first step in understanding the experience of infertile individuals, many infertile individuals never see an infertility specialist. It is now necessary to go further with sampling methods to include the broader array of possible paths. A number of methodologies can be used to address this goal. For example, large national surveys similar to the National Survey of Family Growth could include detailed investigation of when and why individuals sought or did not seek treatment. Another strategy would be to recruit research participants at earlier points in the treatment trajectory, such as from fanrily practitioners or obstetrics and gynecology practices. Additionally, it will be important to conduct prospective studies that follow participants as they consider various options and experience various outcomes. Only in this way can we understand the natural history of the experience of infertility and its treatment, and those factors that predict who will experience significant adjustment problems. Increasing the representativeness of research will not only provide information about currently unstudied groups, it will also broaden understanding of the sociocultural construction of the importance of biological parenthood, the meaning of infertility, and various modes of resolution of it.
As described, most research on psychological aspects of infertility has been atheoretical. The move toward the use of stress and coping models represents an important advance. However, there is a wealth of knowledge and theory within psychology that can be brought to bear on understanding infertility aside from theories of psychological adjustment, For example, as discussed earlier, there has been concern about the psychological functioning of families conceived through ART S. Early research has focused on the question of whether ART families are more poorly adjusted overall than other families. This focus on pathology may have developed because of remnants of the belief that infertile individuals are psychologically deficient in some way. Research should now move beyond comparing these families to others to tackle important challenges these families face. For example, one question that is beginning to be addressed is whether, what, and when to tell ART children about their origin. This question is particularly important with respect to children conceived through donor gametes, because these children not only are conceived using reproductive technology but also do not have genetic ties with one or both of their parents. Regarding the question of whether to tell the child, there is significant research on the effects of family secrets on children that can be usefully applied (e.g., Imber- Black, 1993). Regarding the questions of when and how to tell the child, there is basic research on children's cognitive development that might help in judging what types of information about their origin children can understand at particular ages (e.g., Springer, 1996). There are also many lessons to be learned from the literature on the psychology of adoption (e.g., Brodzinsky & Schechter, 1990). Making use of broad theory and knowledge will prevent research and clinicians working in the area of infertility from having to “reinvent the wheel” each time a new issue must be faced. In addition, there is the potential to advance the scope of the theory itself.
In addition to incorporating theory, attention should be directed to addressing applied problems. Practicing psychologists and other mental health professionals working in the field' of reproductive medicine are now faced with many challenges. They conduct pre-ART assessments with couples. These assessments often have multiple purposes, including identification of patients in need of additional support services during the ART process and sometimes to identify patients they think would not be good candidates for treatment for psychological reasons. They conduct assessments of potential oocyte donors to determine if they understand and are psychologically prepared for being a donor. They offer supportive interventions to patients who experience significant distress.
As the knowledge base advances, there is a need for development of research-based assessment, prevention, and intervention protocols for use with infertility patients (Adler, Keyes, & Robertson, 199 1; Pasch & Dunkel-Schetter, 1997). Although there is widespread belief in the importance of psychological interventions, current procedures are based on an extremely limited empirical foundation. For example, research identifying the risk and protective factors present prior to ART that predict which individuals are likely to be in need of additional support would provide a much-needed empirical basis for pre-ART assessments. By identifying the factors associated with adjustment to ART failure, mental health professionals would be able to target psychological services to those patients at highest risk and thus prevent the development of serious negative outcomes.
The future is sure to bring many more technological developments, raising even more complex ethical, legal, and moral dilemmas. New treatments will continue to come into popular use before the psychological community can consider their potential risks to emotional adjustment and family development. Current treatments will become medically obsolete before their impact is fully understood. Because infertility treatment is a constantly moving target, psychologists who work in this area must remain abreast of new developments and employ the tools of the field to investigate and intervene as appropriate to assist patients, the medical community, and the community at large in understanding the psychological impact of these developments.
Abbey, A., Andrews, F. M., & Halman, L. J. (1991). The importance of social relationships for infertile couples' well-being. In A. L.