Deconstructing infertility: Causes, treatment and impact on mental health


In recent decades, the topic of women's mental health, particularly with regard to their reproductive life, has aroused substantial interest. There has been growing recognition and concern that women are vulnerable to significant changes in their mood, particularly during periods such as pregnancy and postpartum. But what about when pregnancy doesn't happen?


In May, it seems pertinent to address the issue of infertility, contradicting the numerous positive meanings of this month, associated with the experience and celebration of motherhood - for example, according to mythology, May (in Latin, Maius) was named in honor of the goddess Maya (meaning “little mother”), the goddess of fertility, spring and rebirth; in the Catholic religion, May is dedicated especially to the Virgin Mary. But is society too focused on this role of women as mothers, often ignoring the adverse conditions that may occur during their reproductive life?


For a pregnancy to occur, several steps are required, from the formation and release of an egg from the ovaries to the development of intrauterine life. However, this process does not always go as expected, and it may pave the way for a diagnosis of infertility.


What is infertility?

Considered by the World Health Organization (WHO) a public health problem, with numerous psychosocial, demographic and economic implications, infertility can be defined as “the inability of a couple to conceive or carry a pregnancy to term, after at least one year of regular sexual intercourse without any protection” (Portuguese Society of Reproductive Medicine [SPMR]). About 1 in 10 couples have difficulty conceiving or carrying a pregnancy to term. The good news is that in recent years remarkable advances have been made in treatments for infertility.


What are the main causes of infertility? In about 30 to 40% of cases of infertility, the cause is female, followed by 20 to 30% of cases, whose cause is male. Approximately, in 30% of cases, both members of the couple contribute, to a greater or lesser degree, to the diagnosis. However, in about 5% to 10% of cases there is no apparent reason for infertility - this is called unexplained infertility or infertility of unknown cause.


Most common female causes:

  • Ovulation failure

  • Obstruction of the tubes

  • Uterine disease

  • Unfavorable cervical mucus

  • Endometriosis

  • Repeat abortion

Most common male causes:

  • Decreased number of sperm

  • Sperm with reduced mobility

  • Sperm with abnormal configuration

  • Absence of sperm


Although many of the causes for a diagnosis of infertility cannot be controlled, we highlight some habits that may contribute to reducing the probability of this diagnosis:

  • Sleep hygiene: Nocturnal rest is essential for the proper functioning of the pituitary gland, responsible for the production of hormones that stimulate the ovaries in women and the testes in men. Thus, it is advisable to have good sleep hygiene (7/8 hours of sleep per night).

  • Food: A healthy, balanced and varied diet is recommended.

  • Physical exercise: It is advised to practice physical exercise. Be aware that both excessive physical exercise and sedentary lifestyle disturb the functioning of the pituitary gland, interfering with the functioning of the ovaries and testes.

  • Smoking: According to several gynecologists, in women, smoking can rapidly age the eggs, in about ten years; in men, the harmful effects of tobacco are essentially reflected in the loss of mobility and the fragmentation of sperm DNA, which reduces the ability to fertilize.

  • Body weight: Excess weight or low weight leads to hormonal changes with a negative impact on the fertility of women and men. In women, weight deviations interfere with the amount of estrogen produced and its imbalance prevents ovulation. The excess of estrogen in obese women is as harmful as the lack of this female hormone in very thin or sporty women (i.e., with very little fat mass). In men, the high percentage of adipose tissue causes a decrease in the production of testosterone, which can cause loss of libido and difficulty in erection. The greater the excess weight, the lower the quality of the sperm.

  • Temperature in the testicular zone: Very high temperatures in the testicular zone impair sperm production, also affecting the quantity and motility of sperm. Men should therefore avoid bathing in very hot water, working with the computer directly on their laps, and wearing underwear that is too tight.


What are the treatment options for infertility?

Currently, there are several possibilities of treatment for infertility, which should be carefully evaluated according to each clinical case. For example, the use of hormones to stimulate the ovaries, the development of sophisticated surgical techniques such as Medically Assisted Reproduction Treatments (MAR), the emergence of IVF and, more recently, the Intracytoplasmic sperm injection (ICSI) and the possibility of screening of embryos under certain conditions. For more detailed information about the different treatments for infertility, consult: https://www.spmr.pt/ (in Portuguese)


What is the impact of infertility on mental health?

Infertility is commonly experienced as a traumatic event for most individuals and couples, especially if one of their life goals is centred on parenting. In addition, although it varies depending on the cultural context in which the individual is inserted, the usual social and parental pressure to be a mother or father and continue the family name in the next generation, puts great pressure on the individual, often resulting in high discomfort about this theme. According to some scientific literature, the psychological experience of infertility can even be compared to a mourning process, inherent to the loss of an expected fertility, without associated difficulties. Thus, receiving a diagnosis of infertility seems to have a negative impact on the individual's mental health, both at the individual and marital level, often leading to the experience of sadness, anxiety, a sense of loss (loss of the idealized child due to spontaneous pregnancy) and guilt.


In this context, psychological interventions can be essential! Psychotherapy comprises the psychological support necessary to help deal with emotional responses caused by the diagnosis of infertility and possible treatment, as well as the psychosocial consequences arising from this experience and the psychological needs of the individuals involved (e.g., infertile couples, women or men). The psychologist plays an important role, both in sexual and reproductive health counselling (e.g., promoting informed reproductive decision-making), as well as in psychological counselling and promotion of well-being at all stages and aspects of the reproductive process (e.g., treatment of assisted reproduction, if applicable; expectations management).


Living with a diagnosis of infertility requires courage and dedication to face the physical and psychological suffering caused by this condition.


If you have been diagnosed with infertility, seek help from a specialist. Take care of yourself.




References:

Barnes, D. (2014). Women's reproductive mental health across the lifespan. Springer.

Lopes, V. & Pinto, G. (2012). Quando a gravidez não acontece: intervenção psicológica na infertilidade. In M. J. Correia (Coord.), A psicologia na saúde da mulher e da criança: intervenções, práticas e contextos numa maternidade (pp. 36-47). Placebo.

Sociedade Portuguesa de Medicina da Reprodução: https://www.spmr.pt/

van den Akker, O. B. (2012). Reproductive health psychology. John Wiley & Sons.

World Health Organization (2009). Mental health aspects of women's reproductive health: A global review of the literature. United Nations Population Fund, & Key Centre for Women's Health in Society.

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