5/20/2020

PREVENTION & MANAGING CONFLICTS:

COUNSELLING WITHIN INFERTILITY AS A
CASE STUDY

ATERE A.D.
MEDICAL LAB. SCIENCE,
ACHIEVERS UNIVERSITY, OWO

Introduction

• A person suffering from infertility will face complex

issues which span biological, psychological, social
and ethical domains.

• Discussion of these issues in a counselling context is

often beneficial for the patient.

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Purpose
• The aims of counselling are to explore, understand and
resolve issues arising from infertility and infertility
treatment and to clarify ways of dealing with the problem
more effectively.
• The counselling process should consider the needs of the
patient and any other person who might be affected by the
treatment process and the decisions that have to be made.
• Counselling may have different functions and/or goals
depending on the life situation of the patient (e.g.
married, single or lesbian woman) and the treatment
desired (e.g. embryo donation or surrogacy).
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• Individuals may also seek counselling to help make

decisions regarding the continuation or termination of
treatment.
• However, counselling will frequently address issues
outside the treatment context.
• It may be used to discuss alternatives to parenthood
such as adoption or fostering and/or it may be used to
identify ways of living a meaningful and fulfilling life
without children.
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DEFINITIONS
 INFERTILITY – Inability of a couple to achieve
pregnancy (conception) after 12 months (1 year) of
unprotected regular sexual intercourse (Involuntary
failure to conceive).

There are 2 types of Infertility:

 ----- PRIMARY INFERTILITY - No previous

pregnancy.

 ---- SECONDARY INFERTILITY- Previous

pregnancy (irrespective of the outcome). 5

CONTRIBUTION OF
THE PARTNERS TO
INFERTILITY

 Male ---- 30% - 40%

 Female ---- 30% - 40%

 Both ---- 15%

 Unexplained ---- 10% -20%

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CHANCES OF PREGNANCY

 60% of couples conceive ---6 months

 80%-85% conceive --- 1year

 90% conceive ---2years

 10-15% --- Infertile

WHAT IS THE MAGNITUDE OF INFERTILITY

IN NIGERIA?

 It is estimated that 15-20% of couples are

facing this problem at any given time.
 In Nigeria, this translates to 2 million
couples (i.e. 4 million individuals) that are
experiencing infertility at any given time.

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PROBLEMS / CONSEQUENCES OF INFERTILITY

IN OUR ENVIROMENT
 Social Stigma.
 Marital instability and social neglect.
 Exploitation and economic deprivation
of female partners.
 Emotional stress and unhappiness /
Psychological consequences.
 Male ego. 9

FACTORS CONTRIBUTING TO THE INCREASED

DEMAND OF TREATMENT OF INFERTILITY

 Increased numbers of women in the

reproductive age group.

 Greater public awareness of the availability and

scope of such services.

 Availability of new technology and drugs for

treatment of previously hopeless cases.

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PRINCIPLES OF MANAGEMENT

 Deal with the infertile couple together.

 No one is ‘at fault’ or ‘to blame’.

 Carry out investigations and treatment

consistently in proper sequence.

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Laboratory Investigations of infertile Couple

• Clinical examination should include looking

for: Anorexia, Hirsutism, Virilism,
Galactorrhoea/Gynaecomastia, Ambiguous genitalia,
History should also be taken for medications & drugs.

• Baseline investigations for Female and Male

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INDICATIONS FOR ART

 ART is indicated for the management of infertility for

which conventional care is INAPPROPRIATE or
has FAILED.

 These include:

---Tubal damage

---Oligospermia --- < 20 million sperms/ml.

---Azoospermia

---Unexplained infertility 13

ASSISTED REPRODUCTIVE TECHNIQUES(ART)

 Any procedure where the gamete is

manipulated or removed from the body
and returned either as an oocyte or as an
embryo.
 The aim is to approximate the eggs and
sperms at the same time whether within
or outside the body.
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ASSISTED CONCEPTION TECHNIQUES(CONTD)

 Louise Brown --- 25/7/78---First IVF baby

Techniques

 IVF --- In vitro fertilization

 DI --- Donor insemination

 GIFT --- Gamete intrafallopian transfer

 ZIFT --- Zygote intrafallopian transfer

 SUZI --- Subzonal insemination

 ICSI --- Intracytoplamic sperm injection

 TESA --- Testicular sperm aspiration

 PESA --- Percutanous sperm aspiration

 MESA ---Micro-epididymal sperm aspiration. 15

ISSUES IN ASSISTED REPRODUCTION

◦ Cost effectiveness
◦ Ethical / moral / legal
considerations
◦ Emotional issues

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 In the context of infertility medical procedures,

the following tasks of counselling are important,
although in practice these tasks will normally
overlap:

• Information gathering and analysis;

• The implications and decision-making counselling

• Support counselling; and

• The therapeutic counselling.

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 Information gathering and analysis and

implications and decision-making counselling

• Providing sufficient information about the medical

aspects of the treatment is primarily the responsibility
of the medical personnel. However, patients consult
counsellors to obtain more information concerning
the social and emotional implications of the infertility
treatment.
• Implications counselling aims to enable the person or
people concerned to understand the implications of
the proposed course of action for themselves, their
family and any children born as a result.
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 Support counselling

• Support counselling aims to give emotional support

to patients experiencing distress.

• Distress can be caused by frustration of the desire for

a child or social and family pressure, as well as by the
reproductive technology employed and its limited
success rate.

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 Therapeutic counselling
• Within infertility, there is often a natural progression from
support counselling to therapeutic counselling.
• Several models of therapeutic counselling have been
developed over recent years.
• Therapeutic counselling can focus on:
Reflection of individual problems and (family) history;
The acceptance of the situation;
The meaning and impact of infertility, including grief work;
Work on alternative life and self-concepts for the future;
The development of coping strategies and strategies to
minimize distress;
Problem and conflict solving
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WOMEN MUST BE HAPPY AND HAVE

CHILDREN

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