Infertility and the Intentional Therapist

Scene from an infertility counselor’s office

Therapist:  I understand from our phone conversation that you are having some stress as you go through infertility treatments. What’s going on?

Client:  Well, we started with two IUIs, both unsuccessful, and now two cycles of IVF. With the second one I had a miscarriage at eight weeks—no explanation of why. The doctor is now suggesting we have ICSI because the tests showed my husband’s sperm has low motility. At first they thought I had PCOS, but now they are aren’t sure about that diagnosis. I’ve been on clomifene, gonadotrophins, and bromocriptine, all of which have made me feel moody and out of control.  I’m just not sure I can take any more of this. (Tears flow.) I think I might want to stop treatment and pursue adoption, but my husband doesn’t want to adopt. I just don’t know. . . .

Jargon, drugs, and despair

Reading this exchange, you may be lost in a forest of jargon, drugs, and despair. If you are not a trained infertility counselor, you may not know what is going or where to start. How do you help amidst such an overwhelming situation?

The niche of infertility counseling

Infertility is a complex medical condition with many causes and many repercussions. A recent study revealed that a diagnosis of infertility can be just as stressful as a diagnosis of cancer, or even more so. Because the science of infertility is not perfect, some couples are diagnosed with unexplained infertility, which leaves both patients and doctors at a loss of what to do to treat the condition.

So how do we use counseling and psychotherapy to help?

We become intentional infertility counselors, therapists who know enough about the complexities of infertility to be able to help—conscientiously and thoroughly.

Infertility counseling is a rewarding niche—you get to work with individuals and couples who are generally high functioning, are motivated, and are in dire need of help. You get to use a wide range of skills and to challenge yourself to learn information that at first may be out of your comfort zone.

Guidelines for infertility counseling

To be an effective infertility counselor, specific knowledge is key. The American Society for Reproductive Medicine’s (ASRM) guidelines for infertility counselors are stringent. They include training in and knowledge of the psychology of infertility, as well as the medical and legal aspects of infertility.

Here is a sampling of what infertility counselors are expected to know:

• Basic reproductive physiology and the etiology of male and female infertility.
• How infertility can affect the marriage, including sexual functioning, and extended family.
• Ways to approach helping infertility patients with bereavement/loss, crises, post-traumatic stress, and coping, and an understanding of typical/atypical responses to infertility.
• Family-building alternatives including adoption, surrogacy and donor options, and choosing life without children.
• Approaches to treatment that are sensitive to diversity and culture-specific beliefs and situations.
• Legal, ethical, and religious issues associated with infertility treatments.
• Psychosocial effects of infertility and assisted reproductive technologies on intended parents and others who are involved (i.e., donors, gestational carriers, families, social networks).
• Issues of children conceived via assisted reproduction, including issues related to disclosure of conception to offspring.
• The impact of psychotropic medications.
• Testing, diagnosis, and treatment of reproductive problems, including assisted reproductive technologies and genetics.

Infertility counseling training

So all of this sounds interesting to you? Then how do you get the necessary training? There are a few ways:

• Join ASRM’s mental health professional group.
• Read “An introduction to infertility counseling: a guide for mental health and medical professionals”
• Attend a training or conference. For example, Thomas Jefferson University in Philadelphia  3-day course for infertility counselors annually.
• Join a study group or training program. For example, Sharon Covington, head of psychological services at Shady Grove Fertility in Maryland, offers both in the D.C. area.
• Read Infertility Counseling: A Comprehensive Handbook for Clinicians, 2nd edition, edited by Sharon Covington and Linda Hammer Burns, available at major book stores.
• Join Resolve, the National Infertility Association, and take advantage of the information they provide.

On being an intentional infertility counselor

The word intentional captures one of the most important characteristics of any good therapist. To me, being an intentional therapist means working only with clients for whom you have the training and experience to serve expertly—or being supervised by an expert while you get that training.

When therapists work with clients who have medical conditions, being intentional has to include being or becoming knowledgeable about those conditions, their treatments, their etiology, and their effects on emotions and the nervous system.

Because infertility is such a complex medical condition, it takes a while to understand what patients are going through, to listen to the medical jargon and get the gist of it, and to be aware of all the complex variables in each unique situation.

But it is definitely worth the effort. You get to walk along side of couples as they try to build a family, supporting them, helping them cope, grieve or rejoice, helping them find solace and understanding, no matter what the outcomes of their treatment.  I believe that it encompasses just about everything that an intentional therapist needs to find joy and meaning in work.

Susan B. Saint-Rossy  is a  PACT (Psychobiological Approach to Couple Therapy) Level 2 Clinician and is also trained in EFT (Emotionally Focused Couples Therapy) and the Gottman Approach to Couples Therapy. She is a clinical social worker licensed in Virginia and Washington, DC.