Open Collections

UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

How two couples adopt to biological childlessness and reconstruct their lives once fertility is no longer… Bockus, Diana 1997

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-ubc_1997-0207.pdf [ 5.17MB ]
Metadata
JSON: 831-1.0054021.json
JSON-LD: 831-1.0054021-ld.json
RDF/XML (Pretty): 831-1.0054021-rdf.xml
RDF/JSON: 831-1.0054021-rdf.json
Turtle: 831-1.0054021-turtle.txt
N-Triples: 831-1.0054021-rdf-ntriples.txt
Original Record: 831-1.0054021-source.json
Full Text
831-1.0054021-fulltext.txt
Citation
831-1.0054021.ris

Full Text

HOW TWO COUPLES ADAPT TO BIOLOGICAL CHILDLESSNESS AND RECONSTRUCT THEIR LIVES ONCE FERTILITY IS NO LONGER A VIABLE OPTION By Diana Bockus B.A., York University, 1975 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES (Department of Counselling Psychology) We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA April 1997 ® Diana Bockus, 1997 In presenting this thesis in partial fulfilment of. the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make if freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his, or her representatives. It is understood that copying or publication of this thesis for financial. gain shall not be allowed without my written permission. Department of dpXU f) \j^/j^*J{ The University of British Columbia Vancouver, Canada CAJ'PS. DE-6 (2/88) ABSTRACT The present longitudinal study explores how two Caucasian, heterosexual couples experiencing 'unexplained infertility' adapted to biological childlessness after fertility treatment was no longer a viable option. Previous literature on infertile couples' process of adaptation post treatment focused on those who succeeded in having a genetic child. In this study each couple pursued an alternative life path to biological parenthood by either becoming adoptive parents or by choosing non-parenthood. Their respective journeys were documented in a succession of four unstructured, ih-depth audio taped interviews at 10-month intervals over a period of 3.5-years. The findings show that both couples, although they pursued variant life paths, evolved from a negative perception and experience of life without biological children to having a positively lived life as a biologically childless couples. The adaptation process involved a complex and intense interconnected series of events and experiences associated with three phases. Letting Go of the Biological Parenthood Quest, Recovery and Discovering Life Options, and Making and Living a New Life Path. The following aspects were linked to these adaptation phases and enabled couples to construct a new life without biological parenthood: grieving their losses associated with infertility and their genetic child; acceptance of biological childlessness; personal growth experiences; seeking and achieving balance personally and in their daily life as a couple; and envisioning, establishing and living their new life path. ii TABLE OF CONTENTS Page ABSTRACT ii TABLE OF CONTENTS iii ACKNOWLEDGEMENTS v CHAPTER ONE: 1 Statement of the Problem 1 Psychological and Emotional Impact 4 Purpose of the Study • • • • 9 CHAPTER TWO: 11 Adjustment to Parenthood after Infertility Treatment 11 Adoption and Adaptation Post-treatment 13 Non-parenthood After Infertility Treatment 17 Summary . . . 20 CHAPTER THREE: . 21 Design 21 Recruitment and Participants 22 Procedure 23 Selection of Participants for My Study 24 Analysis 26 Limitations of the Study 26 CHAPTER FOUR: . 28 Narrative Accounts 28 Jane and Stephen 28 Loss and Determination (1st interview) 28 Recovery and Hope (2nd interview) 31 Acceptance of Biological Childlessness (3rd interview) . . . 33 Positive Life Path as a Childless Couple (4th interview) . . . 38 Terry and Cory 41 Pursuit of Parenthood (1st interview) 41 Awaiting adoption (2nd interview) 46 Adoptive Parents at last (3rd interview) 48 Positive Life Path as an Adoptive Couple (4th interview) . . 53 Analysis . 57 Letting Go of the Biological Parenthood Quest 59 Recovery and Discovering Life Options 64 Resigned acceptance of biological childlessness 64 Intrapersonal changes 64 iii Seeking and Establishing Balance 66 Interpersonal changes 68 Grieving and resolution 69 Making and Living a New Life Path 72 Adjustment to the Adoption Option 72 Final acceptance of biological childlessness 74 Adjustment to Adoptive Parenthood 75 Loss Associated with Infertility 77 Having a Life without Biological Children 77 A Positive Life Path as a Childless Couple 77 Adaptation to Life as a Childless Couple. 78 Having a Life without biological or adoptive children 80 Summary 80 CHAPTER FIVE: DISCUSSION 81 Restatement of the Purpose 81 Discussion 81 Implications for Research . . 