2. Aim of this talk
SENSITIZE TO UNDERSTAND & DEAL THE
BIOLOGICALLY CHILDLESS COUPLE
3. Objectives of the talk
Introduction : Magnitude of the problem
Consequences of Childlessness
Quality of life
Cope up with situation
Other health issues
What we can do to reconstruct their lives
4. World wide more than 70 millions people suffer from
infertility
Majority being residents of developing countries
Lack of well established data in India
Developing countries experience negative
consequences of childlessness to greater degree
Introduction
5. Introduction
Infertility problems are treated as ancillary problem in
overpopulated country like India
Childlessness is not a life threatening condition
Programme planners & policy makers have little or no
attention in reproductive health services
Treating clinicians & society solely confront this problems
6.
7.
8. Emotional consequences of an
infertility can be
devastating……………………………………
………………..very few life problems
more emotionally painful and
challenging than infertility
Ms Pamela F. Pressman
Director of the infertility counselling
program
10. Quality of life
The crisis of childlessness is devastating & painful as it trend to
be chronic
Crisis usually precipitated by loss or the anticipation of loss
Women receive major blames
Women finds difficulties in confronting the crisis
11. Quality Of Life: Common emotional responses
Depression (15 – 54%)
Stress, Guilt, shame
Anger, Loss of control ( 8 -28%)
Relationship problems
Personal identity change, Isolation
Loss of sexual fulfilment
Irrational pursuit of treatment, financial loss
Men & women may
experience & response
differently
12. What are those differences?
Different perceptions
• Parenthood
• Cause
• Emotional
response
• Role
• Workplace
• Expression
Men
• Ambiguous
• HE is not
• Strong guilt,
reluctant
• Optimist
• Distraction
• Anger
Women
• Primary goal
• Takes responsibility
• Searched endlessly
• Pessimistic
• Less productive
• Depresses
13. QOL : impact on couples relationship
Depression most commonly expressed condition
Lifelong goal unmet- lead to fear, anger
First life crisis for the couple – poorly prepared to cope
Different roles in the cause – misunderstood & uncared for
Above all factors – difficulties in communication with each other
14. QOL: within the family
Unhappiness has direct effect on sexual life
Childlessness is a curse of GOD – fertile ground for divorce or separation
Men usually resorted with addiction – alcohol, drugs, tobacco, country
spirit
Physical & mental tortures in extended family settings
15. QOL: stigma in the community
Children are indicators of family’s wealth & prosperity – childless
parents loose leadership role in different forum of community
Reported to engage in sex with multiple partners (both sex)
Some childless men are compelled to acquire second wife
16. QOL: stigma in the community
Stigma even continues after the death
Infertility also presents stressors in the financial
domain – on insurance coverage?
“Its always the woman’s fault” – highly stigmatised in
community
19. Coping strategies
“Sometimes it is really difficult to imagine life
without children, but you have to find a way of
coping to prevent doing something stupid; this you
do by redirecting your energy towards other
ventures”
20. Healthy coping strategies
So methods of coping :
Strengthening of inner strength,
Self-confidence,
True acceptance their fate,
Trying to carry on by focusing on the future
23. Interventions
Lot can be done !
Early referral must
Mental health professional able to asses &
intervene better
24. Primary aims of psychological
intervention
Enable to “Cope up”
Decision making in
alternate parenting options
Avoid potential conflicts –
partnership
Rediscover & revitalize life
“beyond desire for a Child”
Improve communications
between partner &
physicians
Improve acceptance if
medical treatment fails
Give support in finding
alternative perspectives
25. Reconstruction of their lives:
implications for counselling
Adaptation to unintentional biological childlessness is slow &
painful process
Need of emotional & psychological support in early stage of
transition
Need for support for those waiting for adoption & other
parenting options
Explore & new goals in life those who deny parenting
28. Health risks
Raised concerns
Related to causes that responsible for infertility
E.g. PCOD, Genital TB, Endometriosis
Related to infertility treatment
E.g. Clomiphene Citrate, Gonadotropin, GnRH
29. Health risks
Complications related to Causes:
Metabolic X syndrome
Diabetes mellitus
Premalignant & malignant diseases of endometrium
Osteoporosis
Chronic pelvic Pain
de novo malignancy of endometrioma of ovary
30. Quality of Health: Risk of cancer
There are three types of cancer that would seem to have a
plausible biological link to the hormone regimens used in
ovarian stimulation : Breast, Ovarian, and Endometrial
cancers.
Dr. Roberta Ness,
Chair of the Department of Epidemiology
The University of Pittsburgh
31. Quality of
Health
Clomiphene usage
and risk of ovarian,
breast, and
endometrial
cancers.
SOURCE: Louise Brinton, National
Cancer Institute, personal
communication, 2006.
32. Quality of Health: risk of cancer
There's no evidence that fertility drugs elevate the risk of
breast cancer.
Infertility, not the assisted reproduction therapy, certainly
increases the risk of ovarian cancer.
But for uterine cancer, where the data are too sparse to
lead to any conclusion
33. Quality of Health: Risk of NON
Gynaecological cancer
Exogenous hormones administered for infertility
treatment might be linked with Thyroid cancer &
Melanoma
NO STRONG EVIDENCE
