A review of psychological and social aspects of in vitro fertilisation

Involuntary infertility is regarded as a cause of much distress and marital un-happiness. Couples arrive at the IVF Clinic after many years of investigations and operations and often a long waiting list. The IVF procedure itself is highly stressful and involves medicalisation of the most intimate aspects of the couple's relationship. Inability to achieve pregnancy after so much emotional, physical and financial expense may lead to feelings of failure in one or both members of the couple. Furthermore, since IVF is regarded as the last chance for treatment, when pregnancy does not occur the couple are often forced for the first time to confront their sterility as a pair. This may trigger a crisis, which if successfully resolved can lead to adaptation. Thus the clinician involved with IVF needs to be aware of psychological and social aspects of the aetiology, maintenance, sequelae and adaptation to infertility. Psychiatrists, psychologists and social workers have to be integral members of the IVF team. By utilising a psychosomatic approach, the gynaecologist should be able to assist couples to have a more comfortable passage through the IVF programme and promote a sucessful adaptation to the outcome. Principles of care include involving the couple from the outset with conjoint interviews, developing a management plan to suit each couple, the same doctor to remain involved with each couple throughout therapy, and referral of patients considered at risk psychiatrically to the IVF psychosocial team. These would include patients with psychosomatic symptoms or current psychiatric disorder, past psychiatric treatment, where there is concern about motivation, stability of the marriage and capacity of parenthood, and those with unrealistic expectations of treatment. Finally, the effects of psychosocial factors on the treating physician and IVF team should also be considered.