Abstract

PIP: The psychologic aspects of infertility in men and women are reviewed, neuroendocrinologic factors thought to affect reproduction physiologically are described, and awareness of the stresses that infertility places on a couple's relationship is encouraged. Studies have found infertile women to be more neurotic, dependent, and anxious than fertile women, experiencing conflict over their femininity and fear associated with reproduction. In contrast to these reports, a double blind study could not determine the difference in the psychologic makeup of women who were infertile because of demonstrated somatic causes and those women in whom no somatic cause could be found and who were considered infertile on an emotional etiologic basis. Other studies have similarly come to negative conclusions regarding the relationship between psychologic factors and infertility. The 1st set of studies failed to consider the stress that infertility itself places on the couple. Emotional factors may negatively affect fertility in the male. Up to 10% of infertile males have had improvement in their semen analysis after cessation of all treatment for a prolonged period of time. The concept that emotional stress might lead to oligospermia was further supported in a report describing testicular biopsies obtained from men awaiting sentencing after raping and impregnating women. A more obvious effect of the emotional stress infertility places on the male is the occurrence of impotence. It has been estimated that up to 10% of infertilty may be partially or completely explained on the basis of male sexual dysfunction. The gradual unraveling of the complexities of neuroendocrinology have permitted increased understanding of the role that stress might play in infertility. Catecholamines, prolactin, adrenal steroids, endorphins, and serotonin all affect ovulation and in turn are all affected by stress. Such stress might result from infertility or habitual abortion. Infertility is frequently perceived by the couple as an enormous emotional strain, and counseling may prove helpful as a part of the initial infertility evaluation, an adjunctive measure during treatment, or a final measure to help patients cope with acceptance of their infertility problem. Although statistical evidence is overwhelmingly against the relationship of adoption and subsequent conception, it does appear that a small percentage of patients do achieve pregnancy following adoption. Possibly this can be explained by a reduction in stress, and subsequently, alterations in the neuroendocrinologic characteristics of the infertile couple.