90 Implications for Counselling 92 Summary 96 REFERENCES 98 iv ACKNOWLEDGEMENTS I am grateful for the support, encouragement and insightful feedback of my committee member Larry Cochran and my supervisor/mentor Judith Daniluk. I am especially indebted to Judith who has generously given her time and energy to guide me in my studies and research as well as in my work counselling infertile individuals and couples. I wish to thank my parents, Dave and Ivy Bockus and my sister Sharon for their love and support as well as Malcolm Taylor, Vi Armstrong and Burke Taylor who trusted in my abilities to accomplish my desired goals. I give thanks to the Creator for bringing Lee Crowchild into my life this past year for our relationship has enriched my life in many ways and fostered a positive environment in which to complete my academic commitments and to serve those entrusted to my care as a counsellor. I am also truly thankful to the two couples who shared their journey of adaptation to biological childlessness so that others may benefit from their experiences and insights, and to my clients who continue to help me grow professionally and as a person. v 1 CHAPTER ONE: INTRODUCTION The majority of North American men and women aspire to become parents and incorporate parenthood into their ideal life-plan (Glazer & Cooper, 1988; Glick, 1977; Link & Darling, 1986). Parenthood is viewed as an inevitable and expected part of a marital relationship (Ireland, 1993; Rosenfeld, 1979) and promoted as a desirable and 'vital' role in our society (Pohlman, 1969; Veevers, 1973). In her work on the meaning of parenthood in our culture, Veevers (1980) found that parenthood enables adult individuals to meet such needs as the desire to demonstrate sexual identity, competence and social maturity, to maintain marital adjustment, and, to gain social approval. Developmental psychologists have long considered parenthood an essential part of normal adult developmental in the life cycle of individuals (Erikson, 1950; Deutsch, 1945; Freud, 1905). Social, religious and cultural values worldwide also emphasize the importance of the basic right to bear children and to parent (Menning, 1980; Mullens, 1990). Sandelowski (1993) suggests that since the 1980's there has, in fact, been a renewal of focus on the family and Bram (1989) concurs that in the 80's we have been witness to an invigorated "parenthood imperative" (p. 276). Statement of the Problem Most couples achieve this major life goal and become parents of biological offspring. However, approximately one out of every six couples, or 17% of couples of childbearing age are frustrated in their attempts to bear a child because they 2 experience difficulty with their fertility (Bellina & Wilson, 1985; Corson, 1983; Leader, Taylor & Daniluk, 1984). At least 10 million men and women in the United States from every ethnic, racial, class and religious background and from all sexual orientations are touched by infertility (Burns, 1987; Zoldbrod, 1993). The actual rate may be much higher as many individuals are unaware of their infertility until they attempt to conceive a child (Mathews & Mathews, 1986; Mazor, 1984). There is some debate as to whether infertility is increasing but certainly the number of people reported and diagnosed with infertility has increased (Burns, 1987; Sandelowski, 1993; Shapiro as cited in Forrest & Gilbert, 1992). A variety of environmental, social and economic factors (Butler & Koraleski, 1990; Mazor, 1984; Shapiro, 1988), sexually transmitted diseases, and delayed childbearing have been identified as culprits in reproductive impairment (Leiblum, 1997). Infertility is both a medical condition involving a "physiological impairment" (Greil, 1991, p.6) and a "social condition" referred to as involuntary childlessness (Menning, 1982, p. 155) whereby couples construe their infertility as problematic because they wished to conceive and parent a biological child and are physically unable to do so in the 'normal way' or perhaps not at all. The meaning that couples attribute to their infertility and the cultural and social importance of childbearing and childrearing has a significant bearing on their experience of infertility and the resolution of what some clinicians and researchers have referred to as the crisis of infertility (Greil 1991; Menning, 1988). Infertility is medically defined as the inability to conceive after one year of unprotected intercourse or the inability to carry a pregnancy to a live birth (Menning, 1982), which according to the American Fertility Society includes 3 ectopic pregnancy, spontaneous abortion and stillbirth (Shapiro, 1988). Individuals or couples are clinically infertile if they have never conceived (primary infertility) or if they fail to conceive again after having achieved pregnancy regardless of its outcome (secondary infertility) (Sandelowski, 1993). As recently as twenty-five years ago when 40% to 50% of all infertility had no known physical explanation, the cause of infertility was attributed to psychological and emotional factors (Akhtar, 1978; Bresnick & Taymor, 1979; Denber, 1978; Eisner, 1963; Singh & Neki, 1982), usually on the part of the woman (Cook, 1987; Stanton & Dunkel-Schetter, 1991). With the advancement of more sophisticated medical diagnostic technology and greater knowledge of reproductive physiology, however, psychogenic factors are no longer considered the cause of infertility, [except in less than 5% of all cases according to Wallach and