The role of the psychiatrist in a reproductive biology clinic.

The psychiatrist consulting to an infertility clinic is confronted with a variety of clinical issues and problems. The couple arrives with anxiety, for a work-up that in itself will be traumatic. The psychiatrist's role is to weed out distortions and issues that are unreal. Psychosexual and marital conflicts may also masquerade as an infertility problem. The simplest manner in which psychologic factors can be thought of as causing infertility is through their effect on sexual performance. Brief therapeutic techniques include education, encouragement, and behavioral techniques to improve performance. Psychoanalytically oriented techniques include relating the symptom to unconscious conflicts stemming from the past and understanding the secondary gain of the symptom. The psychiatrist's role may also involve helping the couple to deal with the outcome of the infertility work-up, including helping the couple to mourn the fact that they cannot have children, assisting in decisions involving artificial insemination and adoption, and helping the couple to deal with uncertainty when no definite cause for the infertility has been discerned. The multiplicity of possible psychologic interventions requires the psychiatrist to be ubiquitous. In the light of this, a number of suggestions are listed as to how a psychiatrist might best be utilized.