From the diagnosis of sterility/infertility to the protocols of assisted reproduction: psychological aspects of sterile couples

The choice to begin assisted reproductive techniques is part of a more general 'psychological process of sterility', characterized by several phases: the 'initial shock' for the diagnosis, accompanied by a strong feeling of loss, the negation of the problem and the refusal of the feelings correlated to it; the phase of the 'immutability of the truth' during which within the couple it is observed one differentiation based on the kind of reaction to the diagnosis; the 'crisis of identity' which characterizes both the individual and the couple; finally 'the resolution' which is a deep sense of acceptance, an obvious sign of a change of attitude of the couple in comparison to the truth. The choice and the performance of the assisted reproductive techniques make some important aspects of psychological importance come out. The negative outcome of the treatment is often accompanied by depression, anxiety and self-esteem decrease; on the contrary, the relation between stress and outcome of the treatment is not so clear as of today. However, during the same treatment emotional stress, increase of somatic symptoms and increase of defensive reactions are observed in the couple so that the affective investment is put on a secondary level of importance. Therefore it is obvious that the psychological support must be offered to the sterile couples not only when the outcome of the treatment is negative but along the entire therapeutic process, all phases included.