Long‐Term Adjustment of Infertile Couples Following Unsuccessful Medical Intervention

Infertility is defined as the failure to conceive a child after a year of regular, unprotected intercourse (Tierney, McPhee, & Papadakis, 1999). The current study examined how coping resources and deficits, as conceptualized in the 4S (situation, self, support, and strategies) model by Schlossberg, Waters, and Goodman (1995), related to psychosocial well-being over time for 38 infertile couples whose attempts to produce a child were unsuccessful despite extensive medical intervention. The primary objectives were to inform theory in this emergent area of research and practice and to increase practical knowledge in order to enhance psychosocial support for infertile couples. As an indication of the scope of the problem, infertile couples constitute approximately 15% to 25% of all those who attempt to conceive (Tierney et al., 1999). Male factors account for close to one third of all cases, female factors account for just over a third, and combined male and female factors account for 20% (Corson, 1999). The specific causes of approximately 10% of cases remain unexplained. Despite significant medical advancements in the diagnosis and treatment of fertility concerns such as in vitro fertilization (IVF) and intracytoplasmic sperm injection, medical intervention results in a viable pregnancy for only 30% to 60% of couples seeking treatment, depending on the cause of their infertility (Tierney et al., 1999). The psychosocial consequences commonly associated with the prolonged pursuit of fertility treatments have been well documented in the literature (e.g., Berg & Wilson, 1991; Daniluk, 1988, 1996, 2001; Domar, 1997; Hammer-Burns & Covington, 1999; Leiblum & Greenfeld, 1997). These include grief, depression, isolation, lowered self-esteem, relationship distress, and sexual dissatisfaction. Previous research has also addressed identity and role-loss issues for involuntarily childless women and men (Carter & Carter, 1989; Deveraux & Hammerman, 1998; Ireland, 1993; Matthews & Matthews, 1986) and documented the particular stresses and common concerns of infertile couples who are successful in their efforts to produce a child (e.g., Daniluk & Mitchell, 1993; Glazer, 1990). However, very little is known about the psychosocial consequences of treatment failure (Daniluk, 1996; Sandelowski, 1993). Until couples abandon treatment, they often do not see their biological childlessness as permanent (Greil, 1991). The actual transition to biological childlessness from an identity and life reconstruction perspective really only begins once individuals stop pursuing a pregnancy (Deveraux & Hammerman, 1998). Specifically, research is lacking to explain how couples who are unsuccessful in their efforts to produce a child negotiate the transition to permanent biological childlessness. Schlossberg et al. (1995) contended that important and expected events in life that do not occur often create considerable psychological distress and disequilibrium, challenging people's basic assumptions about life and requiring adaptation and change. Being unable to produce a child despite one's best efforts certainly constitutes such a nonevent transition. Other researchers have also conceptualized infertility as a nonevent developmental transition (Koropatnick, Daniluk, & Pattinson, 1993). As such, Schlossberg et al.'s transition model was used in the current study to conceptualize couples' transitions to permanent biological childlessness following failed fertility treatments. After 20 years of research applying and refining the 4S model, Schlossberg et al. (1995) proposed that individuals have various resources and deficits when it comes to coping with transitions and that the degree of well-being individuals enjoy as they negotiate a transition may change as the ratio of resources to deficits shifts. These resources and deficits are grouped into four categories: (a) situation (the cause, nature, and characteristics of the transition), (b) self (the demographic characteristics and psychological resources of the individual), (c) support (the available social supports and options available to the individual), and (d) strategies (the methods used to cope with the transition). …