[Infertility: psychological-psychopathological consequences and cognitive-behavioural interventions]

Infertility primarily refers to the biological inability of a man or a woman to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term, however other causes can be found in both sexes. The diagnosis of infertility and the concurrent medical treatment are rather stressful events for the couple and can provoke a number of negative symptoms such as depression, anxiety and psychosomatic symptoms which may interfere with the medical therapeutic procedures especially with the in-vitro fertilisation technique. The relationship between infertility and psychological factors has not been explored fully and are still under research. However current findings can be summarized in three basic hypotheses; namely, the effect of psychological factors on the appearance of infertility, the psychological consequences of infertility at the couple, and the reciprocal relation of psychological factors and infertility. Stress and anxiety activate the hypothalamic-adrenal axis (HPA), and this activation can disturb the hormones of fertility. The presence of depressive/anxiety symptoms seems to have a negative impact on the treatment of infertility and sometimes can be a risk factor for lower pregnancy rate. There is a possibility that psychological complaints could develop, prior, during and after the diagnosis of infertility and may interfere with the fertilisation therapy. Should such psychological complaints develop it is suggested that psychotherapeutic treatment is used in conjunction with the treatment approach of infertility, e.g. IVF. The above mentioned suggestion is supported by a large number of researchers and current research efforts focus on different psychotherapeutic interventions such as Cognitive-Behavioural Therapy. Cognitive-Behavioural Therapy (CBT) has shown during research its superiority compared to other psychotherapeutic interventions and that could be an effective way to decrease the depressive and anxiety symptoms during several stages of the infertility treatment. Moreover Cognitive-Behavioural Group Therapy seems to strengthen the infertile couple's ability to deal with possible changes and the stress during the infertility treatment. It has also been reported in the research community that the use of CBT can improve the pregnancy rate. However, this finding should be viewed with caution due to its insufficient body of evidence and methodological problems incurred.