Rrecognized by the World Health Organization (WHO) as a real one pathologyL’infertility in Italy it affects about 15-20% of couples. Many of these couples, between 65,000 and 78,000 each year in Italy, resort to assisted reproduction techniques. A long, physically and psychologically demanding journey. “Above all, a path with no guarantees of success». Beatrice Corsale explains it, psychologist and psychotherapist, specialized in cognitive behavioral psychotherapy and author of the self-help book Belly envy (Erickson). “This is the fundamental point that every couple should accept before embarking on this path”. Often this is not the case and the search for a child takes the form of a obsessive thought. The expert guides us through the central moments of the Pma journey and the psychological discomforts that can easily be encountered.
Infertility in Italy and recourse to Pma
In a country plagued by a record drop in birth rate (last year for the first time it fell below 400,000 births), i children conceived thanks to Pma they were continuously growing until 2019, equal to 3% of all newborns (about 14,000). As a result of the pandemic, based on the latest Report of the Minister of Health to Parliament on the subject, a decrease in the couples treated was observed (from over 78,000 to 65,000) and children born alive have gone (from over 14.00 to 11,418 of 395,072 “birth forms” received in 2021, -20%). So 2.9 pregnancies in which a PMA technique was used for every 100 pregnancies. Pending new data, Pma remains a solution for many couples.
Why? Mainly because one begins to think about the first child later and later (the average age of women who undergo fresh techniques with the couple’s gametes is 36.9 years, 41.8 years for in vitro fertilization with donated oocytes). And why the cases of infertility they are on the increase (due to environmental factors, unhealthy lifestyles, contaminants present in our daily diet).
Having a child is not a given
The result is clear. «In the Western world one in five women and, in some countries, one in four women, is (remained) childless. For hormonal or anatomical reasons, because she tried when it was too late for her, because the relationship with her partner ended badly, because the pregnancy was terminated. The data remains. No children. This is reality, this is the world» says the therapist. This is the passage that must be accepted, at a deep level. If you expect an event to be taken for granted, such as having a child or having it at the right time, «when the child doesn’t arrive, you will feel the lack of him as if something that was rightfully his had been stolen. One has the perception of being wronged. To experience mourning».
Motherhood, women’s identity and fertility education
In regards to conception, women are victims of some erroneous thinking. And that is the centrality of motherhood for the identity of womenthe ease of conception, the total possibility of controlling it, the right to motherhood.
«First of all», continues Corsale, «we need an education in fertility, starting from the schools: there are many prejudices and distorted ideas about natural fertility». More time is spent talking about how to prevent pregnancies, very little explaining how fertility curves change over the years.
But even when couples with infertility problems approach Pma, it must be clarified that it is aopportunities with a high chance of failure. “A path whose outcome is not obvious: only this awareness allows you to continue investing in other areas of life”. Otherwise there is the risk that the search for a child will become the only thought.
“I want a baby.” But what do I really want?
“It’s important to understand what a woman really sees in that son who says he wants,” explains the therapist. And depending on the answer to this question, solutions can be imagined, on a therapeutic but also on a practical level. «Often, due to social or family pressures, we arrive aconfuse one’s value with one’s ability to generate, to give offspring to the family. This generates guilt feelings towards the partner or the family of origin, the envy towards the belly of other women, shame for “not being able”». This sense of self must be restored, regardless of and upstream of the Pma’s possible path.
But in the search for a child, the desire to take care, to educate, to grow. And, in this case, there are many other ways, in addition to conception, to be someone’s “mother”.
The stages of the Pma, from the diagnosis of infertility to the witch hunt
Among the “stages” that a woman goes through, “after the shock of the diagnosis of infertility, there is that of witch hunt. She blames herself for not having made different choices, for not having understood earlier that motherhood was not an automatic fact » explains Corsale.
The incessant brooding, deleterious to mood, worsens quality of life and prolongs stress responses. The dimension of planning is missing: life closes on the thought of motherhood that doesn’t come. A psychological therapy but also, to start, some simple relaxation and mindfulness exercises can help break the brooding. «It can be useful even just to try to postpone the brooding to a pre-established and defined moment. Or introduce a concurrent task, such as, trivially, mentally describing the environment around you», explains the therapist. That is enough to interrupt the exclusive attention on an obsessive thought.
The consequences on the couple relationship and on sexuality
The infertility diagnosis can (tends to) get worse couple relationship and sexuality. Especially if the vision of parenting doesn’t quite match. «Women seem to be more exposed to developing a post-traumatic stress riskwhile men can get to put questioning his own manhood and one’s ability to support the partner,” explains the therapist. «She You can also run into the so-called“emotional trap“»: the woman does not feel understood by her partner who tends to face the situation with practical solutions. Which make her feel even more alone in the parenting project.
Sex programmed according to conception can flatten sexuality to a pure mechanical act. «But the most solid couples resist the tensions of assisted fertilization: through the frank sharing of emotionsmaking them explicit, without assuming that the other understands».
Stress and negative emotions can compromise the success of Pma
Activating all possible solutions to safeguard one’s psychological and couple well-being is essential for many reasons. Including the outcome of the Pma process itself. «The research has in fact highlighted that the numerous and intense negative emotions, as well as the deterioration of the quality of life of women during in vitro fertilization treatments could constitute a further element of difficulty for the success of conception», explains the expert.
Not that it’s easy. «Many couples come to abandon the treatments before the end, precisely because of the difficulty of supporting the psychological weight, especially when the procedure is considered the demonstration of one’s own limit rather than an opportunity”. For this the European guidelines relating to Pma have indicated the importance of psychological support for women undergoing fertilization cycles.
The son does not arrive: the persistence and the elaboration of mourning
There is no absolute limit to the attempts one can make in search of a childif not the one evaluated by the medical staff and indicated by the regulations in force. External pressures can, in this sense, be obstacles. Even trivial phrases, spoken with superficiality by relatives and acquaintances (such as “wanting is power” and “never give up”) they can make it more difficult to get a clear picture of the situation.
«But it is good», explains Corsale «that every woman defines her limit, in order not to risk falling into a sort of obstinacy in the search for motherhood». For example, deciding to try one type of procedure and not others, with a given hormonal stimulation and not other more invasive ones. Deciding to stop after two cycles. Set a limit a priori it can be useful to understand where you are going. Once the limit is reached, it is right to say enough, to accept not to continue. «And the sorrow remains, indeed can take the form of mourning, mourning someone who was never there, for a planning that was unable to express itself».
The starting point, when that limit is reached, is take care of yourself.
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