Moghissi, (1988)], but instead are the result of the infertility problem itself (Cook, 1987). Approximately 90% of infertility cases can now be attributed to specific organic pathology (Bellina & Wilson, 1985; Burns, 1987; Menning, 1988). Traditionally, in both the physical and psychological domain, infertility has been viewed as a woman's problem. However, the actual distribution of the causes of infertility are shared equally by men and women with approximately one third of the cases identified as male-factor and one third being diagnosed as female-factor (Berg, Wilson, Weingartner, 1991). Of the remaining cases, 20% of couples experience problems that include both members of the couple. In 10% of couples where the origin of the problem is unknown, the diagnosis is unexplained infertility (Berg et al., 1991; Corson, 1983; Grantmyre & Hanson, 1992; Menning, 1988; Salzer, 1986; Shapiro, 1988). 4 Presently, at least half of infertility problems can be diagnosed and treated by medical or surgical means (Harkness, 1992; Menning, 1980). Viable techniques for achieving pregnancy in couples previously unable to bear children continue to expand, increasing not only the technical options but the number of repeated treatment cycles. However, some would argue that the great medical progress in the treatment of infertility is really a "myth" (Lilford & Dalton, 1987, p.155). In reality a minority of couples who use the "advance" reproductive technologies take home a baby, approximately 14% for in vitro fertilization patients in the U.S. (Medical Research International and the Society of Assisted Reproductive Technology, American Fertility Society, 1991). What may initially seem a blessing, may in fact become a burden for some couples. The quest for a biological child via medical intervention as well as the experience of being infertile itself increasingly taxes the physical and psychological resources of the couple and may seriously erode the quality of their life (Lalos, Lalos, Jacobsson, & Von Schoultz, 1985; Menning, 1980). As such it is important to look more closely at the diverse and complex events and issues experienced by men and women affected by infertility prior to, during, and after treatment. Psychological and Emotional Impact Couples suffer with their infertility for a minimum of a year and some for a number of years before seeking and receiving medical diagnosis and treatment (Daniluk, 1991). Upon confirmation of their infertility and throughout the treatment process, they may experience additional psychological stress (Freeman, Boxer, Rickels, Tureck & Mastroianni, 1987; Mahlstedt, 1985) and increased emotional distress (Daniluk, 1988; Downey, Jingling, McKinney, Husami, Jewelewicz, 5 Maidman, 1989; Lalos, Lalos, Jacobsson, von Schoultz, 1985; McEwan, Costello, & Taylor, 1987; Valentine, 1986; Wright, Allard, Lecours & Sabourin, 1989). This period of emotional disequilibrium has been conceptualized as a "crisis of infertility" (Bresnick, 1981; Menning, 1982; Rosenfeld & Mitchell, 1970; Seibel & Taymor, 1982), a "biopsychosocial crisis" (Cook, 1987) a personal and family "tragedy," and a "threat" to the long standing assumptions underpinning how couples make meaning and give direction to their lives (Greil, 1991, p. 16). Infertile individuals frequently sustain profound and often multiple "intangible" losses (Hirsch & Hirsch, 1988, p. 13) as a result of their infertility including loss of: a life goal, fertility, self-ideal, genetic continuity, control over various aspects of their lives including their reproduction, a life plan and future fulfillment, the pregnancy experience, trust in their reproductive capacity, prestige, feelings of normalcy in a fertile world, and security about and belief in the fairness and predictability of life (Hirsch & Hirsch, 1989; Mahlstedt, 1985; Menning, 1982; Shapiro, 1993). Those who pursue medical options may suffer additional losses pertaining to failed treatment cycles, miscarriage or medically terminated pregnancies (Shapiro, 1993). A number of psychosocial components of infertility associated with excessive losses and prolonged stress have been identified including shock, denial, anxiety, depression, helplessness, sexual and intrapersonal maladjustment, anger, betrayal, shame, guilt, social isolation and grief (Abbey, Andrews, & Halman, 1991; Lalos, Lalos, Jacobsson, Von Schoultz, 1985; Kraft, Palombo, Mitchell, Meyers, Meyers & Schmidt, 1980; Link & Darling, 1986; Mahlstedt, 1985; 6 Menning, 1977, 1979,1980, 1982; Shapiro, 1982; Seibel & Taymore, 1982; Valentine, 1986; Wirtberg, 1992). Infertility also has been reported to have adverse affects on men's and women's sexuality and sense of identity (Abbey et. al., 1991; Berg et. al., 1991; Berger, 1980; Downey, et al., 1989; Mahlstedt, 1985; Ulbrich, Coyle, Llabre, 1990; Link 1986) causing them to feel personally and socially vulnerable (Cook, 1987; Kaufman, 1968). In their review of infertility studies, examining psychosocial distress Wright, et al., (1989) found that women were more distressed in the areas of anxiety and stress, depression, loss of self-esteem, and