Counselling and Psychotherapy in Infertility

Counselling and Psychotherapy in Infertility:

An Introduction & Scope of Services with us at PCRH

Reproductive Psychologists play a crucial role in supporting individuals and couples dealing with infertility. Here are some key ways they help those struggling from male, female , combined or unknown factor infertility.

These are:

Emotional support and skill development in infertility: Infertility can be a deeply emotional experience, often accompanied by feelings of grief, loss, and stress. Psychologists provide a safe space for individuals to express these emotions and work through them.
Coping Strategies development in infertility: They help develop coping mechanisms to manage the stress and anxiety associated with infertility treatments and the uncertainty of outcomes.
Relationship counselling -Marital and Sexual healing in infertility: Infertility can strain relationships. Psychologists offer counseling to help couples communicate effectively and support each other through the process 1 .
Decision-Making Supportive Counselling in infertility: They assist in making informed decisions about treatment options, such as IVF, adoption, or surrogacy, and help navigate the emotional implications of these choices 3 .
Addressing other psychological factors in infertility: Psychological factors can sometimes impact fertility. Psychologists work to identify and address these factors linked to lifestyle, personality, family related, social and cultural issues, potentially improving the chances of conception.
Self-help and support group coping in infertility: They may facilitate support groups where individuals and couples can share their experiences and gain support from others facing similar challenges.

Overall, at PCRH our team of psychologists and psychiatrists is well trained to provide comprehensive skills and interventions that addresses both the emotional and psychological aspects of infertility, helping individuals, families and couples navigate this challenging journey.

Psychological interventions in infertility.

The nineteen seventies was the era that witnessed the dawn of IVF and newer reproductive technologies and the glorious birth of the first test tube baby delivered by Dr. Steptoe and Edwards named as Louise Brown. Along these developments, the notions of psychosocial counselling and structured psychological intervention for infertility also flourished.

Fertility Counselling: Fertility counselling emerged as a service offered by trained mental health professionals (MHPs such as licensed Psychologists and Psychiatrists) to individuals who were undergoing fertility treatments in order to help them deal with the psychosocial consequences of infertility. It developed as a scientific treatment that aimed to address the extra-ordinary situation specific needs of patients (such as in times of high distress, in pregnancy after infertility, in multiple pregnancies, miscarriages, while facing the end of medical treatment, while entering third party donor programs) and was implemented in several formats like individual or couple and group.

Today, we find that the standard fertility care protocols world-over include 3 three kinds of psychological services offered to patients before, during and after major fertility treatments (IUI,IVF,ICSI, Donor programs). At PCRH we follow these world class standards.

These are: -

Informational / implicational psychosocial counselling: It included providing sufficient information about the medical aspects, causes and treatment plans for couples. Couples are helped with understanding this information, getting aware about the outcomes of their fertility choices. These fertility choices can have short term as well as long term impact for patient and their families and child born out of fertility treatments such as IUI, IVF, ICSI and donor programs. Thus, the mental health counsellor helps the couples, so that most appropriate course of actions can be taken for infertile women, men, couples and their families. These counselling sessions are delivered before, during and after all treatments that the couples undergo .
Supportive psychosocial counselling: It is concerned with helping couples build emotional skills to handle infertility related struggles and distress that arises from multiple sources (personal, family or treatment-related like delays, failures, procedures, waiting periods, decisional conflicts related to continuation or end of treatment and so on). It aimed to help the couples use their existing resources to cope with situations inside and outside the fertility clinic.
Therapeutic interventions or Psychotherapy in Infertility: It is a more intensive form of psychological intervention. It is offered by a trained and licensed clinical psychologist specialized in reproductive mental health. It consists of treating psychological /psychiatric disorders as well as learning how to handle chronic and complex issues arising out of infertility.

Historical Background Behind Evolution of Psychosocial Counselling in Reproductive Medicine & Infertility.

Fertility struggles have always been recognized as stressful. Research suggests that the entry of the mental health practitioner in gynaecology and infertility is not new. It has a long history and dates back to the 1930s, when nearly 30% of all cases were diagnosed to suffer from unknown causes or unexplained infertility. It was back then that unexplained infertility was attributed to a latent psychological conflict in the person.

In the 1970s, the psychogenic model was replaced by the psychological consequence model as the bio-psycho-social approach. This sparked the links between stress, behavior and conceptional delays.

Historical records reflect that the first consumer movement and patient-approach to psychological health and care in infertility was guided by Barbara Menning (an infertility nurse) who recognized the role of psychological grief, anxiety, depression, stress, emotional strain, religious myths, stigma, moral and ethical dilemmas with infertility.

Menning also anticipated that ‘the advent of newer and better medical technologies placed a higher psychological risk for people subjected to them’. Infertile couples may be exploited by several sources in order to ‘have a baby as soon as possible and at any cost’.

In 1970s to 2000s the role of psychologists and counselors were expanded to enroll them as team members in psychological screening, selection, and as a gatekeeper in the treatment Programs such as IUI, IVF, Donor Egg and Donor embryo treatments . Furthering this, the period from 1990s -2000s recognized the need for explicit evaluation of couples with infertility and psychological interventions. It is in this era that several modules of infertility counselling mushroomed. In this period, the development of evidenced based interventions gained momentum. Additionally, patient-centred care ‘was institutionalized into standard care protocols and most clinical setups across India, Europe, U.S.A. Canada, Australia etc and all clinical setups were expected to be provide psychological counselling at their fertility clinics. Psychologists were integrated as reproductive treatment team members and their services such as counselling became a part of routine care.

