Confronting Fertility Problems: Current Research and Future Challenges
Lauri A. Pasch
University of California, San Fmncisco
The great majority of young adults intend to become par- parents at some point in their lives (Jacobson & Heaton, 1991). ents Couples who desire to have children usually assume that pregnancy will occur naturally over a period of months of not using contraceptive methods. For at least 8% of married cou- couples in the United States in which the woman is of childbear- ples childbearing age, this period of anticipating pregnancy passes without ing success (Abma, Chandra, Mosher, Peterson, & Piccinino, 1997). For many of these couples, the life goal of having bio- biologically related children is at least temporarily out of reach. logically Infertility is not a discrete event, but instead an unfolding pro- process. The recognition that pregnancy is not occurring is often cess. followed by attempts to increase the likelihood of pregnancy. Some couples decide to seek the assistance of a physician. If medical intervention is pursued, a protracted period of medi- medical tests and treatment follows, with or without success. cal Eventually, unsuccessful couples consider other options, in- including adoption, surrogacy, or remaining without children. cluding Some couples never seek medical treatment, perhaps as a re- result of financial, moral, cultural, or religious reasons. These sult couples may pursue other options to having children aside from biological parenthood, may continue to attempt concep- conception by traditional methods, may seek nonmedical assistance tion (e.g., from religious leaders or alternative medicine provid- providers), or may conclude that having children is simply not meant ers), to be for them. Whatever the circumstances, each step in the process has the potential to be emotionally devastating.
This chapter provides an introduction to psychological is- issues associated with infertility and its treatment. Over the past sues two decades, there has been an explosion of technology avail-available to treat infertility and a concomitant growth in public demand to use these so-called high tech treatments. These developments have made infertility and its treatment a topic of considerable public interest and concern. Unfortunately, medical advances are occurring faster than their individual, family, and societal implications can be anticipated or understood. Many misunderstandings and myths persist in popular culture about infertility and its treatment. This chapter presents what is currently known and what further information is needed.
The first section presents background information on infertility and introduces the complexity of the issues couples face. The second section examines the empirical literature pertaining to how fertility problems affect individuals and couples and discusses risk and protective factors for psychological adjustment. The third section focuses on psychological consequences of the use of assisted reproductive technologies when they are and are not successful. The fourth section turns to the question of how infertility can be prevented, which is a new area of interest for psychologists. Unfortunately, current knowledge in these areas is limited by the almost exclusive focus in research on White individuals of middle to upper socioeconomic status who seek medical treatment for their fertility problems. It is possible that the findings would be very different if the literature were more representative of all individuals facing infertility. The final section delineates challenges for future work that cut across the specific topic areas.
Infertility is medically defined as the inability of a couple to conceive after 12 months of sexual intercourse without contraception