The first clinical encounter in infertility care: a psychodynamic case study using the infertility history interview

Psychological assessment in assisted reproduction settings is often based on screening procedures and symptom-focused measures, with limited attention to the subjective meaning of infertility and patients’ underlying psychological functioning. From a psychodynamic perspective, infertility may mobilise conflicts, defensive processes, and emotion regulation strategies that are not fully captured by standardised symptom measures alone. This paper presents a narrative single-case study illustrating the clinical application of the Infertility History Interview (IHI), a psychodynamically informed semi-structured interview designed to explore how infertility is subjectively experienced, represented, and integrated within the patient’s personal and relational history. The case concerns a 39-year-old woman undergoing assisted reproductive treatment after several years of unsuccessful attempts to conceive. Interview material was analysed using the IHI Coding System, which supports a structured psychodynamic formulation across three domains of functioning: lived experience, reality testing, and level of integration. Self-report measures of individual and dyadic emotion regulation difficulties were included as complementary sources of clinical information. The case revealed an overall profile of integrated functioning, characterised by preserved reality testing alongside moderate vulnerabilities in lived experience and integration. The patient demonstrated coherent narrative organisation and realistic future representations, while emotional experience was predominantly regulated through cognitive strategies and adaptive defences, including reappraisal, anticipation, intellectualisation, and rationalisation. Infertility appeared to reactivate vulnerabilities related to earlier relational loss while remaining embedded within a stable sense of self and preserved psychosocial functioning. Rather than simply describing a single case, this study illustrates how a psychodynamically informed first interview, supported by the IHI Coding System, can facilitate systematic psychodynamic case formulation by identifying psychological resources and vulnerabilities, thereby informing individualised psychological care throughout the assisted reproductive treatment pathway.