Since earlier times, human race has wholly been concerned with multiplication and increase in number, this trend has been on the rise from the time the world was having only a single couple until now when the world census is clicking in tunes of six billion plus. Thus, inclusive in everyone’s mission, is the quest to have an offspring who would carry the mantle of the family lineage, wealth, name, family traditions, and cultural values. Nevertheless, behind this quest and ambitions, lies the psychological torture on couples who find themselves unable to produce their own offspring. This condition termed infertility has been on the rise amidst the overcrowded world population. The term infertility can be described to mean the incapability of a couple or an individual to conceive a kid or to bear pregnancy to full period. It can either be primary infertility or secondary infertility. Primary infertility is a condition that results when couples fails to conceive a child despite having continued unprotected intercourse for a period exceeding one year. Secondary infertility on the other hand, is that condition that results when couples who have conceived once, fail to conceive any more. This study, in line with psychological health, seeks to explore infertility, its major causes, its effects on couples, and the available treatment (Lamanna, Riedmann, & Riedmann, 2006, p. 287)
The cause of infertility varies in males and females. According to the American Medical Association (2004), infertility in females occurs when several physiological functions of the body are not in place. This condition occurs when the fertilized eggs fail to align on the womb and the ovaries or egg producing organs have problems in creating eggs. If these conditions combine or occur singly in females.
In females, infertility is caused by several factors, which can be singly or combined. The factors that cause infertility in females include excessive consumption of alcohol, development of tumor or cancerous growth in the body which hampers ovum development, birth defects that affect the reproductive tract, diabetes complications, excess or lack of hormones in one’s body, excessive exercise, poor nutrition, old age, obesity, use of certain medications like chemotherapy drugs, blood clotting disorders, having growths in the body such as fibroids or polyps in the uterus and cervix, pelvic infection or pelvic inflammatory disease, thyroid disease, autoimmune disorders such as antiphospholipid syndrome, ovarian cysts and polycystic ovary syndrome and infection from sexually transmitted diseases or endometriosis. This signs presents severe crises in a woman who can eventually be faced with tremendous emotional, physical, and financial challenges
Infertility in males is also caused by variety of factors either singly or combined. Infertility in males’ results when there is a considerable decrease in sperm count, a physical disorder such that sperms are being blocked from being released, and when the released sperms do not work properly. If two or all of these conditions manifest in a man, he will be considered as infertile and consequently unable to bear a child. In evaluating the causes of infertility in males, there are several factors that can combine or occur singly to bring about infertility. These factors include, too much smoking, body defects arising from birth, exposure to too much heat for a prolonged period of time, when the victim’s body has too much or too little hormones, if the victims is an addict of alcohol, marijuana or cocaine, if the victim is impotent, if the victim is getting old, if the victim has once been a consumer of certain drugs such as cimetidine, nitrofurantoin and spironolactone, if the person is suffering from a condition called retrograde ejaculation, if the person has once undergone cancer treatment that includes chemotherapy and radiation, if the victim person has once been a victim of sexually transmitted diseases, and if the victim is exposed to environmental pollutants such as DDT. Once again, all this factors also present severe psychological, financial, and physical challenges to a man (Jequier, 2000, p. 38).
Psychological Causes and Consequences of Infertility
Apart from the above infertility causative agents, psychological factors also play a greater role. There are some proposed mechanisms through which depression could affect infertility. This mechanism involves the physiological characteristics such as elevated prolactin levels, thyroid dysfunctions and in case; the hypothalamic-pituitary adrenal axis is disturbed. In most cases, especially in women, the causes of depression are associated with abnormal regulation of hormones that regulates ovulation. These hormones are called luteinizing hormones. Stress is also known to cause changes in immune functions of the body; which in turn affects the reproduction function of the body leading to infertility (Covington & Burns, 2006, p.7).
The psychological effects have been reported to be one of the contributing factors of infertility among couples. Stress arising from the non-fulfillment of a desire for a baby has been allied with emotional factors such as anger, hopelessness, anxiety, marital problems, and feeling of irrelevance. Couples may perhaps turn out to be more concerned to conceive as luck would have it, escalating sexual dysfunction consequently leading to public seclusion. When couples are under pressure to make medical decision towards infertility, marital discord is bound to develop has been reported to breed sense of loss, stigma, and diminished self esteem, on every occasion the subject of fertility is raised. The response of male and females in regard to infertility differs considerably as study shows that women parades more intensity of sorrow compared to their male counter parts.
