Fouad and Fahje

CONCLUSIONS

This study focused on infertility as an unexpected life crisis. The results of this exploratory study support the positive relationship between infertile women's self-esteem and their internal locus of control, their self-esteem and subjective satisfaction with their social support, and their self-esteem and the general satisfaction with the social support they have received over the last month. The data indicate a negative relationship between the infertile woman's level of depression and self-esteem and between self-esteem and her perception of the fit between the supply of social support and her need for social support.

The study also found that for infertile women in this group there was a positive relationship between depression and external locus of control, as well as between depression and the discrepancy between need and supply of social support (perceived fit). A negative relationship existed between depression and subjective satisfaction with social support and general satisfaction with social support.

There are a number of ways in which counselors can help women cope with the life crisis of infertility and deal with their feelings and behaviors in order to facilitate restabilization and growth. Counselors must first acknowledge the crisis of infertility and be aware that lack of social support, anger, sadness, and feelings of helplessness are very realistic responses to the crisis. While she may not have a perception of inner control over her life due to the intrusive medical tests and procedures in which she is involved, her general coping skills may be well developed. If they are not, counselors may help women refocus their control in a variety of ways. Counselors may help a woman accurately appraise the degree of control she appears to have over other important outcomes in her life by helping her look at the amount of inner control she has over other major life

events.

Counselors may also help women to reduce the importance of unattainable goals and irreversible losses by helping them focus on the fact that they cannot control some life events and must put their attention on those goals over which they have some control.

In addition to attention paid to locus of control, counselors should assess the woman's social support system and help her to decrease the discrepancy between the social support she needs and her supply of social support. This may include teaching her assertiveness skills, communication skills, or reality-testing skills.

Finally, a counselor may help an infertile woman not to overvalue events over which she has no control and to increase the value of attainable goals. To do this, counselors must focus their efforts on three processes, all of which vary greatly with each individual. First, the counselor needs to understand the woman's importance hierarchy. This hierarchy must include the importance of the loss of the ability to bear a child and the effect that such a loss has on other goals. Second, the counselor needs to obtain an understanding of the amount of perceived control the woman has over each goal in her hierarchy by assisting her in looking at each goal. Third, the counselor needs to uncover the reason that the woman perceives little or no control over many important aspects of her life by establishing a safe and nonthreatening environment that will encourage her to share her concerns and feelings.

Counselors must help women who are experiencing the crisis of infertility to disengage from the parts of their lives that they cannot control and focus on other aspects of their lives that they can control. They must provide for the development of skills,

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including seeking social support, that will help women cope with other life stresses and future life crises.

There are a number of limitations inherent in this study. The primary limitation is that the greatest percentage of the participants were from the infertility conference that was held in the midwest. These women were motivated enough to seek additional information and support from the conference staff and participants, and that factor may have biased the findings. Also, no control group was involved in the study. The findings may have been typical of women in general or of women in any medical crisis.

The crisis of infertility is not a one-time event, but rather an ongoing crisis over a long period of testing and treatment. This study surveyed women at only one point of their infertility testing and at only one point in their menstrual cycle, fluctuation in which may affect depression and subjective perceptions of social support and self-esteem. It would be extremely beneficial to do a longitudinal study of each participant at different points of her infertility testing and compare levels of self-esteem and depression as she progressed through the testing and

treatment.

As stated above, future research could include more participants, as well as personal interviews with each participant, in order to obtain additional data regarding their levels of self-esteem and incidence of depression. This additional data would enable a more complex analysis of the correlations between levels of depression and self-esteem, the number of years the participant was involved in infertility testing, whether she was employed outside the home, and a number of other variables, such as the number of years of medical intervention, career commitment, or family expectations.

Another area of future research could focus on the psychological impact that infertility has on couples and how they perceive each other's support in relation to their own levels of needed support. This would enable counselors to help couples learn how to increase their support for each other.

There is a great deal of research on both the medical and psychological causes of infertility. The psychological impact of this life crisis warrants additional research and study.

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Nadya A. Fouad is an associate professor, Department of Educational Psychology, University of Wisconsin-Milwaukee. Kristin Kons Fahje is employed by the Waukesha School District, Wisconsin. Correspondence regarding this article should be sent to Nadya A. Fouad, Dept. of Educational Psychology, P.O. Box 413, University of Wisconsin-Milwaukee, Milwaukee, WI 53201.

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