An infertile couple may feel that they are losing control of their lives if they seek help and receive treatment and this may lead to feelings of anguish and helplessness. Ensuring that couples have accurate and relevant information to enable them to make informed and appropriate choices about their treatment will help alleviate these feelings.

Some couples may exclude themselves from certain situations to avoid contact with pregnancy, babies or children and this may reduce valuable sources of support such as family and friends. As many couples do not discuss their infertility with their families some benefit from attending self help support groups where they may be able to openly discuss their situation and concerns with others who share similar experiences.

Men and women have very different emotional reactions to infertility. Over a four and a half year period, Monarch (1993) studied couples who were experiencing infertility. He discovered that whilst depression was strongly felt by women, none of the men interviewed reported any particular nervous problems in connection with their infertility. These gender differences for coping with their experiences may be partly culturally defined. Typically, women value inter-dependence and similarity whereas men value autonomy and independence (Read, 1995).

These differences may lead to conflict within the relationship as each partner copes in different ways. Men, for example, may keep their anguish to themselves focusing to a greater extent on their partner's emotions, whereas women may talk openly about their feelings and feel aggrieved that their partners are unable to share their feelings with them.

Infertility services are not evenly distributed or available and treatments such as IVF are expensive. Additional worries may therefore develop regarding financial implic

ations of being infertile. Treatment involves regular visits to clinics and women may have to take time off work and change their established lifestyle patterns. Many will be reluctant to inform their employer about their treatment for fear of jeopardising any career plans they may have.

Although infertility is not considered to be an illness and therefore may have low priority, both in terms of medical resources and political interest, it clearly has significant physical, social and psychological effects on a woman and her partner. These effects, as seen in relation to Polycystic Ovarian Syndrome, may be long term, and thus women require adequate support to enable them to cope with these different concerns.

The recent development in assisted reproductive techniques has given both hope and a focus for infertile couples, and as Abbey et. al., (1992) point out, professionals should aim to increase a patients sense of control, optimism (within realistic limits) and social support in order to reduce the stress associated with infertility. This will help couples engage in treatments which may ultimately be unsuccessful. A greater awareness of the problems associated with infertility, and more open concern and interest throughout society in general, may help couples come to terms with their childlessness.

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