BASI PSICOGENE DELLE STERILITA’ MASCHILI [modalità ... and Male Infertility - Rome 24 October...

BASI PSICOGENE DELLEBASI PSICOGENE DELLE STERILITA’ MASCHILI

Emilio MordiniCentro per la Scienza la Società e la CittadinanzaCentro per la Scienza, la Società e la [email protected]

Psychology and Infertilityg

Historically, infertility,Historically, infertility, particularly "functional" infertility, was attributed to abnormal psychological functioning on the part of one or both members of the couple. P li i k i thPreliminary works in the 1940s and 1950s considered "psychogenic infertility" as the majorinfertility" as the major cause of failure to conceive in as many as 50% of cases50% of cases.

Emilio Mordini Centre for Science, Society and Citizenship 2

Psychogenic infertilityg

A tl th l t 1960 it l b li d th tAs recently as the late 1960s, it was commonly believed that reproductive failure was the result of psychological and

emotional factors. Psychogenic infertility was supposed to occur because of unconscious anxiety about sexual feelingsbecause of unconscious anxiety about sexual feelings,

ambivalence toward parenthood, unresolved Oedipal conflict, or conflicts of gender identity.


Stress and Infertility

The concept of “stress” has often been the simplest way t t bli h l ti hito establish a relationship between psychological functions and infertility thusfunctions and infertility, thus burdening the couple with the conviction that theirthe conviction that their mental stress may be responsible for theirresponsible for their infertility.


Stress and infertility

Actually the relationship between stress andbetween stress and infertility is still poorly understood. While there is littl d bt th t i f tilitlittle doubt that infertility causes considerable stress, the question whether stress can cause infertility, and whether stress reduction can enhance pregnancy rates in infertile couples, is still very controversialvery controversial.


Idiopathic Male Infertility

In 30 to 50% of male infertility cases (if we include cases with no sperm improvement after varicocele repair or prostatitis treatment) noprostatitis treatment) no aetiology can be identifiedto explain abnormal semen

i f tilit Ab litior infertility. Abnormalities of all semen parameters are usually observed.usually observed.


Idiopathic does not mean psychogenicg

Many of the patients have anMany of the patients have an idiopathic infertility. Our diagnostic possibilities are unfortunately not good y genough to define every factor contributing to infertility and to find a clear diagnosis in every casediagnosis in every case.

Psychogenic infertility cannot be assumed even after other factors are excluded, itother factors are excluded, it must be diagnosed in a positive way. Not everything we cannot explain has psychological rootspsychological roots.


Stress and Male Infertility

Stress can reduce sperm counts. Testicular biopsies obtained from prisonersobtained from prisoners awaiting execution, and war prisoners, who were obviously under extreme stress, revealed complete spermatogenetic arrest inspermatogenetic arrest in all cases (Walker,1978; Carenza et al.,1979; Urry,1977; S )Sandler,1968; Mc Fall,1979).


Stress and Male Infertility

The stress due to the loss of aThe stress due to the loss of a close parent or due to earthquake (and ironically enough stress due to IVFenough stress due to IVF procedure) could decrease slightly semen quality (Hum Rep 14:753,1999 and 11:1244,1996; , , ;Fenster, J Androl 18:194,1997). In addition to this direct effects, stress can also suppress libido, cause erectile dysfunction, and result in a reduction in the frequency of intercourse, which in turn could also reduce fertility.


However…

Infertile men do not present aInfertile men do not present a special psychopathological profile and compared to a control group of fertile men th d t tthey do not present differences in personality profile and coping strategies (Golombok Humstrategies (Golombok, Hum Rep 7:208,1992). No sperm alteration has been observed in male marathon obse ed a e a at orunners and in depressed patients (Jensen, F St 64:1189,1995; Amsterdam Psychosom Med 43:183 1981)Psychosom Med 43:183,1981).


The vicious circle

The relationship between stress and infertility is actually the typical chicken

d bland egg problem. Stress and infertility can aggravate eachcan aggravate each other, setting up a vicious circlevicious circle.


Psychotherapy of Male Infertility

Some psychotherapeutic approaches suggest that

iaccompanying psychotherapy increases pregnancy rates. There is, however, no real evidence for this.


Can the concept of stress be really helpful?

In everyday life we experience many situations as stressful. Concepts of stress may be understood only individually. The allocation of the causes to 'too much stress' and the use ofallocation of the causes to too much stress and the use of adjectives like 'psychogenic' are not very helpful.


Idiopathic anejaculation

Idiopathic anejaculation is a relativelyIdiopathic anejaculation is a relatively rare cause of sexual dysfunction that usually presents as an infertility problem When suchinfertility problem. When such patients have nocturnal emissions the problem is usually considered psychogenic and referral is madepsychogenic and referral is made to a psychiatrist. Various treatments for this condition have been described includingbeen described including psychotherapy, sexual, marital and behavioral therapy, vibratory stimulation of the penis and ppharmacotherapy (Stewart D,1989; Hovav Y et al. 1999).


A clinical case


Song of Solomon (V, 2-8)g

I slept but my heart was awake. Listen! My lover is knocking: "Open to me, my sister, my darling, my dove, my flawless one. My head is drenched with dew

I opened for my lover, but my lover had left; he was gone. My heart sank at his departure.I looked for him but did not find himMy head is drenched with dew,

my hair with the dampness of the night."

I have taken off my robe-

I looked for him but did not find him. I called him but he did not answer.

The watchmen found me th d th i d i th

ymust I put it on again? I have washed my feet-must I soil them again?

My lover thrust his hand through the

as they made their rounds in the city. They beat me, they bruised me; they took away my cloak,

My lover thrust his hand through the latch-opening; my heart began to pound for him.

I arose to open for my lover,

those watchmen of the walls!

O daughters of Jerusalem, I charge you-if you find my lover, p y ,

and my hands dripped with myrrh, my fingers with flowing myrrh, on the handles of the lock.

y y ,what will you tell him? Tell him I am faint with love.


Conclusions

Don’t look for psychological causes but

Try to understand meaningsTry to understand meanings


CSSCCentre for Science Society and CitizenshipCentre for Science, Society and Citizenship

Centro per la Scienza la Società e la CittadinanzaVia Sistina 37 – 00187 Rome – Italy

Tel +39 064740144 Fax: 0697840359

Email: [email protected] url: www.bioethics.itEmail: [email protected] url: www.bioethics.it


BASI PSICOGENE DELLE STERILITA’ MASCHILI [modalità ... and Male Infertility - Rome 24 October...

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