Managing Psychological Trauma of Infertility

Abiola O. Aiyenigba, Andrew D. Weeks, Atif Rahman


The psychological burdens that patients experience while undergoing treatment for infertility in both men and women are well known and documented, especially within African populations. There are not many tested practical solutions to the problem, and clinical personnel have little time for personal counselling. This article described the development and delivery of an intervention designed to manage the psychological trauma that patients experience while dealing with infertility in resource poor settings. The Fertility Life Counselling Aid (FELICIA) has been developed to manage thepsychological morbidity associated with infertility using cognitive behavioural therapy (CBT) based strategies. FELICIA provides a structured step by step guide to infertility counselling and is designed to be used by general community or hospital health workers rather than specialist psychologists or psychiatrists. This should make it a cost-effective option to deliver holistic care to patients treated for infertility, especially in
resource poor settings. (Afr J Reprod Health 2019; 23[2]: 76-91).

Full Text:



Zegers-Hochschild F, Adamson D, de Mouzon, J, Ishihara, O, Mansour, R, Nygren, K, Sullivan E and van der Poel S. The international committee for monitoring assisted reproductive technology (ICMART) and the World Health Organization

(WHO) revised glossary on ART terminology. Hum Reprod. 2009; 24:2683-2687

World Health Organization. WHO Laboratory Manual

for the Examination of Human Semen and Spermcervical Mucus Interaction, 3rd edn. Cambridge: Cambridge University Press, 1992: 107

Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel

S and Stevens GA. National, Regional, and Global

Trends in Infertility Prevalence since 1990: A Systematic Analysis of 277 Health Surveys. PLoS Med 2010; 9(12): e1001356. doi: 10.1371/journal.pmed.1001356

Okonofua FE, Harris D, Odebiyi, A, Kane T and Snow

RC. The social meaning of infertility in Southwest

Nigeria. Health Transition Review 1997; 7: 205-220

Rouchou B. Consequences of infertility in developing

countries. Perspect Public Health. 2013; Jan 17

Cui W. Mother or nothing: the agony of infertility.

Bulletin of the World Health Organization 2010;

(12) : 877-953

Wu AK, Elliott P, Katz PP and Smith JF. Time costs of

fertility care: the hidden hardship of building a

family. Fertil Steril 2013; 99: 2025–2030

Dutney A. Religion, infertility and assisted reproductive

technology. Best Practice & Research Clinical

Obstetrics and Gynaecology 2006; 21(1):169-180

Berg BJ, Wilson JF and Weingartner PJ. Psychological

sequelae of infertility treatment: the role of gender

and sex role identification Social Science &

Medicine 1991; 33: 1071-1080.

Hammarberg K and Kirkman L. Infertility in resource-constrained settings: moving towards amelioration.

Reproductive BioMedicine Online 2013; 26: 189–

Ardabily HE, Moghadam ZB, Salsali M, Ramezanzadeh

F and Nedjat S. Prevalence and risk factors for

domestic violence against infertile women in an

Iranian setting. International Journal of

Gynaecology and Obstetrics 2011; 112: 15–17

Antai JB and Antai DE. Attitudes of women toward

intimate partner violence: a study of rural women in

Nigeria. Rural and Remote Health (Online) 2008;


Castro R, Casique I and Brindis CD. Empowerment and

Physical Violence throughout Women's

Reproductive Life in Mexico. Violence Against

Women 2008; 14: 655

Araoye MO. Epidemiology of Infertility: social problems

of infertile couples. WAJM 2003; 22(2): 191-196

Larsen U. Primary and Secondary Infertility in subSahara Africa. International Journal of

Epidemiology 2000; 29:285-291

Gerais AS and Rushwan H. Infertility in Africa. Popul

Sci. 1992; 12:25-46

Facchinetti F, Tarabusi M and Volpe A. Cognitivebehavioural treatment decreases cardiovascular and

neuroendocrine reaction to stress in women waiting

for assisted reproduction.

