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不同于许多其他疾患，不育不使人残疾，通常也不引起生理上的疼痛或不使适。早期，不育病人求医问药的原因是满足心理上的需求-----通常是喂养另一个人类或是延续家庭。

不幸运的是，临床上不育的治疗主要着重于治疗病人生理上的异常，以致忽略了他们潜在的生理上的需求。做完了三年的不育治疗，我幸运的成为体外受精技术的获益者之一。然而，当我和丈夫开始不育治疗时，我以为我们的希望是很渺茫的。幸运地，我们没有很多经济上地牺牲。而许多其他人就不一样了。

因此，一开始就评估病人的医疗条件，尝试了解病人的心理需求，预算，计划组成家庭的时间是比较明智的。用这种方法，将这些因素考虑到医学诊断和治疗预后中去，能够更好的满足病人夫妇的需要。

这样的方法有许多益处。一开始，如果治疗的计划不同于病人夫妇的需求，他们就可以避免在不育治疗中投入大量的金钱和感情。成功可以更好的被实现，如果病人夫妇只是满足养育人类的感情需求，而不是生下一个活产婴儿。

当然，许多病人没有“这个”或“那个”的选择。在治疗过程中采取的一些医疗措施可以规律的监测治疗进度。如果这样的话，病人夫妇就很可能避免为渺茫的目标耗费不断增长的费用和内心的宁静甚至夫妇间的关系。不育咨询师的意见是非常宝贵的，可以帮助你决定开始收养、看护、启蒙等一系列非医学计划。还可以帮助你解决不育治疗带来的一些感情上或夫妇关系上的问题。

不幸的是，许多澳大利亚人羞于求助于心理服务。我自己，在没有去心理咨询之前我一直处于流产的心灵创伤中。从那以后，我就知道心理咨询会对心理健康产生积极的影响。

也有一部分是因为社会背景和费用问题，不育诊所并不是很积极的开展心理咨询服务。

但是，目睹专业队伍的成功----咨询师提供建议，病人夫妇共享他们的经验，一个无压力环境的营造，我相信这样的咨询服务是使得不育治疗成功的潜在手段。另外一个正确的方向就是将心理状况考虑进治疗周期中的方方面面。

例如，咨询医生能够帮助病人指定标准的通信格式----就象每日更新一样，从胎动图中提供给病人胚胎的情况----也是估计病人敏感性的一个方法。

然而，理想情况下，咨询师应该是所有寻求不育治疗病人第一个接触到的人。这样，所有治疗计划就都是考虑了感情需求和非医学解决方法之后决定的。

咨询师也应当在治疗的整个过程中提供咨询--提供感情和心理的支持，在关键决定上提供辅助意见，在选择上提供帮助。最后，他们对于病人情况的熟悉，咨询师是病人和病人之间，以及病人和卫生保健小组其他成员之间互相联系的平台。

关于费用，我想要申明的是，在不育治疗过程中加入心理咨询服务，能够将医护人员从一些咨询师能做的更好的工作中解放出来，而提供一些群体咨询会，治疗的费用并不会增加很多。无论如何，诊所提供的整体服务能吸引更多的病人，从而增加收入。

不育治疗需立足于改善病人保健，提高病人的满意度。在更好的满足病人的心理需求方面做努力，这些目标都能达到，还能使得生育力更进一步。

Anne Fox（化名）是悉尼的一位接受了三年不育治疗的43岁的职业女性。她现在怀上她的第一个孩子已经14周了。

Fertility treatment must factor in emotional needs
CASE NOTES: PATIENT PERSPECTIVE
Anne Fox
January 13, 2007

UNLIKE most medical conditions, infertility does not incapacitate, nor does it usually cause physical pain or suffering. Rather, the reason most patients seek fertility treatment is to satisfy an emotional need – usually to nurture another human being or perpetuate the family line.
It is unfortunate then, that fertility clinics focus so heavily on the treatment of their patients' physical disorders at the expense of addressing their underlying psychological needs. Having recently completed three years of fertility treatment, I am one of the lucky ones to have benefited from IVF. However, when my husband and I began treatment, we knew that our chances of success were slim. Luckily, we didn't have to make too many financial sacrifices. Many others are not so fortunate.
It, therefore, seems sensible that, along with an initial assessment of a patient's medical condition, some attempt be made to understand the patient's emotional needs, budget, and timeframe for planning a family. In this way, the medical diagnosis and prognosis for treatment can be factored into an overall plan for meeting the couple's needs.

There are several benefits of such an approach. To begin with, if the proposed medical treatment is unlikely to meet a couple's expectations, they can avoid making the large financial and emotional investment involved in fertility treatment. Success can also be defined more broadly in terms of meeting the patient's need to nurture rather than by the singular goal of a live birth.

Of course, in many cases it will not be an "either/or" decision. Some medical intervention may be performed with the intention of conducting regular reviews as the treatment progresses. If this is done, couples can hopefully avoid the trap of pursing an increasingly futile goal while slowly destroying their relationship and peace of mind. Assistance from a fertility counsellor can be invaluable in deciding when to begin exploring non-medical alternatives such as adoption, foster care, or mentoring programs. It can also be of great help in managing the considerable emotional and relationship challenges posed by fertility treatment.

Unfortunately, most Australians shy away from accessing psychological services. In my own case, it took the trauma of a miscarriage before I resorted to counselling. Only then did I realise the positive difference it could make to my emotional wellbeing.

It is partly due to the negative social connotations, as well as cost, that fertility clinics have been reluctant to promote counselling services more actively.

However, having witnessed the success of a professionally facilitated support group where the counsellor provided advice, and couples shared their experiences and concerns in a non-threatening environment, I believe there is untapped potential for expanding the delivery of such counselling services. Another step in the right direction would be to factor psychological considerations into all aspects of the treatment cycle.

For example, counsellors could be asked to help frame standard patient communications – such as the daily updates provided to patients on the status of their embryos following an egg collection – in a way that takes account of patient sensitivities.

However, in an ideal world, a counsellor would be the first point of contact for all patients presenting for fertility treatment. This would ensure that treatment plans give due consideration to emotional needs and non-medical solutions.

The counsellor would also serve as a guide throughout the process – offering emotional and psychological support, assistance when key decision points are reached, and help in exploring alternative options. Finally, with their knowledge of patient circumstances, counsellors are best placed to be the main communication channel between patients and other members of the health care team.

About expenses, I would argue that, by integrating psychological services into the fabric of fertility treatment, by releasing medical personnel from tasks better performed by counsellors, and by offering more group counselling sessions, the cost of treatment need not rise significantly. In any case, clinics providing more holistic treatment would attract additional patients, thereby generating increased revenues.

Fertility treatment must aim to improve patient care, and increase customer satisfaction. By making a greater effort to meet patients' psychological needs, these goals can be achieved and the cause of fertility care advanced significantly.

Anne Fox (not her real name) is a 43-year-old professional Sydney woman who has undergone three years of fertility treatment. She is now 14 weeks' pregnant with her first child.

http://www.theaustralian.news.com.au/story/0,20867,21048927-23289,00.html

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