Psychosocial aspects

■ Experiences, from more than a decade of counseling, show the importance of offering professional psychosocial support to couples before, as well as during, and after reproductive treatment.

■ Up to one third of the couples decide against the realization of their wish for parenthood after in-depth counseling (Vernazza 2006). Accepting the desire to become parents and dealing with the underlying motives as well as the psychosocial situation in an empathic way enables couples to see obstacles as well as to develop alternative perspectives if this wish cannot be realized for various reasons.

■ Frustration and disappointment may accompany failures or strains during treatment (i.e., unsuccessful treatment cycles, premature termination of pregnancy). Left alone with these strains, couples sometimes decide to conceive using unprotected intercourse, to avoid further stress. Depending on the risk perception of the partners, this decision may sometimes be well planned, but other times be born out of despair. These couples might be at risk of infection: in 56 HIV-discordant couples participating in the Milan program who attempted spontaneous conception after failing to conceive with artificial insemination, at least one infection occurred (Semprini 2005).

■ Psychiatric co-morbidities in one or both partners (i.e., substance abuse, psychoses) can be reasons to at least postpone treatment. Professional diagnosis and support will be necessary in these cases.

■ Often, the central importance of the wish for parenthood of many migrant couples is overlooked in parts of the medical and psychosocial counseling system. Language or communication difficulties on both sides, ignorance of different cultural backgrounds and lack of acceptance of "strange" life-styles can lead to feelings of discrimination, isolation, helplessness or despair in couples.

■ Issues concerning the welfare of the child should be openly discussed during reproductive counseling (Frodsham 2004). Many couples are concerned about a potential negative effect of antiretroviral drugs on their offspring. Severe impairment of the health of the prospective parents might lead to concerns for the future well-being of the child.

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