The experience of infertility can push you to the edge of a crisis, both emotionally and physically. This pressure is compounded by the fact that the social stigma surrounding infertility means that few people are able to discuss their experiences openly.

Emotional responses vary but you will probably find it helpful to use the same strategies now that you have used to deal with other problems in your life.

The help that you gain can come from outside yourself: by reaching out to friends whom you know you can talk to and trust, by becoming involved in Genesis Support Group (WA Self Help Group) by talking to professionals, by reading books.

But perhaps the most useful help you can get is the help that comes from within yourself. Try to maintain your sense of humour and remember that you are a worthwhile person. Value and care for yourself, whatever happens – whether you are able to have a baby or not.

The present may seem black but you will recover. You will find that you do have the capacity to survive this experience. At times in the future the feelings of deep sadness and regret may return. This is to be expected in a sensitive, feeling person. However, it will no longer be the central focus of your life.

The emotional responses to the crisis of infertility are not however only the result of social pressures; they may also flow from your own life experience. This will vary depending upon your past and present relationships, your individual personality and many other factors such as your expectations of adult life, your cultural background and religious faith.

Some of the wide range of emotions you may experience with the discovery that you have fertility problems are expressed very clearly in comments like these:

EMOTIONAL RESPONSES TO INFERTILITY
What sorts of emotions then, are you likely to experience when you discover that you have a fertility problem? One of the emotions that may confront you is a strong sense of surprise. Infertility, as we said earlier, may have been something you never even thought about.

Because of this it may take you quite a while to fully realise its implications. One way you may attempt to deal with this crisis is to convince yourself that for you it is not a big problem. Often the pain of this experience is so intense that you may not be able to cope with it all at once.

Thus you may deny that you feel upset by your fertility problems; and you may even deny that you ever wanted children in the first place. While these emotions can cause you to delay seeking assistance, they may also be useful in that they help you to gradually realise what the experience of infertility will mean to you.

Also, you may find yourself feeling angry and depressed. These emotions may be directed inwards upon yourself, or they may be directed at your partner, or the doctors, nurses, scientists, social workers, family or friends.

At the root of these feelings could be the idea that you are less than a whole human being, and that you have in some way failed – that you have let yourself, your partner or your family down. For women who expected motherhood to play a central role in their lives, this experience can be especially devastating.

Sometimes it can seem as though your world is crumbling and that nothing else matters. It is essential here to remember that there are other parts of your life that are important to hold onto, such as your work, your hobbies and your own special interests and abilities.

Feeling that you are not living up to the expectations of your partner, feeling that you are letting him or her down, can place great stress upon your relationship. Infertility is still a subject that your family and friends are likely to feel uncomfortable with, so you may have very few people with whom you can discuss your feelings. This problem can make you feel even more isolated and make the whole experience more difficult to deal with.

When you discover that you have fertility problems, often the main focus of your relationship as a couple can become the desire to conceive a child.

As one woman described it:

Because of this obsession, the pleasurable aspects of sex in your relationship can be lost. Intercourse can begin to seem pointless and you may feel useless and inadequate as a sexual partner. The stresses created by this perceived loss of purpose in your relationship, are often shown as resentment and disappointment and overcoming them may require a lot of effort from both you and your partner.

You will need to acknowledge that although you make up a couple, you are also individuals with separate feelings which need to be considered, however different they may be.

Finally, one of the most important and complex aspects of the experience of infertility is the sense of sadness and loss it creates. What you are mourning is the ABSENCE of experience.

It is important to stress here that not everyone experiences all these losses, and your experience of them may differ greatly from the experiences of others.

Some of the losses associated with infertility are even more difficult to define. Waiting for treatment and the continual hope that “this will be the time” can leave your emotions painfully suspended, creating a continual “hoping against hope” attitude. The nature of infertility is such that you may never know definitely whether you are able to conceive or what is causing the problem. Your grief therefore has nothing to focus on and this frustration can place great strain upon your relationship.

Infertility therefore is an experience that continually fluctuates in intensity and directions, so that at different times you may have different needs and experience different emotions. There are no set “stages” in this experience, and while at one time your emotions can be mystifying and frighteningly intense, at another you may simply feel numb.

There may be moments when being infertile dictates every facet of your life, whilst at other times you may act to change the direction of your life. The way you learn to deal with the experience of infertility will also be different at different times. One day a particular strategy may help you a lot, but later on you may find it useless. At times you may find the pain you experience very destructive, but at others you may find it a useful motivating force in your life.

