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Infertility is a global health issue affecting approximately eight-ten per cent of couples. It is a multi-dimensional problem with social, economic and cultural implication and defined as the inability to achieve pregnancy after one year of unprotected intercourse. It may arise from genetic abnormalities, infections or environmental agents, delayed childbearing behaviour and certain diseases.
Among them endometriosis, the oestrogen-dependent disorder causes 25-40 per cent infertility in women and occur wide range of women fro pre-menarche to post-menopause and diagnosis have been made in women ranging from 12-80 years of age. It is defined as the presence of endometrial tissue outside the uterine cavity having multifaceted pathology. Its pathology involves various factors like genetic predisposition, menstrual and reproductive factors, lifestyle factors such as smoking, exercise and consumption of alcohol and caffeine. About a third of the time, infertility can be traced to the woman.
Many infertile women in developing countries consider that without children their lives are without hope. Our culture demands that for a woman to be socially accepted, she should have at least one biological child. Primary treatment involves removal or reduction of ectopic endometrial implants, restoration of normal anatomy, and hindrance of disease and alleviation of symptoms. Besides this, ART (Assisted Reproductive Technology), laparoscopic surgery has been also used for the management of endometriosis.
The high-tech reproductive technologies have associated psychological and ethical issues that must be addressed by the infertile couple. Infertility counselling and support services are the well organized psycho-social approach to infertility. Psychosocial issues should be discussed by a physician with the couples in every visit. Information material about the centre, procedural information, booklets or educational videos is provided.
Presence at support groups will build up coping abilities. Psychotherapy and psychosocial counselling are effective in minimizing negative outcome, clarifying life goals, the context for support, advice and guidance will help live more satisfied and resourcefully (British council of Association of Infertility Counseling, 1999). The list of various counselling techniques are;
- diversion by physical and mental activities,
- improve problem-solving skill,
- encourage health defence mechanism,
- reinforcement, and
- change of attitude and lifestyle.
If treatment has been unsuccessful, couples are faced with the decision to either continue treatments or make other choices. Choices include adoption and choosing to live childfree. All of these options are difficult decisions. The early intervention and meeting with a specialist, an infertile person will find answers and be able to realize your dream of having a child.
Written by: Dr Sandhya, Sr.Resident, Dept.of Prasuti & Strirog, Institute of Medical Sciences, Banaras Hindu University, and, Dr.O.P.Singh, Asst. Professor (Occupational Therapy/ Physiotherapy), Dept. of Orthopaedics, IMS, BHU.