The psychological impact on infertile women – A review

INTRODUCTION

Infertility is an inability to get pregnant after 1 year of routine unprotected intimacy.^[1] Women who can conceive but then have multiple recurrent miscarriages also fall in the league of infertility.^[2] It is estimated that 1 in 8 couples are having trouble in getting pregnant.^[3] The hike in infertility could be of mainly four reasons, that is, prolonged childbearing, variation in semen quality due the habits such as smoking, drinking, and alteration in sexual actions.^[4] There are basically two types of infertility, that is, primary infertility, in which a couple has never originated a pregnancy and secondary infertility which occurs after previous pregnancy and unable to conceive for the 2^nd time even after having unprotected intercourse for 1 year.^[5] The aim of my study is to find the association between infertility and its psychological impact on women, that is, stress, depression, anxiety, and low self-esteem.

INCIDENCE

The incidence of infertility is growing rapidly throughout the world. It affects almost 10% of world’s population studied by Katole et al.^[6] From 1990 to 2017, every year the consistent incidence of infertility is heightened by 0.370%.^[7] According to latest World Health Organization (WHO) statistics, infertility is the fifth highest serious condition worldwide.^[8] Furthermore, a multinational study performed by the WHO to determine the gender distribution of infertility, estimated that in 37% of infertile couples, the main cause was from the female side and likewise in 35% of infertile couples, both male and female factors were responsible.^[9] In the study done by Yazdi et al.; 2020, 186 million people are suffering from infertility worldwide.^[10] According to Katole et al., there are 15–20 million people who are suffering from infertility in India.^[6] WHO evaluated that, In India, the incidence of primary infertility lies between 3.9% and 16.8%.^[11] Further, it is estimated that the prevalence of infertility in Jammu and Kashmir is 15% with 15.7% of higher prevalence in the Kashmir region.^[12]

PSYCHOLOGICAL ASPECT OF INFERTILITY

Giving birth to a child is the yearning of every woman and if this wish is not fulfilled, it is associated with lots of psychological problems such as anger, betrayal, guilt, sadness, jealousy, self-esteem, anxiety, depression, and poor quality of life.^[2] Society always expects that a couple will have a child just after their marriage, but it is actually very destructive and heartbreaking feeling that they want to have children but they cannot. This culture is deeply rooted in our human culture as well as in our biology.^[5] It is often a silent struggle that’s why mostly women do not want to share their story of infertility.^[3] The ineptitude to have children is a stressful experience by the patient throughout the world.^[13] A woman without a child loses all her hope for the future. Couples taking infertility treatment always blame women for childlessness.^[14] Almost 50% of women considered infertile as a most hurting thing of their life and only 15% of men reacts on this.^[15] It is very important to give attention to both infertility and psychological distress for infertility treatments. It is concluded by many researchers that infertility is the most disturbing experience of a woman’s life.^[16]

THE RELATION OF STRESS WITH INFERTILITY

For years and years, the relation between stress and infertility has been questioned.^[3] Infertility is the most stressful and depressing period of any couple’s life as it leads to the most traumatic psychological problems.^[17]

The increasing level of distress is much more in females which can affect their mental health very badly because infertility is meant to be a social shame. In India, there are many social traditions where the woman has been forced to bear a child just after her marriage and if she fails so, they put all the allegations on the woman only, knowing the fact that man, and woman are equally responsible for infertility or the failure of pregnancy.^[17] It is often not clear that how stress is related to infertility, whether stress causes infertility or infertility causes stress. Both male and female has a stressful impact of infertility which effects their quality of life.^[18] Fertility problems increase marital and family problems and decreases quality of life, self-esteem, and satisfaction with actions of the partner [Figure 1].^[19]

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Figure 1:

Relationship between stress and infertility.

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PSYCHOSOCIAL CONSEQUENCES

More than a medical state, infertility is a social position.^[20] Infertility effects not only physically but mentally too. It can have dangerous effects on psychological, economic, physical, and social status of both male and female.^[21] Infertility affects a couple and their relationship very badly which includes, the poor quality of life, low self-esteem, and hopelessness. It is very important for an infertile couple to understand how to manage infertility and its treatments.^[22] The female partners were always blamed for childlessness while having the infertility treatments.^[14] For the patient, infertility treatments are so emotional and disturbing procedures. It is meant by many patients that infertility is a punishment given by god to them.^[23]

ECONOMIC ASPECT OF INFERTILITY

Having a child is a necessary ambition of a couple’s life. Thus, infertility effects their relationship in a very negative way. The couple begins to have physical, psychological, and financial problems following infertility treatments.^[24] From the last few decades, the infertility treatments have increased remarkably. The costly treatments, such as assisted reproductive technique (ART), are now generally used for infertility treatments.^[25] During the infertility treatments, the standard of health care system is lacking and the heavy treatment costs are recovered from patient’s pocket. Not every couple can afford all these infertility treatments and it puts the patient under so much pressure. They feel they are being financially exploited. To save the patients from ruining their money, it is the duty of the administration to provide good health-care services to the patient. The financial shortage for the treatment of infertility may cause severe psychological problems.^[26]

SIGNIFICANCE OF PSYCHOLOGICAL IMPACT ON INFERTILITY

Infertility is a growing complication in all the cultures and societies. It has affected 80 million people worldwide.^[2] As we know that parenthood is one of the most important event of human life and the stress of not bearing a child is very depressing for a woman, which leads her to so many psychological problems such as anger, sadness, jealousy, marital problems, feeling of worthlessness, anxiety, and finally depression.^[2] Infertile women reported poor marital life as compare to fertile women.^[27] There is a dramatic increase in infertility treatments which throw the light on the psychological aspect of infertility.

UNRESOLVED TREATMENT OUTCOME

The psychological factors may be influenced by the outcome of infertility treatments. The infertile couples have higher level of psychological stress while taking infertility treatments.^[2] There are 10–25% of clinically recognized pregnancies that end in miscarriages. Majority of women report suffering from anxiety and depression after experiencing the pregnancy loss even after so many treatments.^[3] With the help of ART, some patients get pregnant very easily after their first cycle, and for the rest, it may take a very long time or may not happen at all. Infertility may be caused by many reasons such as polycystic ovary syndrome, endometriosis, male factor infertility, or unexplained infertility.^[3]

CONCLUSION

Women suffering from infertility considered it as a most painful and stressful period of their life. The treatment of infertility may feel like a load on patients in which pain, suffering, economic hardship, and lack of social status are more than the results. The psychological symptoms may interfere with fertility, tolerance, and success of infertility treatments. The lesser psychological problems may higher the chance of pregnancy. Therefore, the psychologists should pay more attention toward the mental health of the infertile women. After this review paper, we propose that our future work will be the incidence of infertility in Jammu and Kashmir.