Psychologist and psychotherapist, Rossana Marenzi is Italian but has been living in Barcelona for the last 10 years, proposing therapies in Italian, Spanish and English.

Her vision of therapy is to facilitate the integration of emotional, cognitive and experiential aspects of one person. Exploring both the past and the present, and through a constant attention to relationships, Rossana wants to help her patients find their own way towards emotional balance.

She has a large experience in adults and couples therapy, but life led her to work especially with people with fertility issues.

1/ There’s a study that shows that women who are into a process of assisted reproduction suffer from a stress that is similar to that of women with cancer.  What do you think about this? What does explain such a high level of stress?

It’s difficult for me to have an opinion about this because I have very little experience working with people with cancer. But yes, I’ve heard this affirmation, it’s part of a study during which certain aspects of fertility treatments have been tested on women who had survived cancer (Dow, 1994; Surbone and Petrek, 1997).

However, I don’t like this kind of comparison: both suffer tremendously, for different reasons, but the consequences of a failure have nothing in common.

What I can say about people with fertility problems is that they are confronted to a very deep personal crisis, because they are questioned in their own essence as fertile persons, capable of giving life – something they probably took for granted.

In addition to that, there is for women a significant amount of stress related to time passing by, and to being a mum probably older than they had imagine.

“To a very deep personal crisis (they are questioned in their own essence of person capable of giving life), we must add the stress generated by time passing by, as well as the social pressure – maternity being what’s expected of women.”

Finally, motherhood is something that in a way society expects from all of us – and consequently, another source of stress for those who cannot meet these expectations.

2/ What other emotions usually go with assisted reproduction processes?

A mix of primary emotions and of syndromes (i.e. a combination of emotions). Stress, insecurity, exhaustion, fear, incredulity, and also a certain regression to the childish feeling of “I want to but I can’t”.

Of course, some persons face it with ingenuity, hope and a certain unconsciousness. It’s very interesting, because this apparent peace hides a deeper fear, and at the same time protects from anxiety attacks. It’s a psychological defense that can be very effective.

That’s why I believe that it’s fundamental to leave our prejudices aside, as there is not always a direct and proportional relation between the pain and the level of commitment to the cause.

3/ A process of assisted reproduction can be very long. What are the different steps in the process? Are some phases more stressful than others? What is your advice on that matter?

I see a lot of couples, especially women, who are very stressed even before starting the process. Before they can begin with the protocol of treatments, there is a necessary phase of information collection and diagnostic procedures. This preliminary phase seems to be very difficult to live because of the sensation of uncertainty, and the anxiety of one that feels he/she cannot wait any longer and wants immediate results.

The phases where waiting prevails are especially hard: waiting for a compatible donor, waiting for the biopsy results which will rule out possible genetic malformations of the embryo, and of course the long and final wait for the pregnancy test and definitive results.

But there are also some very challenging moments during the hormonal stimulation treatments, as the medication can generate an emphasised and unbalanced emotiveness.

“My advice: live each step at a time without projecting in the following phases, be realistic without losing hope, and avoid wanting to control everything.”

My advice, in general, is to live each step at a time, focus on the present phase and avoid projecting in the following phases.

It’s also important to be realistic, yet without losing hope. And avoid wanting to control everything.

4/ Much is told about the emotions and stress of women during assisted reproduction processes. What about the men? What kind of emotions are they confronted to?

The man is much too often a spectator of the process. He probably gave his consent and helps to pay for the treatments, but in the end he is a caring companion. Even though some couples, of course, live the process together and strongly support each other.

It’s important that women do not assign men a minor supporting role in that matter, and on the contrary try and challenge this social established rule according to which the mother is more important than the father, or maternal instinct is stronger in women.


5/ What would be your first advice to a couple who just received the news of their infertility, or necessity to go through assisted reproduction?

I would tell them to give themselves some time to listen to their inner voice, and to think about it. I’d tell them not to ignore any of the emotions they feel.

Before fighting to make our dream come true, it’s very important to mourn over our previous expectations, and over the image of ourselves as fertile persons.

