Reconstructing Their Lives: A Longitudinal, Qualitative Analysis of the Transition to Biological Childlessness for Infertile Couples. (Research)

Article excerpt

Approximately 3.5 million couples in the United States experience infertility, commonly defined as the inability to achieve a viable pregnancy after 12 months of regular, unprotected intercourse (Mosher & Pratt, 1991; Ulbrich, Coyle, & Llabre, 1990). The pursuit of parenthood is becoming more accessible for previously marginalized groups (e.g., single women, lesbians), and increasing advancements in reproductive technologies and options are pushing the upper limits on when women and men choose to pursue a pregnancy. The prevalence of fertility-related concerns is not likely to decrease in the near future (Jacob, 1997; Mosher & Pratt, 1991). This means that most practitioners who work with adults will have clients included in their caseloads who are attempting to cope with the substantial stresses associated with trying to produce a child and who have feelings of grief and loss, often intense, if their treatment efforts fail (Daniluk, 1997; Mahlstedt, 1985; Menning, 1988).

Substantial clinical and research literature is available to inform practitioners about the stresses involved in prolonged fertility treatments (e.g., Berg & Wilson, 1991; Daniluk, 1988; Greil, 1991; Leiblum, 1997; Nachtigall, Becket, & Wozny, 1992; Peoples & Ferguson, 1998; Wright, Allard, Lecours, & Sabourin, 1989, Wright et al., 1991) and the difficulties in coping with a failed treatment cycle (e.g., Newton, Hearn, & Yuzpe, 1990). Recent attention has focused on the challenges of making the transition to parenthood when medical intervention has been successful (e.g., Abbey, Andrews, & Halman, 1994; Daniluk & Mitchell, 1993; Glazer, 1990; Sandelowski, 1993; Sandelowski, Harris, & Holditch-Davis, 1990) and on the ethical and moral dilemmas encountered by infertile individuals and couples when faced with controversial high technology treatments or the use of third-party reproductive options (e.g., donor eggs, donor sperm, gestational carrier, surrogacy) to create their family (e.g., American Society for Reproductive Medicine, 1997; Bolton, Golombok, Cook, Bish, & Rust, 1991; Cooper, 1997; Dickstein, 1990; McShane, 1997; Robertson, 1995; Schover, Collins, & Richards, 1992; Wasserman & Wachbroit, 1992). This extensive and readily accessible literature will not be reviewed here.

What has not been addressed in the empirical literature to date is how the approximately 50% of individuals and couples whose treatment efforts are unsuccessful (McShane, 1997; Mosher & Pratt, 1991) cope with the permanence of their infertility. Little is known about the meaning of infertility and biological childlessness for couples who have abandoned their efforts to produce a child or about how couples meaningfully reconstruct their lives and make decisions about their future after having been unable to achieve their procreative goals. This was the focus of the current longitudinal study that was guided by the following question: How do couples make sense of their infertility and reconstruct their lives when faced with the permanence of their biological childlessness?

METHOD

According to Colaizzi (1978) and van Manen (1990), human experiences about which there is little known, as in the case of the meaningful reconstruction of lives when couples fail to achieve their procreative goals, lend themselves to qualitative, phenomenological inquiry. "Phenomenology provides a way of exploring lived experience--the actuality of experience--from the inside" (Osborne, 1994, p. 170). This method allows the researcher to explore how people experience, describe, and interpret a phenomenon--in this case involuntary biological childlessness.

"Phenomenology uses a descriptive approach that allows the researcher to explore conscious experience directly through ... [participant] introspection rather than inferentially through overt observation" (Osborne, 1994, p. 168). The aim of my research was "to describe the world-as-experienced by the participants . …