Infertility and assisted reproduction.

The inability to have children is a considerable cause of human distress. There is little evidence to suggest that the vast majority of infertile couples differ in their premorbid psychological make-up from their fertile contemporaries. There is understandable grief in response to their loss of the ability to have children and in vulnerable people this may be profound. There is little known of the long-term outcome of such couples, but it seems likely that for some it will be a devastating experience that will affect their life-time mental health. There are a large proportion of couples with unexplained infertility, but there is little evidence that this diagnosis is particularly associated with psychological factors, although research continues into possible links between stress and hormones that affect the reproductive system, such as prolactin. Artificial insemination and IVF have particular problems, not only due to conception occurring out of normal sexual intercourse. In artificial insemination using donor sperm the problems of a genetically different father has similarities with the debate about egg donation for IVF. These technical procedures are undoubtedly stressful but generally, as for other treatments, if they are successful the rewards appear to outweigh any misgivings of the couples involved. There is a need for further research as to whether psychological factors are causative in infertility as the absence of any link might indeed be reassuring to couples. We would also benefit from knowing the long-term outcome of couples for whom treatment is not successful.