Kathleen S. Slauson-Blevins

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.

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.

How Law Shapes Experiences of Parenthood for Same-Sex Couples

abstract Gay, lesbian, and bisexual (GLB) parents are increasingly common and visible, but they face a number of social and legal barriers in the United States. Using legal consciousness as a theoretical framework, we draw on data from 51 interviews with GLB parents in California and Nebraska to explore how laws impact experiences of parenthood. Specifically, we address how the legal context influences three domains: the methods used to become parents, decisions about where to live, and experiences of family recognition. Law and perception of the law make some pathways to parenthood difficult or unattainable depending on state of residence. Parents in Nebraska, where laws are less supportive, discussed having to “work within the system” available to secure their families while those in California described living in “a bubble” that gave same-sex parents legal protections less available in other parts of the country. Policy and clinical implications of these findings are discussed.

Online and in-person health-seeking for infertility

Using data from Wave 1 (2004-2006) of the National Survey of Fertility Barriers (NSFB), a national probability sample of women ages 25-45, we examine online information-seeking among ever-infertile women. Of the 1352 women who met criteria for infertility, 459 (34%) neither talked to a doctor nor went online for information, 9% went online only for information, 32% talked to a doctor but did not go online, and 25% did both. Guided by Chrismans Health-Seeking Model and previous research on Internet use to obtain health information, we employ multinomial logistic regression to compare these four groups of ever-infertile women. Findings generally support Chrismans model. Infertile women tend to seek information online as a complement to, rather than as a substitute for, in-person health-seeking. Greater faith in the ability of medical science to treat infertility and greater perceived stigma were associated with higher odds of using the Internet to obtain information about infertility. In general, women who perceived the symptoms of infertility as more salient had higher odds of using both online and in-person or only in-person health-seeking compared to online health-seeking. Women with greater resources had higher odds of using online sources of information. Strong network encouragement to seek treatment was associated with higher odds of in-person health-seeking and combining in-person and online health-seeking compared to only going online or doing nothing.

Decline in ethical concerns about reproductive technologies among a representative sample of US women

Public awareness and utilization of assisted reproductive technology has been increasing, but little is known about changes in ethical concerns over time. The National Survey of Fertility Barriers, a national, probability-based sample of US women, asked 2031 women the same set of questions about ethical concerns regarding six reproductive technologies on two separate occasions approximately 3 years apart. At Wave 1 (2004–2007), women had more concerns about treatments entailing the involvement of a third party than about treatments that did not. Ethical concerns declined between Wave 1 and Wave 2, but they declined faster for treatments entailing the involvement of a third party. Ethical concerns declined faster for women with greater levels of concern at Wave 1. Initial ethical concerns were higher, and there was less of a decline in ethical concerns for women with higher initial levels of religiosity.

A New Way to Estimate the Potential Unmet Need for Infertility Services Among Women in the United States.

BACKGROUND Fewer than 50% of women who meet the medical/behavioral criteria for infertility receive medical services. Estimating the number of women who both meet the medical/behavioral criteria for infertility and who have pro-conception attitudes will allow for better estimates of the potential need and unmet need for infertility services in the United States. METHODS The National Survey of Fertility Barriers was administered by telephone to a probability sample of 4,712 women in the United States. The sample for this analysis was 292 women who reported an experience of infertility within 3 years of the time of the interview. Infertile women were asked if they were trying to conceive at the time of their infertility experience and if they wanted to have a child to determine who could be considered in need of services. RESULTS Among U.S. women who have met medical criteria for infertility within the past three years, 15.9% report that they were neither trying to have a child nor wanted to have a child and can be classified as not in need of treatment. Of the 84.9% of infertile women in need of treatment, 58.1% did not even talk to a doctor about ways to become pregnant. DISCUSSION Even after taking into account that not all infertile women are in need of treatment, there is still a large unmet need for infertility treatment in the United States. CONCLUSION Studies of the incidence of infertility should include measures of both trying to have a child and wanting to have a child.

Deciding Not to Adopt: The Role of Normative Family Ideologies in Adoption Consideration

ABSTRACT Americans view adoption favorably, yet few consider adopting or actually adopt a child. Using qualitative data from the representative National Survey of Fertility Barriers, we explored why women who had considered adoption decided not to pursue it as a pathway to parenthood. Our sample includes responses from 1,747 women who considered adoption at some point. Seven themes emerged: prioritization of biology, economic concerns, family building prerequisites, relationship barriers, barriers to adoption, family barriers, and change of heart. Findings highlight that barriers to adoption are not always the primary reasons women opt out of adoption; normative conceptualizations of “family” are also important.

Relationship Satisfaction Among Infertile Couples: Implications of Gender and Self-Identification:

We use path analysis to analyze heterosexual couples from the U.S. National Survey of Fertility Barriers, a probability-based sample of women and their male partners. We restrict the sample to couples in which the women are infertile. We estimate a path model of each partner’s relationship satisfaction on indicators of self-identifying as having a fertility problem or not at the individual and couple levels. We find a gender effect: for women, but not men, relationship satisfaction was significantly higher when neither partner self-identified as having a fertility problem. Women’s relationship satisfaction exerted a strong influence on their partners’ relationship satisfaction, but no similar association between men’s relationship satisfaction and their partner’s satisfaction was found. In infertile couples, higher levels of perceived social support are associated with higher levels of relationship satisfaction for women but not for men.