6. Reactions of couples against infertility

Despite the existence of personal differences regarding the reactions of individuals against infertility, studies also indicated a number of commonalities [2]. The ubiquitous emotion experienced by infertility-diagnosed individuals is misery. Personal reactions against infertility are confusion, denial, anger, negotiation (if I get pregnant then…), despondence, withdrawal, social isolation, lamenting, guilt feeling, unworthiness, frustration, and acceptance. The first stage is to feel shock, confusion, and disbelief. When the couple is diagnosed with infertility, first they feel shocked due to this sad fact and choose not to believe. Shock stage is followed by denial stage. Most of the times, couples are busy with not having an unplanned pregnancy so they are totally unprepared against the infertility scenario. Hence, outbreak of infertility problem is particularly devastating for those with high expectations and extreme confidence in overcoming any challenges in life. In order to avoid facing this bitter reality, denial is a popular tactic. Frustration experienced with the menstruation period every month is ignored by the couple, and infertility is attributed to fewness of sexual intercourses and believing that it is quite normal to get pregnant in the early months. Another stage awaiting the couples is fury and anxiety. An infertile partner is anxious with the fear of being left by the spouse; women feel themselves worthless and useless while men feel like having lost their manhood and might-power attributes of fatherhood. Reasons explaining the extremity of such emotions for women are fear of receiving many tests and protocols in her own body, anxiousness to lose the love of spouse, feeling worthless and useless, and a loss of self-confidence due to feeling depreciated manhood or womanhood. The longer waiting period and the more complexities in diagnosis and treatment can result in a heightened level of disappointment and anxiety trap. The next stage awaiting the couples is anger stage. Individuals feel resentful toward themselves, their partners, families, and social circle. Infertile couples feel to be treated unfairly and ask the question "Why us?" This question leads the couple to put the blame on past abortions or secret sexual intercourses that call for punishment. This accusation brings with itself self-directed anger or anger and hostility toward the partner. After all, infertility can be perceived as a problem threatening the continuity of one's lineage. The problem could even end up in solutions such as divorce, remarriage, or even suicide. Another stage awaiting infertile couples is the stage of loss of control. The complex and interventional nature of administered treatments and detailed questioning of couple's sexual life is perceived as a violation of their private life. Unpredictability of treatment success fuels a feeling of ambiguity toward the future. Couples think their private life is violated since administered treatments and directed questions expose their most-intimate life to outsiders. At this stage, women intentionally avoid seeing their pregnant friends and push themselves into loneliness. Another stage to be experienced by a couple diagnosed with infertility is the stage of guilt feeling. Infertile partner blames himself/herself due to the conviction that cultural motherhood-fatherhood role is denied from their partner because of their failure. Such feelings of blame and anger trap the infertile partner into despair. Partners feel themselves guilty since they blame themselves for denying their partner from the right of motherhood-fatherhood. As family and culture pressure are jointed with these emotions, they feel like being punished. They lose their interest to everyday life, they have lower motivation and enthusiasm

#### The Psychosocial Aspect of Infertility DOI: http://dx.doi.org/10.5772/intechopen.80713

and everything loses their former value, and they are likely to develop depression at this stage. For an infertile couple, each month with no pregnancy is perceived as if losing the child in the womb because of menstruation. Feeling of child loss brings mourning and depression. Although there is no tangible loss like in death or divorce, paradoxically, couples mourn for a baby who never existed in the first place. It is because the issue is not the loss of baby only; it means saying goodbye to dreams of ideal family and happy future. As time goes by, they develop apathy to life and feel beaten. In a different saying, mourning process results in depression [26, 27]. Healthy couples gradually enter into the stage of acceptance. Denials recede and facts supersede. By seeking alternative treatment options, they reconnect with each other and their friends and follow a more amiable approach in their reactions. Then these couples accept the infeasibility of having a child through biological ways. At this junction, couples need to make difficult choices like continuing a childless marriage, getting a divorce and remarrying someone else, or adopting a child [2, 7, 8, 28]. Stages of infertility are very much like the mourning process for someone nearing death. Yet, in infertility, there is not a fatal life-threatening issue; life quality and an agreeable marriage are at stake. Besides, although in a fatal disease, individuals come closer, the opposite holds true for infertility and couples distance themselves from one another as partners and from their social circle [28–31]. The reactions given to infertility may be different from among societies. Similarly, men and women exhibit different reactions against infertility. Women express their emotions more frequently and need wider social support, whereas men share their problems less frequently. As a defense mechanism, women negatively react to infertility, while men would choose to forget and deny. This disparity prevents partners to understand each other. Then, they start not to talk about their problems and women feel like shouldering this problem on their own. When the partners fail to provide emotional support to each one, family bond is destined to weaken [8, 32, 33]. In a relevant study, it was identified that among 31% of women and 16% of men, dominant emotions were despondence, pessimism, despair; 23% of women and 16% of men felt lonesome [34]. A different study focusing on the loneliness levels of infertile women revealed that 85.4% were primer infertile, 54% were woman-borne infertile, 78.7% received no psychological support [35]. In the same study, women's loneliness scores were found to be significantly related with the variables such as being employed, education level, length of infertility, number of marriage, need for psychological support, social security status, and social support [35]. Certain studies indicated that infertility affected couples' emotional state, social, sexual life, and marriage bond, and compared to men, these effects were more intensively experienced among women [36, 37].
