title: Infertility. A psychiatrist's perspective.
abstract: This paper discusses issues relevant to psychiatrists working in a reproductive biology unit: 1. The couple's anxiety. 2. The question of whether psychological conflict can cause infertility. 3. Dealing with the outcome of the workup. 4. Donor insemination. The anxiety of couples applying for an infertility workup can usually be countered by supportive and educative measures. More problematic sources of anxiety that require psychiatric consultation are: 1) Fear that the workup may shatter a myth that explains the infertility, a myth reinforced by unconscious conflicts; 2) An untenable wish that having a child will repair problems in the marriage or in the sense of relief. The psychiatrist is often asked whether psychological conflicts can cause infertility. The most understandable manner in which they do is by their effect on sexual performance. Where there is no sexual performance problem, psychotherapy can be offered if one or both partners experiences psychological pain, but with the understanding that therapy cannot be expected to cure the infertility. Psychiatric consultation at the end of the workup is indicated 1) where irreversible infertility is discovered and mourning is excessive, 2) where a myth to explain the infertility has been shattered, 3) to reassess sexual performance and to deal with the uncertainty, where no physical cause has been discovered. Donor insemination (AID) is fraught with legal and ethical problems. There are no criteria for selecting donors or recipient families, and there is concern that AID may lead to genetic engineering. The psychological effects of AID are uncertain. A study at our clinic suggests that the pursuit of AID involves a two-stage process: first, dealing with the outcome of the infertility workup and second, confronting AID itself; and that the secrecy that surrounds AID obstructs resolution of conflict.
mesh_terms: D000328:Adult; D001007:Anxiety; D003220:Conflict, Psychological; D005260:Female; D006801:Humans; D007246:Infertility / Q000209:etiology / Q000523:psychology*; D007316:Insemination, Artificial, Heterologous / Q000523:psychology; D008297:Male; D011602:Psychophysiologic Disorders / Q000523:psychology*; D012735:Sexual Dysfunction, Physiological / Q000150:complications; D020018:Sexual Dysfunctions, Psychological / Q000150:complications