Emotional care facing infertility

DEPARTMENT FOR EMOTIONAL SUPPORT AT INSTITUTO BERNABEU

Infertility affects 1 in every 8 couples worldwide. Some 60% of these couples hide their reproduction issue from family and friends and only 5% seek psychological help in dealing with it. At Instituto Bernabeu, we want our patients to feel that they are not alone and that they are being given support at all times. Our entire team of human resources is trained based on empathy, sensitivity and experience in providing emotional support for reproduction issues, but we also have an in-house expert psychologist and offer patients a free appointment with the psychologist before embarking on treatment. The aim is to prepare the patient emotionally for the different phases he or she may go through on a psychological level.

Often the expectations which arise through treatment, incertitude while waiting, the fear of failure and other such feelings can lead the patient to a state of emotional stress.

The care offered to a person who is undergoing fertility treatments should be all-inclusive and include emotional support. At Instituto Bernabeu couples are offered all round care, not only focussing on the medical treatment but also on mental health.

The reasons for which a person goes to an assisted reproduction unit are many and varied but all have come to the conclusion that they need medical help. This experience, to a greater or lesser extent, can result in a painful psychological process.

The incapability to conceive naturally can generate stress, anxiety and in some cases depression within the couple which can interfere with and complicate the results of the treatments.

Each cycle implies an emotional burden of hope, excitement and happiness but each failure entails a feeling of losing control, of uselessness and hopelessness. The presence of these emotional reactions, their frequency and intensity, are related to personal tolerance levels regarding frustration and chronic stress.

DON’T DREAM OF HAPPINESS, MAKE YOUR REALITY A HAPPY ONE; BE HAPPY WITH WHAT YOU HAVE WHILE PERSUING YOUR DREAMS.

The couple’s relationship while facing infertility

It is important to remember that infertility is a problem of both members of the couple. Whatever the reason, reaction to infertility by each individual is usually different and depends on personality, life-experience and the ability to overcome problems.

There are also differences between men and women. The majority of women tend to be very focussed on their menstrual cycle (this can be a very emotionally traumatic element as each period means the absence of a pregnancy). Men can suffer the emotional strain in silence as they are not used to sharing this type of experience.

Clinically-speaking we can observe that the reaction of one member of the couple influences the emotional response of the other, creating a vicious circle effect.

One could blame the other for their inability to open up which leads to stress and resentment between the couple for thinking that the other is not going through the same emotional rollercoaster.

The relationship can suffer changes: communication can be affected as one member of the couple tries to avoid expressing their thoughts in order to protect their partner which in turn can create feelings of anger or resentment, increasing tension within the relationship. In this way having programmed sexual intercourse can decrease spontaneity and intimacy and can turn it into a chore associated solely with reproduction.

Communicaction is the key to getting over these issues.

Despite everything it is surprising the change of attitudes and opinions that couples experience facing these issues and their possible solutions. As Francis Picabie once said, “our head is round so that a thought can easily change direction”.

Emotional stages while facing infertility

• Paralysis: Characterised by a feeling of being in a tunnel, very distant from others. You are overwhelmed by thoughts that what is happening to you cannot be real.
• Longing: A great need for your dreams of becoming a parent to come true (the couple sees that all their friends have children and that a lot of what their friends do is focussed on their children; infertile couples feel naturally excluded, feel they are alone, are angry and jealous; the medical explanation tends not to be enough to calm them down and the anger is intense coupled with shame and feelings of guilt)
• Lack of organisation and desperation: this is the longest stage, characterised by the feelings of guilt, anxiety and loneliness
• Reorganisation: Acceptance of the couple’s personal situation

Emotional responses while facing infertility

When someone goes for what they really desire and finds it difficult to reach this goal, sooner or later they go through a period of doubt. They feel demotivated, wish to give up, feel anxious, sad, exhausted, frustrated and desperate. Some common responses while facing infertility are:

• Shock: When the couple is diagnosed with infertility, the majority respond with shock and disbelief. After having planned a life with children in mind their plans change dramatically. This is a short stage of the process and helps in the couple’s adaptation.
• Denial: initially the couple could react in such a way as to deny the problem instead of facing it. This phase also helps in their acceptance of the situation. It only becomes unhealthy when the phase continues for a long period of time. Frequently the thought “This can’t be happening to us. There must be some sort of mistake” arises.
• Blame: Feelings of blame for taking away from their partner the possibility of becoming a parent and from the parents the chances of becoming grandparents. Blame is an uncomfortable but common response. It can be overcome with a positive mindset while being focussed on finding solution.
• Anger: A feeling that infertility just isn’t fair. It is very common to feel resentment towards other pregnant women and to be anger with health professionals, relations and friends. These are normal feelings but when they are internalised, they can lead to depression.
• Isolation: Frequently couples feel all alone and this makes it all the more difficult to deal with the situation. Many reject social gatherings with friends so as not to see children. For many it is extremely difficult to share with others an issue that is so terribly intimate and personal.
• Loss of control: Many couples plan the arrival of their children with the same care as they would plan any other aspect of their lives. When they realise that they no longer have control of this aspect of their life, even of their bodies, their self-esteem can plummet.
• Desperation: It is usual to feel hope at the beginning of very cycle and then to slowly lose that hope with repeatedly unsuccessful cycles. It is difficult to keep upbeat but you should believe that every failed try is a step towards the right solution whether it be a successful treatment or other alternative options. Remember to keep hope alive.
• Rush to get a result: “I want a child now!” The couple does not wish to wait any longer as everything seems to take an eternity even a five minute wait in the waiting room before being seen by the doctor. They feel the process is a race against time.
• Not having a Plan B: A feeling of “there is no meaning to my life if I don’t have a child”. Fertility treatment should not be seen as the only and final option in order to be happy.