psychological, sexual, and marital adjustment than men. While men generally report less overt distress in response to infertility than women do, one exception appears to be men with a male-factor etiology (Berger, 1980; Feuer, 1983; MacNab, 1986; Nachtigall, Becker, Wozny, 1992). Plausible explanations for gender differences in response to infertility are linked to social pressure to procreate, the intrusiveness of medical treatment, particularly for women, the use of gender-specific coping strategies (Pfeffer & Woollett, 1983; Wright, Duchesne, Sabourin, Bissonnette, Benoit & Girard, 1991), and internalized cultural norms. The centrality of motherhood to women's self-identity and role-expectations is cited as one possible source of women's difficulties in responding and coping with infertility (Sandelowski, 1993; Wright et al., 1991). Fertility-related stress may also have a deleterious effect on the partnership (Andrews, Abbey, & Halman, 1992; Collins, Freeman, Boxer & Tureck, 1992) particularly in the spheres of marital adjustment, sexual satisfaction and functioning (van Balen & Trimbos-Kemper, 1993), and communication (Berg & 7 Wilson, 1990; Bresnick, 1981; Daniluk, 1988; Daniluk, Leader, Taylor, 1987; Hirsch & Hirsch, 1989; Kaufman, 1968; Lalos, Lalos, Jacobsson, & von Schoultz, 1985; Link & Darling, 1986; Menning, 1977; Morse & Dennerstein, 1985; Shapiro, 1982; Ulbrich, et. al., 1990; Valentine, 1986). Researchers have identified a number of factors that appear to moderate an individual's response to infertility. More negative responses appear to be associated with: advanced age and longer duration of infertility (Berg & Wilson, 1991; Daniluk, 1988; Koropatnick, Daniluk, & Pattinson, 1993; McEwan et al., 1987; van Balen & Trimbos-Kemper, 1994) the receipt of an ambiguous diagnosis such as unexplained infertility (Abbey, et. al., 1991; Berg & Wilson, 1991; Daniluk, 1988, 1991; Koropatnick et al., 1993; Link & Darling, 1986; Mahlstedt, 1985; McEwan, et. al., 1987; Sandelowski, 1987; Ulbrich, et. al., 1990), and being the person identified with the infertility impairment (Abbey et al., 1991; Daniluk, 1988; McEwan et al., 1987; Nachtigall et al., 1992). Sex is also implicated, with women characteristically experiencing more psychosocial distress in response to their inability to conceive (Abbey et al., 1991; Adler & Boxley, 1985; Andrews et al., 1991; Daniluk, 1988; Greil, Leitko, & Porter, 1988; Link & Darling, 1986; McEwan et al., 1987; McGrade & Tolor, 1981; Stanton, Tennen, Affleck, Mendola, 1991; Ulbrich et al., 1990; Wright et al., 1989, 1991). Healthier coping has been associated with individuals who indicated greater masculine or androgenous sex role identification (Adler & Boxley, 1985), and with coping strategies that involve more "regulation of emotions" in order to adjust to the more uncontrollable stressors of infertility rather than solely relying on acute problem-solving techniques (Zolbbrod, 1993). 8 Although couples may endure a great deal of pain and suffering with their infertility and medically assisted attempts to "cure" their infertility, most do not give up their desire for a child easily and as such, may become "obsessive" or develop "tunnel vision" in pursuit of a biological child (Leiblum, 1992; Carter & Carter, 1989). As Wirtberg (1992) states "the desire to create a family is so fundamental that it is not easily interchangeable with other life-plans" (p. 168). van Balen et al. (1994) found that 50% of couples even after having been through extensive medical treatment for more than 6 years expressed their intentions to continue to pursue treatment. Leiblum (1987) also reported that 93% of women after unsuccessful in vitro fertilization attempts indicated they would participate in any new innovative methods that might enhance their likelihood of a biological pregnancy. The ever-changing reproductive technology can feed their hope of attaining biological parenthood (Leiblum, 1990) making it more difficult to relinquish their goal of biological parenthood. However, infertile couples eventually face a time when active involvement in treatment ends. Treatment has succeeded in producing a child or because it has failed in the sense that all current medical options having been exhausted, or the couple have reached their limit financially, physically and/or emotionally and decided that 'enough is enough'. Many authors support the view that griefwork necessary in order to "resolve" infertility and biological childlessness (Glazer & Cooper, 1988; Menning, 1980, 1982; Mahlstedt, 1985, p.344, Sandelowski, 1993; Shapiro, 1982). For the 50% for whom treatment fails, they are faced with dealing with this tremendous loss and grief and having to construct a life without biological children. Even the 9 50% who are successful often need some support in dealing with pregnancy and parenting after infertility (Sandelowski, 1993). The grief associated with infertility has been described as similar to Kubler-Ross's "stages of dying" which includes periods of denial, rage, anger, bargaining, depression, and acceptance (Menning, 1980; Shapiro, 