Psychotherapy of idiopathic male infertility is the use of psychological methods, particularly when based on regular personal interaction, to help a person change and overcome problems with unexplained (idiopathic) infertility. Psychotherapy primarily includes therapeutic counselling, but can also include crisis counselling that is long-term in nature.

Unexplained male infertility is infertility that is idiopathic in the sense that its cause remains unknown even after an infertility work-up, usually including semen analysis. The fleeting periods of impotence and sexual performance anxiety could possibly contribute to the reason for infertility. Studies demonstrate men who are solely to blame for infertility in partnership feel less powerful in their lives, in their ability to meet aspirations. They hold themselves personally accountable for their fertility problems, and negative sexual consequences and emotions. This highlights that because a man is stressed that he cannot impregnate his partner, decrementing his fertility.

There are several psychological (e.g. stress, anxiety) as well as sexual (e.g. erectile dysfunction) problems that can affect male fertility. These problems might be psychological as well as physical in nature; it is hard to separate the physical and psychological aspects. Therefore, individual and/ or couple’s counselling is recommended to determine whether there is an underlying cause of male idiopathic infertility. 

There are various methods to deal with mental reactions caused by infertility. In recent years, cognitive behavioral therapy (CBT) has become popular among patients and therapists and has shown effectiveness in the management of a wide range of maladaptive behaviours (inhibits a person's ability to adjust to certain situations).

CBT focuses on the development of personal coping strategies that target solving current problems and changing unhelpful patterns in cognitions (e.g. thoughts, beliefs, and attitudes), behaviors, and emotional regulation (Pic. 1). 

The CBT model is based on the combination of the basic principles from behavioral and cognitive psychology. CBT is a "problem-focused" and "action-oriented" form of therapy, meaning it is used to treat specific problems related to a diagnosed mental disorder. The therapist's role is to assist the client in finding and practicing effective strategies to address the identified goals and decrease symptoms of the disorder. CBT is based on the belief that thought distortions and maladaptive behaviors play a role in the development and maintenance of psychological disorders, and that symptoms and associated distress can be reduced by teaching new information-processing skills and coping mechanisms.

Simply by talking about infertility with a psychologist, especially the cause is unknown, can surface emotions such as guilt, stress, psychosomatic complaints, or even incompatibility in the partnership. It can also help combat self-regulation and self-discrepancy issues. 

General therapeutic counselling can comprise supportive, coping-orientated and problem solving strategies, including psychodynamic psychotherapy, solution-focused psychotherapy, crisis intervention and process-experiential grief counselling.

The increasing frequency of infertility among men, the associated psychological problems, and common social reactions towards infertility lead to several psychological problems and significantly affect other aspects of life in these infertile men. Infertility can cause feelings of helplessness and anxiety, interpersonal relationship problems, low self-esteem and self-confidence, isolation, and identity issues. These men consider themselves unattractive and regard life as meaningless.

Referrals to a psychotherapist can be made if patients experience major depressive symptoms, severe marital or sexual problems, and/or psychological distress that may have direct impact at fertility.

It is suggested that continuous use of CBT techniques for infertile men without physical and medical problems decreases anxiety, depression, and psychological symptoms. Working with a couple, establishing an open communication within a couple and decreasing level of stress through the stress management therapy may improve couples’ relationship and increase the probability of conception.

However, not all psychotherapy works, it doesn’t work all the time, and it doesn’t work for everyone. Possible factors could be ineffective interventions, minimized role of therapist or if the client is reduced to diagnosis, because two people with the same disease are not the same people.

Potential risks of psychotherapy may include worse feels as the therapy progresses. Research on adverse effects of psychotherapy has been limited for various reasons, yet they may be expected to occur in 5% to 20% of patients. Problems include deterioration of symptoms or developing new symptoms, strains in other relationships, and dependency on the therapist. Some techniques or therapists may carry more risks than others, and some client characteristics may make them more vulnerable. Side-effects from properly conducted therapy should be distinguished from harms caused by malpractice.

It has been found from randomised clinical trials that psychological and psychiatric intervention for infertile patients increased pregnancy rate for couples experiencing intervention by 47.1% compared to 7.1% in control group who did not have therapy, emphasising that when stress levels drop pregnancy rates can raise.

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