Historically, legislation surrounding fertility treatment has focused on welfare in relation to the prospective child. Less attention has been paid to patient welfare, and to the way trauma can impact upon – or be impacted by – fertility treatment.
The latest event from the Progress Educational Trust (PET) focused on how best to understand and address welfare issues of patients, including issues that might arise from trauma.
Sarah Norcross, director of PET, opened by making reference to an unsuccessful attempt to introduce a Human Fertilisation and Embryology (Welfare of Women) Bill (see BioNews 993). Since then, the Human Fertilisation and Embryology Authority (HFEA) has made a number of recommendations for reform in November 2023 (see BioNews 1216), including a recommendation that 'The Act should be revised to include an overarching focus on patient protection'.
The first speaker was Professor Abha Maheshwari, clinical director and lead consultant for reproductive medicine and surgery at the Aberdeen Fertility Centre. Professor Maheshwari stated that the fertility treatment journey is an emotional rollercoaster and there are many points of contact before a patient is able to start treatment. The longer the waiting period between each stage, the higher the level of anxiety and stress can be. This is particularly the case during the two week wait between embryo transfer and taking a pregnancy test. She recommended clinics take a proactive approach and contact patients during this period to provide extra support.
Professor Maheshwari also discussed a case in her clinic where treatment resulted in pregnancy, and the patient was due to come in for an early pregnancy scan. However, on the day of the scan, the team received the news that the patient had committed suicide.
Professor Maheshwari observed that trauma can be mental or physical. Visible traumas are more easily detected, and have established support mechanisms in place. She added: 'Our eyes don't see what our minds don't know, so we really need to look for all these factors actively.'
Ruth Phillips, fertility counsellor at the Edinburgh Fertility Centre, spoke extensively about the manifestation of trauma and distress in the IVF patient. Discussing victims of abuse, she mentioned that it is important to dissipate 'pockets of shame' that may arise in the patient by making it clear that all fault and blame lies solely with the perpetrator of the abuse. She added that the patient may not always believe that they are blameless, but it is important that the healthcare practitioner assumes this in any case, and that this assumption informs and tailors their response.
The third speaker was Dr Susheel Vani, lead clinician at the Glasgow Royal Infirmary's Assisted Conception Service. Dr Vani shared his insights on the stressors associated with men and women seeking fertility treatment.
Dr Vani mentioned that some men are reluctant to undergo a recommended sperm test, if they are convinced that the infertility relates primarily to women. He added that if it transpires that they can never be a biological father to a child – not even via surgical sperm retrieval – then this can be difficult for to accept. The same thing can be true of women, in instances where egg retrieval is not possible.
Dr Vani stated that in couples needing donor sperm, there can be difficulties balancing what they want with societal pressures and religious beliefs. This can also be compounded with problems finding donor sperm. Dr Vani mentioned that there are couples where one partner may feel ready for treatment, while the other may not. This may then lead to one person not participating in appointments, or refusing to provide consent, or even withdrawing previously provided consent.
Dr Vani said measures that can help approve the welfare of patients include clear and honest discussions at the start of the treatment journey, access to specialist counselling support, and referral to support groups.
The final speaker was Nicole McKeith, fertility nurse and nurse sedationist at Ninewells Hospital's Assisted Conception Unit, Dundee. McKeith shared her insights on the importance of understanding trauma, and how trauma can affect the way patients engage with healthcare services.
McKeith explained that trauma can narrow one's window of tolerance, as this is the mind's way of protecting itself from something that it deems to be a threat or triggering. She added that treatment can be a trigger for patients in a number of ways, as some questions can bring up feelings of guilt or shame – for example, 'Have you been pregnant before?' and 'When was your last test/treatment for a sexually transmitted disease?'.
On the issue of sedation, McKeith spoke about how process of being sedated can trigger an emotional response in patients with a history of abuse. For some, waking up from sedation with no memory of anything that occurred in the interim can lead to a feeling of loss of control. McKeith said that one way to reduce the likelihood of triggering an adverse response is to show the patient the theatre room before the procedure, so that they are more familiar with the surroundings and less anxious. It may also be helpful to put the relevant patient first in the list.
During audience questions, one attendee asked the speakers if it is the case that patients conceal their trauma, for fear of being denied treatment or having treatment postponed. McKeith said that this can indeed be the case, which is why it is important appear non-judgmental and to be as forthcoming as possible with the patient beforehand, to help quell any fears. Professor Maheshwari agreed that it is important for practitioners to offer reassurance that they are on hand, to provide support and optimise the treatment journey.
Dr Vani emphasised that in medicine, one should not let one's personal biases affect a patient's treatment. He highlighted the importance of a multidisciplinary team in making treatment decisions.
PET is grateful to the Scottish Government for supporting this event.
Leave a Reply
You must be logged in to post a comment.