Psychological Difficulties and Mental Ill-Health Associated with ART
This chapter deals with the potential for psychological difficulties and mental ill-health during the course of treatment for infertility or sub-fertility, with ART. The importance of screening for a personal and or family history of mental illness prior
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Psychological Difficulties and Mental Ill-Health Associated with ART Neelam Sisodia
Introduction Artificial reproductive techniques (ART) have advanced a great deal over the course of the last 30 years or so and treatment for infertility or sub-fertility has become more easily accessible to “ordinary” couples, both through the national health service (e.g., NHS in the UK) and private fertility clinics world-wide. Alongside the technical advances in assisted reproduction, there has been a burgeoning in literature about the psychological difficulties associated with the inability to conceive a child when a couple wishes to do so, as well as the psychological distress consequent on undergoing any treatment necessary, whether this is successful or not [1–5]. In addition to the impact of stress on the quality of life of any individuals undergoing treatment for reproductive difficulties, there is the very important issue of how to screen for and manage the mental health of patients who have a pre-existing significant mental illness (usually moderate to severe anxiety and mood disorders, but also more serious and enduring conditions such as mood related and schizophrenia-like psychoses) or those who develop such illnesses during the course of treatment with ART or after the delivery of a much wanted and long-awaited child (or children, in the case of twin or triplet pregnancies). The biochemical changes that occur in the pituitary as a result of the “downregulation” and “up-regulation” of the ovulation cycle in women and the subsequent use of large quantities of hormones for stimulating the production of ova in preparation for egg harvesting and IVF are likely to be significant in the aetiology of first onset severe mood disorders and mood related psychoses, as well as the trigger for recurrent episodes in those with pre-existing illnesses of this kind [6]. However, a N. Sisodia, MBBS, MA, FRCPsych Perinatal Psychiatric Service, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham University Hospitals QMC Campus, Nottingham, UK e-mail: [email protected] © Springer International Publishing Switzerland 2017 K. Jayaprakasan, L. Kean (eds.), Clinical Management of Pregnancies following ART, DOI 10.1007/978-3-319-42858-1_3
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N. Sisodia
review and discussion of this topic is beyond the scope of this chapter. Therefore I will briefly discuss the issue of screening for a personal or family history of moderate to severe mood disorders and psychoses, before going on to describe some anthropological and socio-cultural considerations that may help health professionals to understand a couple’s or an individual patient’s response to the stresses of infertility (or sub-fertility) and treatment for this with ART. I will end with a number of clinical scenarios, which demonstrate the way in which patients may present to the treating fertility specialist, whilst they are attempting to conceive, or to a family physician, obstetrician, midwife or psychiatrist, in pregnancy or postpartum.
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