Trauma occurs when the ability to envisage our future and feel safe in the world is no longer possible. While trauma is often a one-time horrific occurrence, it can also be chronic in nature.Indeed, reproductive trauma can encompass both types of anguish: the frightening and painful loss of a miscarriage, with massive bleeding and the potential need for surgery, or the seemingly endless cycle of hope and despair during fertility treatments. Sadly, for our patients, it is not uncommon to experience both infertility and pregnancy loss, and like a soldier on the battlefield, it can be protracted, leaving deep psychological wounds. This chapter not only explores the trauma that occurs in reproductive patients, but also how we, as fertility counselors, cope with being on the battlefield with them.

Lesbian, gay, bisexual and queer (LGBQ) women and men are increasingly utilizing fertility treatment services to build their families. This chapter provides an overview of topics to consider when providing fertility counseling to this population of prospective parents. It first explores the decisions that same-sex couples need to make with regard to family building and fertility treatment, including various routes to parenthood, whose gametes to use, or who will serve as the carrier. The chapter further explores many of the challenges couples often face during fertility treatment via the sexual minority stress framework. Particular attention is given to issues of homophobic discrimination, heteronormative bias and stigma, as well as to challenges related to social support, costs and legal rights. Finally, this chapter provides guidance to fertility counselors and treatment professionals on steps to take to provide culturally competent care to LGBQ patients and their partners. Such practices are crucial for offering an inclusive treatment environment to support same-sex couples in their family-building efforts.

Family building is seldom a straight-line march to the finish, even for those fortunate individuals who avoid a detour into the ethical and legal minefield of assisted reproductive technology (ART). Importantly, intended parents and their third-party helpers often lack fundamental information about the parties’ status to any child created – who is a parent, what rights the respective parties possess, and how those rights are protected. Unless appropriately addressed, these issues may contribute to misunderstandings, misperceptions, and confusion, all of which may be laid at the feet of the fertility counselor. In order to practice preemptive crisis management, fertility counselors must recognize risky situations, analyze them with a critical eye, practice within the parameters of competence, ethics, and legal sound stricture, and apply best practice principles. Collaboration with qualified legal practitioners who understand third-party reproduction law is essential to that end.

This chapter provides an overview of the hormonal and surgical interventions available to transgender and nonbinary (TNB) people, what is known about how these interventions affect fertility, fertility preservation options at different stages of pubertal development, TNB individuals’ attitudes toward family building and experiences with fertility counseling and fertility preservation, barriers to fertility counseling, and recommendations for best practice for fertility counseling for TNB people based on the known literature to date.

The egg donor or sperm donor plays a very important role in the reproductive medicine practice. The donor is both a patient and not a patient. He or she is a patient in that he/she must be taken care of both physically and psychologically. He or she is not a patient, in that the donor is not presenting for his/her own treatment. When the gamete donor enters the consultation room, the fertility counselor will be challenged in his/her many different roles and responsibilities which we will identify and discuss in the chapter. In addition, we will highlight key issues in how to prepare for and conduct the clinical interview, the usefulness of, and decision making, regarding psychological testing, how to ensure informed consent can be given, discuss the short- and long-term implications of gamete donation and zoom in on the experience of the gamete donor.

Telemental health (TMH) is an exciting modality which makes it possible to provide services when it is inconvenient, untenable or impossible to work from one’s professional office. It offers professionals the ability to provide services from flexible locations and for clients to access services from locations that are convenient to them. For fertility counselors, TMH provides potential solutions for the challenges of accessibility for clients who live far from clinics, as well as third-party arrangements such as known donors and gestational surrogacy arrangements. TMH requires significant changes from in-person practice and entails some risks and cautions. Licensing laws, insurance issues, technology failures, privacy concerns, and distortions in transmission all impact the quality and utility of TMH. There is a significant learning curve for fertility counselors to become proficient in TMH and its particular requirements and procedures.Specific training in TMH facilitates this learning and enables fertility counselors to practice effectively and ethically. TMH is best used by professionals who approach this modality thoughtfully and who are knowledgeable about the practice, the ethics and the laws pertaining to it.

