11/29/2017

ParenthoodisaDecision
Infertility
and Crisis Reexaminationofliferoles
Psychosocial
Development
RabbiCatherineAnneFleischman
November29,2017

c multidimensional Infertility
o
m
p Definition
l
e FertilityTrends
x
PrevalenceofInfertility
CausesofInfertility
PsychosocialAspects

Infertility:Definition FertilityRatesWorldwide19602010

Unabletogetpregnant
35yearsold afteroneyear
>35yearsold aftersixmonths
Unabletostaypregnant

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FertilityRatesU.S.19252009 FertilityRatesU.S.19802010

Infertility:Causes Infertility:CausesMen
1015%ofcouplesinU.S.havedifficultygetting Infertilityinmenismostoftencausedby:
pregnantorstayingpregnant(ages1544)
Varicocele enlarged
AllThingsBeingEqual veinsontesticles
1/3ofinfertilitycasesarecausedby
women'sproblems
Spermabnormality
1/3offertilityproblemsarecaused Geneticdisorders
bymensproblems
Diseasesorinfections
1/3ofcasesarecausedbya
combinationofmaleandfemaleor Environmentalfactors
byunknownproblems.
Nutritionandweight

Infertility:CausesWomen Infertility:PolyCysticOvarySyndrome(PCOS)
Infertilityinwomenismostoftencausedby:
Ovulationproblems PolyCysticOvarianSyndrome(PCOS)
PCOSisahormoneimbalanceproblemcharacterizedby
infertility,hirsutism,obesity,menstrualdisorders,and
ovarianscarring(atreticfollicles)andputsfemalesatrisk
fortype2diabetesandcardiovasculardisease

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Infertility:CausesWomen Infertility:Factors:MaternalAge

Physicalproblemswiththeuterus Manywomenarewaitinguntiltheir30s
and40stohavechildren
Blockedfallopiantubes
Approximately20%ofwomenintheU.S.
Uterinefibroids havetheirfirstchildafterage35
Maternalage Inindustrializedsocieties,peopleoften
delayreproductiontoaccumulatesavings

Infertility:Factors:MaternalAge PregnancyandMiscarriageTrendsbyAge

50%ofpeopleincorrectlybelievefertilitylevels
arethesameforwomanintheir40sand30s
Awoman'schancesofhavingababydecrease
rapidlyeveryyearaftertheageof30
Byage40,1in3womenislikelytobeinfertile
Byage45,1in10womenislikelytoconceive

PrevalenceofInfertility
(womenaged1544)

12.1% impairedfertility
6.7% married
7.3 million

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Infertility:Causes Infertility:Treatment
<50%attributabletogeneticandbiologicalfactors Medication,surgeryorAssisted
Preventablefactors: ReproductiveTechnology(ART)
Healthcare
Drugsandsurgerymostcommon
STIsandinfectiousdiseases
Environmentalpollution Intrauterineinsemination(IUI)
Maternalage
InVitroFertilization(IVF) most
commonlypracticedtypeofART

Infertility:TreatmentIssues Infertility:EconomicIssues
Thirdpartyreproductivetechniques: ARTisexpensive
Donationofeggs,sperm,
IUI$3,000/cycle
orembryostoinfertile
IVF$12,000/cycle
couples,surrogacy,and
gestationalcarrier Only15statescoverART
throughinsurance
Thesetechniquespresent Manycouplescannotafford
significantpsychological, infertilitytreatment
ethical,andlegalissues Manycouplesaregoinginto
deepdebt

Infertility:EconomicIssues ReproductiveHealthDisparities
Financialoptions Disparitiesinreproductivehealthcanberelatedto:
GrantsandScholarshipsforIVF
IVFFinancing
Inequalityinhealthcare
CrowdsourcingFundraising Socioculturalissues
Communityspecificresources:Jewish Differencesinlifestyle
community JFCSPhiladelphia
Jewishcouplesexperiencehigher
infertilityratesof15%to20%
FamilyisancoreJewishvalue

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Infertility:Options Infertility:Adoption
ART
Adoption
Childlessness

Infertility:PsychosocialFactors PsychosocialFactors:LifeCoursePerspectives
Mostcouplesexpecttohave Thetiming ofaparticulareventinanindividual'slife
children andthehistoricalcontextinwhichtheeventoccurred
areparticularlyimportanttothelifecourseperspective
Fewevercontemplatethe
possibilitythattheywillbe Societieshaveculturalagedeadlines atwhichpeople
unabletodoso areexpectedtohavecompletedlifemilestones
Infertilitycanrankamong Problemsarisewhentheselifemilestones are
themostemotionallytaxing completed"offtime,"orinadrasticallydifferent
crisisofadulthood mannerfromtherestofsociety

EriksonsPsychosocialStages

Adolescence YoungAdulthood MiddleAdulthood

Eriksons
Psychosocial
Stages

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Eriksons PsychosocialStage:
Psychosocial
Stages

to

PsychosocialStage: Bronfenbrenner
Inordertodevelop,a
humanbeingrequires
activeparticipationin
progressivelymore
complexreciprocal
interaction withpersons
withwhomtheydevelopa
strong,mutual,irrational
attachment,andwho,over
time,becomecommitted
toeachotherswellbeing
anddevelopment,
preferablyforlife.

FamilyLifeCycle McGoldrick&Carter FamilyLifeCycle McGoldrick&Carter

Sixstagelifecycleofintactnuclearfamily:
1. Youngadultleaveshome
2. Newcouple
3. Familieswithyoung
children
4. Familieswithadolescents
5. Familieslaunchingchildren
andmovingon
6. Familiesinlaterlife
Childlessness interruptionoffamilylifecycle
Familybuildingdevelopmentalstage
representsgenerativity
everymemberofthefamily
transitionsfromone
developmentalstagetoanother,
assumingnewdevelopmental
rolesandresponsibilities

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PsychosocialFactors
FornearlyonehalfofwomenwhoundergoIVF,
infertilityisseenastheworstexperienceoftheir
lives.
Infertilityisahighlydisruptivelifecrisis,
consequently,manyinfertilitypracticesemploy
mentalhealthprofessionals.
PsychosocialFactors:SocialStatus
Societyesteemsandrewardsthosewhoraise
children
Culturallyprescribedpatternsofmarriageand
childbearingmaybecentraltosocialstatus,
identity,andselfesteemofmenandwomeneven
whentheyarenotgiventhesameimportancein
thedominantculture
PsychosocialFactors:Coping&Resiliency
Copingwithadversitycanbebeneficial
Reportsofposttraumaticgrowth(PTG)havebeen
documentedfollowinginfertility
Infertilitypatientsfindcomfortinsupportgroups,
nationalinfertilityorganizations,andInternet
chatrooms
Socialworkerscanenabledevelopmentofselfhelp
andmutualaidopportunities
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PsychosocialFactors
Stress,loss,grief,anxiety,depression,andself
esteem;alienationandhopelessness;socialstigma;
relationshipstrain(forsome)
Womentendtostrugglemorethanmenandaremore
apttoavoiddaytodayreminders(e.g.,contactwith
babies)
Asubsetofcouplesareatriskofdevelopingclinically
significantmentalhealthproblems
PsychosocialFactors:Men
Menareaffectedbyinfertility,displayingimpaired
selfesteemandinadequacyinrelationtotheir
societalrole,eventuallyfeelingresponsiblefor
denyingtheirwivesachild
Inmanycultures,maleinfertilityremainsa
stigmatizedconditionandisassociatedwithalackof
masculinity
Thismayresultinsecrecysurroundingdiagnosis,
sometimestothepointwherethefemalepartner
takestheblameforthecouple'sinabilitytoconceive
PsychosocialFactors:Childlessness
Childlessnessisacomplexpsychosocialfactorwith
multiplecausesandconsequences
Childlessadultshavehigherratesofmortalitythan
parents
Childlessnessisadynamicprocessthatevokes
differentemotionsandsocialreactionsatdifferent
pointsintime
Themeaningofchildlessnessmaychange
throughoutthelifecourse
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PsychosocialFactors:Childlessness
Childlessnessimpliesnotjustthephysicalabsence
ofchildren,butalsostrongemotionalreactionsand
feelingsofincompleteness
Fromalifecourseperspective,childlesspeoplemay
feelawkwardwiththeirchildbearingfriendsand
theymaybeleftoutofthesocialgroupof"parents"
Peoplewithoutchildrendonothaveautomatic
recipientsfortheirlegaciesoremotionaland
historichistories,whichcreatesachallengeatthe
latterstagesoflife
SocioculturalFactors
Politicsandreligionmayinfluencehowan
individualexperiencesormanageshisorher
reproductivehealth
AcceptabilityofART,culturallyandmorally,isthe
strongestpredictorofARTusage
ReligionisakeyfactorforART,forexample,the
CatholicChurchisopenlyagainstARTandheavily
influencesthepolicyagenda
InfertilityEtiquetteandAwareness
InfertilityEtiquette
NationalInfertilityAwarenessWeek April2228,2018
PregnancyandInfantLossAwarenessMonthinOctober
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SocioculturalFactors
Althoughwomenandmenhavetherightto
determinethecourseoftheirreproductivelives,
numeroussocioculturalfactorsmaypreventthem
frombeingabletodoso
Itisnecessarytoassesstherelativeimportanceof
therolethateconomic,demographicandcultural
normativefactorsplay
PsychosocialFactors:Generativityvs.Stagnation
Navigatingtheemotionaljourneytowardsbeing
happywithoutchildreninvolvesaprocessofgrieving
Byshiftingtheirperspectiveonlife,couplescan
realizethattheirsenseofvitalitycanbepassedonto
theworldandthecultureinavarietyofways
Resolutionofteninvolvescouplesbuildingchildren
intotheirlives:relatives,childrenoffriends,children
inneedinthecommunity