Choices and motivations of infertile couples

Abstract

When couples are confronted with infertility they may choose among several options: medical help, adoption, fostering, alternative medicine and focusing on other life goals. The frequency of choices and motivations for these options were investigated among 131 infertile couples. Husbands and wives answered a structured questionnaire. The medical option was chosen in more than 80% of the cases. Also, this choice is made very quickly. Other options were considered at a later time, and chosen much later than the medical option. The most frequently mentioned motive for seeking help is the desire to have a child. This motive is reported in all forms of help seeking. Motives for medical consultation are often seeking information, understanding the cause of infertility and physical complaints. Altruistic motives are rather important when considering adoption, and very important when considering foster-care.

Introduction

Infertility is usually defined as having no pregnancy after a year of unprotected regular intercourse 1, 2, 3, 4, 5. This definition is also used by the WHO [6]. In Western societies, around 15% of couples experience infertility problems regarding the first child (primary infertility) 1, 2, 7, 8. When couples realize that they have an infertility problem they may choose among several options. However, the decisions regarding these choices are not always made in a rational way. Decision making concerning infertility can better be described as a continuous and complex process, in which different options arise at different times, depending on the stage in the infertility process. Also infertile couples can choose more than one option, either in succession or even at the same time 9, 10.

It is supposed that the most common option is to seek medical help. An alternative like adopting a child is often considered as a `second best' choice 10, 11. Just a few studies have addressed the question regarding the proportion of infertile couples who seek medical help. Templeton et al. reported that, in the U.K., between 72 and 95% of the primary infertile couples seek medical help 12, 13. In a recent Finnish study it was concluded that 67% of primary and secondary infertile couples in Finland seek medical help [14]. However, Hirsch and Mosher found that, in the US, 50% or more of the couples do not receive medical help for primary infertility [15]. The same figure was found in 1979 in Denmark [16], for couples who were infertile for 2 years.

Most studies dealing with the way in which couples cope with infertility are limited to samples of couples seeking medical help 17, 18, 19, 20, 21, 22, 23, 24, 25, 26. However, there are several other options: adoption, fostering, seeking alternative medicine and choosing other life goals.

The main topic of this paper is the analysis of arguments in favour and arguments against these options. It was investigated whether different options are associated with different motivations. Especially, we were interested in the impact of altruistic motives in choosing for adoption or foster-care. Furthermore, we wanted to find out whether the frequency of counter-arguments varied among the different options. A better understanding of the various choices and the motivations for these choices can help medical and non-medical staff in counseling infertile couples.