Psychological support for couples who resort to PMA

Psychological support should be made available in every center that deals with PMA and should include both psychological counseling and a real psychotherapy course, be it individual, couple or group.

Infertility represents a bio-psycho-social crisis with a double impact. In fact, a first aspect concerns the very meaning of the word “being infertile” .

For many women pregnancy and motherhood represent one of the milestones of development that are significantly emphasized by our culture and sometimes, managing the pressures of society and family can be a challenging task.

Furthermore, when a woman begins to mature within herself, both the idea and the desire to have a child, she creates fantasies, images of what it will be like, starting to picture it in her mind. When this desire remains frustrated, unsatisfied, because it is interrupted by the condition of infertility, a gap is created between what already exists on a mental level and what is not made possible on a biological level , transmitting to the woman the sensation of a body that works.

It is therefore the condition of infertility itself that leads to important symptoms of stress, leading many women to experience it as an insult to their femininity and self-esteem.

Even for men , infertility can have a negative emotional impact, for some it can be experienced as an attack on their masculinity.

The impact of the PMA path on the couple

The choice to resort to assisted fertilization represents a choice, but not the original choice, a solution, but not necessarily the sure solution.

Some women come to the doctor for consultation, carrying unrealistic expectations about the successes of the treatments, thus expecting a positive outcome that can be achieved in the shortest possible time. It is therefore clear that any failure is experienced with even more frustration, disappointment or discouragement.

To this we can add the  stress and anxiety related to assisted reproduction treatments such as daily injections, semen analysis, monitoring, and surgical/diagnostic procedures, waiting for betas and above all a possible negative result which for some couples symbolically represents a mourning to be processed.

I remind you that the way of managing and reacting to stress represents one of the main predictive factors of drop-out, and therefore of treatment interruption.

This is the global panorama, but it is clear that we must not generalize.

If we look at the numbers:

• 70% of patients adapt well to the PMA pathway;
• of the remaining 30%
  • 20% show a dysfunctional adaptation to which it is appropriate to provide psychological support,
  • 10% fall into those patients who have pre-existing pathological conditions in which PMA represents a triggering factor, the tip of the iceberg to be clear.

The importance of personalized psychological support

Psychological support should be made available in every center that deals with PMA and should include both psychological counseling and a real psychotherapy course, be it individual, couple or group.

The elective treatment must be personalized on that specific patient or on that specific couple in their individuality and for this reason specific psychological support should be offered according to the phase of the treatment.

If in the initial phase , therefore diagnostic, the psychological support will be oriented towards providing information on what the emotional implications may be during the treatment:

• help couples identify possible stressors associated with medical procedures,
• the couples are prepared to accept any differences between the couple in the way of managing and facing the various steps during the treatment
• couples are helped to become aware that a path of this type is beyond their control,
• couples are helped to learn to rely on the medical staff.

In a more advanced phase of the treatment, the support will have a double slant, containing and psycho-educational:

• restraint in addressing specific issues and concerns,
• psycho-educational in imparting specific techniques such as relaxation, mindfullnes, anxiety management, distraction techniques, or couple communication techniques that will be expendable at every stage of the journey according to personal needs.

Finally, after the treatment , in case of failure, the couples are called to make a decision on how to continue, whether to start a new cycle of treatment or evaluate the possibility of terminating the process, whether to consider other alternatives such as fertilization with donation of gametes.

All of this obviously depending on what is proposed by the referring doctor, also in this case psychological support can be useful to facilitate taking into consideration new perspectives and/or possibilities for the future.