The belief that infertility is a psychologically mediated condition is long-standing. As an example, the Bible (1 Sam 1:1-28) describes Hannah, wife of Elkanah, as despondent and anorexic; she conceives only after she prays and is promised by a high priest that her wish will be granted . As health care professionals developed the ability to diagnose and treat most cases of infertility, they began to view it as an organic condition. Some infertility patients were told that their stress level had nothing to do with their ability to become pregnant and some health professionals did not assess the psychological status of their patients. However, there is evidence that stress levels influence the outcome of infertility treatment, as well as contribute to patients' decisions to continue treatment . Stress also affects patients' reactions to pregnancy loss during infertility treatment and pregnancy complications. Moreover, psychological distress is associated with treatment failure and interventions to relieve stress are associated with increased pregnancy rates.
ASSESSMENT OF STRESS
Stress is defined as a stimulus which produces mental tension or physiological reaction, for the purposes of this review, the experience of infertility is the stimulus. Distress is the experience of anxiety or suffering, for the purposes of this review, the experience of infertility leads to the suffering
Investigators have routinely utilized self-report questionnaires to evaluate the stress level of infertility patients. This approach may under-report the true level of distress since patients may feign emotional well-being in order to appear psychologically appropriate for infertility treatment. In research studies, the gold standard in psychological assessment is a structured personal interview with a trained mental health professional (psychiatrist or psychologist).
Clinically, the provider can assess stress by observation of the patient and inquiring about the patient's emotional state. Research shows that the main sources of stress for infertility patients are the impact of infertility on their social life, their sexual health, and their relationships with their partner. Thus, questions which ask about each of these areas are recommended. These could include the following:
- Do you feel uncomfortable being around pregnant women and/or children or babies?
- Do you find that you try to avoid situations where there may be pregnant women or babies/small children?
- Is your sexual relationship very satisfying, satisfying, or dissatisfying? And if it is dissatisfying, do you feel that your infertility has had a negative impact on your sex life?
- Do you only make love during the fertile times of your cycle?
- Do you feel that you and your partner mostly agree about how to proceed with infertility treatment?
- Do you feel that your partner is sympathetic and supportive of you?
- How is your mood? How have you been feeling? Are you able to enjoy your usual activities?
- Are you worried? Do you have difficulty concentrating or sleeping? Are you restless?
- Has your appetite changed?