Infertility and psychology

Infertility is considered by the WHO (World Health Organization) a pathology, definable by the absence of conception after 12/24 months of targeted unprotected intercourse.

According to estimates by the Istituto Superiore di Sanità,  infertility affects about 15% of couples and the causes, both in male and female, can be of various types.

What is “psychogenic” infertility?

Alongside biological reasons, scientific literature over the years has repeatedly asked whether and to what extent psychological factors could lead to infertility. Well, it seems that these hypotheses have found positive feedback, so much so that the term “psychogenic” infertility has been coined.

Almost all of these studies involved women who shared one or more of the following factors:

  • unresolved internal conflicts;
  • confusion about one’s sexuality;
  • conflicts in the couple poured into the procreative side;
  • ambivalence towards the desire for motherhood;
  • situations of anxiety and depression.

In 2009, a  WHO report  underlined that cases of “unexplained” or psychogenic infertility are decreasing in step with scientific progress. This also means greater attention and prevention of stigma towards women diagnosed with infertility, often labeled in these cases as “crazy”, “incompetent” or “unsuitable”.

This does not mean that psychological factors can affect the possibility of conception. For example, research published in  Fertility and Sterility  has highlighted how high levels of stress (detectable through enzymatic indicators in saliva) can have a negative impact on the chances of conception.

In particular, the sources of stress have been divided into two broad categories:

  • the internal and external expectations of the couple;
  • previous attempts failed.

This study was conducted on a sample of women; other studies  have shown that completely similar dynamics exist in humans as well.

The diagnosis of infertility and its consequences

on the woman

As with many diagnoses, even in the case of infertility, a very common first reaction is surprise and disbelief. It is not uncommon for the person to turn to other specialists, hoping that the response has been formulated incorrectly.

It is an inexorable sentence: it puts an end to that part of oneself that was struggling with a pregnancy, with birth, with preparations… In this sense it is comparable to mourning, with all the feelings that it typically entails.

The acceptance process goes through a range of emotions:

  • Anger:  Why Me?
  • Regret:  Why didn’t I try this sooner? Maybe everything would be fine…
  • Guilt:  It’s all my fault.
  • Sadness:  now what will I do?
  • Self devaluation:  I can’t procreate, I’m worth nothing.

Especially as regards the last aspect, i.e. the drastic drop in self-esteem, we must consider that there are some socio-cultural realities in which women are considered as such only if they have a desire for motherhood that they are able to fulfil.

Without going too far, these are contexts close to us, where this prejudice is not always openly manifest but is shared more silently. The woman diagnosed with infertility is stigmatized, with effects all the heavier the more this happens on the part of the most significant people.

It is not uncommon for the woman to go back into her past in search of an event to blame herself for, even if there is no rational connection. These repeated thoughts, called “ruminations”, are put into place to make sense of the loss of control that is experienced when emotions become overwhelming.

A value is also attributed to sentences said years before, to behaviors that have nothing to do with it, to the limits of magical thinking.

on man

Historically, most of the studies on the psychological consequences of the diagnosis of infertility have focused on infertility in women; more recent research  is looking at the male point of view.

Even man goes through very similar psychological experiences, including a drop in self-esteem. He feels affected in his masculinity, feeling in some cases the weight of not being able to pass on his family’s genetic heritage.

about the couple

The diagnosis of infertility obviously makes its consequences felt on the couple. All the experiences listed above are multiplied by two and it is by no means certain that they are the same at the same time. This depends a lot on the phase crossed: is the desire for parenthood shared in the same way? For which of the two is it more important?

This is a very critical moment, which can lead the sterile partner to want to leave the other so that he can find another reality with which to fulfill his desire for parenthood; on the contrary, there may be a fear of abandonment and of another “mourning” to be worked through in solitude.

The stress resulting from the diagnosis can exacerbate existing problems as well as create new ones. Anger can bring up past choices, which are reproached even if they were shared at the time. We accuse each other of facts that have nothing to do with infertility but which act as a vehicle for the expression of emotions that cannot be managed in any other way.

As long as the couple remains entangled in an atmosphere of hostility, recriminations and regrets, they will not be able to make future plans. Even for subsequent choices such as assisted fertilization, adoption or the choice to remain as a couple, there is a need for communication and sharing of objectives.

Secondary infertility, what is it

Even if it is not talked about much, there is a type of infertility called “secondary”, which concerns women who have already had a biological child and are unable to conceive a second one or carry the pregnancy to term.

The risk is that it will be trivialized or belittled with phrases such as: “these are women who have already had a child, what right do they have to complain?” or, “they should be less selfish and think of those who have not been able to have any at all.” This kind of affirmation can also come from the closest people and from whom one would expect a different reception.

In this situation, the woman does not feel authorized to express her discomfort, she represses it, tries to hide it but remains in a space of her mind and heart.

Already a mother, she experiences ambivalent emotions: she looks to a future she had hypothesized and which is now no longer feasible and she is unable to enjoy the present with her growing son.

This increases the sense of guilt and affects the perception of one’s parenting skills, as well as being a possible source of conflict in the couple.

Psychological support, because it is important

Emotions following a diagnosis of infertility are of various types and intensities.

They are not a female prerogative, even if culturally and historically we tend to believe the opposite.

Each person, depending on his experience, will have a different reaction. He will find points of contact and differences with other similar situations.

If sadness, bursts of irritability, deep sense of guilt, sleep and appetite disturbances persist,  specialist psychological help  can help process the incident and prevent any depressive crises.

Support is also advisable to rediscover harmony in the couple and to make shared decisions about the future, as well as providing support during targeted medical treatments and the adoption process.

Katherine Johnson, M.D., is a board-certified obstetrician-gynecologist with clinical expertise in general obstetrics and gynecology, family planning, women’s health, and gynecology.

She is affiliated with the Obstetrics and Gynecology division at an undisclosed healthcare institution and the online platform,

Leave a Reply

Your email address will not be published. Required fields are marked *