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The journey to conception is a long, difficult road...
The stress of infertility
Human Ecology Forum, Fall 1995 v23 n4 p12(4)
The stress of infertility. Ericka Taylor.
Abstract: Married couples who are unable to have children are at high risk to suffer great emotional
stress. Psychologists advice couples who suffer from the stress of fertility to seek professional
counseling to help come to terms with their failed hopes and dreams. Otherwise, the stress can make
both partners lose control of their selves, their lives and eventually, their marriage. Infertile couples
should also seek family and friends and tell them what their needs are and what they expect from
other people to help them overcome the stress more effectively.
Full Text: COPYRIGHT 1995 Cornell University, Human Ecology
The stress associated with infertility is often overlooked or not fully appreciated. Consequently,
couples seeking medical help are treated for only some of their problems. Psychological counseling is
recommended for both partners. For couples living in rural areas, this support is more difficult to
provide.
About fifteen years ago most infertile couples looked to adoption as a way of enlarging their families
because infertility treatments were known not to be very successful. Within the last decade, however,
new technology has dramatically improved the success rate of such treatments.
This is good news for the approximately one in every six couples in the United States who are
infertile, says Constance Shapiro, professor and chair of the Department of Human Service Studies.
The group includes couples who have tried unsuccessfully to conceive a child through regular sexual
relations for a year or more and those who have not been able to carry a pregnancy to a live birth. But
the gains in the medical arena have a downside.
"The stress associated with infertility is often overlooked or not fully appreciated by physicians,"
Shapiro says. "Consequently, couples are only treated for a portion of their problems and are often
surprised by the emotional and psychological toll of the experience. Their marriages may also be at
risk because of the tensions and the high emotions they are experiencing."
Psychosocial issues also can be sources of anxiety for infertile couples. Some watch expensive
treatments consume their savings. Some must travel long distances to infertility clinics on days
determined by the woman's ovulation cycle. It is no surprise, then, that both men and women feel
themselves losing control over their lives and their schedules.
Supporting a preventive approach, Shapiro believes that all couples diagnosed as infertile should be
warned that infertility is a stressful experience. They should also be told, she says, that one way to
handle that stress is to join an infertility support group or to talk to a counselor. Even if only one
member of a couple is receiving physical treatment for infertility, the numerous anxieties that ensue
make it necessary for both partners to receive psychological support.
Having studied infertility for fifteen years and counseled dozens of infertile couples, Shapiro has
witnessed the full spectrum of pressures infertile couples face.
"Couples who are unable to conceive must come to terms with their unfulfilled hopes and dreams,"
she says. "They may also face stress as they try to determine how long they will try to conceive and
as they put their lives on hold in so many ways."
Couples dealing with ectopic pregnancies, miscarriages, and stillbirths face another type of stress,
Shapiro notes. "They are grieving the actual pregnancy, which they may have fantasized into a very
real child. These couples are always doubtful as to whether they can conceive again."
The future parents may have designed a nursery and picked out names for a child, Shapiro says. "The
sadness of it is that there is no ritual that is associated with a pregnancy loss."
Furthermore, family and friends who try to help by telling the infertile couple that they can try again
and that the pregnancy wasn't meant to be don't realize that they are further distressing the couple by
invalidating the attachment they had to the developing baby.
In fact, family and friends, whether well-meaning or insensitive, can contribute to the frustrations of
an infertile couple, Shapiro says. Couples who don't share the news of their infertility with their
friends have to endure conversations about planning for children. Even couples who announce their
infertility must deal with fertile acquaintances who may be insensitive to their problem, perhaps
expecting them to share in their own joy over an expected baby. Family members are often unaware
that holiday gatherings can be upsetting for infertile couples, who can be disturbed by seeing pregnant
relatives and small children. Mother's and Father's Days are especially painful to infertile couples.
"One of the ways couples can begin to overcome the stress of infertility is to learn how to be assertive
in stating what their needs are and what they need from other people," she says. Infertile individuals
and couples may choose to confront their relatives and friends verbally, or to approach the issue in a
letter. In either case, the infertile couple is given the opportunity to take control.
Since infertile couples might turn to many sources for advice, Shapiro has given seminars for clergy
who encounter infertile couples and often don't appreciate the extent of the pain couples undergo. She
has also provided seminars for nurses and physicians who, though accustomed to talking about the
medical problems of a couple, may not realize how important it is to recognize the accompanying
emotional stresses.
Helping relieve the burden of an infertile couple can often be difficult, according to Shapiro, because
couples frequently feel a strong sense of urgency regarding their treatment. One way for a couple to
reduce stress, she says, is to temporarily escape the day-to-day spectre of infertility.
"Sometimes I advise couples to take a 'vacation' from treatment, but they often resist because they
want to use every single ovulation cycle to try to conceive."
Even a two-month break from the strict regimen of keeping ovulation charts and precise records is
helpful in reducing stress, she says. Nonetheless, couples are rarely receptive to taking such vacations
voluntarily, especially when the couple is concerned about the woman becoming less fertile with each
passing month.
