The couple facing the issue of infertility.
Today, as we know, couples facing fertility problems are quickly directed to IVF.
However, other options are available, which provide a radically different approach, from the point of view of carers as well as from the point of view of the couple.
I Accompanying couples, a radically different medical approach: It means first, moving from a fertility stimulation to a restoration approach, and second, to respectfully listen to the couple.
1 A fertility restoration approach: For this, as a NPT practitioner, the aim is to teach the woman how to observe in order to allow the couple to identify the fertile period and provide the doctor a « fertility chart », a diagnostic aid. The practitioner provides help to the couple and the physician, to optimize the chances of conception, at 3 levels: identification of the fertile period, making visible the treatment in the chart and especially a diagnostic aid.
1) Helping the couple to identify the days of higher fertility: with "Peak type" mucus: transparent, stretchy (more than 2.5 cm), and / or gives the sensation of lubrication. White stamps + description
2) Making visible treatments, which allow the doctor, at a glance to check that they are well taken, when, and for how long.
3) And especially: to provide the physician with a diagnostic aid by highlighting certain malfunctions: 2 clinical cases
First clinical case: repeated episodes of mucus: Client 030037 n° 2, first cycle: sign of a dysovulation, or even polycystic ovaries.
Second clinical case: a dry cycle, Client 030054, women 40 years old, husband 30 years old. Two possibilities: an ovulation problem or a cervical problem. One can associate the sign of the temperature to confirm or not the existence of ovulation. Here, the temperature graph shows a significant thermal shift. So ovulation is likely and the absence of mucus orients towards an abnormal cervix.
Abnormal bleeding, changes in the duration of the post ovulatory period, menstrual flow , painful menstruation and premenstrual symptoms : irritability, breast tension, bloating, headaches , depression, are also shown in the fertility chart also shows
2 With NPT, a respectful listening of the couple
Respect for people: some complain that in their previous consultations they have not been listened to but have been pressured to go in one direction, usually IVF..
Respect for the couple's relationship: In NPT, there is no third party in the intimate relationship. The child is exclusively the fruit of the conjugal relationship. For testing (semen analysis), couples are also advised to collect samples at home during sexual intercourse.
Respect for ethical choices, including respect for human life since its beginning. Couples often tell us: "A child , yes, but not at any price ... "
Respecting the couple’s rhythm. The desire for efficiency is legitimate: the aim it is to be effective in helping the patient. But there may be the risk of obscuring the good of the couple itself. The aim is to accompany the couple, and not to have for them at all costs a project of a pregnancy. It is common to be thanked, even if a child is not conceived: the couple felt listened to, respected, and often ends its follow-up with details of what hinders pregnancy, both at a medical and a psychological level. We witness couples saying that it is important for them to take this step to build their life together, " with or without children.”
It is important to note that in the NPT process, the first approach is medical. This is fundamental. Couples consult a physician either before, either shortly after the first contact with the instructor, which reassures them because it seems concrete. This is what allows the couple to be listened to without restraint. Thus, the work of a marriage counsellor, which is also a NPT practitioner, can take its entire place for a comprehensive listening. If the couple was told that a comprehensive listening would be offered to them, to reflect about what is happening to them, they might have been afraid or reluctant.
But it is nonetheless at this condition that the couple will have the opportunity to enter a different approach, not only in terms of accompanying persons (see § I) , but also from the point of view of its own behaviour and progress ( § II).
II A different approach for the couple
1 Being "actors" instead of "consumers" or "victims"
- In NPT, the couple is the pilot, because he is the one who brings the information by keeping the fertility chart. These information are helpful for the diagnosis and the identification of the ideal time for an eventual treatment.
Client 030031, married for 4 ½ years at the beginning of the follow up, aged 29 and 31 years. Both are physicians and the couple uses the sympto-thermal method. The woman has a difficulty to identify the right moment to take progesterone that she self- prescribed for several years without success. 3rd cycle: Observation of a very clear mucus discharge between day 11 ( = 11th day of the cycle) and day 18 included. The couple uses days 12, 18 and 15 for intercourse. The NPT trained doctor recommends taking progesterone starting on day 21 (Peak + 3). The couple conceives. Couple’s testimony: " When we consulted with NPT, we where trying to have a child for nearly four years. A gynaecologist had followed us, but we did not feel sufficiently understood in our choices (respect for life conceived within a relationship between a man and a woman) and therefore did not feel confident enough. We had begun the process of adopting a child.... We felt listened by the doctor and the Fertilycare practitioner. The follow-ups gave us confidence. The approach empowered us to face our fertility problem. The women’s observations demanded discipline, but have allowed us to take the treatment at the right time. Maïlys was born April 17, 2013 "
- On the other hand, thanks to this support by being listened, the couple has the opportunity to reflect on what is happening instead of remaining in a status of victim of the infertility, which could prevent it from moving forward. For example, a couple became aware of a great ambivalence, after losing a child at 4 months of pregnancy and not have been able to mourn. Hence the strong ambivalence of the women between " I want a child " and " I'm afraid to go through that again." The NPT follow-up could not be implemented properly. Motivation was too fluctuant. Listening the couple highlighted the need to first establish a follow up of a psychotherapeutic kind to examine this ambivalence.
