Infertility

The conception of a child, often the “living” synthesis of the love between a man and a woman, is almost always lived by the couple as “only” an instinctive and biological process, thus forgetting that the motivation for parenthood is also pervaded by unconscious desires and cultural influences.
The wish for a child in a couple unable to conceive first brings them to a doctor looking for some help about the biological aspect of this problem. The doctor works to understand if the bodies are functioning correctly and wherever there is a physical disfunction he tries to treat it. But the human being is not only composed of a body, but also a mind. Body and psyche are inextricably linked and communicate secretly: whatever cannot be said with words is expressed through the body. The mix between somatic events and symbolic contents lasts throughout life. Emotions have a direct effect on the organic functions and vice versa.
We should therefore begin to reformulate the treatment regarding the difficulty of conception and its developments, going beyond the body-mind dichotomy. The treatment requires an integrated work on the individual as a whole, aimed at finding the “hidden” meaning of the symptom. Without the subject being aware, and without he being able to exercise any control, his body expresses itself by using a specific language. It enacts unthinkable emotions of the individual, his fears, anxieties, wishes, it tells his true story.
For each person, the conception of a child is a journey that requires time for emotional processing that might be long and complicated and not only at a conscious level. Proof of this are the surprise conceptions or unexplainable infertility. Let’s make some examples: how often the simple request to the doctor for help to conceive is sufficient in order to support and restart the natural fertilization?
How many times, once the couple has decided to start a process of assisted conception, the fertilization occurs naturally, just before the beginning of the treatment? How often, despite the fact that the doctor has found no particular physical problems in the couple, that conception seems impossible?
How often, once an infertile couple has decided to turn to adoption, at the moment the adopted baby arrives the woman discovers that she has remained pregnant naturally?
In reality, all these surprising events tell how the route for procreation is a path with ancient origins. In each member of the couple the idea of becoming a parent wakes up emotions, fears, fluctuating thoughts, conscious and unconscious, that exercise an influence on the reproduction functions of each.
Opposite sensations may suddenly arise in the mind of a person, taking him by surprise. This occurs because the mind of each individual is composed of a conscious and unconscious part. The term “unconscious” indicates that psychic dimension containing thoughts, emotions, instincts, representations, behavioural patterns, often at the basis of human action but of which the individual is absolutely unaware.
Ambivalence is present in the unconscious, that is the simultaneous co-existence of both desire and refusal with respect to the same object. The contents of the unconscious may appear in dreams, missed acts, distractions, physical symptoms, thus becoming pre-conscious material. The pre-conscious conveys the unconscious material towards conscious, so that it may be welcomed and elaborated.
Fertility resulting from the union between a man and a woman has also to do with “unconscious desire” specific for each of them, and not only with their intent to have a child. The wish for a baby is never a pure feeling but often ambivalent, that is “wanting” and “not wanting” at the same time. Both the desire to become a parent and the fear of revolution a child would permanently bring into their lives may co-exist in a man and/or in a woman.
It is one thing to be single, another to be a couple and another to be a family. From this silent ambivalence, often hidden, a gap between medical progress and the impossibility of becoming parents may arise.
Thinking about pregnancy therefore means coming to terms with the “genuine and deep” wish of each member of the couple, by suspending the use of contraceptives and letting the biological and unconscious forces play freely.
For a man and a woman, becoming parents means shutting down with their adolescent life and carrying out, with their first child, the evolution from one generation to the next, enrolling in their descendants.  This means representing both mother and father and together “parents” which entails feeling sufficiently adult to give birth and grow another human being who will totally depend on them for many years.
It  implies wondering if as an individual one has the emotional resources for this project and not only the physical ones.
Thinking of a child is a couple’s plan, formed exactly by those two people together. Being a common project, it joins different personalities, each with its own inner world and its own troubles. From the moment in which the parental thought begins to take shape in that particular couple, the individual elements which meet may determine generative difficulties.
In desiring a child, the bodies of the two partners are involved in different ways as conception, pregnancy and birth take place in the woman’s body. This biological difference leads to very different experiences in a man and a woman, also at a psychological level. From my experience of working on women with difficulties in becoming mothers, I believe today I can outline a few emotional issues, particularly delicate, that seem to be present in their psychological world.
I often felt that the femininity of these women was not sufficiently valued. The development of the female identity is a transmitted experience. The awareness and pleasure of belonging to the female sex is defined through subsequent phases. The first factor is the biological one that occurs through the recognition of the female genital features. This will start up a process of identity development, based on interactions and relational and cultural recognition that the child will previously receive in her family environment and then gradually in the outside world. The most important confirmation of femininity is then set out during puberty with the appearance of secondary sexual features, with the arrival of menstruation and with the subsequent recognition that occurs through friendship and love and finally with maternity.
