[Nasional-e] The emotional stresses of infertility

[Ambon]

 The emotional stresses of infertility

 Laurie Tarkan The New York Times Thursday, October 10, 2002

NEW YORK In the past decade, fertility experts have made major advances in
reproductive technology. They have learned how to inject a single
microscopic sperm into an egg to ensure fertilization; they can retrieve an
egg from one woman, fertilize it and implant it into another's uterus, and
they have succeeded in freezing a young woman's eggs so she could have
access to them later in life when she is ready to reproduce.
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But increasingly these experts are finding that they must pay attention to
the most fundamental and low-tech of issues, the emotional health of their
infertility patients.
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In the past two years, about half of the 370 American infertility centers
approved by the Society for Assisted Reproductive Technology have expanded
their psychological services by hiring psychologists, starting support
groups and holding programs and stress-reduction workshops, according to
Resolve, a national infertility support organization.
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Boston IVF, a private infertility center, recently opened the Mind/Body
Center for Women's Health, which offers a comprehensive program that teaches
women relaxation techniques, yoga, stress management and other ways of
coping with the emotional issues of infertility.
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Psychologists became an integral part of the assisted reproduction program
at Stanford a few years ago, when egg donation grew in popularity. The
social and ethical complexities of using a third-party egg demanded
psychological consultations, its director said.
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New York University's program recently began offering stress-management
programs and support groups for men, women and couples.
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"In many situations, the medical part is the simpler part," said Michael
Alper, the medical director at Boston IVF. "It's the frustration of dealing
with repeated failures and disappointments that becomes an even greater
challenge."
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Resolve reported a 60 percent increase in the number of people calling for
referrals to mental health professionals in the last two years. Experts
attribute some of the changes to the rise in awareness about infertility. In
the past, society has not recognized infertility as a disease or the
emotional burden associated with infertility, said David Adamson, director
of Fertility Physicians of Northern California, an infertility center in
Palo Alto.
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"Infertility has been in the closet for so long, and it's just beginning to
come out," said Stephanie Greco, director of communications for Resolve.
"There has been more awareness, so people are beginning to feel it's O.K. to
get help, rather than to feel totally isolated and helpless."
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Distress, anxiety, loneliness, sleep problems, grief and marital stress
occur in many women with infertility who are trying to conceive with or
without medical assistance. Men tend to have these problems to a lesser
degree.
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"The literature has tended to show that women regard infertility as the most
disastrous thing that's ever happened to them," said Nada Stotland,
professor of psychiatry at Rush Medical College in Chicago.
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Infertility, defined as the inability to conceive within 12 months (six
months for a woman 35 or older) or to carry a pregnancy to live birth,
affects an estimated 2.1 million married couples in the United States. More
than 95 percent of these people are treated with drug therapy or surgical
procedures. But 10 percent of those seeking treatment have in vitro
fertilization. In 1999, doctors performed 86,822 in vitro fertilization
cycles. Success was about 25 percent that year.
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At the beginning of a treatment cycle, couples are full of hope, said Pamela
Madsen, executive director of the American Infertility Association, a
national support organization. Then the hope begins to fade, and a fear of
failure creeps in. For every failure, couples can experience grief for what
could have been. As this is repeated month after month, sometimes for years,
it becomes chronic grief.
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Knowing when to stop treatment is the most difficult decision many couples
face. The high cost is one reason many stop, and many more never begin.
Intrauterine insemination costs $3,000 to $4,000 and a cycle of the
higher-tech in vitro fertilization costs $12,000 to $15,000. Only 15 states
require insurers to cover or offer coverage for infertility treatments, and
even in some of these states only certain types of treatments are covered.
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Others stop treatments because their chances of success are low, and others
become emotionally drained.
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"You're ready to stop when you feel sick at the thought of continuing to
try, and when you get excited about alternatives," said Alice Domar,
director of the Mind/Body Center at Boston IVF and the author of "Conquering
Infertility."
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The stress of treatment can take a toll on relationships. "Men and women do
not respond to infertility in the same way, and they never respond the same
way at the same time," Domar said.
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Typically the wife wants to begin infertility treatments before the husband
does, she said. The husband wants the wife to stop obsessing about it and
feels he has to be emotionally strong. "I tell couples, 'Don't have the
expectation that the other person is going to respond the way you do,'"
Domar said.