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Infertility: Interventions for Shame, Mourning, and Feelings of Inferiority
One in six couples will experience fertility problems at some time in their lives, and only one-half will succeed in becoming pregnant (Seibel, 1997). Infertility rates are projected to increase during the next 20 years as the age distribution of the U.S. population reflects the passing of the baby boom generation through middle age (Chandra & Stephen, 1998). Also, a cohort of couples may have delayed childbearing because of financial and career considerations. If projections prove accurate, many will face fertility problems and complex decisions regarding the use of reproductive technologies, often associated with considerable physical, emotional, and financial cost (Greenfeld, 1997).
Infertility has been associated with substantial levels of stress, generally attributed to its indeterminate and often prolonged time frame and the uncertainty and ambiguity of the diagnosis and treatment process. Infertility is variable in time, and with treatment, can span more than a decade, the average being five years (Domar & Seibel, 1997). For example, by the time a couple initiates an in vitro procedure, they may have been infertile for up to six years and in treatment for four (Boivin, 2003). Infertility treatment has been found to have consequences for subsequent health functioning, quality of life, and psychological well-being during presumed childbearing years (Shapiro, 1982). People may feel depleted, isolated, and vulnerable to the experience of prolonged stress (Valentine, 1986). Research in other populations suggests that psychosocial factors may play a role in mediating or moderating stress appraisal and its consequences.
Stress Associated with Infertility Treatment
Factors Associated with Variation in Infertility-Related Stress
There are gender differences in obtaining support (Daniluk, 1997; Kowalcek, Wihstutz, Buhrow, & Diedrich, 2001). For example, Band and colleagues (1998) found that failure to seek support was among the most significant predictors of distress among infertile men. Stress levels in general are higher for women, as they tend to take greater responsibility for the problem even when the cause is unknown (Greil, 1991). Because more is known about the female reproductive system, women experience more treatment procedures; the complexity of juggling work, family, and treatment responsibilities may increase stress for women (Hurwitz, 1989).
Reduced self-esteem has been found to be both a consequence of infertility and a covariate in adjustment to it (Fleming & Burry, 1988). For example, Bernstein and colleagues (1988) and Greenfeld (1997) concluded that damage to self-esteem was a major component of the infertility experience. Perceived health has been shown to predict future health and mortality (Idler & Angel, 1990). It is possible that the chronic nature of infertility influences perceived health in the years following an infertility diagnosis, and conversely, that perceived health affects the overall stress of the experience. Stage of treatment may also affect perceived stress. Because the probability of treatment failure with repeated in vitro fertilization procedures is high, intervention at almost any time in the process may be useful (Bergart, 2000; Black, Walther, Chute, & Greenfeld, 1992).
Despite long-standing involvement of social workers in adoption and child welfare settings, emotional investment in biological children has infrequently been considered a factor in infertility-related stress (Henning & Strauss, 2002; Holbrook, 1990). It is possible that substantial investment in biological parenting may negatively affect self-esteem when conception does not occur, which may ultimately influence stress appraisal (Matthews & Matthews, 1986). Identification of factors found to be negatively associated with stress may ultimately help both the couples and the individuals who work with them.
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