Emotional therapeutic advice

• OPEN YOUR HORIZONS: The wider the scope of your objective, the bigger the chance we have of meeting your goal. It is not the same trying to reach the goal of a couple who wish to have a child regardless of the genetic links than another couple who wish a child of a specific gender. Opening up to all the possibilities that exist in reaching your goal means that stress generated by the treatments will be reduced. Happiness is not a challenge; it is a way of life and patience one of the best roads to turning our desires into reality.

• TAKE DECISIONS: It is of the utmost importance to come to consensus with your partner regarding the alternatives that are offered and on “where are our limits”. For this it is necessary to be well-informed in order to evaluate the pros and cons of each of the alternatives and to choose together the option which best fits you. Once the decision has been taken, the issues surrounding the acceptance of the situation will gradually reduce.
• THE TREATMENT: The clinic consultation tends to be worrying and intense and so your partner’s support is fundamental. Usually you have a lot of questions to ask the consultant but due to nerves you forget them. It’s always a great help to write down a list of questions before going to the consultation.
• EXPRESS YOUR FEELINGS: We shouldn’t take for given that the people around us know and understand our needs and thoughts. We should manage our feelings of isolation as they could lead us to being completely cut-off and falling into a depression. Acceptance is a courageous act; an act which helps us to manage our feelings, our pain. Happy individuals accept situations without solutions but fight for those which do have one. Sterility is extremely frustrating as it seems that we cannot consciously do anything more in order to increase the chances of success in each cycle. A helpful exercise is to identify our feelings and write them down on paper. Also find a friend you can confide in to share your feelings and difficulties. It can also be helpful to speak to others who find themselves in the same situation as yourself through group therapy.
• NEGATIVE THOUGHTS: You should try to stem negative thoughts like “Why me?”, “We’ll never do it!”, “It’s my fault.”, “I can’t deal with the emotional stress”. These types of thoughts can be stopped with the aid of positive thinking, “We’re a step closer to our goal” and “We can do it!”. Emotional and situational problems are caused by a misperception of the situation which can be solved developing different skills (relaxation, assertiveness, social skills) and re-learning and modifying the negative assumptions that we have of ourselves.
• FEELINGS OF CONTROL: Various strategies exist to help us feel more in control of our lives: obtaining all the possible information about the team who are treating you, actively participating in all decision-making regarding the treatment and planning the number of years or treatment cycles you are prepared to go through. It is important to remember that you shouldn’t take part in any activities which make you sad or depressed. It is recommended that fertility treatments should be spread-out so that you have time to relax emotionally between each one.
• THE WAIT: Waiting during the treatment and until the day of the pregnancy test may seem never-ending. You should avoid: continually going to the lavatory to check to see if your period has come and examining your body for any physical changes. Fill your time with relaxing activities and the things you have been looking to do for a long time but have never had the time to do them. The key is to keep yourself busy during the waiting time.
• PREPARE YOURSELF: Difficulties can arise: Seeing pregnant women at the clinic, a negative pregnancy test, wanting to abandon the treatment, etc. To face these difficulties, prepare how you are going to react while facing an uncomfortable situation. In this way you will feel more in control of your feelings.
• REEVALUATE YOUR INITIAL PLANS in order to have the family we have always wanted although through other means to those that we initially planned (for example, through gamete donation, embryo adoption or the adoption of a child)

With a little patience and a positive attitude along with the right treatment plan, many couples with fertility issues can realise their dreams of becoming parents.

DON’T DREAM OF HAPPINESS, MAKE YOUR REALITY A HAPPY ONE; BE HAPPY WITH WHAT YOU HAVE WHILE PERSUING YOUR DREAMS.

Being aware of the importance of caring for emotions during fertility treatment, your Personal Assistant (PA) is experienced to support you through any medical or emotional issue that may arise. Do not hesitate to confide in them.

This information has been developed and written by Natalia Romera Agulló, psychologist and Donor Coordinator in the Egg Donation Department at Instituto Bernabeu.