Unfortunately, this persistence can lead to a virtual removal of pleasure from sexual activity.
"It is almost guaranteed that the sexual relationship of a couple will be affected. Any counselor of
infertile couples must inquire about this," Shapiro says. In fact, many couples often refrain from
sexual intercourse except during the time of the woman's ovulation - a practice that rarely has positive
emotional consequences.
Knowing the numerous anxieties that couples receiving physical treatment for infertility must endure,
Shapiro is concerned particularly about rural infertile couples, who have additional stresses and no
ready access to social and psychological support.
"Rural infertility clients must often travel hundreds of miles to receive treatment at an infertility clinic,"
she says, "and they could consequently miss considerable time from work. Furthermore, many clinical
treatments don't require the presence of both individuals, so it is unlikely that a social worker at the
clinic will get to see the couple together."
In addition to geographical isolation, rural couples are generally less familiar with counseling services
than their urban counterparts and therefore less likely to seek psychological help.
"Obtaining psychological counseling can have more of a stigma attached to it for rural couples, who
very possibly don't know anyone else who has sought such help," Shapiro says. "And if they can find
general counseling services nearby, they are unlikely to encounter a specialist in infertility, a field that
few people are knowledgeable about."
Fortunately, some clinics have established outreach services. One such effort is based on a model
developed by the Ferre Institute in Utica, New York, which provides research and education for
professionals and people seeking infertility services. The institute contracted with social workers from
surrounding counties to provide counseling close to home for their clients.
Shapiro worked with the Mid-York Fertility Clinic in Utica, New York, which was selected as a
setting to test the model with Ferre-trained counselors. The community-based counselors made home
visits and hospital visits and conducted counseling sessions over the phone when couples could not
easily make office visits.
"The outreach program was an immense help to the couples," she notes. "Unfortunately, many clinics
have no vested interest in pursuing outreach programs because there are usually enough infertile
couples in an urban area to supply clinics with ample business. As a consequence, the needs of
infertile couples in rural areas are often not met."
Although the percentage of infertile couples in the country has not risen since 1964, Shapiro says that
the number of clinic visits has tripled. The large number of infertility clients has increased the demand
for infertility counselors. Shapiro hopes that physicians choosing to specialize in infertility will
consider hiring counselors so they can treat both the physical and psychological needs of infertile
couples.
For more information, contact Constance H. Shapiro Cornell University Department of Human Service
Studies N135 MVR Hall Ithaca, NY 14853 607-255-2514 chs4[at]cornell.edu
Human Ecology Forum, Fall 1995 v23 n4 p12(4)
The stress of infertility. Ericka Taylor.
Abstract: Married couples who are unable to have children are at high risk to suffer great emotional
stress. Psychologists advice couples who suffer from the stress of fertility to seek professional
counseling to help come to terms with their failed hopes and dreams. Otherwise, the stress can make
both partners lose control of their selves, their lives and eventually, their marriage. Infertile couples
should also seek family and friends and tell them what their needs are and what they expect from
other people to help them overcome the stress more effectively.
Full Text: COPYRIGHT 1995 Cornell University, Human Ecology
The stress associated with infertility is often overlooked or not fully appreciated. Consequently,
couples seeking medical help are treated for only some of their problems. Psychological counseling is
recommended for both partners. For couples living in rural areas, this support is more difficult to
provide.
About fifteen years ago most infertile couples looked to adoption as a way of enlarging their families
because infertility treatments were known not to be very successful. Within the last decade, however,
new technology has dramatically improved the success rate of such treatments.
This is good news for the approximately one in every six couples in the United States who are
infertile, says Constance Shapiro, professor and chair of the Department of Human Service Studies.
The group includes couples who have tried unsuccessfully to conceive a child through regular sexual
relations for a year or more and those who have not been able to carry a pregnancy to a live birth. But
the gains in the medical arena have a downside.
"The stress associated with infertility is often overlooked or not fully appreciated by physicians,"
Shapiro says. "Consequently, couples are only treated for a portion of their problems and are often
surprised by the emotional and psychological toll of the experience. Their marriages may also be at
risk because of the tensions and the high emotions they are experiencing."
Psychosocial issues also can be sources of anxiety for infertile couples. Some watch expensive
treatments consume their savings. Some must travel long distances to infertility clinics on days
determined by the woman's ovulation cycle. It is no surprise, then, that both men and women feel
themselves losing control over their lives and their schedules.
Supporting a preventive approach, Shapiro believes that all couples diagnosed as infertile should be
warned that infertility is a stressful experience. They should also be told, she says, that one way to
handle that stress is to join an infertility support group or to talk to a counselor. Even if only one
member of a couple is receiving physical treatment for infertility, the numerous anxieties that ensue
make it necessary for both partners to receive psychological support.
Having studied infertility for fifteen years and counseled dozens of infertile couples, Shapiro has
witnessed the full spectrum of pressures infertile couples face.
