Introduction

Infertility is one of the most stressful experiences one can go through in life. When you embark on assisted reproductive treatment (ART) you may experience many different emotions; from joy and excitement to grief and disappointment. This can be an emotionally and physically challenging time.

Counselling with infertile individuals is often also about support and the clarification of life goals. Thus counselling definitions which focus on counselling as a context for support, advice and guidance rather than as a vehicle for change (Applegarth, 1999, p. 89).

Purpose/ Objective(s)

1. To explore, understand and resolve issues arising from infertility and infertility treatment and to clarify ways of dealing with the problem more effectively.
2. Consider the needs of the patient and any other person who might be affected by the treatment process and the decisions that have to be made.
3. Prepare for fertility treatments, and explore the options and implications when making decisions about starting, changing or stopping treatments.
4. Deal with the emotional impact of treatment.
5. Work on relationship issues that may arise as a result of treatment or may be affecting your treatment.
6. Cope with unsuccessful treatment cycles or pregnancy losses.
7. Develop coping strategies for dealing with other people’s pregnancies, births and children.
8. Deal with the reactions of families, friends and work colleagues.
9. Explore ways to help you feel more in control.
10. Manage the anxieties of pregnancy and preparation for parenthood.
11. Deal with the specific issues related to adoption.

Importance of IVF Counseling

A.  Pre-IVF treatment:

• When infertility takes over your life

If you’re finding that infertility is taking over your life, you might consider counselling.

• When infertility is hurting your relationship

Infertility is hard, but it’s even harder if you don’t have the support of your partner or spouse. Sometimes, your partner is the only one who can really understand what you’re going through. Counselling can help you better understand and support each other.

• When you’re not sure what to do

The counsellor can help you make a truly informed choice, and help you consider what your treatment options may involve, including the financial and emotional stresses of those choices.

• Taking the first step towards infertility treatment (Infertility investigations)

It takes a lot of courage for the couples to see their family doctor with request of infertility investigations. The family doctor enquiries about the intimate aspects of your relationship may be stressful. Care and skill needs to be taken and explanation of the purpose of the tests are essential.

• Waiting the results of infertility investigation tests

The doctor will order initial investigations to find out the possible cause of infertility. While awaiting the results of these tests, you may feel very tense; the fear of unknown. The results of the tests may reveal a significant fertility problem such as complete absence of sperm in the ejaculate, which may leave you in a state of shock, and unable to understand the facts presented to you. However, this may not always be the case, sometimes all the tests results would be normal and leave you with no clear reasons for your infertility.

• Prepare for decision-making

It is important to anticipate decisions that may occur during IVF and discuss your options ahead of time. Sometimes these decisions may have moral and religious implications that you will need to consider and discuss. You will need to decide, along with your physician, how many embryos will be transferred while maximizing your chances for pregnancy and minimizing the possibility of multiple babies. You will also need to decide what you will do with extra oocyte and/or embryos, i.e. freeze, and dispose.

B.  During- IVF treatment

• Finance

Couples also may find themselves stretched financially, paying for the high cost of IVF treatment with a somewhat limited probability of success.

• During the IVF stimulation

The female will take medications that stimulate and mature as many oocyte as possible during the cycle. So, they have a lot thing to do such as hormone injections that they are required and do the injection by themselves every day. This situation automatically makes them feels so stress. Some of them, the oocyte response will be slow so they need higher quantities of the medication are used to increase the number of oocyte to be developed and matured.

Besides that, dealing with the medical staff and with the side effects or potential complications of medical treatment has its own stress: hot flashes, headaches, mood fluctuations.

C.  Post-IVF treatment

• Waiting the pregnancy test results

Research has shown that in order of perceived stress for patients, waiting to hear the outcome of the embryo transfer is the most stressful, followed by waiting to hear whether fertilization has occurred, and then the egg retrieval stage. The 10-14 day waiting period between transfer and receiving the pregnancy test results is often described as the most difficult part of the cycle. You need to think about how to fill your time during this time.

• Receiving the results

It is easy to know how you will feel if treatment is successful and you become pregnant. However, you must also understand that if you are unsuccessful in achieving a pregnancy, you cannot get away from the sadness, loss, and disappointment that are part of the grieving process.

• When considering adoption

The most important time to obtain a consultation with a therapist familiar with infertility issues is when a couple is considering using adoption to create their family.

• When considering a childfree life

Whether it comes after years of treatments, or early on with a realization that the available options aren’t right for you, realizing that you’re not going to have kids is extremely difficult. For some, counselling can help with processing the emotions that come with this realization.

