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Counseling in assisted reproductive technology
Etang Abang
Bridge Clinic, 66 Oduduwa Way, GRA Ikeja, Lagos, Nigeria
| Date of Submission | 08-Apr-2021 |
| Date of Acceptance | 04-Jun-2021 |
| Date of Web Publication | 09-Aug-2021 |
Correspondence Address:
Etang Abang,
Bridge Clinic, 66 Oduduwa Way, GRA Ikeja, Lagos.
Nigeria
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/ajiac.ajiac_2_21
The background history of counseling in assisted reproductive technology (ART) relates to when technology was introduced into the infertility treatment of clients. The public reaction then was intense on concern over the vulnerability of potential users and the welfare of children either created or affected by it. As a response, the development of Human Fertilization and Embryology Act (HFEA) in 1990 established infertility counseling with recommendations to address the public perception of moral and social acceptability of ART by the society. The recommendations outlined requirements for clinics offering infertility treatment to individuals and couples to provide counseling for the associated symptoms and treatment consequences that clients may experience with ART. The purpose, definition, indications, types, and scope for counseling in ART were also addressed. Infertility counseling in ART incorporates a clinical team approach consisting of the fertility doctor, fertility nurses, professional counselors and embryologist who through information empower and support clients to cope well with the infertility experiences. Keywords: ART, clients, counseling, infertility
| Introduction | |  |
In 1978, the first IVF baby Louise Brown was born by assisted reproductive technology (ART). The use and application to ART was a huge scientific development which created public concern about the vulnerability of potential users and the welfare of children created and affected by it. This led to the 1982 committee, chaired by Dame Mary Warnock, that enquired into the technologies of in vitro fertilization and embryology.[1]
The findings of the committee were published as the Warnock report of 1984 and resulted in the establishment of the Human Fertilisation and Embryology Act (HFEA) in 1990.[1],[2]
The HFEA of 1990 by its legislation established infertility counseling on a statutory basis and set out its duties to include:
Performing a vital mediating function between the rapid scientific advances of ART and the public perception of moral and social acceptability of its processes through the tools of Ethical Committee and Clinical Governance;
Assisting those contemplating the use of ART to make informed decisions by offering counseling before, during, and after infertility treatment;
That fertility clinics should offer counseling to all those experiencing infertility and receiving fertility treatment to enable them cope well with the experience as a best care regulation for fertility clinics to adopt and practice.[1],[3],[4]
| Counseling Indications in Art | | |
For many years, it has been acknowledged that involuntary childlessness causes a great deal of stress for the vast majority of individuals and couples experiencing it.
They are burdened by:
Parenthood desire, self-imposed stress;
Societal strain and stress (from the expectation to bear children);
Frustration and low self-esteem;
Isolation through avoidance of social interaction with friends and family;
Marital conflict from the blame game to unresolved pressures and failed attempts;
Sexual dysfunction, occasioned by psychological impact.[3],[5],[6],[7],[8]
Other special circumstances causing high distress include
Lack of spousal support;
First time diagnosis of azoospermia and decline ovarian reserve in women under 36 years of age;
A discordant couple (strained marital relationships);
Absence of or poor sexual exposure;
Domestic violence;
Severe family pressure;
Extreme fear of treatment failure;
Grieving the loss of a child/stillbirths/miscarriages;
Lack of finances;
Juggling a stressful job and treatment;
Long commute between home and clinic.[3],[5],[6],[9]
These significant psychosocial and psychological encounters by individuals and couples distress clients through the infertility experience from the investigations to treatment, which could also negatively impact the outcome of treatment management. These stresses decrease with counseling support, which should be offered to all ART patients.[8],[9],[10]
Counseling in infertility is the process in which individuals and couples are given an opportunity to explore their thoughts, feelings, and beliefs about their infertility in order to come to a greater understanding of their present situation and to discover ways of living more satisfactorily and effectively.[7],[10]
When clients are provided with this counseling opportunity, their perspective changes, they become less stressed, and are in a better position to make informed decisions on their infertility management.
Infertility counseling is essentially an interaction in a safe, confidential enabling environment, in which clients are informed and guided on the total view of the infertility condition, its diagnosis, procedures, treatment options, and their implications, while also providing them with a clear understanding of what the process entails in order for them to make informed decisions. This encounter inspires clients to open up and receive support for the treatment or adopt other ways of living their dream desire through the experience.[7],[8],[10]
| Counseling Objective | | |
The basic aim of any type of counseling in ART is to ensure that clients understand the emotions associated with infertility, the implications of treatment choices by information given, and that they receive sufficient emotional support to minimize (unto normalizing) negative experiences which will assist them cope in a healthy way with the consequences of the infertility.[6],[7],[9],[10]
| Counseling in an Art Unit | | |
HFEA (1990) recommends a trained fertility nurse with counseling skills or an independent professional counselor to provide support counseling for emotional issues.[2],[3],[10],[11]
Fertility clinics practice an integrated treatment team approach in consideration of the cultural/traditional, religious beliefs, and other orientations that may govern a client’s perspective, through a multi-disciplinary counseling team approach for holistic care.[8],[10]
The fertility doctor initiates the implication to treatment counseling process upon engaging the client.[7]
Guided by the client’s treatment option, therapeutic counseling is continued by the doctor, fertility nurses, embryologists, and the counselor (treatment team) throughout the treatment management irrespective of the treatment outcome.[3]
| Counseling Types | | |
[2],[3],[6],[7]
Therapeutic counseling
The clinicians/fertility doctors educate and provide information on the causes of infertility through the results of investigations and counsel on the applicable options of infertility treatment and the processes for client’s understanding and consideration.