For a woman, her identification with a positive feminine and maternal image is the basis for her maternity desire and the possibility to realize it.
The mother-daughter relationship is often lived as something natural, instinctive, but it is also the bearer of many complex dynamics. It evolves like a relational path of growth and exchange, starting with a total dependence of the daughter on the mother and gradually continuing with a progressive walk towards independence of the daughter under the maternal guide until reaching adulthood.
Precisely due to the depth and involvement of this bond in both the feminine figures, a few steps may be particularly “delicate”. Whilst the daughter is on her way to reach her femininity, accompanied by her mother, the latter is also facing with  her inevitable ageing process. A mother proud of her womanhood will know how to transmit to her baby those sensations of joy and pride to have given birth to a child of her own sex.
Even the paternal look valorizing the femininity of his daughter will be very important for the child and the girl afterwards, who will feel recognized and admired by her first man.
In the psychoanalytical work with women who have problems with fertility, I have often noticed either the lack of a reference maternal background or that the feminine “relationship” was blocked at an adolescence phase. Adolescence is a natural step during growth but complicated for all the parties involved. The daughter was still trapped in a relationship of anger with her mother. My patients seem to have remained teenagers at war with their mother-rival. This adolescent emotional condition did not allow, however, any further growth, continuity, the generational passage. My patients were not able to feel similar to their mothers, mothers from whom they were born.
In some ways, becoming a mother means being like one’s own mother.
On other occasions, in listening to the life of my patients, I felt hovering a sort of “castrating female rivalry”, a sort of maternal ban to procreate from which the patient does not seem to have the strength to escape. She remained at the mercy of same, without being able to emancipate or go any further.
Other times I felt a kind of “block” in women towards the possibility of conception that had to do with the unconscious transmission from mother to daughter of “tough experiences” regarding maternity. My patients manifested a series of fears tied to pregnancy, giving birth, postnatal depression, the fatigue of looking after a baby that their mother had experienced and clearly told  them and which they therefore expected to go through themselves. With some of my patients we faced the arousal of natural feelings of ambivalence, primarily provoked by the fear of a change of life, of responsibility and physical transformations that they felt they would have suffered rather than chosen.
Let’s now make a few considerations on the other partner of the couple, the man.
I have noticed that a procreative difficulty in a man, especially if subsequently confirmed by a medical diagnosis, often creates a “confusion” between sexual potency and the power to conceive, undermining the sense of male identity. Sometimes I have found that as a response to these feelings of impotence experienced as sexual inability, a man tries to confirm his masculinity outside the couple, far away from his companion-witness of his generative difficulties. Otherwise he may manifest moments of depression, anxiety and sleep disorders owing to his disappointment at not being able to satisfy the procreative desire of the couple.
In reality the male “symptom” in infertility acts as a photograph of a sense of self that is partially anesthetized, of an inability to put himself into contact with the discomfort in assuming the role of parenthood. The individual needs to translate into words his true experience in order not to short-circuit it to somatics. Uncomfortable thoughts, anchored in the deepest parts of the inner world of each person, memories which have been apparently forgotten, painful experiences, are expressed in the symptom of infertility.
Treatment of infertility is therefore to be reconsidered as a medical and psychological cure to be “built” ad hoc for that particular man and that particular woman, human beings each with their unique and unrepeatable history, facing their parental desire where the biological meets  the psychical. We must go back into the unique history of each woman and each man to understand the dynamics existing in the impossibility to conceive a child in order to be able to heal them, also through medicine, from the biological side.
A “psychosomatic” view of the individual, which is beginning to be accepted also by the medical class, traditionally organicist in their orientation, will in this way permit to integrate the cure with the emotional experiences of the couple who turns to the centres for medically assisted reproduction. The psychologist may face together with the couple the emotional resonance that the medical treatments may have on the single individual and the effects on the couple’s relationship of an event that should be natural and characterized by pleasure. The sharing of the emotional feelings that are  involved, characterizing a man and a woman in their different aspects, such as disappointment, impotence, shame, anger if accepted and thinkable will allow the couple to “sustain” and live this experience, welcoming it and elaborating it as one of the steps of their life together. An integrated work of the doctor and psychologist will allow a more complete treatment of the couple, increasing their possibilities to conceive both at a biological and psychological level.