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 It is often experienced as a sentence that can generate a “life crisis” both on an individual and relational level; On the other hand, as every moment of breakage in the existential plan can bring out the fragility and psychic and emotional and emotional resources of the individual subject and the couple involved.
Support and coupons 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 a time in which to discuss their doubts, their fears and how theinfertility influenced their life. In recent years, studies that deal with stress relating to infertility and related psychological aspects have multiplied.
The research has highlighted how in general individuals and infertile couples have (or developing during the process) higher levels of anxiety and depression, low levels of self -esteem and show guilt, shame and anger that can damage social and couple relationships.
THE’Couple infertility It is a theme to be addressed with an integrated approach, considering both the organic and psychological dimension. In this way we try to overtake the three traditional strands of research in the field.
Of these, the first investigates the psychological factors of infertility: This vision claims that psychological problems can influence infertility. In practice, infertility is seen as a psychosomatic problem and research are oriented to the effects of affective aspects (stress, poor emotional states) on neuroendocrine activity.
The second current of thought instead claims that the stress due to condition of infertility produces psychological problems; In this case, studies are oriented to observe the couple’s emotional reaction during the diagnosis phase, medical treatment and finally during post-treatment, whatever the outcome.
Finally, the last trend of studies focuses attention on the strategies of adaptation to infertility. Although the literature regarding the topic has numerous research, none of these manages to fully fill the gap between somatic and psychic factors.
Moreover, we did not even come to reconcile the psychological factors of the cause and effect of infertility, always preferring each other without ever overcoming its dichotomy. Currently we orient ourselves to a more integrated vision of the problem. With this kind of approach, the organization of personal meaning of infertile individuals is identified.
From the first research carried out, an extremely interesting figure emerges, which concerns the high incidence of theobsessive 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.
Noteworthy also the data concerning the coping strategies implemented by infertile couples. To deal with the problem, in fact, it would seem that these use passive strategies, in particular avoidance strategies. In addition, the results appears to be a positive correlation between the period of time used in attempts to fertilize and the levels of state anxiety, the anxiety of trait and the depression. In other words The more the search for fertility continues over time, the more the levels of anxiety and depression increase.
From these data it emerges clearly how relevant, for the purposes of a global evaluation, to seek the personal meanings of the couple, but above all the meaning that it attributes to pregnancy and motherhood. It is therefore appropriate, that thepsychotherapyindividual or couple, in addition to welcoming suffering, provides for an analysis of resources and constructs related to parenting and self -image.
The main objectives of a therapeutic accompaniment of an infertile couple can thus summarize:
- Accept and process the diagnosis of infertility
- Manage stress in a functional way
- Redefine their life and couple project.
For this reason, during taking charge of the couple, cognitive factors must also be explored (attribution styles, possible presence of anxious constructs, internal/external locus of control), sexual and couple problems, external resources and relational skills.
That is, we are looking for from an analysis of resources (and suffering) 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.
On this line in 2013 a study was published (Mahbobeh Faramarzi et al, 2013) which shows how the Cognitive therapy (CBT) of group It may be more effective than a pharmacotherapy treatment in taking care of the effects of relational, sexual, social and self -representation levels.
89 infertile women were recruited to which a moderate depression had been detected through the Beck Depression Inventory and divided three groups: 1) 29 patients in group therapy of group 2) 30 women in pharmacotherapy 3) 30 subjects as a control group not subjected to any treatment.
All participants were subjected to the Fertility Problem Inventory (FPI) and the Beck Depression Inventory (BDI) before and after treatment. The Fertility Problem Inventory is a questionnaire that measures the impact of stress relating to social, relational, sexual and self -representation infertility.
The 29 participants in the group CBT were divided into groups of 8/10 people and subjected to 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, sexual sphere as well as the difficulty in imagining themselves without children have been highlighted.
Between the fourth and the sixth session they worked on the modification of irrational beliefs (transcription management, cognitive renovation, relaxation techniques).
Finally between the seventh and the tenth they worked on maintaining the elimination of disfunctional thoughts and behavior related to infertility.
At 30 participants of the second group (pharmacotherapy) 20mg Fluoxetine were administered for 90 days.
The results highlighted that women participating in the group therapy They reduced the impact of stress in the social and marital sphere. They also showed greater elaboration of their infertility and the parental project. On the contrary, the women to whom Fluoxetine had been administered did not show significant changes in any of the FPI stairs.
The CBT therefore showed itself more effective in reducing the stress caused by infertility compared to the drug. These results are in line with those of other studies in which it shows itself as the cognitive psychotherapy is able to reduce the physical and psychological symptoms of anxiety and depression. Furthermore, it has been highlighted how social support and couple harmony are necessary resources to have a lower perception of stress and greater perception of effectiveness.
It has been widely demonstrated that behavioral cognitive psychotherapy is an effective approach in the treatment of infertility stress, both as a couple treatment and as an individual treatment for women.
The approach cognitive behavioral It is indicated for couples who find themselves having to face infertility as a global approach with techniques capable of identifying and renovating automatic thoughts and/or irrational beliefs, in order to deepen and work on the knowledge, representations and assessments that the members of the couple make about their situation.
Also, through a Cognitive behavioral therapywe aim to increase problem solving skills and through a communication and assertive training, new tools for couples in difficulty can be offered.
In practice, a psychotherapeutic intervention, such as cognitive-behavioral, targeted and structured, can affect the emotional and social cost of infertility and taking charge of the infertile patient cannot be separated from an investigation and a psychological intervention.
The direction of the clinic and research is to structure interventions in order not only to treat and reduce, but also to prevent the incidence of the stress linked to infertility.
