The psychology of infertility

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Discover what helps couples face an inability to conceive positively.

Infertility affects every aspect of a woman's life, from her relationships to her self-esteem to her ability to plan for the future. Women who are involuntarily childless describe an array of difficult emotions, including feelings of grief, anger, frustration, and envy. They can also face social isolation.

Three decades of research have shed light on the psychological and emotional distress caused by infertility.

In one study, almost 70% of women with infertility had a psychiatric disorder - most commonly adjustment and anxiety disorder.

In another study, Harvard Medical School researchers found that infertile women were as anxious and depressed as women with cancer, high blood pressure, heart disease, and AIDS.

In still other research, infertile women were found to have depression levels twice as high as fertile women, and those who had been trying to get pregnant for two to three years were the most depressed.

Infertility can also exacerbate pre-existing psychiatric conditions. For example, infertile women with a history of depression are more likely to become depressed during treatment, and are also more likely to describe infertility treatment as the most upsetting experience of their lives - even more distressing than divorce or losing a loved one.

But while the agony of infertility is ancient, some aspects of the experience are relatively new, due to the advent of assisted reproductive technologies (ART).

Today, there are more than 40 ways to get pregnant without sexual intercourse. By far, the most commonly used method is in vitro fertilization (IVF), which accounts for more than 99% of ART procedures. IVF clinics can be found throughout the United Arab Emirates and other parts of the Middle East.

Other methods of assisted reproduction include intra-uterine insemination (IUI), intracytoplasmic sperm injection (ICSI), gamete intra-fallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), third-party donation, and surrogate mothering.

These methods give hope to many couples who would otherwise be unable to conceive, but their use can also aggravate existing emotional distress. This possibility is something that mental health professionals should be aware of.

What causes infertility?

For 90% of infertile couples, infertility has a physiological cause. Around one-third of these involve factors that affect the woman, another third involve factors that affect the man, and for 10%-30% of couples there are multiple causes. For 10%, the cause is unknown, or idiopathic.

The most common causes of male infertility are vasectomy, varicocele, and sperm disorders. Temporary causes of male infertility include sexual dysfunction, substance abuse, and testicular overheating from high fevers, saunas, or hot baths. In rare cases, male-factor infertility is caused by genetic factors.

Infertility in women is more complicated. The most common cause is pelvic inflammatory disease. Endometriosis may be responsible for as many as 30% of infertility cases. Another cause of infertility in women is polycystic ovarian syndrome (PCOS).

Fibroids and congenital defects involving the uterus can result in repeated miscarriages. Obesity, nutrition, eating disorders, or substance abuse may also play a role.

About half of all couples that use ART end up with a successful pregnancy. But for the other half, treatment failure can amplify feelings of loss and guilt, and trigger additional painful emotions.

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