Definition of Infertility
Infertility can be defined as failure to produce a pregnancy that results in a live birth after one year of unprotected regular intercourse if you are under the age of thirty-five years and after six months if you are over the age of thirty-five years. It affects approximately 7.3 million women and their partners in the U.S. within their lifetime, representing roughly 12% of the population considered to be of reproductive age (American Society of Reproductive Medicine, 2012).
Reproductive vs. Psychological Care
Dr. Alice Domar (2012), of the Domar Center for Mind/Body Health at Harvard Medical School, explains how the medical treatment of infertility through assisted reproductive technology (ART) has made immense advances yet lacks incorporation of appropriate and effective psychological patient care during this difficult time.
Depression, Stress, and Anxiety Associated with Infertility
Dr. Domar (2011) reports that new research on the matter has provided data demonstrating that infertility is commonly associated with higher levels of depression, stress, and anxiety. These findings have sparked interest in researchers and clinicians interested in the inclusion of psychosocial treatments as an important component of ARTs, particularly when dealing with in vitro fertilization (IVF).
Psychosocial Treatments for Infertility Issues
In her attempt to review the literature on the effects of psychosocial treatments on IVF outcomes, Dr. Domar begins by presenting the most common psychosocial treatments offered to patients dealing with infertility.
· Counseling/Support: Conducted either individually or in a group setting, it focuses on emotional expression and open discussion of feelings and thoughts.
· Cognitive-behavioral, educational, and skills-based therapy: Focuses on reshaping negative thought patterns that tend to maintain feelings of depression and anxiety. Programs oriented towards mind/body integration commonly include relaxation training, cognitive restructuring, and psychoeducation on infertility-related topics. Dr. Domar et al. (2000) found that women participating in these types of mind/body programs had significantly better scores on psychological outcome measures when compared to women in counseling/support programs.
· Other interventions: Several other psychosocial interventions, with less evidence supporting them, include hypnosis and medical clowning (being visited by a clown after treatment). However, conclusive data on such interventions have yet to be found.
Results of Psychosocial Treatments
The research to date suggests that psychosocial treatments can help ameliorate psychological distress associated with infertility. However, how can psychosocial treatments increase pregnancy rates in ART and IVF patients?
Increasing Rates of Pregnancy
In and of themselves, psychosocial treatments do not raise pregnancy rates in ART and IVF patients. Nonetheless, data show that by means of several possible mechanisms, they may help rates of pregnancy.
· Increased sexual behavior: Dr. Domar explains how after a six-month Cognitive-Behavioral Therapy (CBT) program, results indicated a decrease in marital distress and an increase in the practice of timed intercourse without a decrease in sexual pleasure during the non-fertile days of the menstrual cycle.
· Decreased dropout rates: ARTs and IVF treatment cause stress to the marriage and produce depression and anxiety in patients. Commonly, these effects drive patients to discontinue treatment. Domar et al. (2010) found that psychosocial interventions that focused on providing information, training stress-reduction skills, and providing support could increase the chances of patients continuing treatment and eventually achieving pregnancy.
· Neuroendocrine system: Reproductive hormones pivotal for conception can be altered by prolonged stress and its effects on the functioning of the neuroendocrine system. Psychosocial interventions geared towards skills training that teach patients to reduce and cope with their stress may help restore the brain centers implicated in reproductive functions.
Efficacy of Infertility Treatments
Dr. Domar concludes by stating that while the available literature on the impact of psychosocial interventions on ART and IVF treatments remains limited, it can be concluded that potential exists to decrease stress and affect reproductive hormones, which in turn can help in the efficacy of medical infertility treatments. There is still much to investigate, but preliminary findings for potential positive impacts of these interventions seem promising. What do you think?
Domar, A. D. & Prince, L. B. (2011). What the evidence shows: Impact of psychological interventions on IVF outcome. SRM-ejournal, 9, 26-32