Infertility is defined as a disease of the reproductive system characterised by the failure to achieve a clinical pregnancy after 12 or more months of regular sexual relations without contraception. It creates a significant psychological burden, since having a child is one of the key tasks in adult life. This may lead to an emotional crisis rooted in frustration and, in many cases, depression, that may go unnoticed.
It has become increasingly prevalent and now affects one of every six couples worldwide, according to data from the European Society of Human Reproduction and Embryology (ESHRE). Several studies (Gameiro et al., 2014; Vikstrom, Josefsson, Bladh, and Sydsjo, 2015) have described the psychological impact and the impact on the quality of life of infertility and assisted reproduction techniques.
They have shown a greater incidence of psychological problems decades after infertility treatments such as in vitro fertilization (IVF), which are sometimes minimally invasive medical procedures. In addition, psychological factors such as pre-conception stress may increase the risk of infertility. Special mention must be made of women aged 42 or over who have had to use techniques with donated eggs due to the fact that the quantity and quality of their eggs decrease with age. Treatment with donated gametes raises concerns in future parents about the implications that the lack of genetic inheritance may have on the parent-child relationship.
Women with a history of depression have a higher risk of infertility and are less likely to undergo assisted reproduction treatment. The psychological state of patients with infertility should be assessed, ideally through questionnaires validated by a mental health professional. In particular, women with a history of anxiety and/or depression should be carefully evaluated before treatment begins, since the level of stress in patients with infertility tends to increase as treatment intensifies and as the process continues.
Therefore, patients with in vitro fertilization (IVF) often experience more stress than women who are at the beginning of their infertility assessment.
Many report depressive symptoms before their cycle begins. This is likely to reflect the impact of repeated, fruitless and less invasive forms of treatment, but it may also reflect a previous history of mood/anxiety disorders that are unrelated to infertility.
Most IVF patients report symptoms of depression, anxiety, anger and isolation after a failed treatment. Many of these symptoms persist for prolonged periods. Infertility specialists have traditionally assumed that patients leave treatment for only two reasons: active censorship, that is, their doctor advises the couple to stop treatment due to poor prognosis, and economics, since the cost of the procedure is often not covered by insurance. Nevertheless, this assumption has been questioned, since most patients covered by insurance voluntarily end treatment before completing their allocation of covered cycles, and the main reason for abandonment seems to be the psychological burden of the procedures.
In its guide for mental health professionals, the European Society of Human Reproduction and Embryology (ESHRE) highlights the importance of the psychological evaluation in choosing the type of help to provide couples with infertility. It is essential to perform an individualised psychological assessment before the assisted reproduction treatment. This will make it possible to identify those who have a psychological disorder or show emerging symptoms in order to prevent their mental health from further declining.
There are a large number of questionnaires for assessing the psychological well-being of patients in general. One of the instruments designed and validated for the population with fertility problems aimed at assessing quality of life is the Fertility Quality of Life tool (FertiQol), which has been translated into 38 languages and validated in a number countries.
This questionnaire has been shown to be very capable of identifying aspects of quality of life directly related to infertility. Thus, detecting and preventing psychological dysfunctions and improving the quality of life is part of the multidisciplinary treatment of infertility.