Impact of Infertility on the Patient

The problem of infertility is not new. From ancient times, cultures have practiced fertility rites to ensure the continuation of their people. Many societies considered a woman's worth in terms of her ability to have children. The ''barren woman'' was frequently banished.

The average time it takes for a woman to conceive is 4 to 5 months. The American Fertility Society defines infertility as the inability to conceive ''after one year of regular coitus without contraception.'' During this time, more than 80% of women conceive. After 3 years of regular sexual intercourse, 98% of women become pregnant.

It has been estimated that approximately one of every six couples in the United States has some problem with fertility. Infertility should be considered a problem of both men and

*DES was given to many pregnant women from 1940 to 1975 for a variety of reasons, such as threatened abortion and premature labor. Vaginal involvement by adenosis often developed in exposed daughters. Carcinoma of the vagina or cervix, as well as cervical incompetence, has also occasionally been reported in the offspring.

women. It was previously thought that infertility was functional (no demonstrable organ disorder) in 30% to 50% of all cases, but it is now recognized that more than 90% of infertile couples have a pathologic cause. However, only about 50% of these couples achieve pregnancy. Fifty percent of infertility is related to a female problem,* 30% to a male problem,{ and 20% to a combined problem.

Infertility is one of several important developmental crises of adult life. The impact of infertility on a woman can be severe. The influence of the higher nervous system on ovulation is well known but only partially understood. When a woman is told that she is infertile, she may be shocked and distressed about the loss of an important function of her body. This psychologic injury lasts for variable amounts of time. Often the woman feels defective or inadequate. This extends to her interactions with others, in addition to her sexual function. Her attitude toward her job may change;her work productivity may decline. There is a significant decrease in sexual desire. Depression, loss of libido, and concern over whether conception will ever occur combine to make sex a less pleasurable activity and decrease the possibility of normal ovulation. A period of mourning and frustration usually occurs.

Often the woman becomes preoccupied with her menstrual periods. When will the next one come? Is she pregnant? Did she have any symptoms of ovulation? When the next menstrual cycle occurs, the woman suffers further grief.

The infertile woman may fear that her partner will resent her, and she may feel alienated from him. She may experience jealousy and resentment toward friends or relations who have children. Her infertility lowers her self-esteem and may make her feel that she is unfit to be a parent.

Regardless of the cause of infertility, the treatment must work to lessen the psychologic side effects. Both partners must be encouraged to communicate. Education regarding the physical problem is important throughout the medical work-up. Communication between the partners and the physician is paramount. The patient needs to be protected from her own insecurities and treated with empathy and compassion.

In some women, psychogenic factors may be the sole cause of infertility. Such factors may act at various phases in the reproductive process. These women may have immature personalities and fear the responsibilities of motherhood. They use their infertility as a defense mechanism. In other cases, emotional conflicts may lead to somatic symptoms and signs. Vaginismus is the most common psychosomatic disorder causing infertility. In this condition, the introitus may become so constricted that it inhibits the penis from entering. Vaginismus protects the patient from conception. Many of these women view sexual intercourse as exploitative and degrading. Intercourse is feared because it is painful. These patients do well with psychotherapy that allows them to express their fears about intercourse, genitalia, and childbearing.

Pregnancy Guide

Pregnancy Guide

A Beginner's Guide to Healthy Pregnancy. If you suspect, or know, that you are pregnant, we ho pe you have already visited your doctor. Presuming that you have confirmed your suspicions and that this is your first child, or that you wish to take better care of yourself d uring pregnancy than you did during your other pregnancies; you have come to the right place.

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