Analysis of The Physical and Mental Attributes that Cause Infertility

Infertility is both a psychological and physical problem faced by many couples all over the world. There are at least 60-80 million people that experience infertility all over the world, and that number could be higher as many people do not report their infertility or seek help with it. (Cassidy & Sintrovani, 2008) The National Survey of Family Growth defines infertility as the failure to conceive after at least 12 consecutive months of unprotected sexual intercourse. (Kessler, Craig, Plosker, Reed, & Quinn, 2013) Many people try for years to have their own children and are unsuccessful which causes many psychological issues from both the infertility and the options for treatment. There are a number of reasons why men and women are unable to have children.

Although there are many biological factors that attribute to infertility the most limiting of these reasons seems to be an increase in reproductive age, as that cannot be reversed despite all of the advancements in treatment options. Many couples and women are choosing to put off having children to pursue careers and more stable financial situations. This could be a potentially detrimental decision for a couple trying to conceive as women reach their greatest fertility in the early to mid-20’s and it steadily declines with age and men it becomes increasingly more difficult to bear children when they reach their mid-30’s and beyond. (Kessler et al., 2013)

Beyond advanced parental age there are an almost overwhelming number of biological reasons that a couple is not able to have a child. Women could experience a blockage or abnormality in the fallopian tube either from endometriosis, STI’s that have left scar tissue. Pelvic inflammatory disease could also be the issue. When there is a blockage in the fallopian tubes that could prevent sperm from reaching egg, or allowing an egg to reach the uterus even if the sperm has successfully made it to the egg and fertilized it. The issue could also lie within the ovaries themselves or with a woman’s ovulation. These could be caused by an imbalance in the woman’s hormones, growths, issues with the women having a body weight that is either too high or too low, cysts within the ovaries or any number of other issues. (Herdt & Petit, 2014) Men also experience infertility due to problems including but not limited to a low sperm count, low sperm movement or even sperm that are malformed. The reasons behind are endless and can be either biological or environmental. (Herdt & Petit, 2014)

Infertility is perceived as a life-crisis with profound psychosocial impacts. (Onat & Beji, 2012) When someone is experiencing infertility or told they cannot have children naturally they experience symptoms typically associated with a significant loss. Many people reacted to an infertility diagnosis like they would to a disaster. (Waltzer, 1982) In one study done of 200 couples at a fertility clinic showed that 50% of the women and 15% of the men said that infertility was the most upsetting experience of their lives. (“The psychological,” 2009) These symptoms include but are not limited to stress, anger, depression, anxiety, problems within a marriage and feelings of worthlessness, incompetence and even defectiveness. Couples or individual partners experience a sense of loss and lowered self-esteem as well. (Deka & Sarma, 2010) When someone is told they are infertile they are technically mourning the loss of the children they thought they could have had which takes a momentous toll on emotions and mental health. A study in Sweden found that three major factors play a role in this psychological stress and include, “Having children is a major focus of life,” “the female role and social pressure,” and “effect on sexual life.” (Deka & Sarma, 2010) When a couple finds out they cannot have a child they experience lower levels of satisfaction in their sex lives. (Lykeridou, Gourounti, Deltsidou, Loutradis, & Vaslamatzis, 2009) These struggles in their sex lives can be attributed to a number of different things including blaming their partner for the infertility, blaming him or herself or even anxiety. (“The psychological,” 2009) In some cases the spouse that is infertile considers leaving their partner because they are unable to give them a child. (Onat & Beji, 2012) If a couple is found to be completely sterile they have reported feeling isolated because unlike other people they cannot have genetic children, angry at having no control over their own bodies. Infertility causes a great amount of stress when couples or individuals realize the high cost associated with treatment. More than 40 percent of couples that seek help for infertility do not ever follow through with their treatment. If someone cannot afford to pursue treatment, or their insurance does not cover the treatments or they cannot hire a surrogate or bear the financial burden of adoption they will have to mourn the loss of the child and they will lose all hope that they will ever have a child, which can be emotionally crippling. (Kessler et al., 2013)

