Jacobs: BPSS Aspects of Infertility

Question 1

What is infertility?

Answer 1

inability to conceive a pregnancy after one year of sexual intercourse w/o use of contraception and/or the inability to carry a pregnancy to live birth

Question 2

Infertility affects (blank) in six couples

Answer 2

one

Question 3

49% of women and 15% of men considered (blank) as the most upsetting experience of their lives (Freeman et al., 1985)

Answer 3

infertility

Question 4

Causes of infertility: 
35% (blank)
35% (blank)
20% (blank)
10% unexplained

Answer 4

female factor;
male factor;
combined factor

Question 5

Female factors leading to infertility?

Answer 5

menstrual problems
blockage
structural problems

Question 6

Male factors leading to infertility?

Answer 6

sperm
blockage
sexual functioning

Question 7

Combined factors leading to infertility?

Answer 7

advanced age
miscarriages
STDs
diabetes
smoking
alcohol/drugs
weight

Question 8

What are some options for infertile couples?

Answer 8

fertility drugs: regulate/stimulate ovulation, hormones have side effects, difficult to inject
antibiotics
artificial insemination
surgical treatments
use of third parties
assisted reproductive technologies

Question 9

What are some assisted reproductive technologies?

Answer 9

In Vitro Fertilization (IVF)
Gamete Intrafallopian Transfer (GIFT)
Zygote Intrafallopian Transfer (ZIFT)
Tubal Embryo Transfer (TET)
May be used with micromanipulation techniques
Intracytoplasmic Sperm Injection (ICSI)
Assisted hatching

Question 10

What are some issues with medical treatment of infertility?

Answer 10

can be disruptive to a couple’s schedule
requires precision & can create anxiety
can pose ethical issues for the couple

Question 11

How is “surprise” a factor in infertility?

Answer 11

bc most couples assume they will be able to have children
birth control gives a sense of control over fertility
successful people may experience a sense of “failure” for the first time

**although, some couples are relieved to get a diagnosis that explains the inability to have a child

Question 12

How is “denial” a factor in infertility?

Answer 12

young, healthy couples may refuse fertility evaluation
may blame other partner
may question the lab/exam results
may discount/deny the importance of having a child
may distract with other activities

Question 13

This is a big factor due to medical treatments & costs, diagnosis & treatment, wait times, anticipatory anxiety, failed treatments, miscarriages, emotional reactions

Answer 13

stress/anxiety

Question 14

Does stress cause infertility?

Answer 14

there are no definitive studies showing that stress causes infertility!!

**educate patients on this

Question 15

Why might patients feel anger with infertility?

Answer 15

loss of control
feeling cheated out of fertility
angry at "defective" body
anger at past perceived "sins" 
angry at partner, family, friends
anger over unwanted pregnancies, abortions, child abuse

Question 16

It’s important to educate parents that fertility has nothing to do with (blank) & that there is no scientific connection between previous (blank) & infertility

Answer 16

worthiness; sins

Question 17

In what ways can couples feel isolation/estrangement during infertility?

Answer 17

Shame may lead to isolation
Martial conflict, gender differences, may cause partners to feel estranged from one another
One partner’s wish for secrecy may isolate them
Couples may feel alienated from friends with children
Incessant and insensitive questions about fertility may lead to isolation from family
Painful feelings may lead to avoidance of pregnant women, babies and children, baby showers, holidays, etc.
May feel alienated from society, for not following traditional life course (getting married and having children)
Many suffer alone, and in silence

Question 18

Why might patients feel sadness & grief associated with infertility?

Answer 18

Potential losses associated with infertility: natural conception, pregnancy, control, security and faith, self-worth, relationship satisfaction, hopes, your dream child, life goals, future plans, being a biological mother/father, miscarriage.
Seeing reminders of fertility
Failed treatments
Lack of support (spouse, friends, family), alienation
Sadness can turn into depression, but full-blown depression is not common
Important to grieve losses and potential losses

Question 19

What kind of relationship problems present in infertility cases?

Answer 19

Arguing over medical treatments
Arguing over expenses of treatments
Different reactions to infertility
Different coping styles
Sex is regulated and monitored, may feel a “demand to perform,” may feel like “work” instead of fun, lacks spontaneity,  postcoital tests may cause pressure

Question 20

How can infertility lead to questioning religious beliefs?

Answer 20

“Why me?”
“Why do bad things happen to good people?”
“It’s not fair!”
“How can a ‘good God’ allow this to happen?
Infertility may be perceived as a punishment from God
“I must not be worthy to be a parent”
Being a parent can bring “status” in society, can be a marker of “adulthood.” How to get status otherwise? How to fit in?
Cultural, religious complications
Not following “the will of God”

Question 21

What other reactions might couples have after experiencing infertility?

Answer 21

jealousy
resentment
loss of control

Question 22

Comes after previous painful feelings are acknowledged and worked through
May not mean getting “over it”

Answer 22

Acceptance & resolution

Question 23

T/F: Infertility can make people stronger, and create more intimacy in relationships

Answer 23

True!

Question 24

How can you integrate a BPSS model into the approach to treatment for infertile patients?

Answer 24

educate couples about the medical aspects of infertility & fertility treatments - dispel myths about infertility
evaluate/screen for common emotional reactions
encourage social support
ask about spiritual/religious reactions

Question 25

Gives existing evidence-based treatments for anxiety, depression, marital discord and grief to the experience of infertility

Answer 25

Coping with Infertility - an evidence based bibliotherapy