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Infertility: Interventions for Shame, Mourning, and Feelings of Inferiority
Infertility continuing education psychology CEUs

Section 11
Parenting Intentions Among Childless Individuals

CEU Question 11 | CEU Test | Table of Contents
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

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On the last track, we discussed a therapeutic approach to late immersion.  This included thinking about the donor option, couple communication about donorship, alienation versus attachment and ongoing "check-in" questions about infertility.

Do you have a couple who is considering ending fertility treatments?  Might they be in the resolution phase? 

On this track, we will discuss couple issues in the resolution phase.  These will include ending medical treatment, sabbaticals and refocusing.  On the next track, we will discuss a therapeutic approach to the resolution phase.  As you listen, think of your clients.  What behaviors do they show that might indicate the resolution phase?

Infertility can take hold of one’s identity, one’s day-to-day life, one’s emotions, thoughts, and relationships, and even one’s bank account.  Therefore, the process of disengagement takes time.  The resolution phase encompasses three overlapping tasks.  These include ending medical treatment, mourning the reality of not having a genetically related child together and refocusing, or moving past the infertility experience by choosing either adoption or a life without children.

Couples may not accomplish these tasks in a linear progression, of course.  For example, a couple may be mourning their losses while still desperately continuing medical treatment in a last-ditch attempt at pregnancy.  Or, having taken what they intended to be a short break or "sabbatical" from treatment, the partners may find themselves reengaging in their careers and social activities to the extent that they are reluctant to reinvest in medical treatments.

4 Possible Outcomes to the Infertility Ordeal
The ordeal of infertility has four possible outcomes: 
-- 1. Couples will emerge with either a genetically related child,
-- 2. A donor-conceived child,
-- 3. An adopted child or
-- 4. No child. 

Those who have achieved a pregnancy through infertility treatments using their own egg and/or sperm will spend a relatively brief time in resolution, although there may be emotional and relational reverberations for years to come.  Couples who have used donor gametes (gha-meetz) often begin to resolve their loss of a genetically related child in late immersion, although they may have residual feelings of loss that need to be acknowledged in order to move forward.  The crucial choice for those who have not achieved pregnancy during immersion is deciding whether they will adopt or have a life without children.

3 Resolution-Phase Issues

#1 Ending Medical Treatment
Many couples reach a point at which they feel so defeated by medical failures that they no longer have the emotional energy to rally for yet another treatment.  Exhausted and unable to concentrate on any other part of life, they realize that their chances of achieving a pregnancy are slim at best.  The following are some of the signs that couples are approaching the decision to stop medical treatment. 

  • Conscientious patients often become noncompliant, forgetting to take their medication or missing medical appointments. 
  • Although doctors’ appointments may previously have been experienced as necessary ordeals, couples now respond to their physicians and the clinical procedures with anger and resentment. 
  • The partners have become increasingly conflicted or emotionally distant as they feel more and more discouraged with themselves and one another. 
  • Couples begin to take another look at alternatives to genetically related children, beginning to focus on parenting as opposed to getting pregnant, or they may weigh what life would be like without children. 
  • When there is secondary infertility, parents are increasingly distraught over how they may be neglecting their existing children.

Despite these signs of readiness, it may take couples time to decide to stop medical treatment, and some never completely give up hope of a pregnancy.  One factor that allows couples to end treatment is the likelihood that they will not conceive.  It is easier to accept the losses of infertility and move ahead if there has been a definitive diagnosis or if the couple believes that they have tried all possible treatments.

#2 Sabbaticals
As the months or years devoted to becoming pregnant go by, some couples put medical treatment on hold without having specific plans about what they will do next.  Made weary by sadness, distress, failure and strained financial resources, their hope and enthusiasm about a medical solution may have petered out.  Sometimes the decision to take a treatment "sabbatical" is deliberate, whereas other couples gradually drift away from the medical arena. 

While taking sabbaticals from treatment, couples may use their energy, previously devoted to the infertility treatments, to reconnect with friends and family members from whom they had become distant, and to re-engage in their careers and interests.  These couples may later return to infertility treatments if a strong desire for a child persists.  Other couples decide not to return to the medical arena.  Enjoying their renewed social and career activities, they may recognize the enormous emotional toll infertility treatments had taken on their lives.  They begin to consider the other options, such as adoption or life without children.

#3 Refocusing
As couples begin to see an end approaching, refocusing can be marked by a sense of relief and an increase of energy.  If couples do not have a child, there is often a bittersweet quality to this time as they acknowledge that things did not turn out as they had wished but that their lives can be full and meaningful just the same.  The sadness, guilt, blame, and shame of previous phases may begin to recede, and couples reach a more neutral emotional state. 

The task of refocusing, therefore, is one of making choices about how to live after infertility, and, for couples who did not have a child, the crucial choice may be between adoption and a child-free life.  If they choose adoption, they accept that, "We are not going to have a child" and embrace the thought that "We can still be parents."  In choosing a life without children, the idea is "We are not going to be parents, but we will have a life."

Do you have a client considering ending infertility treatments who might benefit from hearing this track? 

On this track, we have discussed couple issues in the resolution phase.  These have included ending medical treatment, sabbaticals and refocusing.

On the next track, we will discuss a therapeutic approach to resolution.  This will include restructuring the couple’s relationship, facing denial of loss and choosing a life without children.

Peer-Reviewed Journal Article References:
Darwiche, J., Favez, N., Maillard, F., Germond, M., Guex, P., Despland, J.-N., & de Roten, Y. (2013). Couples’ resolution of an infertility diagnosis before undergoing in vitro fertilization. Swiss Journal of Psychology, 72(2), 91–102.

Riskind, R. G., & Patterson, C. J. (2010). Parenting intentions and desires among childless lesbian, gay, and heterosexual individuals. Journal of Family Psychology, 24(1), 78–81.

Pelham, B. (2019). Life history and the cultural evolution of parenting: Pathogens, mortality, and birth across the globe. Evolutionary Behavioral Sciences. Advance online publication.

Quinn, G., Bleck, J., & Stern, M. (2020). A review of the psychosocial, ethical, and legal considerations for discussing fertility preservation with adolescent and young adult cancer patients. Clinical Practice in Pediatric Psychology, 8(1), 86–96.

Tate, D. P., Patterson, C. J., & Levy, A. J. (2019). Predictors of parenting intentions among childless lesbian, gay, and heterosexual adults. Journal of Family Psychology, 33(2), 194–202.

Online Continuing Education QUESTION 11
What are three issues that couples often experience in the resolution phase? To select and enter your answer go to CEU Test.

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