1982). According to Menning (1979), "fai lure—or more accurately, inability — to grieve is the single most common presenting problem" (p. 104) for infertile couples. Purpose of the Study While the research on the impact of infertility does provide an appreciation of the magnitude of the task that infertile couples are then faced with when attempting to "resolve their infertility," (Menning, 1977), how couples perceive, react to, and resolve their infertility and adapt to life post-treatment is not well understood (Shapiro, 1993). What does exist in clinical and research literature, focuses on the process of resolution and adaptation for infertile couples who become parents of a biological child with the assistance of medical intervention (Daniluk, Mitchell & Pattinson, 1991; Sandelowski, 1993). With few exceptions, what has not been examined in the clinical and research literature is how the 40% to 50% of infertile couples who are unsuccessful in producing a child, adapt to biological childlessness (Ireland, 1993; Mathews & Mathews, 1986; Newton, Hearn, & Yuzpe, 1990). There are basically two paths available for those who remain biologically childless: to pursue alternative parenting options such as adoption, surrogacy, or donor insemination, or to construct a life that does not include parenting together. Since adaptation to infertility and biological childlessness is a very personal process 10 which occurs over time, and is a process about which little is known, in-depth qualitative, longitudinal research may begin to provide a greater understanding of adjustment to infertility following failed treatment. I hope to add to our limited knowledge of this process by repeatedly examining the lives and experiences of two infertile couples who chose different paths as they attempted to negotiate their transition to biological childlessness over time. In this study, I document and explore in-depth the journey, as told over a three and half year period, of one couple who successfully achieved parenthood through adoption, and one couple who elected not to pursue other parenting options. The question that guided this study was: "How do couples adapt to biological childlessness and reconstruct their lives once fertility treatment in no longer a viable option?" With the increased rates of infertility and more acknowledgement of the stresses of infertility on couples and individuals, there is a need for more research in this area of infertility. While we know something about the adaptation process when couples succeed in having their own biological child, I hope my research will help to build a body of knowledge for the 50% of couples who must adapt to biological childlessness when treatment fails. 11 CHAPTER TWO: LITERATURE REVIEW The literature reviewed in this chapter, on infertile couples and individuals, provides the reader with an awareness of the issues, and an understanding of the experiences of the post-treatment transition process to biological childlessness. Three sections are presented which cover the three major possible paths taken by infertile couples once treatment is terminated: adjustment to biological parenthood, parenting an adopted child and living a life "childfree" life (Menning, 1977). Adjustment to Parenthood after Infertility Treatment The bulk of the follow-up studies and literature is focused on adaptation to parenthood after successful infertility intervention. Daniluk, Mitchell and Pattinson (1991) conducted a study on "Adjustment to Parenthood" to determine factors that predicted parental adjustment for 91 individuals who experienced the birth of their first child(ren) through in vitro fertilization. The predictor variables related to the characteristics of the parents included duration of infertility, age of the parent, gender, socioeconomic status and marital adjustment. Predictor variables related to the characteristics of the children include age of the child(ren) and single versus multiple births. Despite the length of time (on average 7 years) infertile couples in this study had spent pursuing a biological child and the relatively high percentage of multiple births, the (IVF) in vitro fertilization parents showed a positive adjustment to parenthood. These researchers found that "while initially taxing, parents in the study perceived 12 themselves as adjusting reasonably well to parenthood: having incorporated their new reality into their lives" (p. 22). Although infertility may not impede a couple's ability to parent, some issues have been identified that may make parenting after infertility a more challenging experience. As some authors on infertility state, parenting may "cure" childlessness but not infertility (Garner, 1985; Glazer, 1990; Sandelowski, 1993). The "legacy of infertility" may continue to have an impact on the lives of infertile couples as they adjust to their new reality of parenthood (Garner, 1985; Glazer & Cooper, 1988; Sandelowski, 1993). With the succession of losses and disappointments associated with infertility, some expectant infertile couples may experience their pregnancy as a time of worry and