Listening to the couple allows also the emergence of an eventual deep desire different from having a child, yet clearly expressed. Example of a woman who, after a few sessions, said: "But I 'm not obliged to have a child! " Thus highlighting the family and social pressure to which she was subject. Her desire to be a mother did not seem so obvious anymore. In fact, the couple dropped out quickly.
- Other questions are thus made possible: the vocation of my marriage may lie in another type of fecundity? How do we live de desire to have a child: as something we are entitled to? Or as a possible welcoming of life?
The accompanying person needs to be very careful. To both allow for these questions to arise and to resist the temptation to provide that could explanations which could be experienced by the couple as a denial or a minimization of their suffering or as a lack of respect for their inner pathway. The risk is that these couples, in addition to their suffering for being childless, are regarded as not having the "right" behaviour, the "right" questions regarding to their fertility problem. Supporting the reflection of the couple, yes, but not to precede them in their awareness, while making it possible.
2 An opportunity to take care of the couple and broaden the scope of research for potential barriers to fertility.
Taking care of the couple: The follow ups included in the NPT protocol offer couples a place to tell their suffering and to interact as a couple. Many of them tell us the importance of having this possibility and how it is valuable to them, for their relationship.
Indeed, Man and woman doe not have the same way to deal with this suffering. This difference in response is often a source of misunderstanding and the fact of expressing it is very liberating for each spouse. This is a source of reconciliation for them. The aim is that the difficulty of having a child does not add to the suffering of a disagreement within the couple.
Furthermore, listening by a marital counsellor allows expanding the field of investigation of the causes of infertility, by highlighting problematic psychological field. For a couple, the fertility table does not reveal anything. Neither for her husband. The woman has been on antidepressants for several years. It emerges that this couple, very generous, makes itself available to all. They have a lot of demands, because they don’t have children. Consequently, they have no free time together, no weekends or holidays or pleasures, only voluntary actions. The man, very invested in his work (perhaps lived as a refuge?), gradually becomes aware of the suffering of his wife who aspires to have time together. They set up time together to relax. The medical doctor trained in NPT supports them: antidepressants are lowered. The woman is transformed. From secret and introvert, she turns into a young smiling open woman. It is spectacular. However, they decided to stop their follow up with NPT. In fact, she realized through these interviews, there was in it a psychological barrier against motherhood. She did not say more but they stopped so that she could take the time to examine it. The comment of the husband when they announced they would stop monitoring temporarily was: "Yes we do not have children yet , but when I see how my wife is today I say thank you ! ".
In other cases, there is a problem with the couple.
Case 1: Client 03004: 36 and 39 years old, married for 12 years: the first child came naturally, the second by IVF. They consult to have a third one. The woman says how badly she lives the fact that the previous was born through IVF. The chart shows dry cycles, with slight changes in the observation (from days 23 to 26, line 2), which locate the mucus discharge for a possible treatment. But the couple will never go into medical treatment. No intercourse is charted during the fertile period (usually noted “I”). And we observe the lack of motivation on the chart: charting errors, abandoning some notations. The woman says: "I alone cannot do it" and decides to stop. There was a lack of spousal support.
Client 030054 (already quoted) 40 and 30 years, married for 10 years: there is a problem with intercourse. No pleasure for her. Intercourse lasts 5 min. How can I desire a child if I am not happy in my marriage, if I "undergo" intercourse? In fact, reports (noted I) occur exclusively in the days they assume to be the most fertile: days 12 to 16. Couple’s therapy is proposed to them.
Conclusion: Listening to couples can unveil potential blocking factors other than physiological infertility, such as the existence of psychological difficulties of a spouse or a problem within the couple, and can lead to counsel investigations in these directions to allow the NPT process of restoring fertility to give all its fruits.
Above all, to combine the NPT approach and listening offers these couples a real opportunity to change, in the treatment of their infertility as well as in the way they look they look at it. In that there is a true opportunity for the couple to get fully involved in the process and to initiate or to continue the search for their own vocation. .