“I can’t get pregnant”: when the problem is in a man

Recently, psychologist Yana Staroverova shared on Twitter an interesting story that happened in a professional chat cognitive behavioral therapists Moscow. A colleague asked for a specialist contact for a client who was unable to conceive and was developing depression as a result. According to all medical indicators, the woman is healthy, which means that the cause remains to be sought only in psychological infertility.

In response, Yana Staroverova asked if the client’s husband had undergone a medical examination. “Just from the similar stories I heard (I worked in a medical center, talked with gynecologists), most often unexplained infertility looks like a fully examined woman and a husband who has “100% everything is in order,” and he will not be checked, ”the psychologist explained. And it turned out to be right.

It turned out that the woman’s husband categorically refuses to be examined, claiming that “everything is in order” with his reproductive function. During this time, several psychotherapists have already managed to share the contacts of colleagues who could work with the “psychological infertility” of the client.

As a result, the author of the post offered to take a woman for a consultation – but not to work with psychological infertility, but with overcontrol, chronic guilt, personal boundaries and the format of relationships. “And it would almost certainly increase her chances of conceiving a child, although not at the expense of improving the functioning of the reproductive system,” she added. 

According to Yana Staroverova, no one, including the psychologist who submitted the request, bothered to collect an anamnesis and calculate the statistical probability of psychological infertility. “Colleagues did not doubt their ability to help at all and did not wait for additional information. Although work without collecting an anamnesis is practically meaningless and often doomed to failure. This approach discredits psychotherapy, wastes the patient’s time and money, and sometimes delays getting the necessary treatment, ”the psychologist comments on what happened.

“Already the second wife is wrong”

Unfortunately, this client’s story is not an isolated case. In the comments, users shared their experience related to the diagnosis of infertility. 

• “I have been observing an absurd situation up close for eight years now. A friend was diligently treated for a couple of years: everything is fine with her, but there are no children. When I talked my husband into going to be examined, they found specific problems with him. Well … and he quickly slipped out of treatment. But she is still recovering.”

• “I had such acquaintances. The husband and his family categorically refused to check him: he is a priori healthy! This is something wrong with my wife, and she is already the second such wrong.

At the same time, other users cited successful examples of psychotherapy for infertility. However, judging by their stories, the solution to the problem was not in the treatment of psychological infertility, but in establishing contact with oneself and reflecting on relationships with a partner.

• “Honestly, with my infertility, I still went to a psychotherapist, because five years later, from all this, the roof was already “roofing”, I had to put it in its place. And somehow, immediately after that, everything got better: I started to get lucky with the doctors, and the diagnosis appeared. As a result, regular aspirin helped.”

• “If the husband and wife are healthy, a frequent cause of infertility is in the woman’s head. Many gynecologists send patients to psychotherapy. Spoiler: many couples break up after that, and the woman is happy to get pregnant in other relationships if she still wants a child.

Infertility is a couple’s problem

Infertility is a common medical problem that affects both partners. According to the World Health Organization, at least 48 million couples suffer from the inability to have a child. Moreover, infertility can be caused by diseases of the reproductive system in both women and men in equal proportion, adds psychotherapist, sexologist Diana Genvarskaya. 

“Infertility is understood as the absence of conception in a couple living a regular sexual life without contraception for one year. The causes of infertility are reproductive disorders in one or both partners. By the way, the last option is the most common.

It has now been proven that it is the male factor that is involved in 50% of infertility cases: varicocele, obesity, hormonal changes, inflammatory diseases, genetic features,” says urologist-andrologist Svetlana Kalinina. 

However, in practice, the problem of infertility is much more likely to concern only women. They put themselves under additional stress by making appointments with different doctors, undergoing dozens of examinations and taking unnecessary tests. At the same time, their partners refuse to check their reproductive health, assuring that they have no problems. And this statement is often taken for granted.

In society, it is generally accepted that infertility is mainly “to blame” for a woman, notes a urologist-andrologist.

“Women tend to think that if something happened, it is their fault, take responsibility and take concrete steps to change the situation. Men, due to their mental characteristics, are not ready to look for the cause in themselves, ”Diana Genvarskaya explains the reasons for this phenomenon.

As a result, desperate to find the reason for the failure to conceive, women easily believe in their own psychological infertility. And they become clients of specialists who are ready to treat this “diagnosis” even without a medical history.

Although the idea to treat psychological infertility – especially without a medical examination of a man – grows out of the same rule: “if something is wrong, then the woman is always to blame,” emphasizes Yana Staroverova. 

Psychological infertility 

Does it exist?

From the point of view of evidence-based medicine, psychological infertility does not exist – at least in the sense that is most often meant. “There is no official diagnosis of “psychological infertility”, but the mental state, of course, affects conception,” says Svetlana Kalinina.

“There are a large number of more plausible explanations, and it is absolutely not clear how such a mechanism could have appeared evolutionarily. Strictly speaking, psychological infertility is the inability to conceive a child against the background of overwhelming stress, due to critically low progesterone or the cessation of ovulation. But, looking at such a patient, not a single doctor will say that she is completely healthy, ”notes Yana Staroverova.

