Infertility is defined most simply as the inability to conceive naturally after 12 months of regular sexual intercourse without contraceptives (Luk & Loke, 2015, p. 610). Having children and starting a family is a conventional staple in society and what infertility represents is an inability to do so. It affects approximately 1 of every 6 childbearing-age couples (Sherrod, 2004, p. 42). The consequences of infertility are manifold and can affect individuals psychologically, socially, and economically (Cousineau & Domar, 2007, p. 293). And while there are numerous treatments for infertility, they are not always successful and often prolong and enhance the distress that a patient is faced with. On top of that, many of the costs for treatments are not covered by insurance or provincial health plans, thus creating a financial burden (Sherrod, 2004, p. 43). This paper will expand on the psychosocial impact of infertility as well as discuss the relevance of income and social status as a determinant of health, on top of that, it will also discuss nursing strategies that can be implemented to promote the health of individuals affected by this condition.
Given that reproduction is a biological imperative, and infertility represents an inability to reproduce, it comes as no surprise that infertility can have extensive psychosocial effects on impacted individuals. Psychologically, anxiety and depression are the most prevalent of mental problems that develop due to infertility (Maroufizadeh, Karimi, Vesali & Samani, p. 253). In fact, it was shown that infertile women have twice the prevalence of depressive symptoms when compared to fertile women (Cousineau & Domar, 2007, p. 295). These psychological issues can cascade and have deleterious effects on many aspects of the individual’s life. The amount of psychological distress that individuals face is influenced by many variables, such as the duration of infertility, the treatment undergone, support systems, and the individuals’ adaptive capabilities (Sherrod, 2004, p. 42). When an individual or a couple is faced with infertility they are met at a crossroads where a decision about how to proceed must be taken. Do they undergo treatment? Do they adopt? Do they accept their future as child-free? For most, they first attempt to treat it (Patel et al., p. 30). Treatment can become an all-consuming process, with daily routine revolving around the condition: the diet is tweaked, hormonal drugs are taken, lifestyle is altered, regular medical appointments are made, etc. In fact, fertility treatment often supersedes other aspects of the patient’s life such that career choices or lifestyle aspirations may be postponed or dismissed altogether (Cousineau & Domar, 2007, p. 293). The process of treatment itself can be one of the most distressing factors of infertility. It was shown that patients who were undergoing assisted reproductive treatments had more psychological strain, helplessness, and dwindling hopes than those who were trying to conceive spontaneously (Patel et al., p. 28). This can be due to the uncertainty regarding success, the treatment duration, the financial costs, and social pressure from friends and family (Maroufizadeh, Karimi, Vesali & Samani, p. 253). Treatment for infertility can go on for an indefinite amount of time, incurring cycles of hope, loss, and despair until a resolution is met either in the form of success or alternative pathways (Allan, 2013, p. 17). The unfortunate reality for many is that, even with treatment, successful fertility is never achieved, and in retrospect time and resources were lost to a state of constant distress over something that was largely out of their control.
Income and Social Status as Determinants of Health
Many of the costs for fertility treatment are not covered by insurance or provincial health plans (Sherrod, 2004, p. 43). This means that access to disposable income is imperative for those seeking treatment, and individuals must plan out their savings and expenses accordingly. It also means that there is a positive correlation between income and access to treatment. Someone with a high amount of disposable income will have access to higher quality treatments at a higher frequency, whereas someone with a low amount of disposable income will be in a more adverse position. As such, it can be postulated that infertile people with higher levels of disposable income will have greater odds of achieving success with their condition than people with lower levels of disposable income. There are also indications that social class plays a factor in the way that individuals cope with the emotional stress attributed to infertility (Lykeridou et al., p. 1972). Some studies have correlated low social class with greater infertility-related stress and anxiety; this was largely in part due to the maladaptive coping mechanisms that people in a lower social class tended to gravitate towards, such as active-confronting and passive-avoidance (Lykeridou et al., p. 1978). This is an important implication because it can be used by nurses to identify patients that are at a higher risk for infertility-related distress.
Nursing is a versatile career and the role that a nurse has can vary depending on the patient’s needs. In the case of infertility, nurses may serve primarily in an emotionally supportive role by providing counselling or psychotherapy, and they may also be involved in physical interventions associated with infertility for diagnostic or treatment purposes (Sherrod, 2004, p. 45). However, the healthcare system’s focus of treating infertility primarily as a medical problem has inadvertently led to a disregard for the patient’s psychological state (Cousineau & Domar, 2007, p. 9). This emotional disregard is one of the greatest frustrations that infertility patients report (Sherrod, 2004, p. 42). Given this, an emphasis should be made on strategies that serve the psychosocial needs of the patient. A thorough assessment should be performed, taking note of important factors such as the patient’s emotional state and coping mechanisms. By assessing the patient’s coping mechanisms, a nurse may be able to identity patients who are at a greater risk for infertility distress and adjustment difficulties (Lykeridou et al., p. 1978). The appropriate interventions can then be taken, such as teaching healthy coping mechanisms, with the goal being to minimize the identified risk factors. Infertility treatment is also a time of great change for the patient, which can be overwhelming, especially for people who don’t have the necessary support systems in place. To mitigate the stress that a patient faces during this transition, extensive health teaching should be done. For example, the nurse could provide education on treatments, or on healthy eating, or even recommendations on programs that can promote their well-being such as support groups. Furthermore, adherence to official guidelines and frameworks should be followed by nurses to enhance care. Watson’s theory of caring for example, when implemented in a fertility clinic setting, decreased levels of patient anxiety, distress, and promoted positive coping mechanisms among infertile women (Ozan & Okumus, 2017, p. 95).
Infertility is a condition that can have extensive consequences on individuals including societal repercussions and personal suffering (Cousineau & Domar, 2007, p. 9). Treatment for this condition can be time-consuming, psychologically distressing, and prolonged indefinitely. On top of this, many of the costs for treatment are not covered by insurance or provincial health plans, which can create financial burden and further distress (Sherrod, 2004, p. 43). Because of this, income and social status are discussed as a major determinant of health for this population. Furthermore, the medicalization of infertility has inadvertently led to a disregard for the emotional health of individuals within this population, and patients viewed this emotional disregard as the most frustrating facet of their health care experience (Sherrod, 2004, p. 42). Thus, for health care providers in this field, the ability to empathize and communicate accordingly is integral. Nurses seeking to promote the health of this population should utilize strategies which facilitate the psychosocial well-being of patients, such as health teaching on positive coping mechanisms, proper treatment protocol, healthy eating, and even recommendations on programs such as support groups.
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- Ozan, Y. D., & Okumuş, H. (2017). Effects of nursing care based on Watson’s theory of human caring on anxiety, distress, and coping, when infertility treatment fails: A randomized controlled trial. Journal of caring sciences, 6(2), 95.
- Patel, A., Sharma, P. S. V. N., Narayan, P., Binu, V. S., Dinesh, N., & Pai, P. J. (2016). Prevalence and predictors of infertility-specific stress in women diagnosed with primary infertility: A clinic-based study. Journal of human reproductive sciences, 9(1), 28.
- Sherrod, R. A. (2004). Understanding the emotional aspects of infertility: implications for nursing practice. Journal of psychosocial nursing and mental health services, 42(3), 41-47.