The women often have clinical depression rates akin to those suffering from cancer or heart disease. Emotional tension and marital troubles are normally high in cases where the infertility is caused by the man. Hence, psychological infertility has devastating impacts both to the victim and the victim’s partner. Infertility, which can cause confusion and segregation on the affected couples, has devastating complications. Majority often go through a series of intense feelings, as soon as they are detected to be having signs of infertility. Often, an individual will develop immense sadness on realizing his or her incapability. In most cases, the affected partner will in turn have the feeling of betrayal mixed with anger. Both the couple and other individuals will be grieved by the imaginations of foregone experiences and fantasies of having a child. The couples in particular will experience drastic change in their relationship. This often results from withdrawal from intimacy or the feeling of betrayal by fate. The feelings of guilt and self blame arises often arise in a case whereby one partner is identified as being the cause of infertility. Also, the partner who has been considered infertile will develop unknown phobia as he/she will feel that their relationship is threatened as the fertile partner is likely to leave any time when patience runs out (Covington & Burns, 2006, p. 7).
In addition, Infertility poses other effects on the victims’ social life and behaviors. The couples and individual found to be to victims of infertility normally isolate from friends, family members, and even colleagues. Often, the victims fear attending social events and functions since in such occasions, discussions concerning marriage life and fertility are likely to crop up. Also, during social functions, couples or individuals often gather with their children and hence, this is likely to psychologically affect the infertile victims. In such cases, socializing with friends who have families becomes very difficult and thus breeds psychological stress. These psychological stresses are influenced mainly by three factors in both men and women. First, there is a widespread notion that having children is a major achievement in life. Most women believe that a successful marriage is attributable to having children. This notion is the most important one in women as it highlights what successful marriage is. With regards to this, often, women show strong desire to have babies than men. Secondly, female roles are prioritized by child bearing. This is the most important factor in males but of second to females. Always, there is that pressure from the peers that a man’s wife has to bear a child in order to complete the marriage institution. Thirdly, couple’s sexual life can pose psychological effects. This has equal magnitude to both partners since sex is conceived in the mind and if the mind has been has the knowledge on the futility of such intercourse, then the mind will not rise to the occasion. The diagnosis of infertility may also have a noticeable consequence on relationship with others, particularly the partner. Anger may be aimed at a partner who is observed as the cause of the infertility or who does not appear to be appreciative, helpful, or committed to the same objective. Feelings of insufficiency can results to thoughts of leaving the fertile partner to bear a child with someone else. On the other hand, the infertile partner may fear neglect. The infertile individual may also be psychologically affected by suffering from low self-esteem and a feeling of failure, which not only remains restricted to the reproductive subject but lengthens to having feelings of general problem, lack of appeal, lack of femininity or masculinity, and an inability to be a suitable parent or partner (Alexander, Larosa, Bader, Alexander, & Garfield, 2009, p.163).
Infertility is like a battle and must not be fought alone; combined efforts of counseling and treatment can produce fruits. There is no specific procedures that has to be followed in the treatment of infertility since the causes of infertility varies considerably. Also, any attempt to treat an infertile person has to take into consideration the level of infertility such as secondary or primary, the sex of the victim, and the magnitude or the extent to which infertility has reached. In addition, the couples’ condition is examined to establish whether their state is either temporary or permanent. Permanent infertility occurs where there is a complete absence of egg producing organs in females and the complete absence of sperm producing organs in males (O’Donohue, 2005, p. 224).
The Psychological Treatment
From the above described causes, the primary focus of infertility treatment is medical but it is importance to deal with the implications that infertility has couples’ mental health, and social life. In the light of these, the acknowledgement that infertility and its treatment are linked with psychological distress has resulted to the introduction of a small number of theoretically conducted psychotherapeutic interventions aimed at infertile couples experiencing assisted reproduction. Besides, marriage and family therapy is most beneficial when one is contemplating on how to undertake new treatment after the first one has failed, in a case where one needs extended family support and assistance, when one if faced with difficult medical decisions, when one is considering a third party assistance such as egg or sperm donation or surrogacy, and also when one is investigating other options of family building such as adoption. Marriage and family therapy are very helpful in cases where individuals or couples experience some or all of the factors including social isolation, suicidal thoughts, difficulty in concentrations and memory lapse, increased disagreements and discord in a relationship, strained interpersonal relationships with friends and family, and continual feeling of sadness, guilt, rejection, anger, and anxiety (Glick, Berman, & Clarkin, 2000, p. 448).
The marriage and family therapist can aid an infertile victim in many ways. Glick, Berman, & Clarkin (2000) assert that, though it is impossible for a marriage therapist to offer an effective medical treatment to help a woman become pregnant, he or she can help a victim wade through the process and be able to communicate well as well as gain family support. Through the help of a therapist, the victim can get to learn better and acquire efficient ways of handling the issue in a confident manner. Through the directions of a marriage therapist, the affected couples can get to agree on the probable channel to use in solving their crisis. Due to the high rate of infertility in the previous decade, researchers have proposed that infertility treatment programs should incorporate an element of psychological treatment component, for instance, individual therapy.