“The term “psychological infertility” is very arbitrary. If a woman psychologically prevents conception, then pregnancy may not occur for a long time due to changes in hormonal levels. Different types of hormones – for example, progesterone (sex hormone) or cortisol (stress hormone) – affect the stages of preparation of the egg for fertilization and attachment to the uterus. But in this case, the woman will have problems with menstruation, disorders of the nervous system, symptoms of borderline disorders: neurotic or anxious, ”explains Diana Genvarskaya.

Exclusion Diagnosis

Psychological infertility is a diagnosis of exclusion (more precisely, a version, since there is no such diagnosis in the current ICD-11). That is, evidence-based doctors begin to talk about psychological infertility in an absolutely healthy woman only when all other versions have already been refuted. However, people often confuse “all versions” and “everything that can be checked in our hospital / in our city,” says Yana Staroverova.

“In the beginning, of course, it is necessary to undergo a complete examination, check the hormonal status. But not every doctor can do such work, since the diagnosis of psychological infertility takes place at the intersection of different sciences – gynecology, endocrinology and psychiatry, ”adds a sexologist, psychotherapist.

What and how do psychologists treat? 

As Yana Staroverova says, working with psychological infertility goes differently: it all depends on the approach of a specialist. Most often, psychologists focus on relieving guilt and reducing overall stress, as this provides subjective relief and increases the frequency of sexual intercourse. At the same time, the result of treatment can be quite successful – due to self-hypnosis and a fortunate combination of circumstances.

“Sometimes we see couples in which both are absolutely healthy, but pregnancy does not occur. Then we recommend letting go of the situation, turning off the obsession with the problem, and relaxing. And this often brings results,” says Svetlana Kalinina.

According to Diana Genvarskaya, the treatment of psychological infertility should be carried out by a psychotherapist who will work with a woman’s mental problems. “Psychologists use techniques that, in theory, can change deep neurotic states, but in general it should be an integrated approach,” she notes. 

“In principle, perinatal psychology is a useful field that requires good preparation. Psychological support of even an uncomplicated pregnancy is a very laborious task. And with reproductive problems, a psychologist should generally be included in the MHI – for both women and men. And often gynecologists refer patients to a psychologist, not because the root of problems with conception is in the head, but because it is necessary for the woman herself, ”stresses Yana Staroverova.

gender bias

Why do men not want to be examined for infertility?

Men in general are much less likely to go to the doctor. Thus, according to the All-Russian Union of Patients, approximately 40% of men and 60% of women seek medical help at least once a year. In the field of reproductive medicine, this bias can be even greater. According to Yana Staroverova, almost every gynecologist and endocrinologist in their practice has encountered a situation where the partners of the patients refused to be examined for infertility.

“This also applies to the field of reproductive medicine, where it is even more difficult to motivate men to go to the doctor. Men are psychologically more difficult to endure examinations and illnesses. Almost everyone considers themselves absolutely healthy,” notes Svetlana Kalinina.

This behavior of men is explained by their gender socialization.

They must maintain an image of being strong, healthy and sexually active. So a man’s acceptance of the fact that there may be problems with his reproductive function makes him less masculine in his own eyes.

At the same time, unlike women, they are not so afraid of infertility, because within the framework of male gender perception, childbearing is not considered a prerequisite, says Diana Genvarskaya. So in most cases, diagnosed infertility does not affect their psychological state. The infertile man continues to display his usual sexual behavior and even enjoy the absence of risks and responsibility for the potential pregnancy of his partner.

If a man refuses to be examined …

If a man categorically refuses to be examined for infertility, this is an alarming and obviously far from the first bell for a woman who is in a relationship with him. What can be said about such a partner? “Infantilism, irresponsibility, defending self-importance at any cost, up to the denial of reality, and the inability to admit their problems. You need to understand that a mentally prosperous woman will not voluntarily remain in such a relationship until the moment when it comes to children, ”says Yana Staroverova.

“When a man does not want to go to the doctor, this is an alarming situation. The partner is not fully involved in solving the problem and does not take responsibility. You should seriously consider whether, in principle, it is worth having children with such a person, ”Diana Genvarskaya is sure.

If a man agrees to be examined …

If a man comes to the doctor and finds out that the problem is in him, he, as a rule, is actively involved in solving it. He undergoes a course of treatment, follows the recommendations of doctors, drinks pills, if necessary. And often the therapy is quite successful, reassuring sexologist, psychotherapist.

In such couples, pregnancy occurs much faster than in those where only the woman takes responsibility for childbearing.

“Infertility is not a sentence, in almost 90% of cases the problem can be solved positively. You just need to be patient for examination and treatment, ”confirms Svetlana Kalinina. 

If both partners have the goal of having a child, then they should participate equally in family planning, including undergoing the examinations necessary for successful conception. If the initiative comes only from a woman, and a man does not want to pass even simple tests, then she should turn to a psychologist and understand herself and relationships. The birth of a child in such a couple will only increase all the disturbing trends, Diana Genvarskaya concludes.