• Because you’d like more support

Maybe you’re not feeling particularly depressed or anxious, and you don’t fall within any of the above groups. But you feel like you could use more support, someone to talk to, who can give you more tools for coping. Counselling can be a good choice for you, too.

Method (How to counsel and consult IVF patient)

The infertility diagnostic and treatment can be described as a 10-step circular process:

Step 1: Introduction and initiation of a working alliance

This is the first cognitive and emotional contact, and provides the basis for a helpful relationship. Emotional and relational skills are used to build up a relationship. The team builds up personal contact by introducing everybody and by taking care to perceive the patients as individuals with unique needs and characteristics.

Step 2: Problem assessment and monitoring

The team can obtain and gather information about all the patient’s problems related to the unfulfilled desire for a child. The team should obtain information about the background, the history and the consequences of the problem as well as the subjective theories of the patients about what is causing the problem. A questionnaire can also help to screen for psychosocial risks such as depression, severe conflicts of the patients, social isolation, and personality disorders.

Step 3: Clarification about problem definition and negotiation about objectives and priorities

The objectives of the patients can be clarified and priorities defined. The patients obtain information about the possibilities and limitations of the work-up and treatment. At this stage it is important for the team to give information about the general knowledge regarding infertility, about the scope of the intervention and about the possibilities and limitations of infertility treatment. A typical patient is able to absorb a maximum of three major points in one consultation. Booklets, videos and other materials can help to ensure information will be retained.

Step 4: Exchange of hypotheses and decision-making concerning diagnostic procedures

The team gives information to the patients about possible causes of the infertility and about possible diagnostic procedures referring to these causes. The team and the patients enter into a decision-making process concerning the diagnostic procedures.

Step 5: Investigations, diagnostic procedures

Investigations provide specific information for the team about causes or contributing factors to the infertility problem (biological, psychological, social factors). Investigations enable the team to elaborate a problem-solution plan. Diagnostic procedures allow the patients to become experts in infertility procedures and to know more about their infertility problem.

The team should explain exactly and in a way that the patient can understand what is going to be done, as well as the possible outcomes. Supplemental charts and diagrams and other written material can be helpful.

Step 6: Information giving about results

Step 7: Elaboration of options to resolve infertility problem

Step 8: Decision-making about specific options

Step 9: Treatment procedures

Step 10: Evaluation of outcome

Outcome(s)

1. There have emotional support and understanding for the patients.
2. The patients enabled empowered to make sense of their own experiences and increase their knowledge and their competence for decision-making.
3. The patients enabled to make choices and to cope with difficulties and losses.
4. The patients can helped to deal with positive and negative reactions in the context of pregnancy.
5. The patients can explore, understood and resolved issues arising from infertility and infertility treatment and to clarify ways of dealing with the problem more effectively.

References

1. Atwood, J. D. and Dobkin, S. (1992). Storm clouds are coming. Ways to help couples reconstruct the crisis of infertility. Contemp. Fam. Therapy, 14, 385–403.
2. Boivin J, Scanlan LC, Walker SM (1999): Why are infertile patients not using psychosocial counselling? Hum Reprod 5, 1384-1391
3. Covington, S. N. and Hammer-Burns, L. (1999). Pregnancy after infertility. In: Hammer Burns, L. and Covington, S. N. (eds.), Infertility Counselling. A Comprehensive Handbook for Clinicians (pp. 425–447). Parthenon, London and New York.
4. de Parseval, G.D.(1992). Clinical remarks concerning parents (potential and real) after different ‘treatments’ for the infertility of couples. J.Psychosom.Obstet.Gynaecol. 13, 65-72.
5. Dunkel-Schetter, C. and Lobel, M. (1991) Psychological reactions to infertility. In: Stanton, A. L. and Dunkel-Schetter, C. (eds.), Infertility (pp. 29–57). Plenum Press, London and New York.
6. Edelmann, R.J., Connolly, K.J. & Bartlett, H. (1994). Coping strategies and psychological adjustment of couples presenting for IVF. Journal of Psychosomatic Research, 38, 355- 364.
7. Golombok, S.(1992). Psychological functioning in infertility patients. Hum.Reprod. 7, 208-212.
8. Kemeter P, Fliegl J, (1998). Adjusting to life when assisted conception fails. Human Reprod 13:4, 1099-1105
9. Lothrop, Hanna (1997). Help, Comfort and Hope After Losing Your Baby in Pregnancy or the First Year. Fisher Books, Tucson, AZ.

Last Reviewed	:	14 April 2016
Writer	:	Sardiana binti Sarmidi
Accreditor	:	Krishnan Kanniah