Medium 9781780491967

Psychoanalytic Aspects of Assisted Reproductive Technology

By: Mali Mann
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This book contributes in an important way to the psychoanalytic understanding and impact of Assisted Reproductive Technology on a majority of patients who have difficulties starting new families. Recent advances in reproductive technology and the increased use of techniques based upon it have created a need for psychoanalytic thinking and understanding of the psychological implications of Assisted reproductive procedures, in-vitro fertilization and other similar procedures.The recent and rapid advances in medical technologies confront us with a mandate in our clinical work to understand their complex impact on women, men, and children. However, attention to the intra psychic conflicts and traumatic experience of the use of such techniques has not been addressed in psychoanalytic literature. The developmental trauma and intra psychic conflicts of individuals using reproductive technologies are ubiquitous, yet it has been neglected as a topic of special interest in our clinical work.The centerpiece of these collective chapters deal with psychic trauma of infertility, the compulsion to repeat through persistent repeated use of assisted reproductive technology, anxiety about motherhood, and finally the lives of children who are born and do not know from where they came.These poignant topics deal with family complexes and the Oedipal circle, repetition compulsion, trials and failures, anxiety related to motherhood, egg and sperm donors, parental identity formation, infertility, trauma, and discussion of a contemporary film depicting the challenging and newly defined family structure.

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Chapter One: Psychoanalytic Understanding of Repeated In-Vitro Fertilisation Trials, Failures, and Repetition Compulsion

ePub

Mali Mann

Recent advances in reproductive technology and the increased use of techniques based upon it have created a need for psychoanalytic thinking and understanding of the psychological implications of in-vitro fertilisation (IVF) and other similar procedures. The recent and rapid advances in medical technologies confront us with the mandate to understand their complex impact on parents and their children.

As a physician and psychoanalyst, I became aware of my patients’ trouble accepting their infertility after drawn-out, repeated attempts to have their own children. The acceptance of their failure in conceiving is more of a challenge for some patients than others, although sometimes there can never be a final acceptance. The denial of their failure as a couple to conceive can become a long process with unfinished mourning throughout their life cycle.

The two cases in this chapter in particular illustrate how infertility traumata were re-experienced. The unconscious self-induced traumatisation resulted from the compulsion to repeat an earlier repressed trauma.

 

Chapter Two: Family Complexes and Oedipal Circles: Mothers, Fathers, Babies, Donors, and Surrogates

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Diane Ehrensaft

Introduction

We are now in a fertile new world in which men and women come together in a variety of combinations of gender, genetics, gamete donation, and gestational carriers to make a baby. As these adults collaborate to give birth to a baby, they create a heretofore unheard of family complex: the matrix of all the individuals involved in the conception, gestation, or parenting of the intended child, along with that child and all the other offspring. This expansive family complex ushers in another new phenomenon. No longer will there be mummy, daddy, and baby makes three, a threesome that will later create an oedipal triangle. By the time baby comes around, up to six people may be involved in the conception and gestation of that baby—two social parents, an egg donor, a sperm donor, one gestational carrier, and a baby. This does not a triangle make. Rather, both the child and the other members of the family complex will find the triangle stretched to a circle as they negotiate the myriad of combinations of relationships involving all the players in the procreation process. Albeit they will discover triangles, squares, pentagons, even hexagons of relational connections within that circle, depending on the number of participants in the assisted reproductive technology family complex and the child's knowledge of their existence. The question I am posing: What are the family dynamics and developmental implications for the child who must negotiate these complicated geometrics, as early as the third year of life?

 

Chapter Three: Psychoanalytic Treatment of Anxiety Related to Motherhood and the Use of Assisted Reproductive Technology

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Terese Schulman

Introduction

For several decades, a striking worldwide demographic shift has occurred in the United States and all developed countries. Women are waiting longer to have children. The average maternal age of one-third of women giving birth to a first child in the United States is thirty. The proportion of first live births to women over thirty-five has increased nearly eight times since 1970. Those using assisted reproductive technology (ART) in 1970 accounted for one in one thousand births; presently, its use has increased to one in twelve births (Covington & Burns, 2006).

