Psychiatric Aspects of infertility

Prof. Hani Hamed Dessoki, M.D.PsychiatryProf. Hani Hamed Dessoki, M.D.PsychiatryProf. PsychiatryProf. Psychiatry

Chairman of Psychiatry DepartmentChairman of Psychiatry Department

Beni Suef University Beni Suef University

Supervisor of Psychiatry DepartmentSupervisor of Psychiatry Department

El-Fayoum University El-Fayoum University

APA memberAPA member

ي ن • نم ل ب مل نه نشءاء ني نمءا ني ل ق ي خل ل ني مض ي ر ني ل نولا مت نولا نمءا س ل ك لال ل مي ل مملل ﴿انءا نرلا ي ك ل ذ ي م ل ه ل ج جو نز ي و ل ي نر * نأ ل كرو ذ نشءاء لال نمن ني ل ب مل نه نوني اثءا ننءا نشءاء مإ ني

)ر مدي نق )م نعملمي ل ه امءا مإن مقمي نع نشءاء نمن ني ل ل نع ي ج نوني اثءا ننءا )نومإ  

رقم آية الشورى سورة49-50

The Dream

Introduction

• The inability to create a desired pregnancy that culminates in the birth of a child is likely to create a life crisis for women and their partners.

• Women seeking fertility treatment look to nurses for care, counsel and health teaching.

Introduction (Continued)

• Primary infertility: The inability to conceive after 1 year of unprotected intercourse for a woman younger than 35, or after 6 months of unprotected intercourse for a woman 35 or older (Speroff & Fritz, 2005).

• Secondary infertility: The inability of a woman to conceive who previously was able to do so (Speroff & Fritz, 2005).

1 in 7 couples will experience a problem with conception in their reproductive lifetime.

Size of the problem

In the study carried out by Freeman et al. (1985), 48% of the women and 15 % of the men stated that they regarded their infertility as their worst life crisis.

Size of the problem

Infertility

• Infertility can be defined as a crisis with cultural, religious, and class related aspects, which coexists with medical, psychiatric, psychological, and social problems.

• Relation between psychiatric and psychological factors stem from a mutual interaction of both

Psychogenic Infertility

• Psychogenic Infertility refers to the inability to conceve without any physiological cause, in other words there are no physical or organic reasons for the infertility.It's estimated that approximately 17% of couples will experience psychogenic infertility.

• The main reasons possibly being linked to psychological stressors.

J Assist Reprod Genet. 2003 Dec;20(12):485-94.

Psychogenic infertility--myths and facts.Wischmann TH.Author informationAbstractPURPOSE:The hypothesis of this review is that the role of psychological factors as the sole cause of infertility is

generally overrated.METHODS:A review is given of studies concerning the influence of psychological factors on the development of

infertility.RESULT:A prevalence of psychogenic infertility of 10-15 per cent must be discussed critically. A value of

approximately 5 per cent is more realistic. Equating unexplained infertility with psychogenic infertility is not justified. A definition of psychogenic infertility according to the German guidelines Psychosomatics in Reproductive Medicine is presented. Spontaneous pregnancies following adoption or the decision to remain childless are the absolute exception. The association of stress and infertility in humans is still unclear. For many women the effect of infertility and notably of medical therapy is a considerable emotional stress. This may make psychosocial counseling necessary in certain cases.

CONCLUSIONS:

An exclusive psychological/psychodynamical point of view on the complexity of infertility is as inadequate as a strictly somatic point of view. Infertility should always be treated as a psychosomatic entirety.

امثله لحال ت العقم النفسى

- حالة عقم نفسي عقب فقدان المرأة لطفلها السابق. - حالة عقم نفسي عقب وفاة طفل ولد مشوه.ا. - حالة عقم نفسي ناجمة عن الخوف من انجاب طفل جديد.

- حالة عقم نفسي ناجمة عن الخوف من النجاب. - حالة عقم نفسي ناجمة عن انجاب طفل شبيه بال خ المتشرد.

- حالة عقم نفسي مترافقة مع فشل التلقيح. - حالة عقم رجولي مستمرة بعد معالجة مسبباتها العضوية.

اسباب العقم النفسى

ان العقم النفسي لدى المرأة يمكن ان يعود الى اوضاع مزاجية •وحال ت نفسية، او عدم انتظام دورتها الشهرية لبسباب عصيبة -

نفسية، او اصابة المرأة باضطرابا ت تنابسلية - وظيفية، كمثل تشنج انابيب الرحم وغيرها من الضطرابا ت البسيكوبسوماتية،

أي (النفسية - الجسدية) ...