What do Psychologists do in infertility setups/hospitals/clinics

The work of a psychologist ranges from services that involve answering common questions, informational guidance, procedural preparation before IUI/IVF/Donor programs/Surrogacy and providing support after distressing events like poorly responding treatments, abandoned cycles and pregnancy failures. Psychologists also work with team of infertologists and reproductive endocrinologists in improving lifestyle, mental status, physical wellbeing and medical outcomes of treatments. Connecting infertile couples, men and women access to self-help groups or support groups and conducting family counselling, marital counselling as well as community health programs is also a vital role of psychology specialists and social workers.

What is the most effective psychosocial treatment approach for sub-fertile couples /male or female infertility related stress?

The recent and the most influential perspective has been the application of integrated care approach to infertility. This approach mandates the need for reproductive medicine specialists along with a team of comprehensive allied health specialists such as nutritionist, physical therapist, yoga specialist with a psychologist in infertility clinics. It stressed on the need to tackle three sources of treatment discontinuation, emotional burden, stress , anxiety and depression in not only infertile men and women but also the fertility staff members as they also are quite stressed while delivering fertility services at IVF centres.

Such an holistic scientific approach in infertility management is effective in improving the following:

Biological outcomes of treatments (Awareness and ability to handle the side-effects of drugs/IUI/IVF, treatment failures, implantation failures, lack of understanding of patient about their treatments, misinformation in patients, poor compliance, poor continuity of couples after their cycle failures, dealing with single or multiple pregnancy loss after an IUI/IVF conception, understanding best suited IUI/IVF procedures etc).
Patient-related outcomPaes (negative attitudes, anxiety reduction, depression coping, grief resolution, low emotional tolerance, psychological vulnerability, relational strains etc).
Clinic-related outcome (associated with staff and patient care communication issues, staff burnout at IVF centres/clinic, technology-related doubts and failures and coping with environment-related stressors etc).
Treatment-related outcomes (Psychosocial coping with financial burden, physical burden, disruption of social and work life and poor prognosis related issues etc).

Summary of psychological interventions at PCRH

Psychological interventions can play a crucial role in supporting individuals and couples dealing with infertility.

At PCRH we are equipped with offering all forms of psychotherapies and counselling for couples facing infertility. Here are some common approaches:

Cognitive Behavioral Therapy (CBT): This form of therapy helps individuals identify and change negative thought patterns and behaviors. It’s effective in reducing symptoms of depression and anxiety associated with infertility.
Mind-Body Interventions (MBI): Techniques such as mindfulness, yoga, and relaxation exercises can help reduce stress and improve overall wellness as well as mental well-being.
Stress Management Skills: Learning how to manage stress through various techniques can significantly improve mental health during infertility treatments such as IUI , IVF, ICSI and donor (IUI or IVF with donor eggs, sperms , embryo) programs.
Support Groups and Counseling: Joining support groups or seeking counseling can provide emotional support and a sense of community, helping individuals feel less isolated.
Expressive Writing and Guided Imagery: These techniques can help individuals process their emotions and visualize positive outcomes, which can be therapeutic during challenging times of IUI and IVF.

At PCRH , we team helps us in tailoring all interventions to individual needs and can be used alongside medical treatments to improve mental health outcomes. If you’re considering psychological support, it might be helpful to consult with a mental health professional such as a reproductive psychologist who specializes in infertility.

If there a specific type of psychological intervention you’re interested in learning more about, then please feel free to contact Dr Ansha Patel or Dr Rahul Taneja at PCRH.

Video talks on Fertility Stress by Dr Ansha Patel

References

Koochaksaraei, F.Y., Simbar, M., khoshnoodifar, M. et al. Interventions promoting mental health dimensions in infertile women: a systematic review. BMC Psychol 11, 254 (2023). https://doi.org/10.1186/s40359-023-01285-1
Kremer F, Ditzen B, Wischmann T. Effectiveness of psychosocial interventions for infertile women: A systematic review and meta-analysis with a focus on a method-critical evaluation. PLoS One. 2023 Feb 28;18(2):e0282065. doi: 10.1371/journal.pone.0282065. PMID: 36854039; PMCID: PMC9974119.
Patel A, Sharma PSVN, Kumar P. Role of Mental Health Practitioner in Infertility Clinics: A Review on Past, Present and Future Directions. J Hum Reprod Sci. 2018 Jul-Sep;11(3):219-228. doi: 10.4103/jhrs.JHRS_41_18. PMID: 30568350; PMCID: PMC6262662.
Boivin J, Appleton TC, Baetens P, Baron J, Bitzer J, Corrigan E, et al. Guidelines for counselling in infertility: Outline version. Hum Reprod. 2001;16:1301–4.
Boivin J, Kentenich H. ESHRE Special Interest Group on Psychology and Counselling. Oxford: Oxford University Press; 2002. Guidelines for counselling in infertility.
Gameiro S, Canavarro MC, Boivin J. Patient centred care in infertility health care: Direct and indirect associations with wellbeing during treatment. Patient Educ Couns. 2013;93:646–54.
Gameiro S, Boivin J, Dancet E, de Klerk C, Emery M, Lewis-Jones C, et al. ESHRE guideline: Routine psychosocial care in infertility and medically assisted reproduction-a guide for fertility staff. Hum Reprod. 2015;30:2476–85.