Psycho-social burdens of infertility

Reproduction is regarded as a basic function of life. Inability to reproduce, also known as infertility, is a widespread problem in our today’s societies, given that the population suffering infertility is significantly increased in the past decades. Infertility is considered as an individual and couples’ experience that affects not only the relationship between the couple but also the family’s social and psychological status according to Fatlinda, Kalaja, Etiona, 2015. In some cultures, traditional or magical treatment is employed for treatment of infertility, but in other cultures, the problem of infertility is solved through adopting a child, remarriage, or even divorce (Even, 2004). According to patriarchal culture and traditional contexts, childbearing is highly desirable, where an absence of children with a first wife may lead husbands to take a second wife with or without divorcing the first one (Ramezanzadeh et al., 2004). Infertility is defined as the inability of a couple to conceive naturally after one year of regular unprotected intercourse (WHO, 2019). The chance to conceive depends on the length of sexual exposure, frequency of coitus, and couple’s age. The normal, young aged couples have a 25% chance to conceive after 1 month of unprotected intercourse; 70% of the couples conceive by six months, and 90% of the couples have a probability to conceive by 1 year. Only 5% of the couples will conceive after one and a half years or two years. Both males and females are equally responsible for the causes (WHO, 2019).

According to WHO, 2019, the following are the types of infertility: primary and secondary infertility. Primary infertility is when a woman is unable to ever bear a child due to her inability to become pregnant. Secondary infertility is a situation where a woman is unable to bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth following a previous pregnancy.  According to the Centre for Disease Control (CDC, 2019), the causes of female infertility include defective ovulation. Defective ovulation can occur as a result of endocrine disorders, physical disorders such as obesity, anorexia nervosa, and excessive exercise, which may lead to overweight or malnutrition. Ovarian disorders can also cause defective ovulation such as polycystic ovarian disease. Defective transport can lead to defective transport of ovum and sperm: Pelvic Inflammatory Disease (PID), gonorrhoea, peritonitis, previous tubal surgery, and fimbrial adhesions can cause tubal obstruction; as a result, the egg is not released or trapped, therefore, delaying conception. Scar tissue after abdominal surgery may also cause defective transport. Defective Implantation: This can result from congenital anomaly and fibroids. Congenital uterine anomaly such as bicornuate uterus and uterine fibroids near the fallopian tubes or cervix may alter implantation of the zygote and cause infertility. The causes of male infertility according to the CDC (2019) are as follows: Defective Spermatogenesis – presence of endocrine disorders such as diabetes mellitus and hyperthyroidism lead to azospermia or the formation of faulty sperms that are not capable to fertilize the ovum. Moreover, testicular disorder such as undescended testis can also affect fertility.

Defective Transport: Obstruction of the seminal vesicles or absence of the seminal ducts may affect the mobility of the sperms, and thus end up in infertility.  Ineffective Delivery: The psychosexual problems like impotence, ejaculatory dysfunction, physical disability, hypospadias, and epispadias can affect fertility of males. According to Merriam-Webster dictionary, the term psychosocial burden refers to both the psychological and social effects. Infertility causes stress, which is aggravated as time passes and the couple remains infertile. Infertility can cause considerable distress. Often cited consequences of infertility are: depression, anxiety, sexual anxiety or difficulty, feelings of anger, bitterness, denial, isolation, relationship problems with partner, family and friends, and an increased sense of self-blame and guilt (Monach, 2005; Klock, 2008).

In many cultures, womanhood is defined through motherhood, and infertile women usually carry the blame for the couples’ inability to conceive and they are the first to ask for medical health care (Tahiri, 2013). Infertile women are frequently stigmatized, resulting in isolation, neglect, domestic violence, and polygamy (Araoye, 2003; Eftekhar-Ardabily, Behboodi-Moghadam, Salsali, Rame- zanzadeh & Nedjat, 2011). The psychosocial problems that can be associated with the infertile woman include: depression, loss of interest in work, feelings of inadequacy, anxiety, sleeplessness, bipolar disorder, psychosis, hallucination, apathy etc. Constant worry can also lead to pseudocyesis (false pregnancy; a woman experiencing the physical symptoms of pregnancy while she is not pregnant in the actual sense). In addition to the feelings mentioned above, Greil et al., (2010), states that infertile women have feelings of worthlessness, inadequacy, anger, resentment and grief. Furthermore, women feel lack of control of their own body and lack of self-esteem. Feelings of helplessness and lack of creativity can also be seen (Cudmore, 2005). Because of the fact that infertility has been blamed on women, men’s emotional reactions have not been explored so much (Ekström-Immonen & Rosenberg, 2005). According to Tulppala (2012), men’s ability to impregnate his partner, becoming a father and the power of reproduction of family tree are crucial factors behind men’s emotional reactions when it comes to infertility. According to Tulppala (2012), 15-20% of men say that infertility is the most difficult issue in their lives so far. Depression and suicidal thoughts occur more often among infertile men than in men who don’t have infertility problem (Tulppala, 2012, Greil et al., 2010, Ekström-Immonen, Rosenberg 2005 & Toivanen et al. 2004).

Tulppala (2002), referred to researches made by Daniluk 1997, Amnell 1998, Burn & Covington 1999 that there have been changes in men’s role. Earlier men were providing livelihood for the family, but lately parenting and role as a father have started to bring pressure to men and how they implement their dreams. Men’s infertility seemed to be particularly shameful and they have more difficulties discussing about infertility than women. There were mixed responses as stated by Tabong & Adongo, (2013) concerning the experiences of couples within the extended family setting. While some people reported support from their families, others blamed their families for their unhappiness.   Mumtaz, Shahid & Levay (2013) noted that the abuse and stigmatization perpetuated by the marital family at the household level was much more. The marital family invariably assumed the woman was the infertile partner, even in cases of proven male infertility. This was frequently followed by abuse that included verbal and emotional harassment and physical violence. There are ways of reducing the impact of psychosocial burdens of infertility. Information and support: Despite infertility being a relatively common problem, people affected by it often believe it to be rare and find themselves feeling isolated from family and friends. An increase in public awareness and information is therefore crucial in order for couples to feel supported.

Counselling: Counselling helps to increase coping strategies, or to provide help with making decisions (as patients face many choices during treatment).  Psychotherapy: Specific types of therapy may also be useful. For example, studies have concluded that interpersonal therapy (which focuses on improving relationships or resolving conflicts with others), and cognitive behavioral therapy (which identifies and tries to change unhealthy patterns of thought or behavior), can give relief to infertile patients suffering from mild to moderate depression.

Relaxation Techniques: Given that infertility and its treatment often cause considerable stress, experts recommend various relaxation techniques. For example, mindfulness meditation, deep breathing, guided imagery, and yoga promote stress management.

Dr Chinweuba Anthonia, Obi Catherine and Alimba Chisom wrote from UNTH, Enugu.