Psychoneuroendocrinology 2004; 29: 162–173

Van den Broeck U, Emery M, Wischmann T and Thorn

P. Counselling in infertility: Individual, couple and

group interventions. Patient Education and

Counselling 2010; 81:422–428

Dyer SJ, Abrahams N, Hoffman M and Van der Spuy

ZM. Infertility in South Africa: women's

reproductive health knowledge and treatment-seeking behaviour for involuntary childlessness.

Human Reproduction 2002; 17(6):1657-1662

Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I

and Petticrew M. Developing and evaluating

complex interventions: The new Medical Research

Council guidance. BMJ. 2008; 337:a1655

Aiyenigba, AO. Fertility Life Counselling Aid

(FELICIA) - A CBT based counselling manual.

Figshare 2018. Paper.

Hollos M, Larsen, U, Obono O and Whitehouse B. The

problem of infertility in high fertility populations:

meanings, consequences and coping mechanisms in

two Nigerian communities. Soc. Sci. Med. 2009;

: 2061–2068

Fledderjohann, JJ. ‗Zero is not good for me‘:

implications of infertility in Ghana. Hum. Reprod.

; 27:1383–1390

Donkor ES and Sandall J. The impact of perceived

stigma and mediating social factors on infertilityrelated stress among women seeking infertility

treatment in Southern Ghana. Social Science &

Medicine 2007, 65:1683-1694

Roudsari RL and Allan HT. Women‘s Experiences and

Preferences in Relation to Infertility Counselling: A

Multifaith Dialogue. International Journal of

Fertility and Sterility 2011; 5(3): 158-167

Bokaie M, Simbar M, Ardekani SM and Majd HA.

Women‘s beliefs about infertility and sexual

behaviours: A qualitative study. Iranian J Nursing

Midwifery Res 2016; 21:379-384.

Agbontaen-Eghafona KA and Ofovwe CE. Infertility in

Nigeria: A Risk Factor for Gender Based Violence.

Gender & Behavior 2009; 7 (2): 2326-2344

Oladokun A, Arulogun O, Oladokun R, Morhason-Bello

I, Bamgboye E, Adewole I and Ojengbede OA.

Acceptability of child adoption as management

option for infertility in Nigeria: Evidence from

focus group discussions. Afr J Reprod Health. 2009;

(1): 79-91

Domar AD, Clapp D, Slawsky EA, Dusek J, Kessel B

and Freizinger M. Impact of group psychological

interventions on pregnancy rates in infertile women.

Fertil Steril 2000; 73(4):805—811

Mabasa, LF. Stigma, community support and therapy

methods of infertility in South Africa: A cultural

perspective. In: S. N. Madu., P.K. Baguma and A.

Pritz. Psychotherapy and African reality

Pietersburg: UNIN Press.2001; 62-71

Lee TY, Sun GH and Chao SC. The effect of an

infertility diagnosis on the distress, marital and

sexual satisfaction between husbands and wives in

Taiwan. Hum Reprod. 2001; 16(8):1762-1767.

Upton RL. 'Infertility Makes You Invisible': Gender,

Health and the Negotiation of Fertility in Northern

Botswana. Journal of Southern African Studies

; 27(2): 349-362

Van Balen F and Inhorn MC. ―Introduction: Interpreting

Infertility: A View from the Social Sciences.‖

Infertility around the Globe: New Thinking on

Childlessness, Gender, and Reproductive

Technologies, University of California Press,

Berkeley; Los Angeles; London, 2002; 3–32.


Chen TH, Chang SP, Tsai CF and Juang KD. Prevalence

of depressive and anxiety disorders in an assisted

reproductive technique clinic. Hum Reprod, 2004;

(10): 2313-2318

Dutton DG and Nicholls TL. The gender paradigm in

domestic violence research and theory: Part 1- The

conflict of theory and data. Aggression and Violent

Behavior 2005;10: 680 – 714

Ameh N, Kene TS, Onuh SO and Okohue JE. Burden of

domestic violence amongst infertile women

attending infertility clinics in Nigeria. Nig J Med

; 16: 375−377

Oladokun A, Arulogun O, Oladokun R, Morhason-Bello

I, Bamgboye E, Adewole I and Ojengbede OA.

