Incorporating Ideological Context in Counseling Couples Experiencing Infertility.

This article describes the influence of ideological values on couples' experience of infertility. Contextual issues are considered in terms of how they influence medical decision making as well as emotional factors. Strength-based counseling interventions that attend to couples' diverse values are described. Last, implications for counselors, educators, and researchers are discussed. ********** Fertility difficulties have a significant impact on couples' intimate lives. Procreation is necessary for the continuation of humankind and is frequently socially and culturally assumed. For example, it is all too common for child-free couples to hear, "When are you going to start your family?" or couples with one child to hear that their child needs a brother or sister. The "necessity" of fertility is also asserted in biblical passages such as "Be fruitful, and multiply" (Gen. 1:28, King James Version). Fertility difficulties, further complicated by often competing ideological values, have a tendency to affect couples' decision making regarding medical intervention, as well as their emotional and relational coping strategies. The experience of infertility does not discriminate on the basis of belief systems. One in six couples experience difficulty conceiving or carrying a child to term (Dayus, Rajacich, & Carty, 2001; Lin, 2002). When a couple is unable to have children, there is often the experience of isolation and exclusion in addition to feelings of inadequacy and failure (Burnett, 2003). These experiences and feelings may be decreased or intensified, depending on internal and external coping strategies and support systems available to and used by couples. Ideological systems have tremendous influence on coping, decision making, as well as self- and relational identity. For example, Molock (1999), in her discussion of religious factors in infertility counseling, reported that "the religious background of infertility clients is ... an important influence on how they adjust to infertility and its treatment.... Infertility may precipitate a spiritual crisis" (p. 259). However, there is limited recent research available that addresses the impact of these types of influences on couples facing fertility difficulties. The increasing number of treatment options that accompany assisted reproductive technologies is creating unique needs, issues, and questions for couples as they navigate this value-laden territory. This article describes the definition of infertility, ideological influences of infertility on couples and related medical and emotional challenges, and strength-based counseling interventions for use with couples that focus on ideological considerations. Examples of various values issues that couples face are used to illustrate the relationship between fertility problems and ideological context. The examples chosen for illustrations in this article are not intended to encompass all the diverse experiences of couples facing fertility and ideological difficulties but are provided to augment the reader's understanding. INFERTILITY DEFINED Infertility is defined by the American Society for Reproductive Medicine (n.d.) as an impairment of the reproductive system that affects one's ability to conceive children. The three types of infertility are primary infertility, secondary infertility, and subfertility. Primary infertility occurs when couples have never been able to have a child, whereas secondary infertility occurs when couples previously have had a child but are currently unable to conceive or maintain a pregnancy to a live birth (Burnett, 2003; Diamond, Kezur, Meyers, Scharf, & Weinshel, 1999). When couples have been able to have children in a previous relationship but are unable to conceive together, then subfertility is diagnosed (Stoppard, 2000). IDEOLOGICAL INFLUENCES AND COUPLES' EXPERIENCE OF INFERTILITY Many medical choices along with emotional and relational factors affect couples seeking fertility treatment. …