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RESOURCES

The Association of Lesbian and Gay Psychologists 2336 Market Street

San Francisco, CA 94114

The Committee on Lesbian and Gay Concerns

c/o American Psychological Association

1200 Seventeenth Street, NW

Washington, DC 22036

(publishes a "Research Roster")

Society for the Psychological Study of Lesbian and Gay Issues (Division 44 of the American Psychological Association) 1200 Seventeenth Street, NW Washington, DC 20036

The Association for Women in Psychology

K Towns/RIE Gentzler Crags-PSU/Capitol Campus Middletown, PA 17057

Lesbian Research Consortium c/o Dr. Sari H. Dworkin California State University Fresno, CA 93740-0003

Psychology of Black Women

(A section of division 35, psychology of women)

c/o American Psychological Association

1200 Seventeenth Street, NW Washington, DC 20036

Barbara E. Sang is in private practice in New York City. Correspondence regarding this article should be sent to Barbara E. Sang, 200 East 16th Street, Apt. 10L, New York, NY 10003.

JOURNAL OF COUNSELING & DEVELOPMENT SEPTEMBER/OCTOBER 1989 VOL. 68

An Exploratory Study of the

Psychological Correlates of Infertility on Women

NADYA A. FOUAD and KRISTIN KONS FAHJE

Infertility-the inability to achieve a pregnancy after a year or more of regular, unprotected intercourse, or the inability to carry a pregnancy to a live birth-will be experienced by 15 percent of the childbearing population at any time. This study investigates the effect of various factors related to infertility on women's self-esteem and the concomitant incidence of depression. Sixty-one women completed instruments measuring self-esteem, depression, locus of control, and social support. Results are discussed with implications for counseling.

nfertility-the inability to achieve a pregnancy after a year or more of regular, unprotected intercourse, or the inability to carry a pregnancy to a live birth-will be experienced by 15 percent of the population of childbearing age at any time (Menning, 1980).

Infertile couples who are unable to be treated successfully through medical technology suffer physically and psychologically. Involuntary childlessness affects women and men cognitively and emotionally, and in many cases, the pain of not being able to bear a child becomes the central issue of their lives (Goodman & Rothman, 1984). It threatens self-esteem, threatens sexual identity, and helps to produce feelings of shame, anger, isolation, and loss, often overwhelming the infertile patient and taking a toll on the couple's relationships (Mai, Munday, & Rump, 1972).

For the past two decades, researchers have focused on the biological and physiological causes of infertility, and a few researchers have studied the psychological causes of infertility (Denber, 1978; Eisner, 1963; Mai, Munday, & Rump, 1972). Little research, however, has focused on the psychological characteristics of infertility.

It has been recognized that the problem of infertility has two parts: a medical component and a psychological component (Bresnick, 1981). The medical definition was stated in the beginning of this article. Psychologically, infertility creates a state that has been conceptualized as the "crisis of infertility" (Cook, 1987). This psychological state is an emotional condition that gives rise to feelings of loss, depression, guilt, and frustration. Individuals and couples facing infertility must cope with an unanticipated life crisis. This crisis results in losses, such as control over one's life and goals, privacy, self-esteem, and the hope of pregnancy and parenting a biologic child (Clapp, 1985). A number of authors have described the crisis of infertility. Henning (1980) describes a feeling of disequilibrium, Rosenfeld and Mitchell (1979) emphasize tremendous stress on individuals and couples, Taymor and Breznick (1979) state that

infertility often affects every part of the couple's relationships with self and others. Lupske (1985) describes infertility as disrupting the self-concept as well as the marital and sexual relationships.

Shapiro (1982) studied the impact of infertility on the marital relationship and identified the couple's response to their infertility as both a crisis and as a mourning process. He identifies two types of crises: (a) expected crises in the life cycle such as the first child leaving for school and the last child leaving home and (b) unanticipated crises. Infertility is an unanticipated crisis. Since it is unexpected, most couples have not developed coping mechanisms to respond to the hurt that accompanies the inability to conceive or bear a child.

Cook (1987) delineates eight stages first proposed by Henning (1980) through which individuals typically progress in their adjustment to infertility: disbelief, denial, anxiety, anger and loss of control, isolation and alienation from others, guilt and low self-esteem, grief and depression, and resolution. Cook makes it clear that these stages "are generalizations that may not accurately represent the experiences of any particular [individual or] couple identifiable as infertile... Differences in the way individuals perceive, react to, and resolve their infertility are not well understood." (p. 468)

Several variables have been emphasized by the previously cited authors as indicative of the crisis of infertility: loss of control, isolation, depression, and low self-esteem. Previous researchers have not tested the relationships among these variables, however, for a sample of infertile women. This study was designed to study those variables to investigate the relationship between locus of control and self-esteem and depression and whether social support is positively correlated with high selfesteem and negatively correlated with depression. If this latter relationship exists for infertile women, counselors can help women learn how to identify their support systems that can help them cope with their crisis. Among other findings, social support has been linked to positive mental health and faster physical recovery from illness. The reader is referred to Pearson (1986) for an excellent and thorough review of the social support literature. An investigation of the relationship between locus of control and self-esteem and depression will help counselors examine a woman's sense of helplessness and loss of control over her life. For many women the medical procedures and treatment may emphasize her loss of control.

The purpose of this study, then, is to explore some of the psychological correlates of the crisis of infertility on women. Although it is known that men, too, suffer psychologically from

JOURNAL OF COUNSELING & DEVELOPMENT SEPTEMBER/OCTOBER 1989 VOL. 68