Psychophysiologic infertility: an overview
It has been recognized for centuries that commotion in the mind very often is reflected in the functions of the body. A few years ago 50% of cases of infertility were classified as emotionally determined. Today only about 5% are so classified because the identification of defects in chemistry or physiology rules out the diagnosis. Many infertile women with physical defects have significant emotional disorders, and many infertile women with no demonstrable physical defect have no significant emotional disorders. The diagnosis of psychophysiologic infertility can be made only after identification of intrapsychic conflicts arising from cultural, environmental, or experiential factors that have modified function, chemistry, or structure. The gradual elucidation of the functions of the limbic system and more understanding of the roles of the neurotransmitter amines have led to the present understanding of the psychophysiology of infertility. It has been shown that the neurotransmitter amines influence the production of reproductive hormones and hormone-releasing factors. Many types of stress change the concentration, production, and modification of these transmitter compounds. Investigators have tried without success to identify specific emotional problems that eventually produce infertility. Infertile women do have more emotional disorders, however, and some seem to be cause-effect related. Infertility protects some women against significant psychic conflicts and becomes a defensive process. Removal of this defensive process without quieting the internal commotion can have deleterious effects. When one or both members of a marriage desire children, the identification of one as infertile puts a significant stress on the relationship. Interpersonal and intrapsychic turmoil results, which may require professional help to quiet. The treatment of psychophysiologic infertility should include identifying specific areas of conflict and then attempting to modify responses, attitudes, and affects that cause or intensify the conflicts. Through a learning experience, anxious and insecure patients can be helped to tolerate the anticipation of pregnancy and parenthood. Even those who do not achieve pregnancy can be helped to maintain their feelings of self-worth and self-esteem.