Psychosocial Factors In Infertility

Social factors that play a part in infertility:

1. Current social phenomena: tendency for marriage to occur at a later age, therefore couples trying to start families at later age. Fertility in women decreases with increasing age.
2. Smoking: decreases libido, has been linked to infertility in both males and females, while both cigarettes and marijuana lead to a decrease in sperm density, motility, and morphology
3. Alcohol: interferes with the synthesis of testosterone in males and has an impact on sperm concentration. Alcoholism may delay the sexual response and may be conducive to impotence
4. Stress: Stress hormones have an impact on the hypothalamus gland, which produces reproductive hormones. Severely elevated levels can even shut down menstruation.

One interesting small study reported a significantly higher incidence of pregnancy loss in women who experienced both high stress and prolonged menstrual cycles.

Another reported that women with stressful jobs had shorter periods than women with low-stress jobs.

In males, stress causes a blunted GnRH release, leading to hypogonadism.

Emotions felt by couple because of infertility:
However, while stress does not cause infertility, infertility most definitely causes stress. The stress and deep emotions one feels are the result of infertility, not the cause of it.

1. Loss of the parenthood experience - full adult status, a fulfilling and "usual" life experience, the satisfaction of nurturing a young child all the way up to adulthood, and a sense of living on through them and their children after we die
1. Affects self-esteem, self-image, feelings about femininity or masculinity, and sexual attractiveness
2. Sense of disappointment, and the feeling of emotions and events being out of control
3. Denial, shock and numbness – After trying repeatedly unsuccessfully, feelings of "This can't be happening to us" or "I know next month we will be successful"
4. Anger - usually results from feeling vulnerable or helpless or both.
1. Helpless feelings result from the lack of control that you may feel over your life plan, your body, and your future.
2. A sense of vulnerability evolves from feeling "jinxed," or feeling that life isn't fair. You may feel as if you can no longer count on anything good happening in your life.
5. Shame - associated with faltering self-esteem, and a sense of inadequacy, defectiveness and helplessness.
1. As repeated attempts to get pregnant fail, self-image affected
2. Anguish, self-doubt, and chronic sadness converge as couples come to think of themselves as failing, not only in realizing their own dream to reproduce and nurture, but failing their spouse, parents, and siblings as well.
3. Rejection: In many cultures, inability to conceive bears a stigma. In closed social groups, a degree of rejection (or a sense of being rejected by the couple) may cause considerable anxiety and disappointment.
6. Depression
1. Infertile women report higher levels of stress and anxiety than fertile women, and there is some indication that infertile women are more likely to become depressed.
2. Women trying to conceive often have clinical depression rates similar to women who have heart disease or cancer.
7. Fear and frustration – lack of information about the situation
8. Seeking help – a big decision in itself, requires acknowledgement of a problem, very private issue that you can’t talk to everyone about, pride issues to be contended with
1. Desperation for a child drives the couple to seek help

Individually:
The wife may feel the problem lies with her, feels sorry for the husband (“If he had married someone else, he would have children”), feels inadequate, less of a woman.

The husband may not know how to deal with the problem, middle-class men are most likely to respond by avoiding the issue altogether, lack of communication may make problem worse.

Infertility also affects:
Work – co-workers who keep questioning “Why haven’t you had a child yet?”; feelings of depression (emotional stress) regarding oneself affects work performance

Family – parents who are clamouring for grandchildren, become irritable towards other family members due to emotional stress

Sex – becomes a chore, no longer enjoyable

Emotions felt by couple when undertaking treatment
There are emotional ups and downs relating to medical treatment, the uncertainty about outcomes, and the challenge of having to make important decisions such as when 'enough is enough.'

1. Afraid to proceed with IVF - “playing God?”, “morally right?”
2. Financial issues – treatment plans require a lot of financial planning; “investment”, risky endeavour, how to obtain money (personal sacrifices, loans?)
3. Going through an IVF cycle, getting your hopes up, and then for it to come crashing down again a few weeks later – repeatedly going through this rollercoaster takes a toll (depression)
4. When to stop, or other treatment options – require a lot of soul searching, “Should we adopt?”, feelings similar to above (fear, frustration, disappointment)
   

Sources:
Domar AD, Zuttermeister PC, Friedman R. The psychological impact of infertility: a comparison with patients with other medical conditions. J Psychosom Obstet Gynaecol. 1993;14 Suppl:45-52. PMID 8142988.
Schmidt et al. "The Social Epidemiology of Coping with Infertility." Human Reproduction. 20 (2005): 1044-1052.
http://www.emedicine.com/med/topic1167.htm
http://www.emedicine.com/med/topic3535.htm
http://www.icaa.cc/WCI/articles/000022_3.htm
http://www.fcsupport.org/
http://www.resolve.org/