Almost every culture places a great deal of importance on the ability to have children.

Rice was originally thrown at couples after marriage, in fact, because onlookers hoped that the great fertility of the rice plant would be transferred to the married couple. The same is true of the baby’s breath plant, which was traditionally used in a bride’s bouquet.

Today many couples—gay, lesbian, and heterosexual—use assisted reproduction.

Fertility rates naturally decline with increasing age, beginning as early as 30 and then decreasing more quickly after age 40 (Swisher et al., 1998). Fertility is something most of us take for granted. However, being able to conceive is not always easy for cou­ples. Infertility is defined as the inability to conceive (or impregnate) after 1 year of reg – ■infertility ular sexual intercourse without the use of any form of birth control (if a woman is over The inability t° conceive (or m^e^teT

the age of 35, usually infertility is diagnosed after 6 months of not being able to con­ceive). About 1 out of every 5 couples in the United States of reproductive age is infer­tile (Berkow et al., 2000). This percentage of couples is much higher than the 8% to 10% average in developed countries (Prevost, 1998). Although decreasing fertility also affects gay and lesbian couples, unless these couples use a surrogate or a friend as a donor, they must often use assisted reproduction to achieve a pregnancy.

The number of couples seeking assisted reproduction treatment is increasing each year. Fertility problems can be traced 70% of the time to one of the partners (40% of the time the female, and 30% of the time the male). In 20% of cases there is a combined problem, and in 10% the reason is unknown (Afek, 1990). Historically, women have been blamed for infertility problems, and up until the last few years, men were not even considered a possible part of the problem.

Infertility has a strong impact on a couple’s well-being (Forti & Krausz, 1998).

Emotional reactions to infertility can include depression, anxiety, anger, self-blame, guilt, frustration, and fear. Because the majority of people have no experience dealing with infertility, many of those who find out they are infertile isolate themselves and try not to think about it. Overall, women tend to have more emotional reactions to infer­tility and are more willing to confide in someone about their infertility than are men (Hjelmstedt et al., 1999). Childbearing in the United States is part of what defines be-

ing female, and so women who are infertile often feel less valued than fertile women. The term motherhood mandate refers to the idea that something is wrong with a woman if she does not play a central role in caregiving and childcare (Riggs, 2005). As one woman reports:

Подпись:Подпись:Подпись:I can’t emphasize how devastating infertility is to one who has spent a lifetime basing her self-esteem on “what I can do.” When you can’t have children, the most natural and important aspect of life—none of your previous accomplishments seem important. They are overshadowed by this supreme failure. (Mahlstedt, 1987, p. 131)

Infertile couples usually seek professional help, although research indicates that women are often more committed than their partners to finding a solution to the infer­tility. Support groups for persons experiencing infertility are often very helpful. One of these groups, RESOLVE: The National Infertility Association (see Web Resources for more information about this organization), offers resources for couples struggling with infertility. RESOLVE helps couples see that they are not alone and provides a safe and healthy environment in which to discuss relevant issues.

The most common causes of female infertility include ovulation disorders, blocked Fallopian tubes, endometriosis (see Chapter 4), structural uterine problems, or excessive uterine fibroids. Causes for male infertility include a lack of sperm production and re­duced or malformed sperm production. Infertility can also be caused by past infections with gonorrhea, chlamydia, or pelvic inflammatory disease (Hatcher et al., 2004), which is one of the reasons college students are encouraged to have regular medical checkups and women are encouraged to have regular Pap smears. If a sexually transmitted infec­tion (STI) is treated early, there is less chance that it will interfere with fertility.

For some men and women who experience reproductive problems, changing lifestyle patterns, reducing stress, avoiding rigorous exercise, and maintaining a recommended weight may restore fertility. For other couples, new medical interventions offer new pos­sibilities. It is also important to keep in mind that some infertile couples experience spontaneous pregnancies, usually when the stress of “getting pregnant” is reduced (Isaksson & Tiitinen, 1998). Many mind-body programs that teach relaxation tech­niques have been designed for women struggling with infertility. Programs include med­itation and yoga to help participants reduce stress and many of these programs have helped infertile women become pregnant (Petersen, 2004).