Infertile, Inadequate, and Isolated: Understanding the Complexities Surrounding Infertility

Background: Infertility, or failure to achieve a pregnancy, can be a devastating diagnosis associated with numerous psychiatric impacts. According to the World Health Organization, data suggests that globally between 48 million couples and 186 million individuals experience infertility(1). Consultation-liaison (C-L) psychiatrists are familiar with the effects of psychotropic medications on sexual function and fertility, but less is known about the psychiatric effects of infertility treatment, which include but are not limited to mood fluctuations, impulse control disorders, and psychosis. Fertility concerns affect individuals throughout the lifespan, e.g., related to congenital anomalies rendering individuals infertile from birth, medical conditions or treatments that compromise fertility before an individual is ready to parent, and diminishing fertility with advanced parental age. Furthermore, infertility exists within a complicated framework consisting of societal customs, cultural nuances, gender inequities, and disparities in healthcare access. Fertility issues can often be overlooked in marginalized populations, and differences in access to advanced reproductive technologies (ART) highlight inequities. This presentation is intended to provide C-L psychiatrists with the available background and tools to assess psychiatric conditions in individuals facing infertility, although we will show that ultimately this is an understudied area of medicine and more evidence is needed.

Approach: In this workshop, we will address topics related to the overlap between infertility and psychiatry as outlined below. P<span style="background-color: white;">olling questions will gauge participants’ knowledge and opinions regarding the subjects presented. We will include ample opportunity for audience contributions and time at the end for a rich question-and-answer session.

Format:
- 15min: Dr. Punko will offer a brief introduction and review medical and psychiatric conditions often encountered by C-L psychiatrists that can affect fertility
- 15min: Drs. Zamiri and Cassady will comment on fertility medications that cause psychiatric symptoms and the psychiatric impacts of ART
- 10min: Dr. Cassady will discuss the relationship between trauma and infertility. She will also review infertility through a psychodynamic lens and discuss the psychological effects of the experience of infertility including grief and loss
- 15min: Dr. Mokonogho will provide background regarding the current guidelines and best practices around psychiatric evaluation of individuals undergoing infertility treatment
- 20min: Dr. Shah will review disparities in access to care for certain populations, differences in male infertility vs. female infertility, accessibility of ART, and studies including LGBTQ+ populations. She will consider social, cultural, and economic factors in infertility and the psychological burden which studies demonstrate is cost-independent. Lastly, she will present treatment options to reduce distress surrounding infertility
- 15min: Audience contributions, brainstorming opportunities, discussion

Conclusions: Infertility is a highly relevant, though often under-discussed condition seen by the C-L psychiatrist. Through this presentation, participants will gain an understanding of psychiatric impacts of infertility, both in terms of overlap of medical comorbidities and impacts of ART, in addition to the psychological implications of infertility. Participants will leave with an understanding of current guidelines in psychiatric treatment in this population and an appreciation of the clinical gaps and disparities in current practice.

Reference:

World Health Organization, retrieved April 2, 2023, from https://www.who.int/health-topics/infertility#tab=tab_1