اما لدى الرجل فيعود العقم الى عدد من الضطرابا ت الجنسية •ذا ت المنشأ النفسي، مثل (بسرعة القذف، انخفاض كمية المني،

الخلفا ت الزوجية، الرهاق الجسدي والنفسي.... الخ).

Psychology of infertility

• Individuals who learn they are infertile often experience the normal but nevertheless distressing emotions common to those who are grieving any significant loss — in this case the ability to procreate.

• Typical reactions include shock, grief, depression, anger, and frustration, as well as loss of self-esteem, self-confidence, and a sense of control over one's destiny.

Relationships

• Relationships may suffer — not only the primary relationship with a spouse or partner, but also those with friends and family members who may cause pain by offering well-meaning but misguided opinions and advice.

• Couples dealing with infertility may avoid social interaction with friends who are pregnant and families who have children.

• They may struggle with anxiety-related sexual dysfunction and other marital conflicts.

Causes of Stress

- Medication side effects

• Drugs and hormones used to treat infertility may cause a variety of psychological side effects. For example, the synthetic estrogen clomiphene citrate (Clomid, Serophene), frequently prescribed because it improves ovulation and increases sperm production, may cause anxiety, sleep interruptions, mood swings, and irritability in women.

• Other infertility medications may cause depression, mania, irritability, and thinking problems.

• Patients and clinicians may find it hard to figure out which reactions are psychological and which are caused by medications — yet identifying causes is essential for determining next steps.

Causes of Stress

- Money worries • For patients who do not have insurance coverage

or the means to pay for treatment, not being able to obtain treatment may contribute to feeling helpless and hopeless.

• Even patients with insurance coverage may find limitations on coverage mean they must pay significant amounts out of pocket.

Causes of Stress

- Choices and outcomes. 

• Over all, infertility interventions help about half of patients become parents, with the likelihood of success decreasing with age.

• Patients who learn they are to become parents may be overjoyed, but also must learn to adjust to new roles and pressures — both during pregnancy and after childbirth.

• Women who have suffered multiple miscarriages, for example, are likely to feel anxious about whether they will be able to carry to term.

• Older couples may debate whether to undergo prenatal testing such as amniocentesis.

Causes of Stress

• Treatment failure, on the other hand, may trigger a renewed cycle of grieving and distress.

Maximum Stress

The psychological stress during the waiting period following embryo transfer is more of a strain for many women than all the medical procedures involved in IVF therapy, and, for example, also more stressful than the routine abdominal laparoscopy

The burden

Reproductive medical treatment, which is time-consuming and emotionally and financially demanding, is an additional psychological burden for many women (Boivin et al. 1995; Olivius et al. 2004).

Male Factor

Men who exhibit an andrological factor describe themselves as being more anxious and interpersonal sensitive compared with the norm.

Male Menopause/Adrenopause?

– Decreased • Testosterone levels

• Libido

• Hair

• Muscle mass

• Strength

– Increased• Weight

• Erectile dysfunction

• Infertility

• Depression

• Cholesterol

As men age:As men age:

Female Factor

• Even though not being able to have a child affects both sexes emotionally, women feel greater amounts of stress, pressure, anxiety, and depression.

• Consequences of infertility arise from short and long-term devastating effects on both individual’s physical and mental health, and marital system.

The problem

It is probably for this reason that over half of the couples, despite the lack of success, do not complete all the treatment cycles

Causes of discontinuation

When questioned in retrospect,many couples say that emotional strain is the main reason for abandoning treatment

Difficulties

• It's also difficult to know when to stop seeking treatment.

• Frequently one partner wants to end treatment before another, which can strain the relationship.

• Most patients need to gradually, and with great difficulty, make the transition from wanting biological children to accepting that they will have to pursue adoption or come to terms with being childless.

على القلب وعلى الدورة الدموية وعمل الشرايين ثبت علمي ا يؤثر التدخين•فهو يؤدي إلى تقلص الوعية الدموية ، مما يسمح لحدوث انسداد في هذه

الوردة وتصلب الشرايين ، ومنها الوعية الدموية للعضاء التناسلية وخاصة الخصيتين ، وهذا يؤدي إلى خلل إنتاج الحيوانات المنوية.