Acceptability of child adoption as management

option for infertility in Nigeria: Evidence from

focus group discussions. Afr J Reprod Health. 2009;

(1): 79-91

Weinger S. Infertile Cameroonian women: Social

marginalization and coping strategies. Qualitative

Social Work 2009; 8(1):45–64

Nieuwenhuis SL, Odukogbe AT, Theobald S and Liu X.

The Impact of Infertility on Infertile Men and

Women in Ibadan, Oyo State, Nigeria: A

Qualitative Study. Afr J Reprod Health 2009; 13


Dhont N, van de Wijgert J, Coene G, Gasarabwe A and

Temmerman M. ‗Mama and papa nothing‘: Living

with infertility among an urban population in

Kigali, Rwanda. Human Reproduction 2011; 26(3):


Galhardo A, Cunha M and Pinto-Gouveia J.

Psychological aspects in couples with infertility.

Sexologies 2011; 20:224—228

Ogawa M, Takamatsu K and Horiguchi K. Evaluation of

factors associated with the anxiety and depression

of female infertility patients. BioPsychoSocial

Medicine 2011; 5:15

Omosun AO and Kofoworola O. Knowledge, attitude

and practice towards child adoption amongst

women attending clinics in Lagos State, Nigeria.

Afr. J. Prm. Health Care Fam. Med 2011; 3(1):259

Adesiyun AG, Ameh N, Bawa U, Adamu H and

Kolawole A. Calabash Pregnancy: A Malingering

Response to Infertility Complicated by Domestic

Violence. West Indian Med J 2012; 61 (2): 198

Yusuf AJ, Maitama HY, Amedua MA., Ahmed M and

Mbibu HN. Socio-demographic correlates of

psychological distress among male patients with

infertility in Zaria, Nigeria. African Journal of

Urology 2012; 18:170–174

El Kissi Y, Romdhane A.B, Hidar S, Bannour S, Ayoubi

Idrissi K, Khairi H and Ben Hadj Ali B. General

psychopathology, anxiety, depression and self-esteem in couples undergoing infertility treatment: a

comparative study between men and women.

Reproductive Biology 2013; 167:185–189

Abarikwu SO. Causes and risk factors for male-factor

infertility in Nigeria: a review. Afr J Reprod Health


Momoh AR, Idonije BO, Nwoke EO, Osifo UC, Okhai

O, Omoroguiwa A and Momoh AA. Pathogenic

bacteria-a probable cause of primary infertility

among couples in Ekpoma. J Microbiol Biotech

Res. 2011;1:66–71

Cape J, Whittington C, Buszewicz M, Wallace P and

Underwood L. Brief psychological therapies for

anxiety and depression in primary care: Metaanalysis and meta-regression. BMC Med. 2010;


Hunot V, Churchill R, Silva de Lima M and Teixeira V.

Psychological therapies for generalised anxiety

disorder. Cochrane Database Syst Rev. 2007;(


Sykes CF and Marks DF. Effectiveness of a cognitive

behaviour therapy self-help programme for smokers

in London, UK. Health Promot Int. 2001;16(3):255-

Fossati M, Amati F, Painot D, Reiner M, Haenni C and

Golay A. Cognitive-behavioral therapy with

simultaneous nutritional and physical activity

education in obese patients with binge eating

disorder. Eat Weight Disord 2004; 9: 134.

