What To Expect When You Are NOT Expecting
We asked psychologist, Cognitive Behavioural Therapist and Fertility Counsellor Alison Bough for tips on how to cope with fertility problems…
Should I be concerned about infertility?
According to the UK’s National Institute of Clinical Excellence, ‘infertility’ is defined as the inability to conceive after two years of regular, unprotected sexual intercourse. Couples can experience either primary or secondary infertility. Primary infertility is the term used to describe a couple who have never been able to conceive, while secondary infertility refers to those couples who are unable to conceive after already having had one, or more, successful pregnancies.
While the overall incidence of infertility is not thought to have increased significantly, in recent years Ireland has seen a considerable rise in the number of people seeking medical help for fertility-related problems. Although many couples experiencing difficulties conceiving will become pregnant naturally given time, a significant number (estimates suggest around 56%) may require medical intervention.
Infertility is a complex and sometimes ambiguous condition
There are many potential causes. It affects both women and men equally, with 32% of all cases attributed to problems affecting the male partner’s fertility and approximately 32.5% of all cases associated with the female partner’s fertility. However, in approximately 17% of cases the difficulty in conceiving may be linked to a combination of male and female factors with about 18.7% of cases remaining unexplained.
Age can be a factor
Common factors affecting female fertility include blocked or damaged fallopian tubes, problems with ovulation, problems with the uterus (womb) or other underlying conditions such as endometriosis and Polycystic Ovary Syndrome (PCOS). There is also evidence to show that women become less fertile as they get older and research suggests that women experience a sharp decline in fertility in their late 30s. For example, figures reveal that only 77% of women aged 38 years and over will conceive within three years of trying compared to 94% of women aged 35 years.
As a growing number of Irish couples delay childbearing until later in life age is likely to become an increasingly salient issue impacting female fertility in particular – age effects on male fertility on the other hand are less clearly understood. Factors that we know are likely to affect male fertility include damage to the testicles, ejaculation disorders, low sperm count, low sperm motility (how the sperm moves) or abnormal sperm.
Your general health can have an impact
There are also a range of additional factors that can negatively impact the chances of conceiving and these can include being under or over weight, having had previous surgery or infections including sexually transmitted infections (STIs) such as chlamydia, and other health problems like diabetes, epilepsy, kidney problems, high blood pressure and thyroid disorders. There may be occupational and environmental risk factors for fertility, such as jobs where you might be with certain chemicals, or radiation, can increase the chances of fertility problems.
In recent years, there has been a lot of interest and research in the role of stress as a potential cause of fertility problems and a factor influencing fertility treatment success rates. Within the context of reproductive health there are a number of mechanisms through which stress could potentially influence an individual’s fertility. For example, high levels of psychological stress and anxiety are thought to lead to hormonal abnormalities, which may affect female ovulation as well as sperm quality and production.
Counselling can be helpful
Seeing a counsellor can help with coping with the unique stresses of fertility treatment and the uncertainty of outcomes, including the possibility of unsuccessful treatment cycles. Attending counselling can also provide much needed support in dealing with family and friends, can help reduce feelings of isolation and can provide a supportive environment as one is undergoing fertility treatment.
In the UK, the Human Fertilisation and Embryology Authority (HFEA) requires that all licensed fertility clinics must offer counselling to any patients considering fertility treatment or donor insemination. They outline three types which should be routinely made available.
Implications counselling is aimed at those who are contemplating a fertility treatment and it is designed to help them understand what the treatment will involve and how it may impact on their life – this is likely to be of particular value to those who are considering the implications of introducing a donor or surrogate into the process.
Support counselling on the other hand is designed to provide emotional support during stressful phases of the treatment process, for example following a treatment failure or miscarriage after initial success.
Therapeutic counselling goes beyond emotional support to help individuals cope with the impact that their fertility problems have on their life and relationships, for example by assisting them to accept their situation and to repair any damage to their relationships.
The Irish Fertility Counsellors Association can help
Set up in 2008, the Irish Fertility Counsellors Association (IFCA) represents 17 professional fertility counselors both North and South of the border, each specialising in the area of human fertility. A list of specialist fertility counsellors is available on their website. There are also a number of Irish organisations who can provide specific advice surrounding fertility problems such as PCOS, endometriosis and adoption.
If you are in any way concerned about your fertility or issues relating to it, your GP will be able to work with you to identify the path that is right for you.
Alison Bough is a Psychologist, Cognitive Behavioural Therapist and Fertility Counsellor. She specialises in health psychology, particularly in the mental and emotional outcomes of women’s reproductive and sexual health. She is an award-winning Clinical Director of The Mindfulness Centre and a busy mum to three small people.