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The Counsellors Role in Infertility August 2001 Welcome An important component of the management of couples with infertility is counselling. Issues covered including psychological preparation for treatment, stress whilst on treatment, and also concerns which arise when pregnancy occurs. Pregnancy achieved after infertility does not necessarily lead to instant joy as this case illustrates. This is the first of our case discussions which has a psycho-social form. Initial Presentation Jane is aged 35 and her partner Michael aged 38 years. The first consultation with the Unit Counsellor was to discuss Jane's significant anxiety following the diagnosis of a twin pregnancy following frozen embryo transfer. Treatment History Following full investigations assisted reproduction was chosen as the treatment option. Jane conceived in her second cycle of treatment after two frozen embryos were transferred. A normal singleton pregnancy resulted in the birth of Samantha who is now 20 months old. Further treatment was requested when Samantha was 12 months old and a pregnancy occurred in the next cycle of IVF treatment. A normal fetal heart beat was identified on ultrasound scan at 8 weeks but the pregnancy miscarried at 11 weeks. There followed a period of recovery from the grief and physical trauma of this event, after which a further transfer of two frozen embryos was requested. Pregnancy was verified and an ultrasound scan at 8 weeks showed a twin pregnancy. Counsellor Comment Prior to treatment couples discuss with medical staff the number of embryos to be transferred. Careful consideration is given to reduce the incidence of multiple pregnancy. Pregnancy following assisted reproduction is known to be associated with greater anxiety about a successful outcome. Some of the other concerns frequently associated with pregnancy after long-term infertility are: fear of birth defects, feeling neither fertile nor infertile and difficulty adjusting to being a normal obstetric patient. Previous pregnancy loss can exacerbate anxiety about the current pregnancy. Meanings and details of the previous loss can have particular overlap to a current pregnancy, for instance, where pregnancy symptoms are very similar, or where particular dates recur. All of these concerns are compounded by the presence of a high risk pregnancy. Initial Counselling Session Jane and Michael attended for counselling together. Jane expressed her major concern as an inability to believe that the pregnancy could proceed successfully. Michael expressed similar concerns plus his worry about how best to assist his partner who was experiencing emotional distress to a greater degree than himself. Counsellor Comment This session allowed for an opportunity to normalise this pregnancy related anxiety. Information about how other patients have reacted to news of a twin pregnancy, and how previous pregnancy loss can add to anxiety was discussed. Jane was particularly pleased to take away reading material about these concerns. Particular care was taken to not be overly reassuring about pregnancy outcome but to actively accept uncertainty about the outcome. At the same time it was necessary to focus on all the positive signs to date. A psychological management plan was constructed for the period of 8 to 12 weeks pregnancy. This plan included a day-by-day focus, maintaining contact with their General Practitioner on a weekly basis, anxiety and self-care techniques personalised for Jane, and for the couple. Second Counselling Session at 14+ weeks gestation Jane came to this session by herself. She had been better able to manage the anxiety about pregnancy loss and so had coped better with daily living. However a new issue of concern had emerged over that week. Feeling more confident about the successful birth of twins, Jane had begun to worry about how she would handle twins with a child aged just over 2 years. She reflected on how tired she was now and how very active Samantha was at 21 months of age. She had begun to feel distressed about the time she would not have for Samantha and had started to think of ways to encourage Samantha to be less dependent upon her. Counsellor Comment At this point in the pregnancy however, there were still 5-6 months when Samantha, Jane and Michael would form the family group. It was suggested that Jane focus on this time as a special, never-to-be repeated phase in Samantha's life. Discussion about this ensued with Jane expressing enthusiasm about this new view of the pregnancy. The arrival of twins does require greater adjustment than the arrival of a singleton. Appropriate resources, support groups, knowledge of others who have parented twins, family and friends who can help, and a team effort at home are all important. Planning for the arrival of twins is enhanced when there is less anxiety, left unchecked this can be an additional risk factor for post natal depression. References 1. Ellen Glazer. The Long Awaited Stork: A guide to parenting after inferitlity (Revised Edition). Jossey-Bass Publishers, San Francisco, 1998 2. Rachel Cook, Sally Bradley and Susan Golambok. A preliminary study of parental stress and child behaviour in families with twins by in-vitro fertilisation. Human Reproduction V 13, 10.11 pp 3244-3246. 1998. 3. The ESHRE Capri Workshop Group. Multiple Gestation Pregnancy. Human Reproduction V15, 7, pp 1856-1864, 2000. More Information Multiple Births Association Ph. 8364 0433  PRINT THIS PAGE
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