The Infertility Experience: Biopsychosocial Effects and Suggestions for Counselors

Infertility affects many individuals and couples. This article begins with a case study of a couple who have experienced infertility yet do not identify infertility as their presenting problem. Clients and counselors alike often overlook infertility. This article offers an overview of the biology of infertility and its psychological and sociological effects. Counseling issues are presented to assist counselors to identify infertility as a concern and provide interventions. Marilyn, 39, and Pedro, 45, have come to you for marital counseling. They report being devout Catholics who are seeking help in determining the cause of their marital discord. Marilyn is Caucasian, and Pedro is Hispanic They report that they have been married for 14 years, have no children, and for the past 4 years have been "drifting apart." Pedro reports that Marilyn has "changed." She used to be actively involved with their extended families, now he states that "Marilyn has refused to go to my sister's baby shower, and I don't understand her anymore." Marilyn states that she feels depressed and "doesn't feel up to seeing her family." She has also stopped going to many of her typical social functions. Marilyn reports that her mother has been concerned and has stated that Marilyn and Pedro should have a baby. Marilyn shares that her mother continuously questions her about "becoming a Grandma" and puts pressure on her to "be a good Catholic." Pedro observes that Marilyn keeps saying things like, "What's the purpose of living" and "We are failures as adults." Pedro also reports that he is unsatisfied with their sexual relationship. In particular, Marilyn has been anorgasmic, and he has had incidences of impotence. When asked about her sexual relations, Marilyn says that she cannot "stand her menstrual cycle" and all of the "mess it entails," but she does not address the act of intercourse. Pedro reports being confused and that he does not understand the emotional lows Marilyn is experiencing. They are thinking about getting divorced. Statistics indicate that 3.5 million couples in the United States are infertile (Daniluk, 2001b). In other words, 15% of all couples will experience the frustration of infertility at some point in their relationship (Serono Laboratories, 1996). The high incidence of infertility almost guarantees that the complex emotional roller coaster related to infertility that individuals and couples face will be an issue in some facet of their counseling. To ethically address the issues that clients like Marilyn and Pedro present, counselors must understand the complexities that infertile individuals and couples experience, including the biological, the psychological, and the sociological effects. This article explores the wide array of conditions individuals and couples endure because of infertility and provides specific counseling strategies. For a clearer writing style, the word couple will be used throughout the remainder of this article, although the reader is advised that many "single" people also go through the infertility experience. In addition, the article is written to provide a model for counselors to use. We are not implying that every couple will go through each of these experiences, only that many couples have done so. Coping with infertility is a dynamic, personal process, and couples will experience it through their own lense of understanding. Infertility is defined as the inability to achieve a viable pregnancy after 12 months of regular, unprotected sexual intercourse (Anderson, 1989; Atwood & Dobkin, 1992; Cooper-Hilbert, 2001; Daniluk, 2001b; Serono Laboratories, 1996). This definition contradicts the 42% of people who have reported that concern about infertility should not begin until after 30 months of unprotected sexual intercourse (Gibbs, 2002). The National Center for Health Statistics (Atwood & Dobkin, 1992) has stated that infertility affects 27.2% of women between the ages of 40 and 44 years who are trying to conceive. …