عدد وفي دراسة أجريت في جامعة واشنطن ، تبين أن التدخين يقلل من •غير ، والى ظهور نسبة من الحيوانات المنوية الحيوانات المنوية وحركتها

وعدم قدرة هذه الحيوانات طبيعية الشكل أو عديمة الفائدة والوظيفة بين غشاء الرحم أو الدخول إلى الختراق والدخولالمنوية على ما يسمى نفس البويضة للتلقيح.

حقائق مذهلة عن التدخين

التي للمراض مسسبب أهسم عالميا التدخيسن يعتسبر فاةيمكن الوقاية منها كما أنه أهم مسبب لحال ت الو

المبكرة.

كسل العالسم حول شخسص بسبب 8يمو ت ثوانسي مليون وفاة سنويا. 5التدخين، وهذا يعادل حوالي

يصل عدد المدخنين حول العالم حاليا إلى ما يقدر بليون مدخن. 1.1بسس

Therapies that may help

• Counseling. Referrals for short-term counseling are common — especially to increase coping strategies, or to provide help with making decisions (as patients face many choices during treatment). Patients who experience prolonged changes in mood or sleep patterns or who have relationship problems should seek a more comprehensive evaluation, as these may be signs of anxiety or depression.

• Ideally, counseling should begin before patients start infertility treatment, as some studies — though not all — suggest that addressing psychological factors such as depression, anxiety, and stress may help increase the chances of giving birth to a child.

• Clinicians working with infertile patients can provide information on how to manage fatigue, reduce stress and anxiety, and improve communication with others.

Infertility Counseling

• Infertility counseling, whether provided by a psychiatrist or another health care professional, involves the treatment and care of patients, not simply when they are undergoing fertility treatment but also with their long-term emotional well-being, and that of their children.

• They can educate patients about the side effects of infertility treatment medications and the impact of hormone shifts on psychologic well-being.

Other persons

• Many patients find a way to cope on their own, or they seek support from friends, family, or one of the many infertility support groups now available in person and online. But others need additional help.

Therapies that may help

• Psychotherapy. Specific types of therapy may also be useful. For example, studies have concluded that interpersonal therapy (which focuses on improving relationships or resolving conflicts with others) and cognitive behavioral therapy (which identifies and tries to change unhealthy patterns of thought or behavior) can give relief to infertile patients suffering from mild to moderate depression.

• Researchers have shown that psychotherapy can be helpful for anxiety or depression whether delivered individually, to couples, or in a group.

Therapies that may help

• Relaxation techniques. Given that infertility and its treatment often cause considerable stress, experts recommend various relaxation techniques. For example, mindfulness meditation, deep breathing, guided imagery, and yoga promote stress management. (See our online stress resource center for additional information and tools: www.health.harvard.edu/stress.)

Therapies that may help

• Medications. Antidepressants and anti-anxiety medications are useful when symptoms are moderate to severe. However, it's wise for women taking psychiatric medication to consider the risks to the developing fetus. Further complicating treatment, some infertility medications can interact with psychiatric drugs.

• For example, birth control pills prescribed to regulate ovulation may decrease blood levels of certain benzodiazepines, including lorazepam (Ativan), while increasing blood levels of other medications, such as alprazolam (Xanax) and imipramine (Tofranil). It is important for patients and clinicians to weigh all these factors when making medication decisions.

الصحة النفسية للجنين

حديثة أن شعور الجنين بأمه يزداد ال اتدراسالوجدت •بشكل مطرد مع الوقت.

وهذا ل يتعلق بسماعه لدقات قلبها فحسب، ولكن المر •يتعدى ذلك؛ حيث وجد أن الجنين يستلم إشارات كيماوية

من ال م من خل ل المشيمة.

بمركز الندىلدعم النفسي الخدمات التى تقدمها وحدة ا

الخدمات التشخيصية:التقيم النفسى الشامل لكل من •

الزوجين

عمل التختبارات النفسية •المختلفه لتشخيص

الطضطرابات النفسية

الخدمات العلجية:عل ج الطضطرابات النفسية عند كل •

من الزوجين

عل ج العنه النفسية•

عل ج سرعة القذف•

عل ج تعاطى المواد المخدرة•

برامج عل ج التدتخين•

الدعم النفسى للزوجين من البدايه •وطيلة الرحلة العلجية

الخدمات البحثية:وطضع تخطه بحثية بالمشاركة مع استشارين النساء والذكوره لعمل •

ابحاث باسم المركز والمشاركم بها فى المؤتمرات العالمية لبثبات وجوده محليا وعالميا

هذا وبال التوفيقهذا وبال التوفيق