The women's movement of the 1960s and 1970s highlighted women's inequality to men in the workplace and the inequality of expectations in the home. Important changes were promoted, such as equal pay, equality in promotion, and increased participation by men in the home and in parenting. The economic independence of women, increased longevity, as well as the promise of high-tech assisted reproductive techniques if problems with conception arose, has influenced more women to delay marriage and motherhood.

 

Chapter Four: Egg Donors and Sperm Donors: Parental Identity Formation

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Mali Mann and Andrea Mann

Infertility is a medical condition that affects many aspects of human life. It affects one's relationship with one's self and consequently influences one's identity as a mother or father. Individuals who resort to assisted reproductive technology (ART) methods experience emotional, physical, social, and financial hardships, which in turn impact their families. How individuals deal with the unexpected emotions depends on personality style, coping mechanisms, and external and familial support systems.

Often, facing infertility and having to deal with its traumatic impact can lead to denial and projection. The traumatic loss of one's ideal self is a challenge for individuals struggling with infertility. One cannot rely upon secondary-process thinking. Unconscious wishes will always be carrying along reason in the course of the decision process and in choosing an egg or sperm donor.

In-vitro fertilisation (IVF) is a process in which an egg is fertilised outside the body. It was first implemented in 1978 and has since increased in use dramatically. Infertility rates have increased over the past several decades, in part due to better forms of contraception, thus decreasing the rate of unplanned pregnancies. A shift towards marrying later in life and a subsequent delay of childbearing also explains higher rates of infertility. Today, one in every eighty to a hundred births in the United States, one in sixty births in Australia, and one in fifty births in Sweden are created through some form of in-vitro fertilisation (IVF) (Van Voorhis, 2007).

 

Chapter Five: Infertility, Trauma, and Assisted Reproductive Technology: Psychoanalytic Perspectives

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Monisha Nayar-Akhtar

Psychoanalysis has long had a complex and psychologically nuanced relationship with infertility and with the treatment of women suffering from infertility. From once being seen as the treatment of choice for women suffering from infertility, it is now the least sought-after psychological intervention for infertility (Apfel & Keylor, 2002; Downey, 1991). This decline warrants further attention and examination.

In an extensive review of the psychoanalytic literature, Apfel and Keylor (2002) suggest that for many years, the primary psychoanalytic focus has been on “psychogenic explanations”, with an emphasis on “unconscious repudiation of femininity and motherhood, and fears of sexuality”. This focus has become increasingly more problematic, obsolete, and outdated, as cultural and social factors altering the reproductive trajectories for women (as many women postpone starting their families or choose same-sex partners), suggest that infertility and/or the use of assisted reproductive technologies can now result from exercising personal choice and occur as a result of delay in choosing when to have a child. In addition, the mushrooming of several goal-focused brief psychotherapy options has provided the lure of quickly moving through and resolving (superficially) any and all psychological issues related to the current biological predicament of infertility. This trend was noted almost twenty years ago by Leon (1996), who wrote: “adherence to certain unproven psychoanalytic beliefs in the area of reproductive psychology as well as overlooking the benefits of less intensive, psychoanalytically informed short-term approaches may obstruct psychoanalytic contributions in this area” (p. 342). These observations are significant and point to an imperative need to understand infertility, assisted reproductive technology, and the suffering of women in a more nuanced way.

 

Chapter Six: Assisted Reproduction as Explored in the Kids are all Right

ePub

Katherine MacVicar

The Kids Are All Right is a well-received film that deals in a comedic way with many of the difficulties faced by families that have conceived children through assisted reproduction. In this case, the parents are lesbian and the children have been conceived by artificial insemination, each woman in the couple having used the same donor so that the children are half-siblings. The pregnancies have been routine; the children are not regarded as fragile or as miracle children, but everyone is aware of the special status of having two mothers and no father. The children, two attractive teenagers, refer to their parents as “the two mums”. There is a feeling in the film that the family is on display, and that the audience and the world are watching to see how the children fare. The mothers are eager to prove themselves, and do encourage the children to perform well, but it is moderated by the obvious loving commitment they have to them. The children have been informed, presumably in much earlier childhood, about the fact of a father, but have never met him. The audience is not told about male relatives or friends in the children's lives, but we presume that in this intelligent and sophisticated family, there have been some. What is portrayed is a normal caring family, but one that lacks a biological father. It is also one in which the parental couple has a sexuality that is given prominence in the film but that has complicated meanings to the children.

 

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