What Women With Infertility Want Nurses to Know

Introduction

The purpose of this paper is to identify those aspects typically associated with infertility that adversely affect women, and to a lesser extent men, as they attempt to resolve the economic, physical, social, and psychological effects that are frequently part of the response to the condition. Both men and women have reported that their experience with infertility healthcare practitioners was almost entirely negative, describing the experience as impersonal and insensitive — focused on the "cure" of conceiving a child rather than on a holistic approach that addresses the full range of emotional and physical issues confronting a couple experiencing infertility.

Current statistics on infertility in the United States vary, with some authorities placing the incidence at approximately 3.5 million couples (Daniluk, 2001) and others reporting that infertility is currently experienced by approximately 2.1 million married couples in the United States (Gibson & Myers, 2002). A common definition holds that infertility is the inability to achieve a pregnancy after one year of regular sexual intercourse without the use of contraception (Daniluk, 2001). The incidence of infertile couples is expected to increase in the future as a result of a growing population of childbearing age, postponement of pregnancy, and a "silent" epidemic of sexually transmitted diseases (Men and Women React Differently, 1993).

Current Statistics on Infertility in the U.S.

Because childbearing is a major, normative life transition for both men and women, the experience of infertility constitutes a nonevent transition and has been conceptualized as a "crisis" (Atwood & Dobkin, 1992). While the inability to conceive children is frequently devastating to both partners, studies have shown that men and women have different reactions to infertility (Men and Women React Differently, 1993). The crisis associated with infertility is regarded as highly complex and is comprised of multiple physical, financial, social, and psychological stressors (Gibson & Myers, 2002). According to Gibson and Myers (2002), "The experience of infertility creates negative economic, physical, social, and psychological effects, especially for women. This often results in multiple stresses and needs for coping in these women" (p. 68). The manner in which women cope with these experiences is perhaps better described than understood in the literature; consequently, these authors suggest that existing counseling interventions do not adequately meet the needs of women experiencing infertility.

Gibson and Myers report the results of a study of 83 women who received varied services at assisted reproduction clinics. The study examined the relationship between the use of social coping resources, growth-fostering relationships, and infertility stress, and supports the use of social coping resources for managing infertility stress. The authors also point out that these results reinforce the usefulness of understanding the types of growth-fostering relationships that can serve as an additional resource for helping nurses conceptualize women's experiences and design effective interventions to help women cope with infertility stress (Gibson & Myers, 2002).

Generally speaking, and not surprisingly, women experience more negative effects than men throughout the entire infertility diagnostic and treatment process. Common effects include a greater sense of loss of control than men experience and a greater tendency to blame themselves for the couple's infertility. Furthermore, a number of studies have shown that women are more likely to perceive childlessness as simply unacceptable, and numerous gender differences in coping with infertility have been identified (Gibson & Myers, 2002).

Types of Needs Associated With Infertility

The study by Gibson and Myers examined the relationships among social coping resources, growth-fostering relationships, and infertility stress in 83 women who participated in fertility treatments at urban medical clinics. The findings suggest that both social coping resources and growth-fostering relationships contribute significantly to the variance in infertility stress, with infertility stress decreasing as social coping resources increase. These findings are congruent with earlier research on the positive effects of social coping on emotional health, particularly for infertile women. In addition, Gibson and Myers found that partner support and family support contribute significantly to the prediction of variance in infertility stress. "Based on these results," they state, "it is clear that family and partner supports are very important coping resources for women coping with infertility stress" (p. 69).

While the psychosocial and sociocultural aspects of infertility can extend to both men and women, the biological component naturally tends to affect women more severely than their male counterparts, who may not experience any discernible needs in this regard at all. According to Rutter (1996), "During the baby boom, couples began having children at about age 20. But by 1980 — when women were in the workforce in record numbers and putting off motherhood — 10.5% of first births were to women age 30 and older" (p. 48). By 1990, 18% of first births were among women aged 30 and over. Rutter notes that because more aspiring parents are older today, when the time comes to try to conceive and results are not as immediate as expected, both men and women may become impatient.

"But how much of a factor is age in the conception game?" she asks. "Men have fewer age-related fertility problems than women do. The quality of their sperm may diminish with age; when they reach their 50s, men may experience low sperm motility — slow-moving sperm are less likely to inseminate" (Rutter, 1996, p. 49). After about age 37, a woman's eggs will tend to exhibit signs of aging and may disintegrate more easily, making it increasingly difficult to conceive or maintain a pregnancy. However, this is not to say that there is anything unusual about a 40-year-old woman having a baby.

According to Rutter, "Some older women may even be as fertile as their younger sisters. A 40-year-old woman who has been taking birth control pills for a good part of her reproductive life — thus inhibiting the release of an egg each month — may actually benefit from having conserved her eggs. She may even have a slight edge over a 40-year-old mother with one or two children trying to conceive" (1996, p. 50). Other clinicians suggest that focusing on aging as the primary source of infertility is a distraction. "Age becomes a factor when women have unknowingly always been infertile. These are women who, even if they'd tried to get pregnant at age 20 or 27, would have had difficulty despite the best technology" (Rutter, 1996, p. 50).

Registered nurses and advanced practice nurses are positioned to play a critical role in addressing the holistic needs of women experiencing infertility. This includes providing patient education, facilitating referrals to counseling services, and advocating for care models that integrate emotional and relational support alongside clinical treatment.

Primary prevention efforts focus on education and awareness — informing women and couples about the factors that affect fertility, including age-related considerations, the risks of sexually transmitted infections, and the implications of delaying childbearing. Nurses can support informed decision-making before infertility becomes a presenting concern.

Secondary prevention involves early identification and intervention for women already experiencing infertility stress. Nurses working in fertility clinics and reproductive health settings can screen for psychological distress, facilitate access to support groups, and encourage the use of social coping resources identified as effective in the Gibson and Myers (2002) study.

Tertiary prevention addresses the long-term management of infertility's effects for women who have completed treatment — whether or not conception was achieved. Nursing interventions at this level may include grief counseling referrals, support for couples considering adoption or childlessness, and ongoing assessment of mental health needs. The CDC's reproductive health resources provide a foundation for evidence-based approaches that nurses can integrate into tertiary care planning.

Conclusion

The experience of infertility presents nurses with a unique opportunity to address the full spectrum of patient needs — physical, emotional, social, and economic — rather than focusing solely on the clinical goal of conception. The literature reviewed here consistently demonstrates that women bear a disproportionate burden of infertility's psychosocial and biological effects, and that social coping resources, growth-fostering relationships, and partner and family support are critical mediators of infertility stress. Nursing practice must move beyond a purely biomedical model to embrace holistic, patient-centered care that acknowledges and responds to the complex, multidimensional crisis that infertility represents for women and their partners.