acknowledging the stress, sadness, and even shame, that many couples and individuals experience as a result of their infertility. The primary care clinician also serves in educating patients about the process, as well as dispelling myths and fears. The physician can help reduce tensions by preparing patients for the emotional roller-coaster aspects to the treatments, by setting expectations about success rates, and by encouraging the couple to talk openly about the process. The members of the couple may have different responses to infertility diagnosis and treatment. This may pose challenges to the relationship, which frequently interferes with the evaluation and treatment. Patients should be counseled that they are not alone. Acknowledging that people may have different attitudes toward informing family and friends and participating in support groups can also be helpful. Depression is a common finding in couples with infertility. Early recognition and referral for appropriate treatment is paramount. There are mental health providers (e.g., psychiatrists, social workers, and psychologists) who specialize in infertility, and they should be used as a resource for primary care providers or obstetrician-gynecologists who care for infertile patients. There is usually a mental health professional associated with centers for reproductive medicine, as recommended by the American Society for Reproductive Medicine guidelines. These therapists see individuals alone or as a couple, and they can help not only with the emotional aspects of treatment, but also offer strategies for dealing with work or home conflicts that come up because of the need for frequent testing and treatments. Support groups, offered at most reproductive medicine centers, are attractive options for individuals and couples with infertility, as they may help alleviate feelings of isolation. Finally, mind-body programs are available to help patients learn relaxation response and other stress-reduction techniques. These programs help patients gain awareness of how behaviors and attitudes can trigger stress. By practicing these techniques, patients report improvements in their sense of well being as they go through infertility treatments. The primary care clinician or obstetrician-gynecologist should also understand that most couples are very anxious to get started on their evaluations and treatment. By performing as many preliminary tests as possible before the referral, and by expediting the referral to the infertility specialist, the clinician can help to alleviate some of the anxiety that many couples feel in the early stages of the process. An important aspect of the care for couples with infertility is respecting their privacy. Many patients seek care in the institutions where they work or in their communities, and because of the necessity of frequent visits for testing and treatment, are anxious that coworkers may inadvertently discover their medical histories. Even for patients who are not health care workers, privacy is a paramount concern. Primary care clinicians should ask couples during the evaluation and treatment if they have any concerns about privacy issues and what can be done to make them feel more comfortable.