For the majority of couples, this new reality comes as a shock, especially for the one who has been “diagnosed as infertile”. But only by accepting our limits can we accept the alternatives that come to us.

6/ Trying to have a baby doesn’t affect only people on an individual level, it also affects their relationship as a couple. What advice can you give couples so that the process affects their relationship as little as possible?

The process affects, and must affect both members of the couple. This is my main advice: live the process together, as future parents but more than anything, as a couple.

Try by any means not to put the blame on the other.

Do not think that the woman is the sole protagonist, only because she is the only one taking medication and having to go through surgery.

If everything goes well, both are going to be parents, together, with different roles but with the same importance.

“We have to challenge this social established rule according to which the mother is more important than the father, and the maternal instinct is stronger in women.”

The ideal would be to do a couple therapy before, during and after the process.

7/ In assisted reproduction, not only are there heterosexual couples with fertility problems. There are also more and more homosexual couples, and single women. Of course, their situation is certainly very different: how do they usually live the process? What emotions do they feel? What advice do you give them?

These are two very different cases.

Lesbian couples have no choice but to introduce a third party in their desire to create a family, but they usually deal with it with serenity, as they already form together the grounds for a solid family. They see the sperm donor as a mean to achieve their goal, and little more (in the majority of the cases I’ve seen).

On the contrary, in the case of single women, a lot of emotions and prejudices are omnipresent. Sometimes, at the very moment of making the decision, they feel lonelier than ever. They doubt whether they’ll be able to do this on their own, whether the child will miss having a father… In the majority of cases, they turn to a donor because they feel that the clock is turning, and they haven’t found yet the person they want to be a mother with. They’re standing with their back to the wall, it’s very hard.

My advice for the lesbian couples: think thoroughly about their respective roles as both mothers of the child, and about the importance of a masculine element for his development (which doesn’t necessarily mean a real flesh and blood father).

And to the single mums I’d advise them to be psychologically accompanied during the process, to be careful not to fall into feelings of guilt, and finally to avoid charging their future child with too many expectations.

8/ How can we deal with a negative result, especially when it’s not the first one?

Repetitive negative results put us face to face with the limits of technology and of human beings. Repeating the same treatment over and over can be exhausting.

We can either start contemplating the alternatives, or else think and decide how much longer we want to try this way.

It’s fundamental not to see the negative result as a personal failure, but rather as an event that depends on many factors we cannot control. Have we done all that could be done, and tried all that could be tried? Most probably, yes, we have.

“There is an idealisation of the very concept of maternity or paternity, as if we were all born to become parents and those who experience difficulties to do so are somehow “defective”

9/ When a couple turns to assisted reproduction, do you recommend that they talk about it with their close circle?

The wider and stronger is their circle of “social support”, the more they will feel accompanied and supported during the process. Also, opening to others about their situation is a good way to relieve the pressure they certainly feel, and to avoid feeling lonely.

I think it’s important, but it’s also very important to choose correctly the persons to talk to.

10/ How can the close (family, friends) ones help a person or a couple in a process of assisted reproduction?

Listening to them, encouraging them, normalising the situation.

And also proposing, with respect and a lot of patience, alternative activities to do together, that can help them take some distance and forget about their obsession for a little while. Sometimes a simple night not thinking about it can do a lot.

11/ How can we explain that, in our actual society where fertility problems are increasingly present, the subject is still such a taboo?

It’s true, this is a total contradiction. On the one hand, in terms of communications and social media, the subject is widely spread and seems to have no secrets to the public.

But on the other hand, it is not the case in the intimacy or in closed circles. We are influenced by deeply rooted cultural legacies, which state that a couple should carry out their family project on their own, with no support from the community. This makes it even more difficult to share with others the experience of being (or not being) a parent.

We also need to take into account the idealisation of the very concept of maternity or paternity, as if we were all born to become parents and those who experience difficulties to do so are somehow defective.

We should also mention the bio-ethical debate over the fact of using technology or medicine to take part in a natural process. It’s a very complex but interesting question, and I would love to have the opportunity to talk about it in another occasion. Thank you very much!

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