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Infertility: Interventions for Shame, Mourning, and Feelings of Inferiority
Infertility continuing education psychology CEUs

Section 17
An Unpredictable, Drawn-Out Rollercoaster

CEU Question 17 | CEU Test | Table of Contents
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

It is a widely held expectation that if and when we choose to, we will be able to have a family. We do not challenge this assumption until difficulties in conceiving are encountered and for some this presents a major life crisis. The pain and loss can be immense. And, not surprisingly, infertility can have a significant negative impact on marital and sexual relationships. It is a multi-layered and complex phenomenon and a number of issues are involved for the individual and couple going through it, as it spans the biological, emotional, physical, relational, social, financial and psychological domains.

Arguably, infertility is therefore an issue that all counselors need to be aware of and understand if this growing client group is to receive the therapeutic support they need and deserve: My work as a counseling psychologist led me to reflect on the psychological and emotional impact of infertility on those couples, and what role counseling and counselors have to play in this field.

The Impact of Infertility
This differs between males and females, regardless of the cause. It is the nature of these different experiences, in addition to the actual infertility issue, that can exert a significant strain on the couple relationship. The extent to which infertility exerts a negative psychological impact can differ between individuals and couples and is likely to be due to a number of factors, including: their desire for a child/family past experience; family history; relationships past and present; diagnosis; cultural beliefs; and treatment outcome. These factors are also likely to contribute to whether infertility becomes an experience that prompts individuals and/or couples to seek counseling, at what stage and for how long.

The impact of infertility on females and males outlined below describes the key characteristics that are experienced by each member of the couple regardless of the cause of infertility: e.g. male factor, female factor or unexplained. The experience is doubtless more complex than the descriptions suggest and each individual and couple will have their own unique experiences -- not to mention diagnosis or lack of one -- that feed into their responses to infertility, and which ideally need to be established and explored in the course of counseling.

Impact on females
The female experience can be both complex and painful. It is generally characterized by periods of intense feelings of isolation -- from her partner, her social circle and society. As more than one female client has reflected, it can feel as if they are 'on the outside looking in on the rest of the world'. Females can feel unsupported and misunderstood throughout the experience, which adds to their despair and isolation. Pregnancy and motherhood is inextricably wrapped up in perceptions of femininity, and infertility can evoke a pervasive sense of failure as a woman, a person, and, in cases of unexplained and female-factor infertility, she can feel that her body has failed her. All of which can have a devastating effect on self-esteem. For those females who desire a child, this desire can increase as the possibility of having one reduces and for some it can become overwhelming, which creates a sense of urgency about finding a 'solution' to the problem. The result of this can be that treatment is pursued without pausing to consider the impact of this route on them, their body, their partner and their relationship. Treatment can be an unpredictable, long drawn-out rollercoaster of hoping, waiting and disappointment, which may or may not result in the birth of a child, and which can take a serious toll on females in a number of ways. Ultimately the experience for females can be one of grief.

Impact on males
Whilst many males have a strong desire for a child and a family, unlike many females they tend to have a 'pragmatic ambivalence' towards fatherhood and children. That is, they will be happy if it happens, yet can come to accept if it does not. A symptom of their pragmatic ambivalence is that they consciously adopt a compliant position in relation to treatment. One consequence of this and their inability to 'fix the problem' -- as perhaps they can in other situations -- is that they tend not to express their negative feelings about the treatment process or how they feel about having/not having children, to their partner. This can be mistaken by their partner as 'not caring', but, on the contrary, it is often because they care about their partner so much that they adopt this position. This, in combination with the medical focus on the female, can leave males feeling marginalized and inadequate throughout the experience, and this is further compounded in cases of male-factor infertility. It can also lead to a build-up of resentment, which is mirrored by their partner.

The experience for males can be an anxiety-filled one that poses a major threat to their masculinity. However, it is not necessarily an experience they either want or feel able to share with their partner, or anyone else. And unfortunately, this can lead people around them to make the assumption that they are 'OK' and 'coping fine'. This is often not the case and, moreover, it can add to their anxiety and sense of inadequacy. Another feature of the experience for males is that they worry about the pressure on their partner, and their partner's increasing desire for a child, and the prospect of what might happen in the future if they do not achieve their goal. So it can be a time of great insecurity for males.

Impact on the couple
A combination of factors, including female sense of isolation, male pragmatic ambivalence, growing resentments, the medical, emotional and financial pressures of treatment and uncertainty about what the future holds, can exert extreme stress on the couple relationship. This normally manifests in a distance between them. The result of this distance is at best a lack of communication and at worst a breakdown of communication, which for many couples can result in separation. Throughout the experience, couples tend to oscillate between periods of distance and closeness, and the nature and frequency of these distances is likely to be a key factor in whether couples stay together during and beyond the experience.

How can counseling help?
Given that infertility impacts on males and females in distinct ways and that they tend to deal with it in their own way, it follows that they each have distinct counseling needs. The couple unit also has its own distinct counseling needs. So there is a role for both individual and couple counseling, and, where there are older children involved, there is a case for family therapy.
- Perkins, Jo; The psychological impact of infertility; Therapy Today; Oct 2006: Vol. 17, Issue 8

Personal Reflection Exercise #3
The preceding section contained information about the impact of infertility.  Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Galst, J. P. (2018). The elusive connection between stress and infertility: A research review with clinical implications. Journal of Psychotherapy Integration, 28(1), 1–13.

Hudson, J., Nahata, L., Dietz, E., & Quinn, G. P. (2018). Fertility counseling for transgender AYAs. Clinical Practice in Pediatric Psychology, 6(1), 84–92.

Papadakis, J. L., Poquiz, J. L., Buchanan, C. L., Chan, Y.-M., Crerand, C. E., Hansen-Moore, J., Kapa, H. M., Nahata, L., Pratt, K. J., Tishelman, A. C., & Chen, D. (2020). Fertility discussions: Perspectives of adolescents and young adults with differences of sex development. Clinical Practice in Pediatric Psychology. Advance online publication.

Online Continuing Education QUESTION 17
What aspects of a client’s life can infertility impact? Record the letter of the correct answer the CEU Test.

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