Infertility and the physician--patient relationship: a biopsychosocial challenge.

Research to date has not been able to dispel controversy over the question of "psychogenicity" of infertility. Increasing numbers of studies suggest that neuroendocrinological factors play a role in what is most likely a multidetermined condition. Whatever the etiology, and whether infertility occurs spontaneously (e.g., anovulation) or by choice (e.g., surgical sterilization), the physician must be alert to the special needs of the patient, to the environmental setting, and to the intricate interplay between infertility and emotional reaction. The physician-patient relationship as a triadic rather than dyadic relationship introduces unique transference and counter-transference considerations which must be an acknowledged part of evaluation and treatment.