Sikander S, Lazarus A, Bangash O, Fuhr DC, Weobong

B, Krishna RN, Ahmad I, Weiss HA, Price L,

Rahman A and Patel V. The effectiveness and costeffectiveness of the peer-delivered Thinking

Healthy Programme for perinatal depression in

Pakistan and India: the SHARE study protocol for

randomised controlled trials. Trials 2015; 16:534

Sikander S, Maselko J, Zafar S, Haq Z, Ahmad I, Ahmad

M, Hafeez A and Rahman A. Cognitive-behavioural

counselling for exclusive breastfeeding in rural

pediatrics: a cluster RCT. Pediatrics 2015; 135(2):


Blenkiron P. Stories and analogies in CBT: a clinical

review. Behavioural & Cognitive Psychotherapy

; 33: 45-59

National Institute for Health and Clinical Excellence

(NICE). Depression and Anxiety – Computerised

Cognitive Behavioural Therapy for Depression and

Anxiety. NICE, 2006.

National Collaborating Centre for Mental Health.

Schizophrenia: core interventions in the treatment

and management of schizophrenia in primary and

secondary care (update), National Institute for

Health and Clinical Excellence, London (2009)

Rupke SJ, Blecke D and Renfrow M. Cognitive Therapy

for Depression. Am Fam Physician. 2006; 73: 83-86

O‘Hanlan KA. Health policy considerations for our

sexual minority patients. Obstetrics & Gynecology

; 107(3):709–714

World Health Organization. Thinking Healthy: A

Manual for Psychosocial Management of Perinatal

Depression. WHO generic field-trial version 1.0,


World Health Organization. mhGAP Intervention guide

for mental, neurological and substance use disorders

in non-specialized health settings: Mental Health

Gap Action Programme (mhGAP) version 2.0.

World Health Organization 2016.

World Health Organization. Mental Health Gap Action

Programme (mhGAP): scaling up care for mental,

neurological, and substance use disorders. Geneva:

WHO; 2008

Dua T, Barbui C, Clark N, Fleischmann A, Poznyak V,

van Ommeren M, Yasamy MT et al. Evidencebased guidelines for mental, neurological, and

substance use disorders in low- and middle-income

countries: summary of WHO recommendations.

PLoS Med. 2011; 8:e1001122

Bloch S. Assessment of patients for psychotherapy. The

British Journal of Psychiatry 1979; 135 (3) 193-208

Richardson L and Puskar K. Screening Assessment for

Anxiety and Depression in Primary Care. Journal

for Nurse Practitioners 2012; 8(6), 475-481

Theron L, Cockcroft K and Wood L. The resilience-enabling value of African folktales: The read-me-toresilience intervention. School Psychology

International 2017; 38(5): 491–506

Gbadegesin S. "Destiny, personality and the ultimate

reality of human existence." Ultimate Reality and

Meaning 1984; 7(3): 173-188

Chinyowa, K. "The Sarungano and Shona Storytelling:

an African Theatrical Paradigm." Studies in Theatre

and Performance 2001; 21(1): 18-30

Otto MW. Stories and metaphors in cognitive-behavior

therapy. Cognitive and Behavioral Practice 2000;

(2): 166-172

Stangor C. Principles of social psychology 2014.

Irvington, NY: Flat World Knowledge

Chang LW. Task Shifting: A Solution for the Health

Worker Human Resource Crisis? Medscape 2009

World Health Organization. Taking stock: Health

worker shortages and the response to AIDS.

Geneva, World Health Organization, 2006


World Health Organization. HIV/AIDS Programme:

Strengthening health services to fight HIV/AIDS.

Task shifting to tackle health worker shortages.

WHO publication 2007.


Woodward JO. Ayur Veda- An approach to holistic

health care in the 21st century. The International

Journal of Humanities and Peace, 1993-1994

Chan TW. On Alternative Medicine, Complementary

Medicine and Patient-Centred Care. Asian

Bioethics Review 2012; 4(2): 132-134

Sanjeev R. Towards Patient Centred Care. Asian

Bioethics Review 2012; 4(2): 127-131


  • There are currently no refbacks.