This article is more than 5 years old. Information may no longer be current.
Infertility and psychological distress: How to help patients cope
Approximately 12% of women and men of reproductive age in the United States are affected by infertility, according to the CDC.
Many individuals with infertility experience physical and emotional distress which is often exacerbated by medical interventions, according to Harvard Health.
With April 22 to 28 designated as National Infertility Awareness Week, Healio Internal Medicine spoke with Kelly Pagidas, MD, director of the University of Louisville Fertility Center, about the risk factors of and treatments for infertility and how primary care physicians can help patients cope with associated anxiety, depression and stress. – by Alaina Tedesco
Question: What are the underlying causes or risk factors of infertility?
Answer: Infertility is defined as the inability to conceive or achieve a pregnancy after 12 months of attempts in women less than 35 years of age and 6 months of attempts in women greater than 35 years of age. Infertility can be due to a number of factors in women and men, but the most common causes are often secondary to ovulatory disorders or tubal factors in women and male factors in men.
Risk factors such as prior pelvic infection or pelvic surgery in women can be associated with tubal factor infertility or blockage of the fallopian tube(s), whereas male factor infertility with either poor quantity and/or quality of sperm can be associated with either a hormonal, infectious, genetic or structural cause. However, in 10% to 15% of couples, the cause of their infertility may not be known or able to be identified.
Q: What therapies are available to treat infertility?
A: The treatment of infertility is based on whether a cause has been identified and if that cause can be corrected, reversed or bypassed. In women with ovulatory disorders, a simple treatment option is the use of oral or injectable medications to induce ovulation, such as Clomid, letrozole or gonadotropins. If tubal disease is the cause, then based on the severity of the disease, surgical repair of the tube(s) may be possible, but in vitro fertilization (IVF) for moderate-to-severe tubal factor is far superior in achieving a pregnancy in such women.
Male factor infertility can also be treated with IVF in moderate-to-severe cases, but for mild male factor infertility, then intrauterine insemination is a promising option.
Q: How can PCPs help patients cope with anxiety, depression and stress related to infertility?
A: Couples with infertility experience tremendous anxiety and stress over their inability to conceive. It is very important to acknowledge such emotions and grief and emphasize that they are not alone as approximately 10% of couples have difficulty achieving a pregnancy.
Supportive services should also be offered to couples, including counseling, since couples experience different stages of grief and often need assistance to overcome such feelings. However, a number of support services and groups exist that can provide insight for couples as to what they are going through, such as Resolve and the American Society of Reproductive Medicine.
Other options such as participation in mind body programs, relaxation therapy, acupuncture, etc., have been reported by couples to be favorable to help them cope through their infertility journey.
Q: Is there any validity to certain wives’ tales associated with fertility/infertility?
A: A number of myths exist as to what one needs to do to get pregnant but sadly there is very little basis if any to such wives’ tales. However, it is important that couples should exercise a healthy lifestyle and optimize their health prior to even attempting to conceive, as that is associated with better or more favorable pregnancy outcomes.
Disclosure: Pagidas reports no relevant financial disclosures.