Anwar and Anwar (2016) defined infertility as an illness whose main characteristic is the inability to develop clinical pregnancy post 12 months of successful and regular unprotected sexual intercourse. It is common in both males and females.
This study's identified issue is the need to develop care practices that effectively address individuals with infertility based on individual needs and differences rather than generalizing the care. The aim is to outline the effectiveness of singling out individuals and treating each patient as a different case. The interventions to infertility are based on the causes, although a single intervention can be used for various infertility causes in most cases. This study's question remains whether pharmacological, including surgical interventions, are more effective than the non-pharmacological and natural management modalities. Studies reveal that infertility is commonly closely associated with psychological issues, hence questioning the relevance of pharmacological management of infertility (CDC, 2019).
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The intervention identified for this study is the psychological and psychosocial management approach in the management of infertility. Studies reveal that psychological stress in women causes amenorrhea, which results in infertility. Mental health plays a crucial role in all body functions, including reproductive capacity (Skozdiak et al., 2020). The population under study is healthy female patients who suffer infertility due to psychosocial factors. This study aims to determine the care practices that address this aspect and elicit their effectiveness in infertility management.
The Sources of Evidence
Cognitive Behavioral Therapy (CBT)
This approach utilizes different techniques to modify emotions, behaviours, feelings and thoughts. It is a psychological treatment modality employed in infertility management due to a non-pathological cause, linked to psychological causes. Its basis is the cognitive model of emotional responses whose approach is challenging the patients to change unhealthy attitudes, drop unhealthy emotions and adopt positive ones (Hayes & Hofman, 2017). The unhealthy thoughts, ideas and feelings promote the development of emotional stress and anxiety; thus, the patient must drop them for their well-being. This treatment modality is individualized and patient-centred and addresses the psychological aspects that lead to infertility.
Cognitive Behavioral Therapy has been identified as the most effective non-pharmacological management modality for psychological disorders such as anxiety, depression and emotional stress. CBT is a talk therapy that is specific to a problem focusing on the patient's set goals. Some of the techniques employed during CBT include group therapy, role-playing activities, one on one counselling, body-calming techniques such as yoga, Rational Emotive Behavioral Therapy (REBT) addressing emotions and giving consistent feedback (Hayes & Hofman, 2017).
Psychoanalysis and Psychodynamic therapies
This intervention aims to eliminate problematic ideas, thoughts, and feelings by discovering their unconscious motivations and meanings. Psychoanalysis effectively outlines the underlying psychological burden through the patient's close partnership and the psychologist or healthcare provider. Patients understand themselves by exploring their interactions in therapeutic and non-therapeutic relationships (Laplanche & Pontalis, 2018).
The humanistic theory is an approach that focuses on enhancing people's capacity to make rational decisions. Therapists aid the clients to change by expressing their interests, concerns and care. This is the client-centred theory of the humanistic theory (Laplanche & Pontalis, 2018).
Articles' Findings
The study's central aspect is psychotherapy as a non-pharmacologic means of treating infertility in patients with non-pathological infertility. This method's effectiveness in this situation is compared to the alternative method, the pharmacological methods in treating non-pathologic infertility. The pharmacological treatment methods recommended for infertility in women are mostly drugs that stimulate or regulate ovulation. These drugs include; Clomiphene citrate (Clomid), gonadotropins, Letrozole Metformin, and Bromocriptine. These are the most recommended drugs for treating infertility due to failure to ovulate. Psychological disturbances cause amenorrhea, altering the cycle, which also alters the ovulatory capacity. The use of these ovulatory drugs has been deemed effective in treating infertility in cases that psychotherapy alone cannot. This is after careful evaluation of the risks of using them and weighing them against the benefits and establishing that the benefits outweigh the risks (Mayo Clinic, 2019).
While infertility diagnosis is easy to establish, the underlying cause may take various tests and comprehensive history to determine. The routine use of pharmacological treatment poses a hazard to pregnancy outcomes. Such risks include; development of the ovarian hyper-stimulation syndrome which is characterized by painful, swollen ovaries, presenting as abdominal pain with bloating, nausea and vomiting, development of multiple pregnancies, mostly triplets due to ovulation of multiple ovaries due to the stimulant effect of the drug, and development of long-term ovarian tumours (Mayo Clinic, 2019).
Such pregnancy risks can be avoided by the use of psychotherapy in treating non-pathologic infertility. Studies reveal that psychological stability has a hand in establishing fertility, and mostly, non-pathologic infertility is caused by psychological stress. In itself, infertility is a stressful situation and, in most cases, worsens the already existing condition by further increasing stress. In a study conducted by Mahbobeh et al., 2018 on the effects of CBT and pharmacotherapy on infertility stress, they concluded that CBT is more effective in managing stress and reducing anxiety, thus treating infertility due to psychological stress as compared to the use of pharmacological means.
The relevance of the Findings
The rationale for selecting the study by Mahbobeh et al., 2018 is that the study outlines the effectiveness of CBT as a method of treating stress over the pharmacological approach, which in this study was Fluoxetine. The study provides evidence that CBT is the most effective non-pharmacological method for managing psychological stress and changing attitudes and perceptions, which help the patient develop a healthy lifestyle.
The relevance of the study by Laplanche and Pontalis (2018) is that it provides evidence that most psychological issues can be addressed by focusing on patients individually allowing them to self-assess their choices and make rational decisions. Infertility due to psychological stress can easily be managed by psychotherapy as outlined by this study. The effectiveness of psychotherapy over medication use is also discussed in this study, which was discussed in this paper.
The study by Hayes and Hofman (2017) discusses the importance of CBT in managing psychological issues. As this paper tries to outline the importance of psychotherapy as a non-pharmacological treatment method for infertility, CBT is the most effective form of psychotherapy. This proves the importance of addressing the psychological problems in infertility before resorting to pharmacological methods.
Conclusion
The routine use of pharmacological interventions in instances of infertility should be avoided. It is crucial to establish psychological clearness and calmness as the first intervention to rule out psychological stress as a cause. This calls for psychosocial and psychological interventions. CBT has been outlined as the most effective psychotherapy form for treating infertility and should be applied regularly before initiating medication in non-pathologic interventions.
References
Anwar, S., & Anwar, A. (2016). Infertility: A review on causes, treatment and management. Womens Health Gynecol , 5 , 2-5.
Centers for Disease Control and Prevention (CDC). (2019). Infertility . Reproductive Health. https://www.cdc.gov/reproductivehealth/infertility/index.htm
Hayes, S. C., & Hofmann, S. G. (2017). The third wave of cognitive behavioral therapy and the rise of process‐based care. World Psychiatry , 16 (3), 245.
Laplanche, J., & Pontalis, J. B. (2018). The language of psychoanalysis . Routledge.
Mayo Clinic. (2019). Female infertility - Diagnosis and treatment - Mayo Clinic . Mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/female-infertility/diagnosis-treatment/drc-20354313
Szkodziak, F., Krzyżanowski, J., & Szkodziak, P. (2020). Psychological aspects of infertility. A systematic review. Journal of International Medical Research , 48 (6), 0300060520932403.