stress based on concerns about the health of the fetus and sustaining the pregnancy. Garner (1985) suggests that past experiences and feelings related to infertility may affect a couple's "role development and task achievement" (p. 1) during pregnancy and delivery. Some couples may enter a "strange state of disbelief and anxiety, of fear and loneliness" (Glazer et al., 1988, p. 167; Shapiro, 1986). Sandelowski, (1993) in her longitudinal research, interviewed ninety-four infertile couples expecting a biological baby after successful infertility treatment, a minimum of five times from the trimester to three months after infant's arrival with each session lasting approximately one hour. She found that infertility continues to haunt couples and influence their lives after treatment ends. The infertile couples in her study expressed difficulty trying to "shift gears" and to "leave [infertility] behind" (p. 134) and that a "mental barrier" (p. 134) hindered their transition from infertile couple to expectant parents. Anxiety, fear connected to infertility and even 13 guilt for becoming pregnant when other infertile women did not, sometimes prevented positive feelings about their own pregnancy from being expressed. Social isolation became an issue for some couples who saw themselves as not "fitting-in" but instead "in between" two groups. They feel out of place or different from fertile couples as well as awkward or alienated from infertile friends who were 'not yet pregnant' or ceased pursuing efforts to have a biological child. However, some couples attempted to "normalize" or locate themselves in the world of the fertile once they were pregnant by making a clear distinction between conception and pregnancy. On one hand, they acknowledged the "abnormality" of infertility and the "high-tech" process of conception, but separated these events from the resulting "normal" pregnancy in order to normalize their situation (p. 128). Adoption and Adaptation Post-treatment For couples who are unable to achieve a viable pregnancy, adoption is the only available parenting option. Approximately, 25% of infertile couples embark on the adoption quest (Burgwyn, 1981) and most eventually succeed in securing a child (Leiblum, 1997). Adoption is viewed by some infertile couples as 'the light at the end of the tunnel,' as a 'backup' option, a way of 'hedging their bets' or as "the best means to a family" given their situation (Glazer & Cooper, 1988, p.181). Infertile couples contemplating adoption express concerns about entitlement, attachment, reactions by family and friends, financial and emotional investment, as well as attitude and expectation adjustments on the part of the child and themselves (Glazer & Cooper, 1988). 14 Sandelowski's (1993) longitudinal research (described previously) on the transition to parenthood following infertility, is a particularly rich source of information regarding the experiences of the 31 adoptive couples in her study during the preadoption waiting period. The preadoption waiting period is characterized as a "liminal phase" where the couple "in waiting" is not a parent but "hoping-soon-to-be-parents" (p. 156). Childwaiting couples live in a "temporal void" unlike pregnant couples who by virtue of their pregnancy have a schedule of sorts to order their lives, and events to mark the arrival'of parenthood such as baby showers, preparing the nursery, etc. Infertile, expectant, adoptive couples attempt to create a temporal order by constructing a chronology of waiting, referred to as "could-be-time, anytime now, and past time" (p. 162). Sandelowski describes the "disembodied nature of childwaiting" (p. 181) for women preparing for motherhood without the physical and emotional experience of being an expectant mother, and the accompanying feelings of loss for many of these women. In their struggle to "survive" the waiting, couples in her study engage in ways to make good use of their time but were cautious, about investing too much in terms of their psychological, emotional, and financial resources as a result of their experiences with infertility/Some long-waiting couples or women feeling especially deprived by their infertility became more despairing as time progressed. The preadoption process was found to be both a "deprived, anxious time" (Marquis & Detweiler, 1985, p. 1055), and a "dynamic interlude" where couples shared in the joint project of achieving parenthood (Sandelowski, 1993). The transition to parenthood for couples who adopted Involves reinforcing their parental claims. 