ABSTRACT
Reproduction is considered the most basic of human needs, propelled by powerful biological and psychological drives. When the ability to reproduce is thwarted, a crisis ensues—the life crisis of infertility. The psychological crisis of infertility has been well documented in the literature. It is considered an emotionally difficult experience that impacts on all aspects of a couple’s or an individual’s life: relationships with others, life goals, social roles, selfimage, self-confidence, and sexuality, to name a few (1). The losses associated with infertility are multifaceted, including the loss of hopes, dreams, future plans, marital satisfaction, self-esteem, sense of control, belief in the fairness of life, health, and well-being, and, most important, the “dream child” (2). Further, these losses evoke feelings of grief—shock, disbelief, sadness, anger, guilt, blame, and depression—which occur in a repetitive and predictable process as patients move through medical diagnosis and treatment. It is through the experience and expression of emotions involved in the grieving process that the infertile couple moves toward an acceptance of their infertile state, engages in the exploration of alternative plans, and begins to move forward with their lives (3). During the past 50 years, we have seen a shift from the psychogenic infertility model, in which demonstrable psychopathology was thought to play an etiologic role in infertility, to a psychological sequelae model, in which numerous psychological factors were considered the result of infertility (4). In this concept, infertility is viewed as an emotionally difficult experience affecting all aspects of an individual’s and a couple’s life. Thus, emotional distress is a consequence and not a cause of infertility, as conceptualized previously. The application of a broader spectrum of theoretical approaches has led to a less individualistic perspective and a more holistic approach to infertility. In this sense, the interactions among individuals/couples and social/medical components are considered and must be factored into medical treatment. These perspectives have also increased understanding of individual and couple differences and resilience, the impact of reproductive medical treatments, and the efficacy of therapeutic psychological interventions. Research examining the psychosocial context of infertility has burgeoned during this period. In a comprehensive review of the literature, Greil and associates (5) expanded on earlier work (6) by assessing research published in the last 10 years to determine how it has changed, where methodological progress has been made, and what generalizations can be drawn about the experience of infertility. They note the change from viewing infertility as a medical condition with psychological consequences to placing infertility within a larger sociocultural construct that shapes the experience.