Group psychological interventions have been reported to be helpful by enhancing pregnancy rates among infertile women. Victims with major mood or anxiety disorders should be offered psychotherapy treatment and/ or psychotropic medication. Besides, a psychiatrist can assist affected couples by discovering alternative parenting options, incorporating adoption. The psychiatrist plays a vital role in encouraging affected couples to contribute in therapy, either jointly or individually. The psychiatric clinician is also responsible for psychiatric assessment, clarification of matters pertaining treatment decisions, facilitation of consensus between partners about treatment, assisting couples to tackle stresses associated with infertility treatments, referral of affected couples to support groups, provision of support through treatment holidays or after unproductive course of treatment and provision of psychopharmacological treatment (Glick, Berman, & Clarkin, 2000, p. 448).
A cognitive-behavioral intervention is a psychological treatment which is designed to instruct the infertile couple in effective coping and problem solving approaches. It also takes account of behavioral rehearsal, role-play, and reappraising dysfunctional cognitions. Besides, researchers of health psychology have proved that support strategies (individual, couple, and group interventions) are effective in assisting affected couples deal with stress, depression, anxiety. Evidence points out that cognitive-behavioral and psychophysiological intervention have their advantages for decreasing anxiety and depression among infertile women. Patient education, psycho-physiological and cognitive-behavioral interventions are commonly utilized in an infertility context (Covington & Burns, 2006, p. 125).
The treatment of male victims who are infertile differs from females’ treatment since only a small portion of males who are sub-fertile and completely infertile are capable of undergoing a rational and effective treatment. Fertility drugs are the most generally used therapeutic agents for treating ovulatory dysfunction in females. Psychological treatment should also be provided along with medical treatment. In situations where the man’s infertility problem is untreatable, the couples can opt to have a donor sperm insemination. On the other hand, egg donation is an alternative for women who do not react to ovarian stimulation. Additionally, medication can be provided to the donor and the infertile woman with the aim of synchronizing their cycles. The donor eggs can become fertilized with sperm by means of IVF or GIFT process and then reallocated to the infertile woman, who will then hold the pregnancy. With regards to the woman who is in a position to ovulate but cannot hold the pregnancy, a fertilized egg may be inseminated in a surrogate mother who will afterwards hold the pregnancy (Fritz & Speroff, 2010, p. 1158).
The treatment of infertile males similar to females does not follow a single procedure but instead depends on the nature of the infertile conditions. After analysis of the victim’s medical history, he is subjected to various levels of diagnostic tests. In the first level, the semen is analyzed in accordance, hormonal measurement is performed, and the hormone testosterone is analyzed to ascertain its quantity. In the second level of diagnostic test, an examination of bacterial content and ultrasound is carried out on men with medical conditions. If the victim has chromosome abnormality signs, then genetic assessment is done. In the third level of diagnostic test, a process called testicular biopsy is done on the victims. Furthermore, a routine semen analysis is performed as a sperm function test. If the man’s sperm are obstructed by thick cervical mucus attributable to infection, passage may be aided by treating the woman with antibiotics, or the cervix may be evaded by employing artificially insemination In addition, sexual therapy is vital for couples with sexual problems. For instance, a man with a small number of sperms can be advised to wear looser clothing so as to diminish testicular temperature or remove a varicoele. However, no hormonal treatments have been successful in raising the quantity of sperm. Researchers have found out that medication of infertility programs can give rise to couples engaging in consecutively painful and costly infertility treatments, often with little comprehension or formal concern of the medical and psychological effects of such approaches (O’Donohue, 2005, p. 224).
Infertility, though termed by many as the inability to conceive a child or carry a pregnancy to complete full period, is not that bleak as people have come to term it. Infertile couples have been portrayed to pass through a series of stages involving astonishment, denial, anger, despair, grief, remorse, and acceptance or resolution. Those couples and individual found to be the victims of infertility should not isolate from friends, family members, and even colleagues or fear attending social events and functions on grounds that discussions concerning marriage life and fertility often arises. As seen from this study, there is not an infertile case that can be termed as hopeless and the victims should not handle the case alone. Combined efforts from family, friends, counselors, and doctors can yield the desired fruits. Treatment plans are generally aimed to alleviate the symptoms that infertile couples experience and enable them to cope with treatment and/ or the ultimate loss of hope for conception .This study has shown without reasonable doubt that infertility manifests in many ways and there is treatment for the same, medically, and also through proper counseling.