In the past, the reasons for many cases of unexplained infertility were lazily consigned to a metaphorical dustbin labelled ‘psychological basis’. This was so ingrained in medical opinion that a 1950s medical textbook stated, “A latent psychological conflict always underlies complaints of infertility!”
However, psychological behaviours, which includes a lack of sexual intercourse actually causing infertility are relatively unusual and affect only about 7% of women and 1% of men diagnosed with infertility according to research carried out in 2012 in Heidelberg, Germany.
As a result, the textbooks of today are far less unanimous, for instance one text warns that that, “In fact, a false psychological diagnosis may exaggerate a modest reaction of frustration into a feeling of sexual and feminine inferiority, that may result in demonstrable changes in the reproductive cycle.” Another text says that, “psychogenic diagnosis of infertility could be considered a source of iatrogenic stress in and of itself.”
What about psychological behaviours following a diagnosis of infertility? Here, in contrast, psycho-sexual dysfunction as a consequence of an infertility diagnosis is common, and seems to be triggered by the emotional rollercoaster of trying to conceive. In particular, in the German study, half of the female responders reported a change in their sex lives following diagnosis, with two thirds reporting deterioration.
In fact, the negative impact of infertility and of reproductive medicine treatment on the sexuality of couples is well known in the fertility-counselling sector. For instance, other studies have shown that there are clear indications that heterosexual couples experience a loss of spontaneous sexuality during the treatment of infertility.
The psycho-sexual impact of diagnosis and treatment is probably related to the fact that infertility also has a detrimental effect on female self-esteem with around 50% of women rating it as the most upsetting experience in their lives in one well known study. This was in contrast to men for whom only 15% rated it as the most upsetting event, but this may be because women tend to recognise and express their emotions more easily than men. Yet men when completing the questionnaire in the German study showed around the same deterioration in points in the sexual satisfaction scale as women.
What can clinics do about this?
The authors of some of the studies suggest that ongoing infertility counselling could be facilitated by using instruments like questionnaires for couples to quickly identify if treatment is having a negative impact on their relationship quality and/or sex lives. Once identified it may be that these couples may have special needs in infertility counselling that can then be addressed.
It is clear that fertility health care professionals have a duty to patients to start and maintain a dialogue about the psychological obstacles to maintain a sexual relationship. This aspect of psychosexual counselling should be available at all stages of treatment.
