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1/3. Individual and group psychotherapy with infertile couples.

    After reviewing some of the relevant literature, the writers proceed to describe a new development in psychotherapy for couples presenting with relatively unexplained infertility. Several couples who had failed to achieve conception (despite the use of assisted reproductive techniques and personal psychotherapy) were brought together into a supportive-expressive group led by the writers, an experienced analytic cotherapy couple. An interesting outcome is described, and mention made of current plans for a future research project.
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keywords = psychotherapy
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2/3. infertility and depression.

    This is a preliminary report of an ongoing study of the relationship between unexplained infertility and depressive illness conducted by a team of two specialists: a gynecologist and a psychiatrist. Over a 3-year period, 16 cases of unexplained infertility and depressive illness were treated by the team. Nine of the cases received psychiatric treatment, consisting of pharmacotherapy with amitriptyline and a limited number of psychotherapy sessions. The other seven cases terminated with the psychiatrist after the psychiatric evaluation. Three of the cases that received the psychiatric treatment became pregnant. Follow-up at the end of the 3-year period revealed that none of the 13 others (psychiatrically treated and untreated) had become pregnant. These preliminary data suggest that in cases of depression preceding the onset of unexplained infertility psychiatric treatment as described above increases reproductive capacity.
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ranking = 0.16666666666667
keywords = psychotherapy
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3/3. infertility. A psychiatrist's perspective.

    This paper discusses issues relevant to psychiatrists working in a reproductive biology unit: 1. The couple's anxiety. 2. The question of whether psychological conflict can cause infertility. 3. Dealing with the outcome of the workup. 4. Donor insemination. The anxiety of couples applying for an infertility workup can usually be countered by supportive and educative measures. More problematic sources of anxiety that require psychiatric consultation are: 1) fear that the workup may shatter a myth that explains the infertility, a myth reinforced by unconscious conflicts; 2) An untenable wish that having a child will repair problems in the marriage or in the sense of relief. The psychiatrist is often asked whether psychological conflicts can cause infertility. The most understandable manner in which they do is by their effect on sexual performance. Where there is no sexual performance problem, psychotherapy can be offered if one or both partners experiences psychological pain, but with the understanding that therapy cannot be expected to cure the infertility. Psychiatric consultation at the end of the workup is indicated 1) where irreversible infertility is discovered and mourning is excessive, 2) where a myth to explain the infertility has been shattered, 3) to reassess sexual performance and to deal with the uncertainty, where no physical cause has been discovered. Donor insemination (AID) is fraught with legal and ethical problems. There are no criteria for selecting donors or recipient families, and there is concern that AID may lead to genetic engineering. The psychological effects of AID are uncertain. A study at our clinic suggests that the pursuit of AID involves a two-stage process: first, dealing with the outcome of the infertility workup and second, confronting AID itself; and that the secrecy that surrounds AID obstructs resolution of conflict.
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ranking = 0.16666666666667
keywords = psychotherapy
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