Not every couple conceives with ease. Clinical psychologist and play therapist Dr Jó-Marié Bothma gives advice on how to cope with some of the emotional struggles couples might face during infertility treatment.

For most couples, falling pregnant will be fairly easy and will happen within one year of actively trying to conceive. For some, however, it will unfortunately be a struggle.

Fertility rates have declined worldwide and the World Health Organisation officially recognised infertility as a disease in 2009, stating that women’s infertility was ranked the fifth highest serious global disability among populations under the age of 60. Statistics, therefore, show that if you are not the one struggling to fall pregnant, the chances are reasonably good that you know of someone who is.

Up and down the ‘worry hill’
Infertility and the treatments that follow can often place tremendous stress on a couple’s relationship as well as on their relationships with family and friends. Most of these couples will confirm that through the months or (often) years of waiting and longing, their hearts were nearly crushed under the weight of the anguish to become parents.

Emotionally and spiritually, a rollercoaster of hope and despair is coupled with an often difficult leap of faith. It is an experience that continually fluctuates in intensity, so that at different times couples may have different needs and experience different emotions.

Working as a team
The biggest decision an infertile couple will have to make is whether they really want to have children. Fertility treatment requires an enormous emotional and financial commitment and can have a permanent impact on a couple, irrespective of whether the treatment outcome is successful or not.

If the relationship is not rock-solid and both are not on the same page, navigating through the many stressful phases of fertility programmes is going to make the wheels come off completely.

By the time they decide to go for in-vitro fertilisation (IVF), many other interventions have probably failed to yield a positive pregnancy test. Timed intercourse, medicated cycles, artificial insemination methods, laparoscopic surgeries and the heartache of early losses have often already taken their emotional and financial toll on a couple by then. As a result, most couples embark on IVF with their emotional tanks far from full, and with some stress-baggage. It is therefore a priority to invest into filling your own, as well as your partner’s emotional tanks before, during, and even after IVF.

In contrast, some couples can feel very excited and exhilarated, as IVF does offer newly found hope for many. IVF‑related stress cannot completely be avoided, but it can be moderated if a couple commits to offering unconditional support towards each other.

It is also imperative to mobilise other support systems such as family and friends to encourage you along the way. Some couples do, however, prefer to be more private about their fertility status and treatments, and if that feels more helpful to them, it should be allowed.

Dealing with emotions during IVF
There are different phases during an IVF protocol and these are a few suggestions of how couples can help each other cope emotionally during each phase.

In the beginning…
During the initial phase of IVF, basic tests or even invasive procedures are done so that a tailor-made IVF protocol can be designed and other possible barriers to conception can be medically treated.
Talk to the staff at the fertility clinic, as it helps to normalise and demystify the experience as much as possible. The services of an in-house therapist at the clinic can be particularly beneficial.

It may also be helpful to join a support group with other couples undergoing IVF or to join an online forum. More often than not, such support structures keep a couple’s sense of humour intact as well as keeps them motivated and optimistic.

It is also of great help if both partners can start the process by drawing up a budget and helping each other to stick to it. Most medical aids do not pay for the expenses of IVF and helping each other not to accumulate unnecessary debt will at least take away extra stress in the form of financial concerns. If you realise that you do not have the money for IVF at that stage, it is a great idea to work out a savings plan. Many couples have had surprise natural conceptions while they were saving up for IVF.

And then come

the ‘jabs’ …
This phase usually kicks off with the specialist firstly checking the ovaries and uterus via an ultrasound to make sure that everything is ready to go for the stimulation protocol. Even though the man’s contribution towards the process is not yet needed, it is really wonderful if he can be at the first visit and learn how to offer his partner the injectable medication. More and more women expect their husbands to give them the injections. This really sets the stage for creating that feeling that both are eagerly committed to the process.

Take photos and start a journal that you can give to your child one day. It is, after all, the very first step in creating another human being and should be celebrated.
Injectable stimulatory medication consists of hormones in an attempt to make the ovaries grow more follicles. There is no need to explain what extra hormones can do to a woman’s emotions, her mind and even her body. It helps if her partner can keep this in mind during that time and exercise a level of patience.

More peeks to see what is happening inside…
A visit to the specialist will take place at least once during the injectable phase to ascertain whether follicle growth is on track. Arrange for a celebratory activity, such as a romantic dinner when the scans show great developmental progress.

Alternatively, arrange for a nurturing activity, such as a couple’s massage if the growth is not what was anticipated. There are opinions that holistic treatments such as fertility massages, acupuncture and reflexology could improve IVF outcomes. Discuss this with your specialist and book some if recommended. These appointments will help you both to feel more focused and relaxed.

Harvesting some eggs and donating the swimmers
The other physical demands of IVF, ranging from the discomfort of egg retrieval for the woman and the need for the man to produce a semen sample on demand, all add to the emotional stress associated with this part of the process. Couples can support one another by both arranging some extra time off work. Spend that time offering one another a venting space to talk about the procedures and the emotions arising from them.

The time between fertilisation and embryo transfer
Depending on the protocol that is followed this can be anything from three to five days. During this time embryologists usually keep in daily contact with the couple to let them know how fertilisation and embryo cell division is taking place.

This is a particularly challenging stage, especially if things do not turn out the way you’d hoped. Be prepared to experience highs and lows during those days and try to stay as busy as possible by going out on date nights or cooking dinner together.

Sometimes the specific protocol only allows for a frozen embryo transfer several weeks later due to either complications or when a resting period is needed for the ovaries. Although such a protocol is delaying the IVF cycle, it does offer some breathing space for a couple and they can carry on with normal life until arrangements are made for the transfer.

Transferring the precious cargo…
Be together during the transfer of the embryos and even though everything up to this point will have been tense and exhausting, this should be a day to be positive and optimistic for each other. Try to take the day off and follow specialist instructions, which are often just to be relaxed and not to do anything strenuous.

The two week wait…
It’s important to keep your mind busy during this time. Watch movies and create opportunities to talk about the fears and excitements of the IVF outcome soon to be revealed.Couples must realise that there is no guarantee of a successful outcome and they should continue to also focus on other aspects of their relationship. IVF has many highs and lows and it is important for both partners to keep their chins up through the whole process and keep in perspective that sometimes a failed cycle gives many answers that can be helpful during a subsequent attempt.

In the end both partners will need to remind each other that there is little they can do to influence the outcome of IVF and that they do have each other, and that relationship remains important to nurture.

Although the psychological challenges of infertility can be overwhelming, most couples ultimately reach some type of resolution and most couples going for fertility treatments experience success at some point. The key is to help each other stay positive and make each other feel loved and accepted.

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