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Infertility: Interventions for Shame, Mourning, and Feelings of Inferiority
The experience of infertility creates negative economic, physical, social, and psychological effects, especially for women. This often results in multiple stresses and needs for coping in these women. Because the manner in which women cope with these experiences are not fully understood, existing counseling interventions fail to adequately meet the needs of women experiencing infertility. Eighty-three women receiving varied services at assisted reproduction clinics participated in a study of the relationship between the use of social coping resources, growth-fostering relationships, and infertility stress. The results support the use of social coping resources for coping with infertility stress. In addition, the results indicate the usefulness of understanding the types of growth-fostering relationships that can be an additional resource for helping counselors conceptualize women's experiences and design effective interventions to help women cope with infertility stress.
The Relational Model of Development proposes that women are relational beings and grow in, through, and toward relationship (Jordan, 1995; Jordan, Kaplan, Miller, Stiver, & Surrey, 1991). Connection to others, through growth-fostering relationships, is central to the psychological well-being of women. As a consequence, women's experiences in relationships may be used to promote their psychological well-being. The Relational Model has been applied in counseling with individuals, couples, families, and groups who are experiencing a variety of issues (Bergman, 1991; Fedele & Harrington, 1990; Jordan, 1995; Miller & Stiver, 1997; Philipson, 1993), including infertility (Gibson & Myers, 2000; Schiller, 1997). However, an empirical link between growth-fostering rela tionships used in coping and improvement in women's psychological well-being has not been established. If a positive correlation between these factors exists, this link could provide a basis for counselors to develop specific interventions to help decrease women's infertility stress.
In this article, the results of a study investigating the use of growth-fostering relationships and social coping resources by infertile women are presented. The primary purpose of the study was to determine the relationship between the use of social coping resources, growth-fostering relationships, and the amount of infertility stress reported by infertile women. The main research question was whether social coping resources and growth-fostering relationships would account for a significant variance in infertility stress. Additional research questions included: What is the relationship between: the use of social coping resources and growth-fostering relationships in infertile women, the use of social coping resources and the amount of infertility stress reported by infertile women, and the use of growth-fostering relationships and the amount of infertility stress reported by infertile women?
Over one third of the participants (39.8%) reported that they were receiving in vitro fertilization treatment for infertility. Thirteen percent reported receiving artificial insemination as their only treatment with 9.6% reporting that they received injectable hormones as their sole treatment. Other treatment types that represented less than 8% of the participants for each type of treatment included controlled ovarian stimulation, artificial insemination with hormones, Clomid, artificial insemination with injectable hormones, artificial insemination with controlled ovarian stimulation, diagnostic laparoscopy, frozen embryo transfer, or reversed tubal ligation. Just under two thirds (60%) reported that their fertility problem was female factor, 12% reported male factor as their infertility problem, 13% reported an unexplained infertility problem, and 12% reported a combination of female and male factor infertility problems.
Participants were asked to identify sources of social support, specifically the gender of a peer sought for support and the type of community group they looked to for support. The majority of participants chose a female peer (92%), while only four participants (5%) chose a male peer, and 4% indicated no preference. Community preferences for social support included: work (46%), religious group (24%), school (16%), support group (4%), volunteer activity group (1%), hobby group (1%), or no choice (8 %).
Pearson Product Moment Correlations were calculated to examine the relationships between social coping resources and growth-fostering relationships, social coping resources and infertility stress, and growth-fostering relationships and infertility stress. A strong (and significant) positive correlation was found between social coping resources and growth-fostering relationships (r = .74, p = .01). Significant negative correlations were found between social coping resources and infertility stress (r = −.35, p = .001) and between growth-fostering relationships and infertility stress (r = −.16, p = .05). These results supported hypotheses two, three and four. Although positive correlations were not originally hypothesized between social coping resources and partner and family support, and between growth-fostering relationships and partner and family support, analyses of these relationships indicated significant positive correlations between social coping resources and partner support (r = .31,p = .006) and between growth-fostering relationships and partner support (r = .19, p = .05).
Upon closer examination of the results, social coping resources and growth-fostering relationships may have been assessing similar constructs. The strong positive correlation between the two variables (r = .74, p = .01) is consistent with literature that supports the relationship between them (Connor, Powers, & Bultena, 1979; Genero, Miller, Surrey, & Baldwin, 1992; Jordan, 1997; Liang et al., 1998).). Although the correlation is not strong enough to suggest multicollinearity, the regression statistics should be interpreted with caution due to the potential adverse effects of correlated independent variables on the estimation of those statistics (Pedhazur, 1997). For example, an examination of the standardized beta coefficients revealed that all of the coefficients were negative with the exception of growth-fostering relationships. Based on these results, an increase in the score for growth-fostering relationships means an increase in the score for infertility stress. However, this is not theoretically sound if growth-fostering relationships and social coping resources are assessing the same construct. Furthermore, the amount of variance in infertility stress that is accounted for by social coping resources and growth-fostering relationships may actually be smaller than what is reported in the current analysis. In other words, coping resources may be overshadowing the impact of the specific growth-fostering relationships being used as coping resources by infertile women, not allowing for a better understanding of these relationships. However, the usefulness of social coping resources, partner and family support should not be overlooked. There is strong support for using these coping methods in dealing with infertility-related stress.
As is true of all studies using self-report measures, the possibility of bias in responding must be considered a potential limitation in interpreting the present findings. The sensitive nature of infertility issues is an additional possible confound; however, the procedures for recruitment of participants were designed to help overcome these limitations by motivating participants to provide information to help health care providers enhance the quality of services provided during their infertility treatment program. In addition, although the sample for this study was relatively small and restricted to one geographic region of the country, the proportional representation of demographic factors (e.g., economic level, marital status, infertility status, type of infertility, and type of treatment) was consistent with many studies that have been conducted at specialized infertility treatment centers (Abbey et al., 1991; Brand, 1989; Jones & Hunter, 1996; McEwan et al., 1987; Raval, Slade, Buck, & Lieberman, 1987; Wright, Allard, Lecours, & Sabourin, 1989). As a consequence, the findings may provide evidence of trends that further researchers may want to evaluate more closely.
It was interesting to note that differences in the variables of interest did not emerge based on any of the demographic variables of interest for the study. In particular, the nature or type of infertility problem was not related to infertility stress. Rather, the fact of infertility itself was the major issue, and the presence of growth-fostering relationships, social, partner, and family support were the major factors resulting in stress reduction for all of the women who responded. These findings have implications for counseling practice as well as further research.
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