"Couples who are unable to conceive must come to terms with their unfulfilled hopes and dreams,"
she says. "They may also face stress as they try to determine how long they will try to conceive and
as they put their lives on hold in so many ways."
Couples dealing with ectopic pregnancies, miscarriages, and stillbirths face another type of stress,
Shapiro notes. "They are grieving the actual pregnancy, which they may have fantasized into a very
real child. These couples are always doubtful as to whether they can conceive again."
The future parents may have designed a nursery and picked out names for a child, Shapiro says. "The
sadness of it is that there is no ritual that is associated with a pregnancy loss."
Furthermore, family and friends who try to help by telling the infertile couple that they can try again
and that the pregnancy wasn't meant to be don't realize that they are further distressing the couple by
invalidating the attachment they had to the developing baby.
In fact, family and friends, whether well-meaning or insensitive, can contribute to the frustrations of
an infertile couple, Shapiro says. Couples who don't share the news of their infertility with their
friends have to endure conversations about planning for children. Even couples who announce their
infertility must deal with fertile acquaintances who may be insensitive to their problem, perhaps
expecting them to share in their own joy over an expected baby. Family members are often unaware
that holiday gatherings can be upsetting for infertile couples, who can be disturbed by seeing pregnant
relatives and small children. Mother's and Father's Days are especially painful to infertile couples.
"One of the ways couples can begin to overcome the stress of infertility is to learn how to be assertive
in stating what their needs are and what they need from other people," she says. Infertile individuals
and couples may choose to confront their relatives and friends verbally, or to approach the issue in a
letter. In either case, the infertile couple is given the opportunity to take control.
Since infertile couples might turn to many sources for advice, Shapiro has given seminars for clergy
who encounter infertile couples and often don't appreciate the extent of the pain couples undergo. She
has also provided seminars for nurses and physicians who, though accustomed to talking about the
medical problems of a couple, may not realize how important it is to recognize the accompanying
emotional stresses.
Helping relieve the burden of an infertile couple can often be difficult, according to Shapiro, because
couples frequently feel a strong sense of urgency regarding their treatment. One way for a couple to
reduce stress, she says, is to temporarily escape the day-to-day spectre of infertility.
"Sometimes I advise couples to take a 'vacation' from treatment, but they often resist because they
want to use every single ovulation cycle to try to conceive."
Even a two-month break from the strict regimen of keeping ovulation charts and precise records is
helpful in reducing stress, she says. Nonetheless, couples are rarely receptive to taking such vacations
voluntarily, especially when the couple is concerned about the woman becoming less fertile with each
passing month.
Unfortunately, this persistence can lead to a virtual removal of pleasure from sexual activity.
"It is almost guaranteed that the sexual relationship of a couple will be affected. Any counselor of
infertile couples must inquire about this," Shapiro says. In fact, many couples often refrain from
sexual intercourse except during the time of the woman's ovulation - a practice that rarely has positive
emotional consequences.
Knowing the numerous anxieties that couples receiving physical treatment for infertility must endure,
Shapiro is concerned particularly about rural infertile couples, who have additional stresses and no
ready access to social and psychological support.
"Rural infertility clients must often travel hundreds of miles to receive treatment at an infertility clinic,"
she says, "and they could consequently miss considerable time from work. Furthermore, many clinical
treatments don't require the presence of both individuals, so it is unlikely that a social worker at the
clinic will get to see the couple together."
In addition to geographical isolation, rural couples are generally less familiar with counseling services
than their urban counterparts and therefore less likely to seek psychological help.
"Obtaining psychological counseling can have more of a stigma attached to it for rural couples, who
very possibly don't know anyone else who has sought such help," Shapiro says. "And if they can find
general counseling services nearby, they are unlikely to encounter a specialist in infertility, a field that
few people are knowledgeable about."
Fortunately, some clinics have established outreach services. One such effort is based on a model
developed by the Ferre Institute in Utica, New York, which provides research and education for
professionals and people seeking infertility services. The institute contracted with social workers from
surrounding counties to provide counseling close to home for their clients.
Shapiro worked with the Mid-York Fertility Clinic in Utica, New York, which was selected as a
setting to test the model with Ferre-trained counselors. The community-based counselors made home
visits and hospital visits and conducted counseling sessions over the phone when couples could not
easily make office visits.
"The outreach program was an immense help to the couples," she notes. "Unfortunately, many clinics
have no vested interest in pursuing outreach programs because there are usually enough infertile
couples in an urban area to supply clinics with ample business. As a consequence, the needs of
infertile couples in rural areas are often not met."
Although the percentage of infertile couples in the country has not risen since 1964, Shapiro says that
the number of clinic visits has tripled. The large number of infertility clients has increased the demand
for infertility counselors. Shapiro hopes that physicians choosing to specialize in infertility will
consider hiring counselors so they can treat both the physical and psychological needs of infertile
couples.
For more information, contact Constance H. Shapiro Cornell University Department of Human Service
Studies N135 MVR Hall Ithaca, NY 14853 607-255-2514 chs4[at]cornell.edu