Implication counseling
When a treatment requires the input of third parties, i.e., via the use of donated gametes of donor sperm, donor eggs, embryos, or surrogacy, the implication to the intending parents, involving parties, and the future offspring will be explored, discussed, and considered for understanding and acceptance before commencement of the treatment.
Support counseling
The clinical team comprising fertility doctors, fertility nurses, embryologist, and the counselor provides care and support upon a client’s engagement of infertility treatment. It carries on until the treatment ends irrespective of the outcome. Clients are encouraged, empowered strategically, and reassured as they relate their feelings to the processes on a need basis.
Additional facilitated support can be provided by a client (peer-to-peer)/self-help group within the ART unit where it might be beneficial and acceptable to the individual or couple in treatment.[8],[10]
| Counselors Scope | | |
[3],[6],[7],[11]
The use of gamete donation treatment (recipient and donor);
Surrogacy treatment;
Single women treatment;
During treatment—on the therapeutic consequences;
Support and care provided as identified and required.
Emotional management intervention includes:
Special circumstances causing high distress in ART clients;
Support for staff in ART units.
| Conclusion | | |
The psychosocial and psychological impact of trying to have a baby has over time been very overwhelming for individuals and couples as they deal with the realities associated with infertility, its treatment, and management.
Clients going through ART have found counseling to be helpful due to the fact that the process is quite involved and demanding and can lead to significant psychological stress that could also negatively impact the outcome of the treatment.
Clients who are faced with the challenge of how to manage and deal with the public perception of ART also benefit from counseling support. It helps them cope well by enabling them to work through the turbulent emotions associated with the infertility.
Counselors would deploy the empathic tools of listening, assessment, evaluation, and support to explore distressing emotional issues and provide information on coping strategies to empower and support clients during the infertility experience.
Ultimately clients will
Exercise their autonomy toward self-help
Become well-informed to make decisions on the applicable treatment option;
Achieve reduced negative psychosocial reactions that improve health outcomes;
Express a convicted emotional state required to come to terms with infertility treatment.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Covington SN, Burns LH. Infertility Counseling: A Comprehensive Handbook for Clinicians. Cambridge, NY: Cambridge University Press; 2006, 10013, 635 pp. Available from: http://tuleoffice.com/images/editor/File/pdf/book/omomi/book/6%20(2).pdf.  |
| 2. | Blyth E. Guidelines for infertility counselling in different countries: Is there an emerging trend? Hum Reprod 2012;27:2046-57 [cited February 28, 2021]. Available from: https://doi.org/10.1093/humrep/des112 |
| 3. | European Society of Human Reproduction and Embryology-ESHRE [Internet]. Guidelines for Counselling in Infertility. Available from: https://www.eshre.eu/Specialty-groups/Special-Interest-Groups/Psychology-Counselling/Archive/Guidelines.aspx. [Last accessed on 28 Feb 2021]. |
| 4. | Human Fertilization and Embryology Authority [Internet]. The HFEA Code of Practice 9th edition. Available from: https://portal.hfea.gov.uk/media/1605/2019-12-03-code-of-practice-december-2019.pdf. [Last accessed on 28 Feb 2021]. |
| 5. | Harvard Health Publishing [Internet]. The Psychological Impact of Infertility & Its Treatment. 2009 May Available from: https://www.health.harvard.edu/newsletter_article/The-psychological-impact-of-infertility-and-its-treatment. [Last accessed on 28 Feb 2021]. |
| 6. | Peterson B. Fertility counseling for couples. In: Covington SN editor. Fertility Counseling: Clinical Guide and Case Studies. Cambridge, UK: Cambridge University Press; 2015. pp. 60-73. Available from: https://digitalcommons.chapman.edu/cgi/viewcontent.cgi?article=1001&context=mft_books. |
| 7. | Sarmidi SB. My Health Portal Ministry of Health Malaysia [Internet]. In: Kanniah K, editor. The Important of IVF Counselling. April 14, 2016. Available from: http://www.myhealth.gov.my/en/the-important-of-ivf-counselling/. [Last accessed on 28 Feb 2021]. |
| 8. | Thorn P. Infertility counselling: Alleviating the emotional burden of infertility and infertility treatment. Int J Fertil Steril 2009;3:1-4. Available from: https://www.researchgate.net/publication/235222793_Infertility_Counselling_Alleviating_the_Emotional_Burden_of_Infertility_and_Infertility_Treatment. [Last accessed on 28 Feb 2021]. |
| 9. | Reproductive Science Center of New Jersey [Internet] Infertility Counselling. Available from: https://fertilitynj.com/services/counseling/. [Last accessed on 28 Feb 2021]. |
| 10. | Van den Broeck U, Emery M, Wischmann T, Thorn P. Counselling in infertility: Individual, couple and group interventions. Patient Educ Couns 2010;81:422-8. |
| 11. | Boivin J, Appleton TC, Baetens P, Baron J, Bitzer J, Corrigan E, et al. Guidelines for counselling in infertility: Outline version. Hum Reprod 2001;16:1301-4 [cited February 28, 2021]. Available from: https://doi.org/10.1093/humrep/16.6.1301. |
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