It is important to acknowledge that emotional responses to infertility vary greatly, as do people’s methods of coping with them. Each person has to find their own way of coping with their situation, and sometimes might need help to do this.

EMOTIONAL RESPONSES TO INFERTILITY

Our trained staff at the Centre for Assisted Reproduction Private Limited are always willing to listen to you and talk to you.

A person’s weight can have a profound impact on their fertility.

Men and women who are either under or over their ideal weight have a higher risk of experiencing infertility. The body mass index (BMI) is the routine measure used to assess whether a person is under or over their ideal weight.

BMI is calculated as weight (in kilograms) divided by height (in metres) squared. A BMI of less than or greater than the desired weight (see below)

BMI Description
<20 Underweight
20-25 Desired Weight
25-30 Overweight
>30 Obese

can lead to fertility problems. Being under or over the desired weight for both males and females can disrupt the hormonal balance that is necessary for normal egg and sperm production.

The impact of weight on female reproduction

Research from as early as the 1930s demonstrated a link between excess body weight and polycystic ovary syndrome (PCOS). Excess body weight can lead to menstrual cycle irregularity, infertility, an increased risk of miscarriage and difficulty achieving a good response to assisted reproductive procedures.

It also appears that excess weight as a teenager has a significant effect on subsequent fertility. This was the conclusion of a number of large research studies from the Netherlands, Japan, the United Kingdom and Australia. Conversely, being under weight can also lead to disruptions in the normal menstrual cycle and subsequent fertility problems.

The effect of weight on success of assisted reproductive procedures

Recent research has shown that a lowered or elevated BMI significantly reduces the chance of achieving a pregnancy after in vitro fertilization and embryo transfer (IVF-ET). In this study of nearly 400 couples, 21.8% of the female partners had a BMI below the normal range and 22.3% were above the normal range.

The results suggest that being either underweight or over weight can have a negative effect on IVF outcome leading to a decreased chance of pregnancy from these procedures.

The effect of weight loss on fertility

In the 1950s it was shown that reducing weight in overweight women could restore menstrual cycle regularity. This study has since been confirmed by studies from Italy, the United Kingdom and Australia which demonstrated that a weight reduction of 5% is enough to restore normal menstrual cycle function in up to 60% of overweight women.

Furthermore, several studies have shown that if an overweight female partner reduces her weight before undergoing IVF the chance of becoming pregnant is dramatically improved.

Obesity and pregnancy outcome

Many articles report that obesity has a significant negative impact on the out come of pregnancy and the offspring. Obese women who become pregnant have an increased risk of hypertension; pregnancy related diabetes, urinary infections Caesarian sections and assisted delivery.

In addition, the miscarriage rate was reported to be much higher in overweight women. Other studies have shown an increased incidence of Down’s syndrome in the children born from overweight mothers.

Does body weight effect male fertility?

The potential for obese males to have a reduced sperm count does exist. For example, obesity can lower levels of the male hormone testosterone (which is directly linked to sperm count) that is converted to estrogen by fat cells.

Obese males can also develop an “apron” of fat around the genital area heating up the testicles and potentially reducing sperm numbers. Obesity can often lead to poor health in general but no studies to date have shown that obese men have reduced sperm counts.

US scientists have found a possible link between low dietary folate levels and abnormal sperm in men. The findings, from the University of California, Berkley, and the Lawrence Berkley National Laboratory, provide further evidence that healthy diets aid fertility.

Folate is a soluble B vitamin found naturally in foods such as citrus fruits, green leafy vegetables and pulses. The synthetic form, folic acid, can be taken in dietary supplements. The benefits for women of high folate levels are well established in preventing birth defects, but this is the first time a reproductive benefit for men has been shown. The normal recommended daily allowance (RDA) of folate for humans is 200 micrograms, and 400 micrograms for women trying to conceive and during pregnancy.

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Endometriosis is a disorder of the female reproductive system, where endometrial tissue (the normal lining of the uterus) is found in areas other than the uterus. The most common sites are in the pelvis – the ovaries or tissues near the uterus and fallopian tubes, including the bladder, ligaments and bowel.

HOW DOES ENDOMETRIOSIS OCCUR?

The exact causes of endometriosis are still not fully understood. It is believed that endometriosis occurs as a result of normal tissue from the uterus escaping into the fallopian tube and out into the pelvic area at the time of menstruation (“retrograde menstruation“). These tissue fragments are then thought to implant and grow onto the surrounding pelvic tissue and, sometimes, organs.

