Having access to psychological support during fertility treatment can be very helpful for many patients. With this in mind we set up the specialist Unit of Psychology in Assisted Reproduction in 2021 which is led by Psychologist, Raquel Urteaga García, who supports national and international patients during their time with Tambre.

Raquel is passionate about her profession and says that it is extremely gratifying to see how psychological care and support can help those seeking to expand their families.

Why is a Psychological Care Unit important?

Tambre is a clinic characterized by excellence in individualized care for its patients and is an advocate of comprehensive care. We recognize how infertility can impact on our mental health and that is why it is vital to offer support services to patients as they start and travel through their treatment journey.

What emotional support needs are sought by fertility patients?

During treatment, thoughts, emotions and even behaviors that are new to many people will arise. These may necessitate changes in individual feelings and impact on relationships. In 40 to 60% of patients fertility treatment triggers anxious, depressive or mixed symptoms. The Psychology Unit is there to prevent these symptoms from being triggered and to address those patients that are already experiencing these symptoms.

Who is fertility counseling for? Do all people need it?

Fertility treatments are processes of variable duration, which can generate unique and novel feelings for patients. Some patients can respond to these changes but it can be more challenging for others who might need additional support to ensure their psychological well-being. Our experience shows that not everyone needs that support but for those that do, the benefits are tangible.

“It is necessary to have support and psychological support by specialized personnel within the IVF team” concludes Dr. Boivin one of the world’s leading experts in the field of psychological infertility care (Peterson B, Boivin J, Norré J, et al., 2012).

Depression that causes infertility is said to be similar to that experienced with cancer

This comes from a study that measured the psychological discomfort of female patients with different diseases and the results showed that the psychological symptoms associated with infertility are similar to those associated with other serious medical conditions (cancer, cardiac rehabilitation…) (Domar, Zuttermeister and Friedman, 1993).

In both processes, oncology and infertility, patients suffer similar feelings. In one case it is their own health threatening their life and in the other it is their reproductive health threatening the life of the future child. Both are fundamental existential situations for the human being, hence the similarity.

Are there emotional phases that you go through during treatment?

When a person is given a diagnosis of infertility, they invariably experience a number of different emotions. This could involve feelings of shock/denial, anger, negotiation, depression, and acceptance although not all patients go through them in the same order or in the same way. Emotions will also vary depending on the type of treatment required or if the patient has experienced trauma including miscarriage. The intensity and prevalence of these emotions have led Psychologists to develop the notion of “emotional roller coaster” in relation to the ups and downs experienced by patients going through assisted reproduction treatments.

What advice would you give to those who have experienced several failed treatments?

We know that multiple treatments equates to a lot of emotional wear. It is necessary to adopt realistic expectations but also continue to hold the dream of parenthood. I recognize that this is sometimes difficult but this is an example of where we can help.

To ensure our work has a professional footing we work closely with the European Society of Human Reproduction and Embryology (ESHRE) and the Spanish Fertility Society (SEF). Both influence our daily work. For example, in its ‘Good Practice Recommendations on Recurrent Implantation Failure’ (RIF), ESHRE recommends patient care and counselling because women with recurrent implantation failure have significantly higher levels of stress compared to more fertile women. In addition they are more likely to admit to feelings of social isolation and sensitivity to comments (ESHRE Working Group on Recurrent Implantation Failure, 2023).

From my experience, the dream of wanting a child is so great that patients will do anything in their power to achieve it, and although many do succeed, the road is not always easy.

What are the main psychological challenges facing couples struggling with fertility problems?

A diagnosis of infertility can equate to a long and costly journey at an emotional, psychological and economic level according to scientific studies of reproductive psychology, (Domínguez, 2010 and Crawford, Hoff, Mersereau, 2017). It is estimated that some 40% of all patients will suffer from depression or anxiety. From my experience in the Psychology Unit, if I had to sum up the biggest challenge everyone agrees on is uncertainty. Until we reach the positive we must take small steps that take us closer to our goal however we must always remember that at each step we could experience negative or positive feelings. I like to say that it is a trip full of stops and as our journey continues each stop is a reflection of our personality, expectations and previous experiences.

Inexperience is another factor that can generate discomfort and anxiety, because at the beginning of their fertility journey patients are exposed to feelings and experiences that are new to them. Many believe that these feelings are unique to them. However, let us not forget that one in six couples suffers from infertility, according to WHO data in 2023. Patients therefore need reassurance that they are not along in their fertility struggle.

How does stress and anxiety affect the chance of successful fertility treatment?

Many patients think that if they are stressed they will not get pregnant. There is no scientific evidence that stress prevents pregnancy in assisted reproduction treatment. What we do know is that sustained stress and anxiety can lead to alterations in the immune or hormonal system. We know however, as the Spanish Fertility Society (SEF) confirms, stress or anxiety directly can indirectly affect the process. For instance, patients could abandon treatment due to high stress or anxiety levels and consequently deny the opportunity of pregnancy via assisted reproduction.

Is the moment of fertilization the time which offers the greatest test for the patient in terms of anxiety?

There is a stress peak at the time of oocyte extraction, although the transfer and  waiting for results, the so-called beta-wait are periods when anxiety levels are raised.

What role does emotional and psychological support play during fertility treatment?

I believe that historically the role that psychology plays in fertility treatment has been overlooked somewhat. But today however, thanks to the elimination of taboos on mental health and the increased scientific knowledge in neuroscience and psychology, we recognize the important role psychology plays in comprehensive patient care.

Patients who come to the Unit share their experiences and report that the emotional shock of negative news is lessened when they have worked with us. So too, they state that are better able to cope with situations after our intervention.

In addition, the Unit not only deals with present symptoms, but also various interventions are made to prevent the road from being excessively hard. For this purpose we use psychoeducation at the beginning or during treatment to address present and potential issues as well as to manage expectations.

What are the warning signs that a woman or a couple might need psychological help during their search for the baby?

People benefit from specialized psychological care when they travel through this assisted reproduction journey as they are exposed to situations that generally exceed the demands to which they are accustomed in their daily lives.

• Some of the most frequent ones which indicate that support would help are:
• Loss of interest in normal activities.
• Consistent Low mood.
• High levels of anxiety.
• Interpersonal difficulties with partner, family, friends etc.
• Difficulties in concentration.
• Inability to think about things other than infertility.
• Alterations in sleep patterns.
• Alterations in diet (excess or default).
• Increased consumption of toxics.
• Feelings of anger.
• Persistent social isolation.

The recommendation is that if this discomfort interferes in your life intensely for more than two weeks and almost daily you should go to the Unit for assessment and together we can seek tools to reverse any negative feelings or emotions as soon as possible.