Psychological Counselling In Infertility

04Feb, 2025

Psychological Counselling In Infertility





psychological counselling

Parenthood is considered a highly desired social role by couples and the wish to have a child is a Universal phenomenon. The want for a child is a deeply felt individual instinct but also depends on the individual's personality, societal and personal expectations, economic factors, interpersonal and family dynamics & religious beliefs.


If this wish remains unfulfilled, it leads to:

  • Anxiety and distress due to the state of childlessness
  • diminishing self-esteem and hopelessness
  • feeling of guilt
  • troubled relationship with partner and family
  • desperation and grief
  • societal isolation

The huge emotional impact of fertility can often be overlooked or neglected, thereby reducing the problem to mere biological or medical ones.


Counselling in infertility and ART


Counseling in the context of infertility refers to a confidential interaction between professionally qualified health personnel and a couple grappling with the aftermath of infertility and its treatment.


It is aimed at helping them to cope with the associated stress, make decisions and choices based on the available information, explore, understand, and resolve issues arising from their problems and treatment and thereby arrive at realistic solutions and attain clarity to live satisfyingly and resourcefully. Counselling may have different functions depending on the life situation of the patient (married, single, or lesbian woman) and the treatment advised (Embryo donation, surrogacy, etc.). Also, counselling needs to address issues outside of the treatment context and alternative options such as adoption or contemplating a meaningful and fulfilling life without children. Counselling in infertility involves discussions far beyond the realm of purely medical or biological aspects.


psychological counselling with patients

Who does the counselling?


There needs to be a Continuum of care from being patient-centric which can be handled by the medical and nursing staff to a more formal session with the counsellor. Additionally, a psychologist or a psychotherapist if needed can also be involved on a case-to-case basis. Ideally, a counsellor should be someone with at least 1 year of experience in counselling patients of infertility.


continuum of care

Need for Counseling


Not all couples, facing the diagnosis of infertility and the subsequent treatment have been found to express extreme levels of distress. Only about 20 – 30% avail counselling sessions even when offered, this resilience is possibly a protective factor against distress and improving this inherent resilience should be considered a goal of counseling irrespective of the outcome of ART:

  • Enhancing resilience and life quality.
  • Self-esteem and social relationships.
  • Understanding and acceptance of the problem and its solutions
  • Coming to terms with the available treatment options and alternatives.

Special indications


Ideally, every couple going through infertility treatment should be offered and should avail counselling services, but in certain circumstances, it is specially indicated:


  • Couples with high-intensity stress levels and those facing social pressures / or isolation.
  • Feeling a sense of incompletion as a man or woman unable to reproduce.
  • Viewing parenting as a big stress factor
  • Where there is evidence of marital discord.
  • Poor social networking
  • Repeated passed treatment failures or pregnancy losses,
  • Couple with a history of anxiety and depression and those with a history of psychiatric illness.
  • Those who need donated gametes or surrogacy
  • Need genetic counseling &/ or Fetal reduction.
  • And those who have been advised adoption as the only means to parenthood

In many of these situations more than the medical aspect of treatment, counseling is likely to help these couples view and handle the situation with maturity.


Components of counseling


  • Evaluation and screening - Done by a mental health professional. Aspiring couples must be evaluated for their vulnerabilities, expectations, coping skills, social support, and financial status. Various tools and models can be used to effectively and objectively to assess couples. The two most widely used tools are Screen IVF and FertiQol Questionnaire.
  • Information gathering and assessment - It is the responsibility of the medical practitioner to provide information about all aspects of the treatment plan to the aspiring couple, such as protocol, medication, duration of treatment and side effects, financial implications, success percentage as well as failure rate, which will help them make informed choices and decisions. The Counsellor provides additional support in making decisions along with enabling them to understand the implication of the proposed treatment on themselves on their immediate family members and the unborn children as a result of the treatment. This is called Implication counseling and usually, it is aided by providing written material, videos, pamphlets, connecting with self-help groups of patients and even telephonic conversations with the clinic staff. All this can help empower them and normalize the experience of infertility treatment.

Components of counseling

  • Support counseling - The aim is to give emotional support to patients experiencing distress, arising out of despair and frustration of childlessness, social and family pressure, as well as the ART treatment itself and its limited success rate. Patients need additional support even during the treatment such as during phases of intensive waiting periods, negative pregnancy test reports, thoughts of a bleak future, no remaining embryos and end of treatment leading to even severe depression. Support counseling is also important when patients are no longer part of the clinic and they can still access help if and when needed.

Therapeutic counseling


Therapeutic counseling

This can be provided as a natural progression from support counseling in various modes such as individual couple or group invention strategies. Therapeutic counseling can focus on


  • Individual and family issues
  • acceptance of the situation
  • grief handling
  • working on alternative options
  • coping strategies to minimize stress
  • problem and conflict resolution
  • sexual, marital, and interpersonal problems
  • Psychotherapy may be advised for those when needed including Cognitive Behavior Therapy

Crisis counselling


Acute emotional stress, as a result of treatment failures, miscarriage and abortion can be extremely distressful and needs very gentle and expert handling by well qualified mental health specialists. Acute grief reactions following pregnancy losses can be extremely devastating and such patients need immediate help and assessment of their coping abilities and support systems. Knowledge of the stages of grief progression is important while dealing with such couples.


Supportive counseling with the help of specific techniques can avoid these crises and train these patients to acquire adaptive behavior to enhance their ability to cope and strengthen their resilience by providing both positive and negative information.


Conclusion


holistic approach


A holistic approach needs to be adapted in order to

  • Improve health outcomes
  • patient and team satisfaction
  • less negative psychosocial reactions
  • healthy coping abilities
  • continued care in pregnancy after treatment and follow up
  • hand holding throughout before, during and after treatment

Counselling is an art to be applied in ART with both empathy and sympathy for the patients. Medline Academics, associated with the best IVF hospital in India, offers the best IVF fellowship in India, providing world-class training for aspiring fertility specialists.



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