In 2002, the World Health Organization estimated that infertility affects approximately 80 million people from all parts of the world. The inability to conceive children is experienced as a stressful situation by individuals and couples all around the world. The consequences of infertility are manifold and can include societal repercussions and personal suffering. Advances in assisted reproductive technologies, such as IVF, can offer hope to many couples where treatment is available, although barriers exist in terms of medical coverage and affordability. The medicalization of infertility has unwittingly led to a disregard for the emotional responses that couples experience, which include distress, loss of control, stigmatization, and a disruption in the developmental trajectory of adulthood. Evidence is emerging of an association between the stress of fertility treatment and patient drop-out and pregnancy rates. Fortunately, psychological interventions, especially those emphasizing stress management and coping skills training, have been shown to have beneficial effects for infertility patients. The content of counselling may differ depending on the patient and the treatment choice but will usually involve at least some form of information and implication counselling, support or therapeutic counselling. Information and implication counselling might focus on ensuring that individuals understand the different psychosocial issues involved in their treatment choice whereas therapeutic counselling might involve an understanding of the emotional consequences of childlessness. These issues might include whether the counsellor will be involved in the assessment and/or screening of patients for treatment and whether counsellors will work independently or within the clinic environment. Many infertility treatment programs, particularly those offering assisted reproductive technologies such as IVF, either provide the opportunity for or require couples to participate in, an assessment and or counselling process prior to treatment. This provides the opportunity to screen for individual problems (anxiety, depression, substance abuse) or relationship concerns that might compromise a couple’s ability to cope, comply with, or agree about treatment.
Goals in Counselling the Couple
There are numerous potential goals in providing couples counselling, which can often partially overlap with the goals of the individual counselling. The goals of couples counselling regarding infertility fall into three broad categories:
■ Facilitating the couple’s management of treatment as a team by
increasing awareness of treatment implications;
addressing decision conﬂict
reducing stress on the relationship
encouraging more active participation in decision making;
improving or facilitating communication between the couple and medical staff
■ Facilitating the management of infertility as a couple through identifying
differences in motivation for having children;
differences in reaction to infertility and in coping styles;
problems in constructive communication.
■ Assisting in dealing with infertility strains on the relationship related to infertility or its treatment through
support for grief work;
help for the couple in identifying alternatives and new life perspectives.