Social pressure to have a child is everywhere. As soon as a couple is married people question when they will start having babies and people do not give much thought to whether or not a couple is physically able to have children. Couples have reported being under pressure, excluded and treated poorly by their families for not having children. (Onat & Beji, 2012) In one study a couple reported avoiding being in places with children so they did not have to deal with questions relating to their own childbearing. The pressure from society to have children is so great that couples isolate themselves from it. (Onat & Beji, 2012) If a couple is dealing with infertility they may avoid social interactions with friends or family that already have children of their own or are pregnant. (“The psychological,” 2009) Not only does pressure exist for couples, but also many cultures expect women to bear children and there seems to be a stereotype that this is not the case in the United States, but in reality the pressure on women to conceive still exists. American culture stigmatizes a woman without a child as less than a “true woman,” deviant, abnormal and sometimes even selfish. Not only should these women be reproducing, but also they should want to reproduce, as it is their “social duty.” (Cassidy & Sintrovani, 2008)

It used to be that if a couple was found to be infertile the only option to have children would be adoption, but there have been a number of different techniques developed to help assist people in their efforts for children. Couples can choose to have children through adoption, a surrogate, egg donors, in-vitro fertilization, gamete intrafallopian transfer, zygote intrafallopian transfer, and artificial insemination either from the man trying to conceive or a donor. Adoption is when the couple takes legal custody of a child they usually do not have any genetic ties with, a surrogate relies on a woman that is not part of the couple to carry the baby to term, deliver the baby and then turn it over to the couple to adopt. The baby can be conceived using donor sperm, a donor egg from either the surrogate or another donor, or even with the sperm and egg of one or both parts of the couple. In-vitro fertilization is when eggs are removed from the woman’s ovaries and fertilized by sperm in a laboratory dish, and then implanted directly back into the woman’s uterus. Gamete intrafallopian transfer is a when a doctor places a sperm and egg directly into a woman’s fallopian tube. Zygote intrafallopian transfer is when an egg is fertilized in a laboratory dish and then that egg is placed directly into the fallopian tube. Artificial insemination occurs when the sperm of either a donor or partner and is placed directly into the vagina or uterus when the woman is thought to be ovulating. (Herdt & Petit, 2014) While all of these options have a chance of success they come at a heavy financial and emotional cost and run the risk of not being successful. Many couples report the cost of infertility treatments caused financial problems. (Onat & Beji, 2012)

Infertility treatments and options have an affect on both women and men physically as well as psychologically. Women report that they experience negative changes in their bodies during treatment such as headaches or pain where injections occur. (Onat & Beji, 2012) A study done in Greece showed that women going through infertility treatment experienced high levels of anxiety. (Lykeridou et al., 2009) Both members of the couple are shown to feel more depressed and stressed out as well. When a couple is stressed out from the treatment it could actual become counterproductive and create an even bigger challenge to getting pregnant. It is thought that a person in a depressed state experiences higher levels of prolactin, thyroid dysfunction, and a change in the immune system that could affect fertility. In depressed women the hormone that regulates ovulation is thought to function abnormally when depressed. These psychological symptoms lead many people to stop receiving treatment. (Deka & Sarma, 2010) It has been shown that some of the medications used in treatment can cause psychological side effects of their own. For example, a medication that is normally prescribed to improve ovulation is suspected to cause anxiety, trouble sleeping, mood swings and irritability. Some other medications have been thought to cause depression, irritability, trouble thinking and even mania in some patients. (“The psychological,” 2009) Sexual life is also thought to be affected by these medications, and patients begin to see themselves as “fertilization machines.” (Onat & Beji, 2012) Both the person undergoing treatment and the doctors themselves find it very hard to figure out what symptoms come from the stress of the treatment and what come from the medication. Not only can infertility treatments cause new psychological problems, but also it can make existing conditions worse. (“The psychological,” 2009) Patients experience these psychological symptoms very intensely while they undergo treatment. (Onat & Beji, 2012) One woman is quoted as saying, “Menstruating during the treatment was a mourning period. I was feeling really sad and disappointed. It is a terrible frustration. It takes away all of your physical and psychological strength.” (Onat & Beji, 2012) Women seem to undergo more stress than men during both the diagnosis and treatment of infertility. (Deka & Sarma, 2010) For this reason, women undergoing treatment are recommended to seek psychological support. (Lykeridou et al., 2009)

