Editing Infertility (section)

==Effects==

===Psychological===
The consequences of infertility are manifold and can include societal repercussions and personal suffering. Advances in assisted reproductive technologies, such as [[in vitro fertilisation|IVF]], can offer hope to many couples where treatment is available, although barriers exist in terms of medical coverage and affordability. The [[Fertility medication|medicalization of infertility]] has unwittingly led to a disregard for the emotional responses that couples experience, which include distress, loss of control, stigmatization, and a disruption in the developmental trajectory of adulthood.<ref>{{cite journal | vauthors = Cousineau TM, Domar AD | title = Psychological impact of infertility | journal = Best Practice & Research. Clinical Obstetrics & Gynaecology | volume = 21 | issue = 2 | pages = 293–308 | date = April 2007 | pmid = 17241818 | doi = 10.1016/j.bpobgyn.2006.12.003 }}</ref> One of the main challenges in assessing the distress levels in women with infertility is the accuracy of self-report measures. It is possible that women "fake good" to appear mentally healthier than they are. It is also possible that women feel a sense of hopefulness/increased optimism before initiating infertility treatment, which is when most assessments of distress are collected. Some early studies concluded that infertile women did not report any significant differences in symptoms of anxiety and depression than fertile women. The further into treatment a patient goes, the more often they display symptoms of depression and anxiety. Patients with one treatment failure had significantly higher levels of anxiety, and patients with two failures experienced more depression when compared with those without a history of treatment. However, it has also been shown that the more depressed the infertile woman, the less likely she is to start infertility treatment and the more likely she is to drop out after only one cycle. Researchers have also shown that despite a good prognosis and having the finances available to pay for treatment, discontinuation is most often due to psychological reasons.<ref>{{cite journal | vauthors = Rooney KL, Domar AD | title = The relationship between stress and infertility | journal = Dialogues in Clinical Neuroscience | volume = 20 | issue = 1 | pages = 41–47 | date = March 2018 | doi = 10.31887/DCNS.2018.20.1/klrooney | pmid = 29946210 | pmc = 6016043 }}</ref> Fertility does not seem to increase when the women takes antioxidants to reduce the oxidative stress brought by the situation.<ref>{{cite journal | vauthors = Showell MG, Mackenzie-Proctor R, Jordan V, Hart RJ | title = Antioxidants for female subfertility | journal = The Cochrane Database of Systematic Reviews | volume = 8 | issue = 11 | pages = CD007807 | date = August 2020 | pmid = 32851663 | pmc = 8094745 | doi = 10.1002/14651858.CD007807.pub4 }}</ref>

Infertility may have psychological effects. Parenthood is one of the major transitions in adult life for both men and women. The stress of the non-fulfilment of a wish for a child has been associated with emotional consequences such as anger, depression, anxiety, marital problems, and feelings of worthlessness.<ref name="Deka, P. K. 2010">Deka, P. K., & Sarma, S. (2010). Psychological aspects of infertility. British Journal of Medical Practitioners, 3(3), 336.</ref>
Partners may become more anxious to conceive, increasing [[sexual dysfunction]].<ref name=barrattberger>Donor insemination Edited by C.L.R. Barratt and I.D. Cooke. Cambridge (England): Cambridge University Press, 1993. 231 pages., page 13, citing Berger (1980)</ref> Marital discord often develops, especially when they are under pressure to make medical decisions. Women trying to conceive often have depression rates similar to women who have heart disease or cancer.<ref>{{cite journal | vauthors = Domar AD, Zuttermeister PC, Friedman R | title = The psychological impact of infertility: a comparison with patients with other medical conditions | journal = Journal of Psychosomatic Obstetrics and Gynaecology | volume = 14 | issue = Suppl | pages = 45–52 | year = 1993 | pmid = 8142988 }}</ref> Emotional stress and marital difficulties are greater in couples where the infertility lies with the man.<ref name=barrattconnolly>Donor insemination Edited by C.L.R. Barratt and I.D. Cooke. Cambridge (England): Cambridge University Press, 1993. 231 pages., page 13, in turn citing Connolly, Edelmann & Cooke 1987</ref>
[[Psychological effects of male infertility|Male]] and female partners respond differently to infertility problems. In general, women show higher depression levels than their male partners when dealing with infertility. A possible explanation may be that women feel more responsible and guilty than men during the process of trying to conceive. On the other hand, infertile men experience psychosomatic distress.<ref name="Deka, P. K. 2010"/>

===Social===
Having a child is considered to be important in most societies. Infertile couples may experience social and family pressure, leading to a feeling of social isolation. Factors of gender, age, religion, and socioeconomic status are important influences.<ref>{{cite book | veditors = Inhorn MC, Van Balen F |title=Infertility around the Globe: New Thinking on Childlessness, Gender, and Reproductive Technologies |date=2002 |publisher=University of California Press |location=Berkeley (CA)}}</ref> Societal pressures may affect a couple's decision to approach, avoid, or experience an infertility treatment.<ref>{{cite book | vauthors = Singh HD |title=Infertility in a Crowded Country: Hiding Reproduction in India |date=2022 |publisher=Indiana University Press |location=Bloomington (IN) |isbn=9780253063878}}</ref>
Moreover, the socioeconomic status influences the psychology of infertile couples: low socioeconomic status is associated with increased chances of developing depression.<ref name="Deka, P. K. 2010"/>
In many cultures, the inability to conceive bears a stigma. In closed social groups, a degree of rejection (or a sense of being rejected by the couple) may cause considerable anxiety and disappointment. Some respond by actively avoiding the issue altogether.<ref>{{cite journal | vauthors = Schmidt L, Christensen U, Holstein BE | title = The social epidemiology of coping with infertility | journal = Human Reproduction | volume = 20 | issue = 4 | pages = 1044–1052 | date = April 2005 | pmid = 15608029 | doi = 10.1093/humrep/deh687 | doi-access = free }}</ref>

In the United States, some treatments for infertility, including diagnostic tests, surgery, and [[therapy for depression]], can qualify one for [[Family and Medical Leave Act]] leave. It has been suggested that infertility be classified as a form of disability.<ref>{{cite journal | vauthors = Khetarpal A, Singh S | title = Infertility: Why can't we classify this inability as disability? | journal = The Australasian Medical Journal | volume = 5 | issue = 6 | pages = 334–339 | year = 2012 | pmid = 22848333 | pmc = 3395292 | doi = 10.4066/AMJ.2012.1290 }}</ref>

=== Sexual ===
Couples that suffer from infertility have a higher risk than other couples of developing sexual dysfunctions. The most common sexual issue facing the couples is a decline in sexual desire and erectile dysfunction.<ref>{{Cite journal |last1=Leeners |first1=Brigitte |last2=Tschudin |first2=Sibil |last3=Wischmann |first3=Tewes |last4=Kalaitzopoulos |first4=Dimitrios Rafail |date=2023-01-05 |title=Sexual dysfunction and disorders as a consequence of infertility: a systematic review and meta-analysis |url=https://academic.oup.com/humupd/article/29/1/95/6651121 |journal=Human Reproduction Update |language=en |volume=29 |issue=1 |pages=95–125 |doi=10.1093/humupd/dmac030 |pmid=35900268 |issn=1355-4786}}</ref>