Very recently, I saw an infertile couple; the wife was talking about how she was constantly stressed and had reached a point where she felt she was slipping into depression too. As I listened to her, I reviewed a number of other patients who had come to consult me over the years and I assured her that she wasn’t alone and very importantly, that what she was feeling was normal under the circumstances.
Many infertile couples find this unwelcome guest of depression in their lives and the sad part is that a number of doctors don’t really address these issues while dealing with patients.
The fact is that depression isn’t very well understood and very little is known about how infertility results in depression. However, when you look at it from a logical viewpoint, there are certain complicated psycho-dynamics at play, which may contribute to the incidence of depression in people who are dealing with infertility.
The Effect of Isolation
There are a numerous reasons for depression; but a number of these get exacerbated when it comes to infertility. This occurs due to the feelings of isolation from family, friends and society at large; some couples also grow away from each other and this adds to the feeling of isolation.
Many couples who I consult have gone to other clinics for treatment before coming to ours. This also means they aren’t alien to the entire infertility treatment process and are carrying the burden of one or more failed cycles as they trudge wearily along the infertility route; just in the hope that they will eventually see light at the end of the tunnel.
For many couples, even the act of lovemaking becomes forced rather than impromptu and it ends up becoming a repetitive opportunity for failures versus being an important part of a normal relationship that couples share. Many patients also find that they are unable to place the blame anywhere else and they end up blaming themselves.
Feelings of anger and loss of control are the other contributing factors to emotional disorientation. It is truly said that depression is actually anger turned inwards and that is also what I perceive when I talk to some of my patients during the course of the consultation.
Just Too Much to Deal With
I generally recommend that the couple opt for talk therapy; in the right setting, it can be quite helpful. Though it’s a fact that a number of these feelings could be irrational, the other fact is that for many couples, they are also very real. Women are at higher risk of developing depression , compared to men. In an infertile couple, the man doesn’t have a major role to play, either during the course of the diagnostic workup or during the treatment phase. On the other hand, women have to deal with:
• Dramatic hormonal changes (infertility treatments which involve hormone stimulation make this worse)
• Many treatments involve dye injection, shots, and biopsies (some of which can be painful, and all of which can cause anxiety and apprehension)
• Fear of miscarriage/ birth defects
• In cases of unexplained infertility, the family tends to attribute the couple’s inability to conceive, to “poor uterine environment” or “bad eggs”; in short, they are casting blame on the woman for certain factors that she has zero control over
Which Came First- Infertility or Depression?
But this isn’t where the story ends; there is another side to the coin too. In many ways emotional problems including depression and anxiety themselves tend to contribute to reduced fertility. After all, a depressed woman has diminished libido, and this will reduce her fertility. In addition, infertility treatment can be very expensive and this also stresses the patient. It’s no wonder then that women feel lost, without hope and helpless when their IVF cycle fails. Multiple failures can result in the situation spiraling out of control.
Since this is a reactive depression, there are good chances of it being amenable to improvement by increasing self-awareness of the effect of anger and isolation that surrounds the state of infertility.
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