Infertility and the strains imposed by treatment can produce almost unbearable highs and lows of emotion among couples, the European Society of Human Reproduction and Embryology in Bologna, Italy, heard today (Monday 26 June).
Patients find themselves riding an emotional roller coaster -- feelings veering from optimism to anxiety, from elation to depression and even fears of abandonment by the treatment teams. And, as advancing technology offers even more control over reproduction, for those for whom it fails, the promise proves only to be an illusion increasing the potential for distress, said Dr Elizabeth Koptizke of the University of Kentucky College of Medicine, Lexington, Kentucky, USA.
She told the conference that although as many as a fifth of patients report physical discomfort severe enough to interfere with everyday life she and colleague Dr John Wilson found it was, overwhelmingly, emotional problems that caused the most distress.
There was evidence emerging also that, as more treatment interventions become available for men, the reactions experienced by men and women were beginning to follow a similar pattern.
"Constant efforts to regulate these emotions may take a significant toll," said Dr Koptizke. "We don't know what the long-term effects may be, but we do know from studies that these acts of self control and volition deplete 'psychic energy', which is an important self- resource, particularly when patients feel they have no personal control over their lives. There is bound to be a cost for these frequently stoic 'super copers.'"
Although women reported that they received social support, relationships were dramatically affected and could actually be jeopardised. Previously enjoyable experiences such as family get-togethers, shopping trips and friendships at work could become sources of pain. Unwanted advice, although well-intentioned, hurt. Some dreaded going to work for fear a co-worker would announce she was pregnant -- symptomatic of an often expressed view by infertile women that they felt envious of others with children.
"Becoming a parent is part of one's core identity. For those who can't have children life is diminished; they lose their link with the future. It becomes difficult to mobilise action in the present and life seems to be on hold. Their whole identify is disrupted and they can't seem to visualise themselves in the future. We scientists and doctors may not be able to measure these experiences in our studies and questionnaires, but it doesn't mean they don't exist," said Dr Kopitzke.
Many couples found considerable comfort and help from infertility support groups. Ironically, though -- in contrast to cancer support groups -- these groups can also cause ambivalent feelings and distress. "It's as though the chances for success are limited and others' success signifies a reduction in one's own chances. If a cohort of patients going through IVF is in a group with a 20% success rate, then one in five would be favoured and in some sense these might represent rivalry for a scarce commodity."
She believes that one way to way to offset this is to have support groups with a greater range of patients.
Dr Kopitzke said that ART had its own impact involving heightened intensity as new treatment opportunities offered increasing chances of parenthood. A seemingly irresistible progression thorough a protocol could propel staff and patients alike to ever more complex steps without stepping back to consider the wider view. "As the momentum on patients' emotional and financial investment increases, it gets more and more difficult to make the decision to stop treatment."
She had a warning for professionals in these circumstances: "In our quest to help people, we can forget to help them to stop."
Exciting advances did hold the promise of increased conception rates, and increased control could afford the potential for selection -- the most viable sperm, the best egg...
But again she gave a warning: "we go beyond viability issues into that of customising our offspring. It raises issues that we, as a culture, have not had to face. With the increase of choice will come the burden of choice. Even as we embrace the power that this new technology affords us, we must be mindful that it does not exceed our grasp."
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