Treating Infertility From the Inside Out : Using Support Services to Cope Can Optimize Treatment

By now, it's commonplace to read and learn about how the infertility struggle can and usually does impact the entire life of the people who go through it.

Nobody wants to be infertile, and no one wants the heartache that accompanies it. An important first step in successfully maneuvering this unexpected life challenge is to know what's "normal," according to Sharon N. Covington, MSW, LCSW-C, who says that couples and individuals usually go through a fairly predictable grief process that includes:

• a sense of loss of control
• disbelief
• anger
• sadness
• guilt
• blame
• anxiety
• depression

Covington is one of the world's foremost experts on the psychosocial aspects of infertility and its treatment. In addition to her work as Director of Psychological Support Services at Shady Grove Fertility and as a Clinical Assistant Professor at Georgetown University School of Medicine, she is a co-author and editor of the original physicians' information source on the topic, Infertility Counseling: A Comprehensive Handbook for Clinicians, now in its second version to include international research and issues.

In the time since Covington first started assisting infertility patients, the availability of related psychological services has skyrocketed in the United States. The latest research, she says, confirms what she and colleagues have consistently presented to both healthcare consumers and to providers: that infertility can affect how you feel about yourself.

"Some study results document, for example, that infertile women tend to be more depressed and anxious than control subjects," Covington says in reference to research that compares people going through infertility with people who are not. "How much stress impacts fertility is still debatable, but evidence seems stronger that women with untreated depression tend to have lower pregnancy rates when they go through fertility treatment cycles."

Same experience, different approaches

As with many things in life, men and women typically "see" infertility through different filters. Women experience a profound sense of loss, depression, and sadness, even when their cause of infertility is male-factor related. Men experience tremendous negative impact on their self-esteem and self-image. In responding to their emotions, women want to gather information, reach out, and find support. Men may want to withdraw, distancing themselves with avoidant ways of coping.

Covington says that one of the most crucial things for couples to realize is that their approaches are different -- not better or worse, just different. She counsels, "Couples can't rely solely on their partners to help them through this."

The concept of time can feel like an insurmountable challenge for many who enter infertility treatment, especially those who are in their 30's or older. Decision-making feels rushed and pressured.

"When you're battling the biological clock," says Covington, "you can't stop time. It's particularly hard for couples who marry later in life and want to have children immediately." Counseling throughout the treatment process from the start, rather than after a crisis has occurred, can help couples and individuals maintain a foundation through all the choices they'll make.

Covington and other mental health professionals have finally convinced most fertility experts of the need to address problems in virtually every segment of a patient's life whenever possible. Shady Grove Fertility was one of the first infertility clinics in the country to provide in-house professionals to serve the psychosocial support needs of patients.

Contrary to what the average person may think, though, it's not helpful to lump every type of supportive service into the same basket. Not only are there differences in how a given service, such as discussion groups or individual therapy, meets patient needs, there are also variances among patients' preferences.

A recent study presented at the annual conference of the European Society of Human Reproduction and Embryology (ESHRE) in 2007, for example, proposed that men, who are notorious for not participating in counseling, experience just as much unhappiness about infertility as women. The Copenhagen researchers suggest that especially soon after diagnosis, men often get more out of introduction to social networks where infertility is a shared experience.

A good fit between the patient's needs and preferences and available programs results in the most beneficial help. There's even some evidence that appropriate professional assistance to cope with infertility's emotional trials can optimize your fertility treatment.

While possibly the most common reason for infertility patients to consider psychosocial assistance are the lingering feelings of sadness, grief, and despair, even patients who are relatively new to treatment should be aware that their decision-making skills can be subtly impacted by the infertility experience, even when they don't necessarily feel depressed. Another ESHRE study from the 2007 conference demonstrated that mood affects choices. In the Canadian study, women who were going through IVF and considering how many embryos to transfer were given tests to measure their moods. Those with more negative moods made riskier choices and downplayed the possible consequences.

Treating the whole patient

Clinical Social Worker Covington applauds the increase in research on the psychological components of infertility. She reflects, "This is now being looked on as an integral aspect of treating patients. Twenty years ago, it was uncommon and cutting edge to provide counseling within the clinic setting. Shady Grove has always been at the forefront of recognizing the role that emotional health plays in physical health and treatment."

"A well-trained infertility counselor is going to be a well-trained therapist, first and foremost," says Covington. She goes on to advocate for specialized fertility education. "If someone goes to a really skilled marriage counselor who is simply not experienced in aspects of infertility, often times the patient winds up educating the counselor. They can waste tremendous time and money that way."

Today, Shady Grove Fertility has the most integrated and biggest variety of services on-site than any other practice in the country. Their website calendar reflects the presence of mental health professionals in each Shady Grove office. The same information is available in printed form in waiting and exam rooms.

Consistency of service availability, whether it's individual counseling sessions, group discussions, or seminars, is especially important in the typically busy lives of infertility patients. The support staff at Shady Grove Fertility regularly queries patients and their doctors to find out if there is increased demand for specific topics to be covered, in addition to the regularly held support groups on every aspect of infertility and its resolution.

Some of the most popular discussion groups, which frequently present experienced patients in a panel format, are on

• the decision-making process related to donor egg use,
• adoption as an option, and
• talking to children conceived through donor egg or sperm.

Among her many writings that have served as a guide for thousands of patients both at Shady Grove Fertility and from anywhere in the world via the Web, the following quick list of pointers from Sharon Covington are what she considers basic "tools of the trade":

• Approach infertility as a couple problem.
• Become educated on the medical and emotional components of infertility.
• Identify and utilize support as individuals and as a couple.
• Find ways to manage stress in your life.
• Recognize what you do have control over in your life, and what you don't.
• Realize that infertility is not experienced in a vacuum.
• Periodically reexamine your goals.
• Explore family building options while in treatment.
• Consider counseling as a resource and support.

(adapted from The Infertility Journey : A Guide For Coping)

Covington assures that the experience of infertility can be transformed into a journey filled with learning and personal growth, so long as individuals and couples are willing to seek and use the wealth of knowledge and helping hands that are available today.

Resources :

Male or female factor infertility - men suffer just the same
European Society for Human Reproduction and Embryology