The Other Side of Infertility

By the time most people have reached a point of asking for reproductive assistance, they've learned that the infertility experience is far more than a physical challenge. Trying to conceive without success places an emotional strain on partnerships and on each individual's sense of well- being.

For this reason, fertility experts have long recognized the importance of offering psychological services to their patients. In some practices and for some patients' situations, involvement with a counselor may be mandatory. Virtually all practitioners who follow the guidelines of the American Society for Reproductive Medicine (ASRM) can provide their patients with a list of mental health providers who are experienced with helping people experiencing infertility. Some clinics have established direct relationships with counselors, who may be clinical social workers (CSW), licensed marriage and family therapists (LMFT), licensed professional counselors (LPC), or licensed psychologists who have a doctor of philosophy (PhD).

One such connection is that between Houston IVF and Alison J. Wilson, PhD.

Working as an independent consultant with Dr. Timothy Hickman and his staff, Dr. Wilson offers her experience in assisting women and couples with issues surrounding infertility, pregnancy loss, and postpartum adjustment. She maintains both a private practice office and an office within the Houston IVF facility.

Initially, most of Dr. Wilson's time was spent with egg donors and recipient couples. The ASRM requires that all individuals who wish to be egg donors participate in psychological screening. The consultation consists of an hour-long interview and a computerized version of an instrument called the Minnesota Multiphasic Personality Inventory, 2nd Edition (MMPI2), a commonly used personality assessment.

Some of the items addressed by Dr. Wilson's interview screening are:

  • Personal and family history of psychiatric treatment
  • Personal and family history of alcoholism or drug abuse
  • Severe emotional instability
  • Individual and familial medical history
  • Learning disorders and/or cognitive impairment
  • Sexual and gynecological history

The MMPI looks at personality characteristics and potentially helps to identify any maladaptive traits. For example, information from an individual's MMPI results can give additional information about symptoms of anxiety or other issues.

Dr. Wilson uses the information gathered to make recommendations to Dr. Hickman and his staff about a potential donor's suitability for the egg donation process.

Similarly, all patients who are interested in using donor gametes (egg or sperm) or a gestational carrier are strongly advised to consult with Dr. Wilson.

When asked to describe the assessment of donor recipients, Dr. Wilson said, "We talk about a number of important considerations, such as their beliefs. It's important to look at the grieving response of both partners. For most people, by the time they're using egg donors, a lot of these patients are feeling like this [IVF treatment] is their 'last shot' at conceiving."

She says most individuals have come to terms with the loss involved in their decision to use donor gametes, and they're ready to move on accordingly. Some, though, may be making a leap toward donor-assisted treatment a little too quickly.

"We explore the couple's relationship in regards to whether they are fully in agreement, or if some level of appeasement is going on," Dr. Wilson elaborates. "We discuss whether and how they'll disclose to their children the specifics of donor-assisted conception."

Because donor-assisted therapy is often the last of many attempts for some couples, Dr. Wilson helps them confront the hard possibility that treatment may not work. Along similar lines, she facilitates talking about options for embryo reduction, pregnancy termination for reasons of congenital defects, and future disposition of any unused embryos. Spiritual or religious beliefs are also an important component of the process.

Since her initial services to Houston IVF's donor program, referrals from the clinic to Dr. Wilson have broadened to include other individuals and couples who are about to start a non-donor IVF cycle, who have experienced a failed cycle, who are considering the next steps in their infertility treatment journey, and those who are seeking stress management assistance for purposes of mastering the mind/body relaxation response.

Much of Dr. Wilson's work is cognitive-behavioral. "We talk about what people are telling themselves," she explains. "In my experience, many of the women I see are already very accomplished in their lives, and it can be very hard for them to restructure their thoughts when they reach this 'wall' of infertility." The difficult work can be as simple as assisting patients with healthy boundary-setting, for example, helping women truly give themselves permission to politely decline invitations to friends' baby showers.

Some of the other benefits that patients may glean from their consultations with psychologists such as Dr. Wilson are:

Coming up with plans of action for communication with friends and loved ones. "For example, let friends know before an uncomfortable situation arises that you'd prefer them to email you with their news of pregnancies before calling on the phone or announcing it in person. That will give you a chance to unwind from what may be the initial shock."

Learning new ways to make yourself feel special, especially when you're undergoing stressful infertility treatment.

Normalizing the grieving process, which can help you feel less isolated. "I try, through my counseling," the psychologist says, "to infuse hope to these patients through the presentation of options." Dr. Wilson notes that men and women usually grieve differently, and it's important for both partners to recognize this fact and communicate openly about those differences.

For couples, rebuilding the intimacy and romance of their relationship, reconnecting with each other.

The number of one-hour sessions that each patient takes advantage of varies -- some may feel satisfied with one session, while most choose to meet once weekly or every other week for longer periods. Dr. Wilson usually encourages "homework assignments," an example of which is journaling to help put your feelings and thoughts in black-and-white on a daily basis.

Houston IVF's Dr. Hickman recognized the convenience for his patients of having an on-site psychologist for their related needs. One of the ways in which Dr. Wilson's presence immediately benefits patients is through the computerized donor assessment process. "I'm able to render a report for Dr. Hickman in a very short period of time," Dr. Wilson explains, "so that there's less wait time for both donors and recipients."

From her several years of working with the infertility patient population, Dr. Alison Wilson believes the most important message to convey is that they're not alone. "Help is available for the issues that come with infertility," she says. "The patients need only ask."

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