3. Psychological factors as one reason of infertility

It was detected that causes of infertility are widely ranged for men and women. The causal factors of infertility are not limited with medical factors but extend to psychological factors too [11]. Emotional drivers of infertility for women can be listed as tubal spasm, anovulation, rapidly throwing seminal sperms, and vaginismus. Added to that, another infertility factor related to women is unintentionally avoiding sexual intercourse while ovulating. There are a number of psychological commonalities among infertile women. Although most women seem to dearly want to get pregnant and express their desire verbally, deep down they may hide negative views and fear toward pregnancy. These fears may originate from pregnancy, delivery, or motherhood. Among some of the potential underlying causes with psychogenic roots are also fear of having a bad body shape due to pregnancy, fear of losing her life or the baby during delivery, or fear of failing as a good mother. Studies revealed that if women were encouraged to express such emotions, a more affectionate and unrestricted bond could be developed among partners, which then could lead to pregnancy [12–14]. Among men, impotence in erection and ejaculation are root causes of psychological infertility. Besides, as is the case for women, men can also avoid coitus unintentionally. Male impotence may exist from birth or develop in life later. In a vast majority of men, it is also possible to experience temporary impotence in any stage of life. A great part of impotence breakout could be related to psychological causes. Most of the times, past psychological traumas, nutritional disorders, childhood diseases, and overaffectionate and protectionist mothers are among the initiative factors of psychological impotence [12, 15, 16].

#### 4. The relationship between stress and infertility

Infertility is mainly categorized as an unsolvable life crisis that threatens being a parent, which is one of the salient life objectives, putting pressure on personal resources and having a potential to resuscitate unsolved conflicts of the past years. For infertile couples, stress sources may originate from personal, societal, and marital life. It was reported that single or collective presence of these factors increased the stress level during treatment process more [17–19]. For the couples defining their infertility experience as "the most distressing life event," overcoming their current condition can only be possible by coping the stress and adapt into the current situation. Individuals diagnosed with infertility are forced to counteract a condition not solvable with the available coping strategies. In stress management, personal capacity, past experiences, and support from immediate social circle are very critical [20]. Failure to reproduce fuels both familial and environmental pressures among couples while also igniting stress and tension at home. If failure to

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

reproduce were perceived as if it were a crime and if it forced the individual to feel like a loser in community, infertile couples would then choose to be isolated from their close circle. As spouses become more discreet toward one another, their marriage life may also be adversely altered. Another explanation for infertilityrelated stress among couples is the financial cost of treatment process. Since it is a long, exhausting, and also costly stage of which treatment process is uncertain, partners are likely to undergo an emotionally difficult and tense experience. Extended length of infertility and treatment is another factor related to psychiatric problems. Sociofinancially advanced couples prove to be more apt in accepting infertility and develop favorable coping methods against infertility-induced psychological problems, but the opposite holds true among sociofinancially backward couples [16, 21–23]. On the other hand, it was acknowledged that rather than financial hardships, the influencers of quitting the treatment protocol are physical and emotional burden, huge stress, and disappointment. The same study also highlighted that feeling stressful prior to IVF operation is an acceptable case. Yet stress during the actual treatment process led to adverse consequences [24]. In one study conducted across 151 female cases to investigate the effect of stress on IVF treatment, three vital findings were obtained [25]. These findings were, respectively, listed as follows. (1) Stress level in the beginning of treatment is significantly correlated with biological parameters such as collected number of oocysts, total number of fertilized oocysts, pregnancy ratios, live birth ratios, and birth weight. (2) Stress level during IVF procedure is significantly correlated with collected number of oocysts and total number of fertilized oocysts. (3) When infertile couples having least amount of stress in the beginning are compared with the ones having most amount of stress, it is detected that frequency of dead birth is 93% lower. Stress-lowering interventions during infertility treatment are correlated with increased ratios of pregnancy. Among women with adequate level of active-effective defense mechanism and emotional self-expression, there is higher success of infertility treatment compared to women not having these traits [25]. It is reported that unpredictability, negativity, uncontrollability, and ambiguity dimensions of infertility may be perceived as stressors for individuals. The application of stress and coping theories to infertility; in which situations infertility is perceived as more stressful, what is the factors that facilitate and complicate adaptation of individual and couples diagnosed with infertility would assist in better understanding which therapeutic interventions are more beneficial for reducing stress.
