The Psychology of Infertility in Reproductive Medicine and Healthcare, c. 1940s-2000s
Sofia Gameiro and Jacky Boivin
The psychology of infertility refers to the study of cognitive, emotional, behavioural, social, and relational aspects of the experience of infertility. In past decades, published work on psychological aspects of infertility has described psychological phenomena, identified explanatory mechanisms of action, predicted the relationship between psychological determinants and psychological or biological outcomes, and attempted to control psychological experiences via intervention. This chapter reviews the history of psychological approaches to infertility within reproductive medicine and healthcare between the 1940s and the present. It demonstrates that while psychological inquiry initially responded to the needs of reproductive medicine, psychological needs now influence infertility healthcare. The chapter traces the evolution of this reciprocal relationship, using illustrative cases of interchange from the 1940s to the present day.
This approach reveals five major developments. When psychology entered the field of infertility medicine in the 1930s, the diagnostic techniques of the time were limited and a high percentage of infertility cases could not be medically explained. This led the psychogenic model of infertility, which explained infertility as a form of psychosomatic illness, to dominate psychological approaches to the disorder within medicine and reproductive healthcare for several decades. In the 1970s, there was a realization that the inability to have children was in itself a major source of psychological distress, and this led to the focus on the emotional and social consequences of infertility characteristic of the psychological sequelae model of infertility. Then, in the 1980s, the
S. Gameiro ? J. Boivin (*)
© The Author(s) 2017
G. Davis, T. Loughran (eds.), The Palgrave Handbook of Infertility in History, DOI 10.1057/978-1-137-52080-7_21
rapid proliferation of assisted reproductive techniques such as in vitro fertilization (IVF) led to a better integration of psychologists in fertility clinics. Psychologists were now responsible for assessing couples requesting treatment, in order to ensure the welfare of the child, and for delivering implications counselling to support informed decision-making. In the 1990s the medical field embraced a more rigorous approach to interventions in the treatment ofinfertility, calling for empirical evidence of their effectiveness and side effects, including psychological support interventions. Finally, in the new millennium there is now growing awareness that a major problem which infertile people face is preparing for and managing the protracted treatment period. This awareness is leading to an increased emphasis on optimizing all factors contributing to treatment success.
This historical overview is necessarily constrained. First, psychological issues are addressed by many disciplines (psychiatry, psychology, social work, nursing) and each might recognize different critical time points. Where important, we have referred to specific disciplines, but otherwise use generic terms such as ‘researchers’ or ‘mental health professionals’. Second, it has not been possible to acknowledge all important contributions to psychological approaches within infertility medicine. The research base is voluminous and the journey has been long. We focus on contributions that changed the direction of travel but acknowledge that many important contributions were made by those who persisted in one direction. Our aims in this chapter are to describe the medical and psychological context of each of the major developments outlined above, explain the paradigm shift, and reflect on the nature of past and present contributions related to the domain of inquiry. In this way, we hope to illuminate the interrelation between psychology and reproductive medicine, identify the major turning points in the psychology of infertility, and demonstrate the importance of past and current psychological contributions to reproductive medicine.