The difficulty in procreating and becoming parents is an increasingly widespread problem with important social, emotional and economic costs to the point of being considered one of the most stressful events in a person’s life.
The diagnosis of infertility is often experienced as a sentence that can generate a “life crisis” both on an individual and relational level; on the other hand, how every moment of rupture in the existential plane can bring out the frailties and the psychic and emotional resources of the individual and the couple involved.
Support and counseling interventions for couples struggling with medically assisted procreation are entering the clinical practice reserved for these patients as an opportunity to offer them a space and time in which to discuss their doubts, fears and how ‘ infertility has affected their lives. In recent years, studies dealing with infertility-related stress and related psychological aspects have multiplied.
Research has shown that infertile individuals and couples typically have (or develop during the process) higher levels of anxiety and depression , low levels of self-esteem and display states of guilt, shame and anger that can damage relationships. social and couple.
L ‘ couple’s infertility is an issue to be addressed by an integrated approach, considering both the organic dimension as the psychological. In this way we try to go beyond the three traditional strands of research in the field.
Of these, the first investigates the psychological factors of infertility : this view argues that psychological problems can influence infertility. In practice, infertility is seen as a psychosomatic problem and research is focused on the effects of affective aspects (stress, poorly regulated emotional states) on neuroendocrine activity.
The second current of thought, on the other hand, maintains that the stress due to the condition of infertility produces psychological problems; in this case, the studies are aimed at observing the emotional reaction of the couple during the diagnosis phase, the medical treatment and finally during the post-treatment, whatever the outcome.
Finally, the latest line of studies focuses on adaptation strategies to infertility . Although the literature on the subject contains a lot of research, none of these can fully bridge the gap between somatic and psychic factors.
Moreover, the psychological factors of cause and effect of infertility have not even been reconciled, always preferring one to the detriment of the other without ever overcoming the dichotomy. Currently we are oriented towards a more integrated vision of the problem. With this kind of approach it is possible to identify the organization of personal meaning of infertile individuals.
From the first researches carried out an extremely interesting fact emerges, which concerns the high incidence of obsessive organization in infertile women. On the basis of this it is possible to hypothesize that one of the central themes for these women is precisely that of control.
Also noteworthy are the data concerning the coping strategies implemented by infertile couples. In fact, to cope with the problem, it would seem that they use passive strategies, in particular avoidance strategies. Furthermore, the results show a positive correlation between the length of time taken in fertilization attempts and the levels of state anxiety, trait anxiety and depression. In other words, the more the search for fertility continues over time, the more anxiety and depression levels increase .
From these data it emerges clearly how relevant it is, for the purposes of a global evaluation, to search for the personal meanings of the couple, but above all the meaning that the same attributes to pregnancy and motherhood. It is therefore appropriate that the psychotherapeutic intervention , individual or couple, in addition to welcoming suffering, includes an analysis of the resources and constructs linked to parenthood and self-image.
The main objectives of a therapeutic accompaniment of an infertile couple can be summarized as follows:
- Accept and process the infertility diagnosis
- Manage stress in a functional way
- Redefine your life and couple project.
For this reason, cognitive factors (attribution styles, possible presence of anxious constructs, internal / external locus of control), sexual and couple problems , external resources and relational skills must also be explored during the couple’s care .
That is, starting from an analysis of resources (and suffering), we try to intervene on how the stress caused by the condition of infertility is managed, stress that can have an effect on the outcome of the treatment itself.
Along this line, a study was published in 2013 (Mahbobeh Faramarzi et al, 2013) which shows how group cognitive behavioral therapy (CBT) can be more effective than pharmacotherapy in treating the effects of infertility on a relational level. sexual, social and self-representation.
89 infertile women with moderate depression were recruited through the Beck Depression Inventory and divided into three groups: 1) 29 patients in group cognitive behavioral therapy 2) 30 women in pharmacotherapy 3) 30 subjects as control group not subjected to any treatment.
All participants underwent the Fertility Problem Inventory (FPI) and Beck Depression Inventory (BDI) before and after treatment. The Fertility Problem Inventory is a questionnaire that measures the impact of stress related to infertility on a social, relational, sexual and self-representation level.
The 29 participants in group CBT were divided into groups of 8/10 people and underwent 10 sessions of two hours each. In the first three sessions, the patients received a clear explanation from a gynecologist on the causes of their infertility and the concerns relating to the social, marital and sexual spheres as well as the difficulty in imagining themselves without children were highlighted.
Between the fourth and sixth sessions they worked on the modification of irrational beliefs (management of brooding, cognitive restructuring, relaxation techniques).
Finally, between the seventh and the tenth they worked on maintaining the elimination of dysfunctional thoughts and behaviors related to infertility.
The 30 participants in the second group (pharmacotherapy) were given 20mg fluoxetine for 90 days.
The results showed that women participating in group therapy reduced the impact of stress in the social and marital spheres. They also showed greater elaboration of their infertility and parenting project. In contrast, the women given fluoxetine did not show significant changes in any of the FPI scales.
Therefore, CBT has been shown to be more effective in reducing the stress caused by infertility than the drug . These results are in line with those of other studies which show how cognitive psychotherapy is able to reduce the physical and psychological symptoms of anxiety and depression. It was also highlighted how social support and couple harmony are necessary resources to have a lower perception of stress and a greater perception of effectiveness.
It has been widely demonstrated that cognitive behavioral psychotherapy is an effective approach in the treatment of infertility stress, both as a couple treatment and as an individual treatment for women.
The cognitive behavioral approach is indicated for couples who find themselves having to face infertility as a global approach with techniques capable of identifying and restructuring automatic thoughts and / or irrational beliefs, in order to deepen and work on cognitions, representations and evaluations that the couple members do about their own situation.
Furthermore, through cognitive behavioral therapy , the goal is to increase problem solving skills and through communication and assertiveness training, new tools can be offered for couples in difficulty.
In practice, a targeted and structured psychotherapeutic intervention, such as the cognitive-behavioral one, can affect the emotional and social cost of infertility and the management of the infertile patient cannot be separated from an investigation and a psychological intervention.
The direction of the clinic and the research is to structure interventions in order not only to treat and reduce, but also to prevent the incidence of stress related to infertility.