15 forming connections to children who were biologically unrelated, and contending with societal responses to parenting an adopted child or children. Wirtberg (1992) in her doctoral dissertation on "His and Her Childlessness" investigated and described men and women's day-to-day experience of infertility and involuntary childlessness and its affect on couples in the normal context of their lives. The longitudinal study involving 31 couples involved collecting data from two separate, in-depth, semi-structured interviews with an interval of two years. At the time of the initial interview all of the couples were childless and undergoing treatment to try and achieve pregnancy and birth of a biological child. However, by the time of the second interview participants were divided into six distinct groups. Five of the couples had their desire for "a child of their own," meaning a biological child, fulfilled. Two couples were pregnant, three adopted, six were investigating adoption, eight were still actively trying with help of medical investigation, and six finished medical treatment and given up on having children (p. 136) and one couple had both adopted and was pregnant at the time of the interview. Two central themes were confirmed in this study: first, the revolutionary importance of involuntary childlessness for the couples involved; and secondly, how all pervasive the experience of childlessness was for these couples, affecting most areas of their life in negative or destructive ways. Specific observations were made about the six groups with respect men and women's responses to medical diagnosis and treatment, attitudes toward childlessness, and construction of a joint project. Post-treatment adaptation to biological childlessness for adoptive couples or adoption candidates, and couples who remained childless varied on gender-lines 16 to some extent and amongst individuals. All but one of the couples who adopted or were pursuing adoption had biological children as their first priority. The majority of the women in the first interview who were engaged in the pursuit of an adoption had entered the adoption process still very much aware of their experience of loss for their own biological child. By the second interview, however, most men and Women who were waiting to adopt were calmer about their situation and relieved to be doing something to try and become parents. Two women who adopted by the second interview felt regret over their long childless period, while the third women and one man felt content with the decision to adopt and had no regrets. Two of the men who were going along with the adoption for their wives were now looking forward to adoption and to having a chance to complete their family. Adjusting expectations from having a biological baby to an adopted child posed the greatest difficulty for these couples. Couples had to "work through this to make themselves ready and able to welcome an adopted child" (p. 150). Wirtberg found that couples reported a "significant change event" that catalyzed their decision to cease their prolonged attempt to have biological child. For some the turning point was a particular medical procedure after emotionally exhausting infertility-investigations. Some found that participation in support group with others in the same situation and/or with those who had either succeeded or were proceeding with adoption (p. 165) gave them strength to make a decision to abandon medical treatment efforts and pursue other parenting options. In Reimer's (1991) study, "A Circle of Life" on the transition from infertility to adoptive parenthood, she interviewed six adult co-researchers, three husband and wife couples. She identified twenty themes associated with the transition 17 process. Themes of trauma, crisis, and grief were reported during the experience of infertility. Recurring themes of loss of control and humiliation, as well as relief and gratitude were experienced during the adoption, and themes of excitement, adjustment and personal growth were reported after the adoption, in the transition to parenthood. Some of the meaningful changes that resulted from the experience were: "healing of profound emotional wounds, renewed appreciation of the spiritual dimension of life, and a sense of personal fulfilment in the cherished task of parenting" (p. 112). Non-parenthood After Infertility Treatment For some infertile couples, adoption is not a desired or available parenting option and they must find a way to adapt to life without children after they cease to pursue medical efforts to be parents of biological children. Mathew and Mathew's (1986) research on "Infertility and Involuntary Childlessness: The Transition to Nonparenthood" provides a theoretical framework for understanding the consequences of their involuntary childlessness for infertile couples. The authors claim that from the time of infertility diagnosis, infertile couples experience the psychologically painful "transition" from "anticipated status of potential parenthood to the unwanted status of nonparenthood" (p. 641). The process of adjustment requires infertile couples to undergo reconstruction of reality by partners and family members, identity transformation and role adjustments as a consequence of "involuntary childlessness." Infertility and medical treatments force the couple to reconstruct their reality, as they call into question the meaning and purpose of procreation with respect to their marriage, the social continuity of the 18 family, and even their very "existence on this earth" (p. 643). Individuals' self-concept and self-esteem are often negatively affected by infertility. Mathew and Mathew (1986) suggest that