How to help patients help themselves

Becoming a parent is a key personal life goal and people tend to assume that unprotected sexual intercourse will automatically lead to pregnancy as soon as they decide to conceive. For the 9% or so of couples that are infertile, however, such an assumption is challenged with monthly disappointment and the realisation that their futures will necessarily include treatment to help them conceive and/or the eventual acceptance that they will never become the parent of a child that is biologically their own. More than half of couples do seek treatment, but although treatment may enable couples to become parents this is not guaranteed and treatment itself is associated with physical, psychological, and social demands that can have a negative impact on quality of life and mental health. The balance between the demands of life-experiences and the resources people have available to deal with those demands is a key principle of the Transactional Theory of Stress and Coping (Lazarus & Folkman, 1984). According to this approach, psychological stress is experienced when the demands of the situation exceed resources. In terms of demands, infertility and fertility treatment certainly heap a significant number of these onto the shoulders of infertile couples! There are cognitive demands such as decisions about treatment, the financial and physical demands of treatment itself, uncertainty about treatment success, worries about pregnancy, and distress from treatment failure, to name but a few. As it may not be possible, however, to alter specific treatment protocols to lessen demands and it is certainly not possible to guarantee treatment success, lessening the demands of treatment is not within the control of medical professionals. Bolstering the resources that patients have available to help them deal with those demands is therefore an appropriate way to try and redress the demands-resources balance and bolster patients’ psychological wellbeing. The ESHRE Guideline “Routine psychosocial care in infertility and medically assisted reproduction – A guide for fertility staff on the implementation of psychosocial care by healthcare professionals in infertility and medically assisted reproduction” differentiates specialised infertility counselling and psychotherapy for the minority of patients with clinically significant emotional problems or special needs, from ‘routine’ psychosocial care. This presentation speaks to the latter form of psychosocial support and provides information about theoretically driven self-help interventions that could provide the basis of a ‘self-help tool kit’ that medical professionals can guide patients towards as part of routine psychosocial care. Effective coping is our first line of defence against stressful life experiences, and the self-help interventions presented can be broadly described as ‘coping interventions’ because they encourage individuals to employ coping strategies (e.g., positive reappraisal coping, distraction, relaxation, social support seeking) that have been shown to be appropriate and helpful during stressful life-experiences including fertility treatment. Such self-help interventions are a valuable adjunct to the high quality psychosocial support offered by medical professionals in face to face clinic sessions because patients can access these interventions in their own time to meet their ongoing needs when they are not in clinic. Bolstering coping resources in this way will help patients to negotiate their way through the various psychological demands of infertility and fertility treatment.