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Life beyond infertility: how to reconstruct their lives

sensitize to understand & deal with biologically childless couple
role of treating clinicians

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Life beyond infertility: how to reconstruct their lives

  1. 1. Life beyond infertility: Reconstructing their lives BAIDYA JL DEPARTMENT OF OBSTETRICS & GYNAECOLOGY AGMC, AGARTALA, TRIPURA
  2. 2. Aim of this talk SENSITIZE TO UNDERSTAND & DEAL THE BIOLOGICALLY CHILDLESS COUPLE
  3. 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. 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. 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. 6. 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
  7. 7. Factors influencing psychological stress 1. “Having Children is a Major Focus of Life” 2. “The Female Role and Social Pressure” 3. “Effect on Sexual Life”
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. How do they accept the life !?
  16. 16. Coping strategies KUBLER ROSS CURVE
  17. 17. 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”
  18. 18. 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
  19. 19. Unhealthy coping strategies  Social isolation  Abuse of alcoholic beverage  Engaging sex with multiple partners
  20. 20. Through counselling BEST TIME TO INTERVENE DURING TRANSITION PERIOD Reconstruction of their lives
  21. 21. Interventions  Lot can be done !  Early referral must  Mental health professional able to asses & intervene better
  22. 22. 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
  23. 23. 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
  24. 24. Quality of Health One must not forget
  25. 25. 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
  26. 26. 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
  27. 27. 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
  28. 28. Quality of Health  Clomiphene usage and risk of ovarian, breast, and endometrial cancers. SOURCE: Louise Brinton, National Cancer Institute, personal communication, 2006.
  29. 29. 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
  30. 30. Quality of Health: Risk of NON Gynaecological cancer  Exogenous hormones administered for infertility treatment might be linked with Thyroid cancer & Melanoma  NO STRONG EVIDENCE
  31. 31. On lighter note !!
  32. 32. Thanks for giving me an opportunity to be here !!!

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  • HridayDas4

    Jun. 1, 2021

sensitize to understand & deal with biologically childless couple role of treating clinicians

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