Couples are offered with many different options for treatment that all provide their own negative and positive outcomes. Many couples attempt to adopt children but have increasingly found dissatisfaction with the process due to the grueling nature of the selection procedure, worry about laws and high costs and the small number of children available for adoption, as the waiting list is very long. Doctors suggest that couples looking to adopt should deal with their issues of grief over their inability to have genetic children and any bitterness they have towards their spouse over the infertility. It has been shown that when the adopted child reaches puberty, these feelings can reemerge in the parents, leaving the father feeling threatened by a son’s ability to procreate and a mother feeling envious if her daughter is able to have her own genetic children. (Waltzer, 1982)

Another option offered to couples looking to have children is artificial insemination whether it is from the husband or from a donor. Many parents prefer this method of creating children so that the mother can carry her own child and experience giving birth, there is a genetic link between parents and children, it gives the parents the ability to bond with the child before it is even born. Donor insemination is also a way to deal with the social pressures of infertility, as it is unbeknownst to most people but the couple that the father was unable to bear his own children. (Daniels, 1994) On the other hand, the husband in the relationship could feel that “the growing abdomen… may be a reminder… of his ‘incapability’ and of a rival father.” Some women get approval from their spouse through emotional blackmail, which can lead to complications. (Waltzer, 1982) It has been shown that many people who become parents through donor insemination tend to not tell their conceived children and they never know that they are not genetically related to both of their parents because the parents fear that the child will not be able to bond with the non genetic parent. It has been shown that keeping this secret can have a negative effect on the family. Many children have reported that children suspect something is “amiss” in their childhood and if the child ever does find out that they are not genetically related to one parent, they become very curious about their genetics and want to learn more about their biological parent. (Golombok, Murray, Brinsden, & Abdalla, 1999) Opinions vary on whether or not parents disclosing the true genetic makeup of their child have negative or positive effects on the child.

Surrogacy is an option some couples choose so that they can keep a genetic relationship with their child or avoid the adoption process. It has been shown that the absence of a pregnancy could change the experience that the parents have bonding with the child before it is born, and that if another person besides the couple is involved in the birth of a child, this could lead to difficulty parenting and even psychological problems for the child. (Golombok, MacCallum, Murray, Lycett, & Jadua, 2006) Surrogacy is not widely socially accepted and is in fact somewhat controversial. It is possible that some couples view surrogacy as an “unwelcome but necessary reproductive option.” (Ciccarelli & Beckman, 2005) Couples could experience disapproval from their family, friends and more, which could also affect how they bond with the child. (Golombok et al., 2006) On the other hand it has been shown that women who are able to undergo the stress involved with a surrogacy arrangement are highly tolerant of stressful parenting situations and that the desire to have a child overcomes the need for a genetic bond or the experience of pregnancy. (Golombok et al., 2006)

Women and couples who choose to use IVF experience more and more negative effects as treatment goes on. When first time participants in IVF and women that have gone through the cycle multiple times were compared the symptoms of depression were shown to increase. (Deka & Sarma, 2010) As treatment goes on and is unsuccessful it becomes harder and harder to find hope in the process.

Even though the diagnosis of infertility and treatment options cause significant stress and psychological issues to those going through it, if they are able to have children someway or another, genetic or not, it has been shown that those who have pursued assisted reproduction are able to overcome this and actually experience positive outcomes as they had a very strong desire for children as compared to couples and people who were able to conceive naturally without any medical intervention. The strong desire for the child they eventually receive seems to overcome all of the emotional and psychological damage that could and does occur. (Golombok et al., 2006)

Whether or not the couple is able to have children in the end people experiencing infertility must overcome extreme psychological challenges but in the end they ultimately reach a resolution whether it be somehow having genetic children of their own, adopting or using a surrogate, or deciding to move on and lead a life without children. This experience can change people forever. (“The psychological,” 2009)