Infertility Drugs, Psychosocial Issues

BIBLIOGRAPHY

Throughout American history, sociocultural expectations and norms have been that adults of childbearing age should procreate and become parents. This expectation presumes that every couple is able to have children and that they are broken, defective, or flawed if they are not able to conceive. While infertility is a medical problem, a variety of emotional responses are often associated with one’s inability to have children. Individuals may begin to struggle with feelings such as anger, stress, disappointment, depression, anxiety, and low self-esteem. These negative emotions, in addition to the often invasive medical procedures associated with trying to become pregnant, can have a significant impact on individuals as well as on their relationships. Advances in assisted reproductive technologies as well as a variety of adoption and surrogacy arrangements now make it possible for some previously infertile individuals and couples to achieve parenthood. However, the psychological and sociocultural issues with regard to using outside interventions to become a parent can be problematic.

It is estimated that infertility affects approximately 6.1 million women and their partners in the United States, about 10 percent of the reproductive-age population (National Survey of Family Growth, Cycle IV 1995). Infertility is defined as the inability of a couple to achieve a pregnancy leading to a live birth after one year of regular, unprotected sexual intercourse. Infertility is experienced equally by males and females. Forty percent of infertility is due to what is termed “male factor,” 40 percent is due to “female factor,” and the remaining 20 percent is shared between the couple. In nearly 90 percent of cases, a clear medical diagnosis is presented to couples after an infertility evaluation. The remaining group, 10 percent, is diagnosed with “idiopathic” or medically unexplained infertility. Even with a clear medial diagnosis of the etiology of infertility, it is estimated that only 30 percent of all couples who receive medical treatment for infertility successfully attain a live birth.

The medical diagnosis of infertility can lead to profound emotional, relational, and sexual distress and social stigma in addition to challenging financial, legal, and medical treatment decisions. The negative feelings and difficult challenges can be profoundly disruptive to a couple or individual’s life. In empirical and anecdotal literature, people experiencing infertility often note heightened emotional disturbance (e.g., anger, anxiety, depression, and helplessness), faltering self-esteem, and preoccupation with thoughts about conception. These thoughts and feelings can lead to a disruption in daily functioning as well as changes in sleeping, eating, and moods. Additionally if a diagnosis of infertility is received, there is often little or no societal, cultural, or religious preparation for the impact that is commonly experienced by those struggling to become parents. The duration and intensity of infertility treatment and its failure can increase or exacerbate preexisting mental health issues, intrapersonal and interpersonal concerns (including domestic violence), alcohol and substance use, and workplace challenges. Issues such as pregnancy loss, miscarriage, stillbirth, chemical pregnancies (pregnancy resulting from in vitro fertilization or other reproductive technology, characterized by low levels of HCG and usually miscarriage prior to implantation) may also be experienced by those undergoing infertility treatments and clearly can cause undue stress, anxiety, and health problems as well.

During infertility medical treatments, people often experience a variety of extreme emotional responses as they are faced with repeated high hopes of pregnancy crushed by the failure to conceive month after month. Those undergoing infertility treatment might feel overlooked by medical staff, insensitively managed, or overwhelmed by an array of invasive and expensive procedures. Fertility medications rarely are successfully utilized in isolation and accompany the vast majority of common infertility procedures and assisted reproductive technologies (ART), such as intrauterine insemination (IUI), in vitro fertilization (IVF), egg donation, sperm donation, and embryo donation.

The drugs used to treat infertility work by promoting ovulation (ovulation induction) through stimulating hormones in a woman’s brain to prompt multiple eggs to release from the ovaries. Most fertility medications have been safely and effectively utilized for more than thirty years. Common fertility drugs include clomiphene, human menopausal gonadotropins, and bromocriptine. Potential side effects of these medications can include weight gain, hot flashes, mood swings, nausea, breast tenderness, cramping, and ovarian hyperstimulation. Drugs for infertility may result in multiple births, which can be challenging because they increase the likelihood of premature births and babies who may be at higher risk for developmental, social, and psychological complications. Further, conflicting empirical research indicates that women who take ovulation-inducing medications in conjunction with ART might be at increased risk of developing breast, ovarian, or uterine cancers.

As infertility medical technology continues to develop, navigating ethical and legal issues becomes important for both medical and legal policy makers as well as individuals and couples. Increased options for those experiencing infertility continue to be developed. Specialty procedures available through medical treatment include sex selection, screening for genetic anomalies, preimplantation genetic diagnosis (a procedure that can assist couples who have serious genetic disorders such as cystic fibrosis and Tay-Sachs disease), and egg and sperm freezing. While the concept of building a “designer baby” (i.e., one with certain physical or genetic characteristics) tends to get a lot of attention from the media, for most people handling infertility this is a misnomer. The vast majority of people who are trying to conceive simply want to begin or continue building a family in a way that most closely mirrors nonmedical assisted conception.

Infertility medical treatments are typically quite expensive and sometimes financially prohibitive for individuals through private pay. Insurance companies often do not cover infertility treatments, and coverage policies vary by state. Due to the cost of fertility medication and accompanying medical procedures, it is often only the more socially and economically mobile individuals or couples who are able to attempt to undergo medical infertility treatment options in their efforts to have children.

SEE ALSO Anxiety; Childlessness; Depression, Psychological; Determinism, Genetic; Emotion; Fertility, Human; Medicine; Role Conflict; Self-Esteem; Stigma; Stress

BIBLIOGRAPHY

Cooper-Hilbert, B. 1998. Infertility and Involuntary Childlessness: Helping Couples Cope. New York: Norton.

Daniluk, J. C. 2001. The Infertility Survival Guide: Everything You Need to Know to Cope with the Challenges While Maintaining Your Sanity, Dignity, and Relationships. Oakland, CA: New Harbinger Publications.

Jaffe, Janet, Martha Diamond, and David Diamond. 2005. Understanding and Coping with Infertility: Unsung Lullabies. New York: St. Martin’s.

National Survey of Family Growth, Cycle IV. 1995. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.

Peoples, Debby, and Harriette Rovner Ferguson. 1998. Experiencing Infertility: An Essential Resource. New York: Norton.

Rosen, Allison, and Jay Rosen, eds. 2005. Frozen Dreams. Hillsdale, NJ: Analytic.

Wendy L. Dickinson
Jana E. Frances-Fischer