the greater the commitment to having children, the greater the "identity shock" and impact on self-esteem brought about by the infertility and subsequent involuntary childlessness. The authors point out that until infertile couples end their search for an effective treatment to have a biological child, aspects of the transition are not likely to be permanent or complete. Glazer and Cooper (1988) in the brief chapter on "Living Childfree" in their book, "Without Child" make mention of the transition from being "childless" to "childfree." The term 'childfree' is used by Glazer and Cooper to designate those infertile couples who feel that the best option available to them when biological parenting is denied, is to live a life without being parents (Glazer & Cooper, 1988, p. 207). As the authors say, infertile couples have invested heavily in their pursuit of a biological child and so the decision to be childfree does not come easily. They suggest that decision-making involves a process of grieving the many losses associated with childlessness such as the loss of their potential children and dreams and fantasies about parenthood. Also, a process of engaging in careful thinking, soul-searching and extensive communication about their best route to a satisfying life is involved. In her study on biological childlessness Wirtberg, (1992) characterized the attitude of five of the six couples who did not seek parenthood as one of "resigned acceptance" (p. 155) to their childlessness by the time of their second interview (p. 155). The author noted a difference between men and women's relationship to 19 childlessness, with the women beginning to come to terms with their situation sooner while the men were becoming more concerned, over time, with their childlessness. Deprived of the "joint project" of parenthood, some couples sought other alternatives that became a kind of "glue" for the family such as "the house." Dogs and other pets were also frequently chosen as a "nurturing outlet" for several of these couples. Carter and Carter (1989), in their book, "Sweet Grapes" describe a transformation for involuntary childless couples from acceptance of childlessness to being childfree through the process of making a life decision" (p. 60). Whether couples adopt or decide to "make their lives good without children" (p. 15), the authors advocate a psychological process of working through the life stress of infertility. When couples learn to embrace both the losses and the gains that come with infertility they begin to define their lives by those gains rather than the loss of what they do not have. According to Carter et al., (1989), the key to living childfree is choice, "because it is the act of choosing that gives you control over your life" (p. 65). Grieving is an important step in becoming "free" of the desired biological child so that couples can make a "real" choice about adoption or living childfree, rather than by default or out of a sense of desperation or rejection of something else. They suggest that arriving at a decision to adopt or choosing to be childfree means to transform infertility into an opportunity and to acknowledge and act on the advantages inherent in the choice made. 2 0 Summary The anecdotal, clinical and research literature reviewed in this chapter provides useful information on salient issues in the process of resolving infertility and biological childlessness. Some important but limited insights are also provided into the process of short-term adaptation to infertility for couples who eventually conceive, for those who adopt, and for those who remain childfree. However, a more in-depth understanding of how couples reconstruct their lives after failed infertility treatment is needed. CHAPTER THREE: 21 METHODOLOGY Design This study was conducted in an attempt to begin to understand how infertile couples adapt to life without parenting a biological child. The underlying research question that guided this inquiry was: "How do couples adapt to biological childlessness and reconstruct their lives once fertility treatment in no longer a viable option?" The goal was to portray the journey of adapting to life without a biological child as "lived" and told by two infertile couples over a three and half year period. Much of the literature on the social-psychological impact of infertility is based on quantitative analysis (Abbey et al., 1991; Brand, 1982; Berg & Wilson, 1990, 1991; Bresnick & Taymor, 1979; Daniluk, 1988; Feuer, 1983; Hirsch & Hirsch, 1989; Kedem, Mikulincer, Nathanson, & Bartoov, 1990; Koropatnick, et al., 1993; McEwan et al., 1987; Ulbrich, et al., 1990; Wright, et al., 1989) and often the data is quiet removed from the actual experience of participants. Infertility is a very sensitive topic and all pervasive in that it touches many aspects of a person life from the most intimate moments between a man and a woman to the broader issues of family and sense of place in society. Thus, the study required an approach which was considerate of the scope and nature of the situation and which would allow for a comprehensive picture to emerge. