Arthur L. Greil

The experience of infertility: A review of recent literature

About 10 years ago Greil published a review and critique of the literature on the socio-psychological impact of infertility. He found at the time that most scholars treated infertility as a medical condition with psychological consequences rather than as a socially constructed reality. This article examines research published since the last review. More studies now place infertility within larger social contexts and social scientific frameworks although clinical emphases persist. Methodological problems remain but important improvements are also evident. We identify two vigorous research traditions in the social scientific study of infertility. One tradition uses primarily quantitative techniques to study clinic patients in order to improve service delivery and to assess the need for psychological counselling. The other tradition uses primarily qualitative research to capture the experiences of infertile people in a sociocultural context. We conclude that more attention is now being paid to the ways in which the experience of infertility is shaped by social context. We call for continued progress in the development of a distinctly sociological approach to infertility and for the continued integration of the two research traditions identified here.

The Importance of Motherhood Among Women in the Contemporary United States

We contribute to feminist and gender scholarship on cultural notions of motherhood by analyzing the importance of motherhood among mothers and non-mothers. Using a national probability sample (N = 2,519) of U.S. women ages 25-45, we find a continuous distribution of scores measuring perceptions of the importance of motherhood among both groups. Employing OLS multiple regression, we examine why some women place more importance on motherhood, focusing on interests that could compete with valuing motherhood (e.g., education, work success, leisure), and controlling for characteristics associated with becoming a mother. Contrary to cultural schemas that view mother and worker identities as competing, we find that education level is not associated with the importance of motherhood for either group and that valuing work success is positively associated with valuing motherhood among mothers. Consistent with feminist explanations for delayed fertility, valuing leisure is negatively associated with valuing motherhood for non-mothers.

Conversion to the world view of Alcoholics Anonymous: A refinement of conversion theory

Most empirical studies of the conversion process have focused on individuals who have come to espouse the world view of a deviant religious denomination or sect. Using observational data our research analyzes the conversion process by which individuals come to identify with the ideology propounded by Alcoholics Anonymous (A.A.). A.A. provides prospective “alcoholics” with both a solution to drinking problems and an overarching world view with which to reinterpret their past experience. The A.A. conversion process can be divided into six phases: hitting bottom, first stepping, making a commitment, accepting your problem, telling your story, and doing Twelfth Step work. Each of these phases is described in detail. Similarities and differences are noted between the observed A.A. conversion process and the model generally described in the sociological literature on religious conversion. Our analysis indicates certain weaknesses in the process-model explanation of conversion and points to the necessity of taking into account organizational context and situational variables.

Help‐seeking patterns among subfecund women

A random sample of women in the Midwestern United States was studied in order to provide a fuller picture of the ways in which US women responded to subfecundity. Using a biomedical definition of infertility, we examined women who did not conceive within 12 months of unprotected intercourse whether they were trying to get pregnant or not. Of the 196 ever‐subfecund women in our sample, 123 experienced subfecundity while trying to get pregnant; we called these ‘subfecund with intent’. Another 73 women experienced subfecundity while not actively trying to get pregnant; we called these ‘subfecund without intent’. Of the 196 subfecund women, 39% reported having sought treatment. Treatment‐seekers had clearer intentions to get pregnant, were more likely to seek infertility information on their own, and were more likely to self‐define as having fertility problems. Those with more income, more education and lower internal locus of control were more likely to seek medical help. Among the subfecund with intent who pursued medical help, about a fourth had received treatment. The few women who had sought spiritual counselling or non‐conventional help often combined these actions with medical help‐seeking. This study supported the conclusion that common‐sense understandings among subfecund women play an important role in help‐seeking behaviour. From a practical point of view, there is a large unmet need for infertility services and infertility counselling in the United States.

Race-Ethnicity and Medical Services for Infertility: Stratified Reproduction in a Population-based Sample of U.S. Women

Evidence of group differences in reproductive control and access to reproductive health care suggests the continued existence of “stratified reproduction” in the United States. Women of color are overrepresented among people with infertility but are underrepresented among those who receive medical services. The authors employ path analysis to uncover mechanisms accounting for these differences among black, Hispanic, Asian, and non-Hispanic white women using a probability-based sample of 2,162 U.S. women. Black and Hispanic women are less likely to receive services than other women. The enabling conditions of income, education, and private insurance partially mediate the relationship between race-ethnicity and receipt of services but do not fully account for the association at all levels of service. For black and Hispanic women, social cues, enabling conditions, and predisposing conditions contribute to disparities in receipt of services. Most of the association between race-ethnicity and service receipt is indirect rather than direct.

Infertility and Life Satisfaction Among Women

Using data from a random sample of 580 midwestern women, the authors explore the association between lifetime infertility and life satisfaction. Past research shows lower life satisfaction among those seeking help for infertility. The authors find no direct effects of lifetime infertility, regardless of perception of a problem, on life satisfaction; however, there are several conditional effects. Among women who have ever met the criteria for infertility and perceive a fertility problem, life satisfaction is significantly lower for nonmothers and those with higher internal medical locus of control, and the association is weaker for employed women. For women with infertility who do not perceive a problem, motherhood is associated with higher life satisfaction compared to women with no history of infertility.

Infertility treatment and fertility-specific distress: A longitudinal analysis of a population-based sample of U.S. women

Because research on infertile women usually uses clinic-based samples of treatment seekers, it is difficult to sort out to what extent distress is the result of the condition of infertility itself and to what extent it is a consequence of the experience of infertility treatment. We use the National Survey of Fertility Barriers, a two-wave national probability sample of U.S. women, to disentangle the effects of infertility and infertility treatment on fertility-specific distress. Using a series of ANOVAs, we examine 266 infertile women who experienced infertility both at Wave 1 and at Wave 2, three years later. We compare eight groups of infertile women based on whether or not they have received treatment and on whether or not they have had a live birth. At Wave 1, infertile women who did not receive treatment and who had no live birth reported lower distress levels than women who received treatment at Wave 1 only, regardless of whether their infertility episode was followed by a live birth. At Wave 2, women who received no treatment have significantly lower fertility-specific distress than women who were treated at Wave 1 or at Waves 1 and 2, regardless of whether there was a subsequent live birth. Furthermore, fertility-specific distress did not increase over time among infertile women who did not receive treatment. The increase infertility-specific distress was significantly higher for women who received treatment at Wave 2 that was not followed by a live birth than for women who received no treatment or for women who received treatment at Wave 1 only. These patterns suggest that infertility treatment is associated with levels of distress over and above those associated with the state of being infertile in and of itself.

The hidden infertile: infertile women without pregnancy intent in the United States.

A national probability sample reveals two relatively distinct groups of infertile women: those with intent, who have experienced a period of 12 or more months during which they tried to conceive but did not, and those without intent, who had a period of at least 12 months during which they could have conceived and did not but who do not describe themselves as having tried to become pregnant at that time. Those with intent are more likely to identify as having a fertility problem, to be distressed, and to pursue infertility treatment than those without intent, suggesting that many women do not realize that they meet the medical criteria for infertility and may wait longer to get help, therefore lowering their chances of conception.

What Have We Learned from Process Models of Conversion? An Examination of Ten Case Studies

Abstract Many attempts to understand the conversion process have been guided by Lofland and Starks (1965) “process-model.” We examine ten case studies of the conversion process in diverse groups in order to specify the conditions under which the Lofland-Stark model applies. Several components of the model are rejected for conceptual reasons. Other components are to be found in some types of groups but not in others. Only “formation of affective bonds with group members” and “intensive interaction with group members” seem to be indispensible prerequisites for conversion. Thus, any group which is to successfully convert people must be structured so as to foster interaction among group members. Because there is no one process-model that can accurately account for all cases of conversion, the process-model approach should be abandoned in favor of “subjective” and “organizational” approaches to understanding conversion.

Specifying the effects of religion on medical helpseeking: The case of infertility

Several recent studies have examined the connection between religion and medical service utilization. This relationship is complicated because religiosity may be associated with beliefs that either promote or hinder medical helpseeking. The current study uses structural equation modeling to examine the relationship between religion and fertility-related helpseeking using a probability sample of 2183 infertile women in the United States. We found that, although religiosity is not directly associated with helpseeking for infertility, it is indirectly associated through mediating variables that operate in opposing directions. More specifically, religiosity is associated with greater belief in the importance of motherhood, which in turn is associated with increased likelihood of helpseeking. Religiosity is also associated with greater ethical concerns about infertility treatment, which are associated with decreased likelihood of helpseeking. Additionally, the relationships are not linear throughout the helpseeking process. Thus, the influence of religiosity on infertility helpseeking is indirect and complex. These findings support the growing consensus that religiously-based behaviours and beliefs are associated with levels of health service utilization.