Positive Health Online

I have worked as a Counsellor specializing in infertility since 2005; I am an accredited member of British Infertility Counselling Association (BICA). Currently I work for a fertility hospital in Tunbridge Wells and from my private clinic near Rye in East Sussex. I see what a difference support can make. I say support, as this is often the type of counselling infertility clients need. Sadly, it seems support is often lacking in this area. Often counselling is not funded on the NHS or included in treatment packages in private hospitals. Clients are frequently stretching themselves financially to afford treatment, and counselling is seen as an unnecessary luxury. The emotional roller coaster of treatment is regularly overlooked and underestimated. Consequently clients are left feeling resentful, stressed and unsupported. This is not an ideal way to embark on treatment and begin or continue an often long and stressful journey.

Complex and painful emotions are common for clients experiencing fertility problems, those who can’t have children and those having fertility treatment. They can feel as though they have failed, as though they are less of a man or less of a woman. It can hugely impact a person’s sense of self and confidence. Most people never imagine they may have problems having a child. Often it is something they have actively been avoiding until it is the ‘right’ time. When conceiving becomes difficult it can be a terrible shock. For those whose fertility problems prevent them having a children, there can be a sense of loss or grief. It is like bereavement for the child they couldn’t have. They may have built a vision for a future round a plan to have children and suddenly it is taken away. Whole lives need to be reconsidered and reassessed. Isolation is also a common feeling, families may find it hard to show empathy and may say or do unhelpful things.

Fertility clients are to my mind unique compared to general counselling clients - if they were not experiencing fertility problems they would not need counselling. The emotions they are experiencing are similar to a person going through any type of trauma, like cancer sufferers or soldiers experiencing PTSD - it’s the immediate situation that has caused the need for support (counselling). If they had become pregnant without difficulty the emotions they are feeling would not have come to fruition. It is undoubtedly a highly charged circumstance, one that maybe become a long term situation. Support will be needed if the client is to cope well with treatment.  

Yet there seems to be some kind of reluctance involved in accessing support from fertility clients. I see people struggling to cope, silently, with massive expectations of going through this huge ‘thing’ without making any fuss. Or to just slip a treatment cycle into their day to day life without anyone noticing. Taking no time off work and without asking for any help or support. Often having scans early in the morning to enable them to arrive at work on time, or getting a negative test and having to move on immediately…. the list of challenges goes on. It is a very lonely place - clients are going through a very private issue and consequently support is difficult to access. Those who are lucky enough to have family or friends offering support often find this is limited, as this situation is something that is outside of family and friends’ experience and therefore concrete assistance is limited. It is difficult to support someone if you do not understand the process and have not experienced the situation. I hear time and time again clients say they feel they are unusual in finding it difficult to cope. That they are the odd one out and believe others are coping so much better than them. In the main this is inaccurate - it’s just that no one talks to each other, so therefore expectations and reality are misconstrued. The waiting room is a silent place where eye contact is avoided and chatter non existent.

Distinctively with fertility issues both partners are stressed at the same time and may be coping in very different ways. It can be unrealistic to expect support from each other, especially if you are only just about keeping your own head above water! Being incredibly politically incorrect, I see a massive difference in the way men and women generally (but of course not exclusively!) cope. Men seem to want to discuss, for example, a treatment programme, get specific details and then forget about it until they have to pitch up at the clinic - this is a way of coping. Men generally seem to be very practical, looking for solutions and often fairly unemotional. Women on the other hand generally want to talk about specifics, get dates, times etc. and then talk about it all again and again. They consider everything – “is it the best time, would it be better to wait a month, should she stop coffee now, should she drink alcohol, should she tell her boss etc.” Often wanting to go through all these scenarios again several times - this is a way of processing information and emotions and a way of coping. Women often ‘like’ a good cry, they feel better after releasing these emotions; however I hear men say “I asked her how she was and she burst in to tears so I made it worse!“ Men often struggle to understand the need for a cry! In general life in these types of situations women often turn to other female friends to find this kind of support; however during fertility treatment this type of provision is often sadly lacking as the situation is so private and so specialized.  It may be that a client just doesn’t feel able to talk to friends or it maybe that friends just don’t know what to say. The client is often left feeling isolated and alone.

Fertility treatment is without doubt stressful. It can be helpful to work with someone to come up with concrete strategies that will reduce stress. Strategies that will make the situation easier to deal with and develop ways to help cope as a couple. You may need to work out how to cope with the inevitable questions you are being asked from well meaning friends and family - a few well thought out sentences can relieve pressure considerably. One of my favourites being in answer to the question “when are you two going to be having children” is “things aren’t that simple”; this immediately makes the question bearer back off and you feel more able to cope with social situations. You will need space to process things and make decisions. If you are undergoing treatment, you will almost certainly need a plan to help make the infamous two week wait more manageable. It may be you need help to gain the confidence to make a bit of a fuss, to get signed off from work, if you’re struggling either physically or emotionally and to acknowledge it’s not fair, it’s frustrating, sad and hugely stressful. Counselling is a safe space to explore.  Finally you may need time to make a backup plan for the future - whatever that future may hold. Having this in place, a plan that is just one step ahead, hugely takes the pressure of the current treatment cycle. Knowing that you are in agreement with your partner is helpful. This is what support counselling is about. It can help a client to see clearly and make informed and less emotional decisions. The client is allowed space to discover his or her own journey and the way in which to move forward. He or she is able to talk freely and openly the without fear of being judged.

Implications counselling is hugely beneficial to every client who may be considering the use of donor eggs, sperm or embryos. It enables the client to consider the issues surrounding this route of treatment. Things such as the feelings involved in the loss of any genetic connection, the way in which they tell the child how he or she was conceived and the effect on the wider family. Since 2005 donors in the UK have to agree to identifying information to be given to the child when he or she is 18 years old - part of implications counselling is to look at the feelings that maybe evoked should the child decide to contact the donor. The implications of this type of treatment need to be fully considered before treatment is undertaken; having space and time to consider things may help a couple to decide on the way forward.

I could go on about the benefits of counselling, but I thought I would leave you with a few thoughts:

Did you know there is mounting evidence to suggest that for some people experiencing a negative pregnancy test is similar emotionally to experiencing a close family bereavement? However there is nothing concrete to mourn; this makes the grieving process incredibly hard. Support is just not there.

Did you know evidence suggests that for clients going through treatment the stress levels can be similar to someone in a crisis situation (e.g. being in a bus on the edge of a cliff) - what is unique about infertility is that it can be a long lasting crisis. This makes it unlike most crises which are usually resolved fairly quickly (e.g. your bus falls or you are rescued!) This is incredibly bad for stress levels - it means they are at the level of expecting the impending disaster all the time.

Researchers in the USA found that in some women cognitive behaviour therapy (CBT) was enough to help these women who had stopped having periods and ovulating regain their fertility. These women all had raised levels of cortisol a hormone linked to stress.

Did you know Alice Domar conducted research that showed people suffering from infertility receiving psychological support achieved better pregnancy rates than those without support. It seems to me that that alone should be indicating that everyone under going treatment should be getting support. It should be seen as a normal part of treatment. Something that everyone needs and benefits from.