Unfortunately, the tragedy of not having children affects many couples today. What experience lies behind this deep wound? We talk about it with a psychologist who knows closely many stories of couples who want a child and, unable to conceive spontaneously, approach medically assisted procreation (PMA). The perspective here is not that of a moral theologian or a bioethicist, which is also necessary, but of listening to the profound suffering and hardships that infertile couples experience. Why talk about it? Christian family approaches the topic of homologous Pma (with gametes internal to the pair) starting from a fact that cannot be ignored: in Italy in 15 years the number of children born through in vitro fertilization with the couple’s gametes has increased fivefold. In the issue of the magazine on newsstands this week, readers will find an investigation that delves into the medical aspects and the demographic, ethical and theological implications of homologous reproductive techniques, while below we delve into the possible psychological implications with Stefano Clericiclinical psychologist IRCCS San Raffaele Hospital in Milan.
Doctor Clerici, what emotions accompany those approaching the equivalent PMA?
« Emotions vary depending on experiences and expectations. From disappointment to the fear of “not being up to par”, the issues that couples find themselves facing are multiple and also conditioned by the reproductive technique adopted. In general I would say disappointment: a form of mourning for not being able to do something that would seem natural, that is, father a child. On a social level there is no awareness of the drama experienced by those who would like children but are unable to have them. Questions like “And you, children, nothing?!”, make you suffer deeply.”
Is knowing you have infertility a shock?
«Yes, the first communication can be a dramatic experience. The most surprised of all are men: male infertility is asymptomatic, without warnings as – in some cases – irregular cycles or specific pain for women can be.”
How do couples feel when they are unable to procreate?
“Sun. The comparison with those who have already had children is very important. We ask ourselves “why others do and we don’t?”. Friendships also often become thinner: peers, in fact, are caught up in the little ones and it is not easy to talk about one’s experiences. Even with families of origin it’s not easy: sometimes parents don’t understand why they go to the doctors to have a baby and then ask for updates after each visit. As a result, couples stop talking about it.”
What are the hardships of the homologous Pma?
«I would say that there are physical and emotional hardships. For example, ovarian stimulation for women is extremely stressful and requires frequent monitoring, for which the woman must appear every other day in specialized centers and is not always comfortable asking for time off to work. Regardless of what anyone says, in Italy it is still not easy to say that you are trying to have a child.”
And on the male side?
«There is no shortage of hardship for men too, especially if the cause of infertility is male. The worst situation, however, is idiopathic infertility, i.e. “without cause”, which leaves one left in uncertainty with an unexpressed question: “So we don’t deserve a child?”. Another desperate experience is when one has had a voluntary abortion at a young age: in these cases the failure to conceive can appear to be a punishment of retaliation.”
Do your moods change during the process?
«When the diagnosis is formulated and treatment is proposed, one exposes oneself to further possible disappointment, since one attempt is often not enough. Couples report a “bottleneck” experience: each exam brings with it further in-depth analysis and the path seems increasingly uphill.”
How much does the time factor affect you psychologically?
“Very. It is a source of concern because we would like to “hurry up”. While the World Health Organization advocates progressively invasive treatments, couples would like to resort to the quickest “solution”, this is because when it comes to treatments, up to three years may have passed since the couple felt the desire for a child. And, in the meantime, this desire has already had wounds and disappointments.”
Psychological counseling is offered, by law, by all PMA centres. How useful is this type of support?
«Psychotherapy works when the couple believes it can be a useful tool. All the couples I have followed have achieved success, sooner or later: this makes me say that being able to talk to a therapist gives greater serenity. Many complain of an increase in quarrelsomeness and the decrease or interruption of sexual relations which, although targeted, can disappoint the expectation of conception and renew the wound of “not knowing how to generate”. If you don’t talk about it you risk exploding, so it’s always better to discuss it. When I meet couples the spokesperson for emotion is almost always the woman, while among men there is greater reluctance to express pain, even just for the idea of having to support their partner.”
The average age of women who undergo fresh gamete techniques from the couple is 36.7 years. How important is the time factor, psychologically?
«Very much, especially when an attempt is not successful and the temptation is to continue without stopping, one treatment after another. After every unsuccessful attempt, I instead tell couples to stop and think, not to focus only on the pregnancy goal. We need to take time for ourselves, to reflect and share how much energy we have available and then decide how and whether to continue. Unfortunately, difficulties can also arise during pregnancy, leading to the loss of the baby. In these cases the mourning is very complicated, amplified by the time of desire. Pregnancies lasting a few weeks can have years and years of waiting behind them in which the much desired child grows to an ideal level. Added to this is the effort of having to get back on track for visits and checks, as in a Dante’s circle.”
Captain second thoughts?
«Yes, some couples consider adoption as an additional possibility. Although even in that case it is not a certain and immediate path.”
And when, finally, a child is born?
«The joy is great! There may be an aspect of removing the path taken, just leaving pain and hardships behind. Couples tend to keep the details of procreation to themselves, for fear that the children will be considered “different”.
What kind of parents are the fathers and mothers of children born from PMA?
«Studies speak of overprotective parents: the much desired children are precious, as well as more delicate. Sometimes parenthood can also be more anxious, also because it comes at a more mature age. Even on these aspects, it is always better to consult with specialists.”