Because these fragments are made of the same tissue as the lining of the uterus, they too respond to the hormonal changes that occur during the menstrual cycle and, therefore, “bleed”. Whereas menstrual blood can escape from the body, this has no exit and, as a result, the areas surrounding the implants of tissue become irritated or inflamed.

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This fact sheet is designed to assist friends and family members to understand your needs and support you more effectively.

FACT: There is rarely a quick or simple answer to infertility problems. Assessment and treatment procedures usually take considerable time.

FEELINGS: You can help by not forcing the issue with questions such as “When are you going to have a baby?” The person/s may not know if they can have a child, much less when it will be. You can help by allowing the person/s to decide if and when they want to talk about it.

FACT: There is a huge range of factors that can contribute to infertility, and treatments vary accordingly.

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Caffeine

Large research studies have been undertaken in Europe and the USA to ascertain whether coffee consumption is related to infertility. The results however are conflicting and difficult to interpret.

The authors of one study concluded that a high level of coffee consumption is associated with an increased risk of delayed conception. One study found that as little as one cup of coffee per day was enough to increase the time taken to get pregnant.

Another study of nearly 3000 women found that coffee consumption was not associated with infertility. Other studies have shown 2-3 cups of coffee per day is associated with an increased risk of miscarriage during early pregnancy.

Very little is known about the impact of coffee consumption on semen quality, although in vitro studies have demonstrated that caffeine can enhance sperm motility. There is little evidence that coffee can improve the fertilizing capacity of sperm. In men who drink coffee and smoke, deleterious effects on sperm motility and vitality have been observed.

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Many lifestyle choices can potentially reduce human fertility. A large number of research studies have identified alcohol, smoking, caffeine, recreational drug use, excessive exercise and certain occupations as lifestyle factors most likely to contribute to infertility.

Alcohol

Alcohol consumption is widespread and believed to be increasing in many countries throughout the world. Research on animals has shown that alcohol can decrease steroid hormone production, inhibit ovulation, and disrupt sperm transport through the fallopian tubes.

Does alcohol have similar affects in humans? High and frequent alcohol consumption can contribute to menstrual disorders and an increase in the percentage of abnormal sperm. Pregnant women with excessive alcohol intake have a higher incidence of spontaneous abortion, placental abruptions, pre-term delivery, stillbirth and fetal alcohol syndrome.

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A diet rich in steak and other red meat might hinder a man’s chances of conceiving a child, say Spanish researchers. According to their study published in the journal ‘Fertility and Sterility’, a healthy antioxidant-rich diet might be the key to sperm quality and motility. Men who eat a lot of fruit and vegetables, in particular peppers, spinach and citrus fruits, have higher quality and faster swimming sperm.

‘A healthy diet is not only a good way of avoiding illness, but improves the quality of semen’ said Professor Jaime Mendiola, the leading researcher. ‘We saw that, among couples with fertility problems coming to the [fertility] clinics, men with good semen quality ate more vegetables and fruit, which means more vitamins, folic acid and fibre, and fewer proteins and fats.’

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C) MISCELLANEOUS

1. DISAPPOINTMENT

Infertility itself creates a feeling of intense hurt and disappointment. The opportunity of an ART treatment and thus the possibility of a pregnancy offers hope. However, the intensity of effort put in undergoing ART procedures is more than likely to be unrewarded in each cycle (otherwise the pregnancy rate would be more than 50%).

Success is achievable for most couples, as long as a number of attempts are tried. It is also likely that your parents, relations or friends will not appreciate what you have been through. They cannot really know. You may feel lonely yet become irritated by sympathy; angry, but not sure who or what with or why.

Do not be afraid or ashamed to ask for help. The CAREPL Counsellor is available for everyone to talk to.

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B) MEDICATIONS

It is neither possible nor useful to list all the possible reactions to medication. All drugs produce some side effects. These can be one or more of the following;

• Allergic reactions: These are bizarre responses peculiar to some individuals and not to others (eg. Penicillin can produce lumpy rashes or sudden fluid retention and, if this occurs within the larynx, some obstruction to breathing is possible).

• Exaggerated side effects: These are the effects of medication which in some degree are common to many patients taking drugs but some people have an exaggerated reaction (eg. Pethidine produces relief of pain but commonly “queasiness” or light headed feelings).

The specific medications which are used in ART are as follows:

1) LUCRIN/SYNAREL

This medication is used to suppress the natural menstrual cycle to allow greater control over the response by the ovaries to gonadotrophins eg. Menogon/Puregon and Gonal F.

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