This chapter provides an overview of the psychology of infertility as an aspect of reproductive psychology, and the field of fertility counseling.The changing role of reproduction in modern society is reviewed.Major theories related to reproductive psychology, including grief and loss, stress and coping, as well as posttraumatic growth are discussed. Additionally, the history of infertility counseling is described. The US and international guidelines for the provision of psychological services, both assessment and counseling, are provided.The formats for the provision of clinical care are discussed and the clinical research on the impact of psychological services is reviewed. The qualifications for mental health professionals practicing as fertility counselors are also included.

Extraordinary reproductive technologies are continuing to evolve for people needing medical assistance to have a child, which are replete with complex psychosocial issues. Optimal patient care involves the collaboration of numerous healthcare professionals (physicians, nurses, laboratory scientists, administrative staff, as well as counselors) working together to provide reproductive medical services. This chapter provides a biopsychosocial model for the medical and psychosocial assessment and treatment of individuals and couples seeking reproductive medical assistance. Beginning with an overview of infertility and reproductive physiology/pathophysiology, evaluation and treatment are discussed from a collaborative perspective of medical and psychosocial management. All aspects of reproductive medical care are presented from the lifestyle choices to assisted reproductive technologies including IVF, gamete donation and gestational surrogacy. The complex psychological challenges of patients dealing with significant medical conditions and the consequences of invasive medical procedures, coupled with treatment failures and loss are examined. In addition, a collaborative approach to decision-making in treatment and family building alternatives is discussed. The chapter also serves as a springboard to topics in the second edition of Fertility Counseling covering therapeutic approaches, assessment and preparation in assisted reproduction, addressing the needs of diverse of populations, practice issues, and special topics on pregnancy loss, reproductive trauma and resiliency, postpartum adjustment, and the pregnant therapist.

The recipient interview is primarily psycho-educational in nature. The fertility counselor strives to understand the recipients’ family building goals and help them frame their unique “family story.” Preparation for disclosure to the potential child has become increasingly important, due to the technological and genetic impact on donor anonymity and growing openness. Societal changes have brought about expansion in the types of recipients seeking treatment, as well as greater diversity in the cultural background of both donors and recipients. The recent worldwide pandemic has also caused an increase in virtual counseling.Fertility counselors need to be open and flexible while integrating these changes into our work with recipients. Fertility counselors are essential not only at the outset of the recipient journey, but are increasingly seen as a valuable lifelong resource to be consulted at different stages in the experience of being a donor-conceived family.

Fertility counselors see an array of clients who may be diverse in terms of countries of origin, ethnicity, race and/or cultural background. This chapter identifies principles to guide this conversation. These principles include understanding how we consider race, ethnicity and culture, and emphasize the importance of not essentializing race, ethnicity and culture. The chapter continues with a brief overview of the meaning and consequences of infertility in various places worldwide and among migrant and racial minorities in particular, how this can affect access to, use of and experiences with fertility treatments and assisted reproductive technologies (ARTs). Finally, we offer considerations for racially and culturally sensitive clinical approaches in fertility counseling.

This chapter addresses the role, and importance, of individual counseling and psychotherapy in providing psychological assistance and support to patients who are struggling with infertility and loss. Depression and anxiety are the two most frequent emotional sequelae of the infertility experience.The chapter therefore speaks not only to what factors contribute to making fertility counselors effective in their work, but also addresses specific treatment approaches that can yield positive outcomes in working with this unique population. These approaches include psychodynamic psychotherapy, cognitive–behavioral therapy (including dialectical behavior therapy and trauma-focused therapy), and supportive counseling. A brief history and description of each approach is presented in addition to a discussion of ways in which these psychotherapeutic treatments can be effective in working with fertility patients. Each of these approaches can be longer term or time-limited, often depending on the needs and preferences of the patient.The chapter also emphasizes the importance of appropriate professional mental health training as well as an understanding of the unique medical treatments that are an inherent part of the personal experiences of fertility patients. A strong therapeutic alliance is critical to effective individual treatment, and each psychotherapy approach provides strategies for assisting individuals who are emotionally challenged by infertility.