The problem of infertility and its consequent treatment (denoted as Assisted Reproductive Technology or ART) represent an increasing phenomenon, especially in industrialized countries. Confronting with one's own procreative limitations can generate strong negative emotional reactions. This study aims at understanding how the desire for motherhood manifests itself in infertile women undergoing ART, studying their emotional and subjective perspective. An in-depth explorative research study was conducted on 17 infertile women attending an Italian hospital clinic for fertility treatment. Emotional text analysis was conducted to analyze the corpus of their interviews, allowing the identification of four thematic domains (clusters) which refer, respectively, to the following emotional dimensions: an inclination to selfsacrifice, seen as the price to be paid for the desired success of the treatment (Cluster 1), pursuit of inclusion in the world of procreative mothers (Cluster 2), precarious equilibrium between the deep desire for a baby and the withdrawal from the treatment (Cluster 3), surrender to any possible consequence in order to obtain the desired mother-child relationship (Cluster 4). The witness of the couples' suffering for their condition of infertility and their strong desire for parenting can represent a source of high pressure for the fertility care staff, as they are the only ones responsible for the fulfillment of the great dream of biological parenthood. For these reasons, a multidisciplinary approach, which involves psychological as well as medical experts all working together, could benefit both the patients and the healthcare professionals and improve the quality of the reproductive healthcare services.

Infertility-related psychological research is traditionally oriented to analyze the wellbeing of couples undergoing Assisted Reproductive Technologies (ART), than to study the job-related effects on the healthcare fertility staff. This piece of research aims at understanding the subjective perspective of the fertility professionals and contribute to identify their emotional dynamics in their work environment. An in-depth explorative research study was conducted on 12 healthcare professionals of an Italian ART hospital clinic. Structured interviews with open-ended questions were administered to explore their deep feelings about their professional experience. Emotional text analysis was then conducted to analyze the textual corpus of their narratives to grasp their affective symbolizations. Statistical multidimensional techniques were used to detect some thematic domains (cluster analysis) and latent factors organizing the contraposition between them (multiple correspondence analysis). Five thematic domains were detected which refer to different emotional dimensions, as follows: performance anxiety (Cluster 1), ambivalence between omnipotence and powerlessness (Cluster 2), care burden (Cluster 3), feeling of duty (Cluster 4), and sense of interdependence (Cluster 5). Then, four latent factors were identified dealing with the laborious attempt to remedy, the realistic sense of limitation, the incumbent feeling of pressure and the restorative sense of justice, respectively. The results are discussed based on the existing literature and some useful recommendations for staff education, training and clinical supervision are provided accordingly.

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Objective This study described the development and psychometric evaluation of the fertility reparation inventory, providing measures of manic and expiatory reparation as symbolic dynamics of restoring one's procreative and generative identity through Assisted Reproductive Technology (ART). Methods Two cross‐sectional studies were conducted on female patients undergoing ART (N = 150) and women from the general population (N = 250), respectively. Exploratory factor analysis and confirmatory factor analysis assessed construct validity and reliability. Pearson's bivariate correlations were used to provide convergent evidence of validity with omnipotence, perceived infertility‐related stress, anxiety, depression, need for reparation, fear of punishment, and hope. Results The results confirmed a two‐factor solution of the 12‐item instrument, with adequate fit, a very good internal consistency, and well‐supported forms of convergent validity. Conclusion This study provides a meaningful psychodynamic contribution, in both theoretical and empirical terms, for the understanding of emotional dynamics and psychological issues underlying the demand for ART.

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Infertility-related psychological research is traditionally oriented more at analysing the wellbeing of couples undergoing Assisted Reproductive Technologies (ART), than to studying the job-related effects on the healthcare fertility staff. The unfulfilled desire for a child can cause an emotional crisis for couples: they may experience high levels of stress with physical, emotional, social and financial concerns related to infertility and ART treatment. Little is known instead about the emotional reaction of healthcare members to infertility and treatment delivery. In fact, it is well documented that patients with infertility problems may challenge usual approaches to care, leading to potential difficulties in the therapeutic relationship: patients undergoing ART are often dissatisfied with the level of empathy and attention received by the healthcare staff. Besides, patients may be experienced as manipulative, emotionally dependent, self-destructive, non-compliant and with a hostile attitude, thus raising negative feelings of frustration, anxiety, and dislike among healthcare professionals. This is the aim of the research titled “What about fertility staff emotions? An explorative analysis of healthcare professionals’ subjective perspective”, aimed at understanding the subjective perspective of the fertility professionals and their emotional dynamics in relationship with patients. An in-depth explorative research study was conducted on 12 healthcare professionals working in the fertility clinic of a public healthcare hospital of Rome. Structured interviews with open-ended questions were conducted and Emotional Text Analysis was carried out to analyse the transcripts of their interviews. Five thematic domains were detected that describe the staff’s emotions about their professional experience, as follows: performance anxiety (Cluster 1), ambivalence between omnipotence and powerlessness (Cluster 2), care burden (Cluster 3), feeling of duty (Cluster 4), and sense of interdependence (Cluster 5). This study suggests that the professionals’ awareness about the implicitly emotional meanings, beliefs, values, referred to the professional function and therapeutic relationship may facilitate team work and care relationship. For this reason, the Italian National ART Register of the National Institute of Health and the Department of Dynamic Clinical and Health Psychology of La Sapienza University carried out a research to examine the characteristics of psychological services in Italian ART centres. A questionnaire consisting in 26 questions was sent to the physicians in charge of 341 ART centres active in Italy. The overall picture was rather disappointing in that only half of the responding centres (47%) have a psychologist permanently on staff and psychological intervention seems to be considered as targeting the inner world of the individual or the couple and not their relationship with the ART context. Moreover, relatively few couples (10-20%) resort to counselling in 70% of the responding centres. Referrals did not seem to be regulated by specific policies and procedures in 60% of the cases and in 70% of centres the fee for psychological counselling was not included in the ART treatment fee. Furthermore, 30% of the responding centres worked with an independent psychologist who is called in upon request. It is possible to hypothesise instead that health professionals in the field of reproductive medicine could offer their care on an ongoing basis during the course of treatment with an integrated and collaborative approach that also involves: 1. education, training, and support of the fertility clinic staff to help reduce staff stress, prevent burnout, and improve overall patient care. 2. offer support to adopt an emotional accompanying function into the healthcare relationship, through attempts at restitution, clinical supervision, joint listening setting (physician, psychologist, patients), analysis and sharing of the emotional dimensions involved in the Centre's activity, in order to improve the care experience of the patient and of the carers in relation to each other. This approach may represent a real multidisciplinary model of caretaking.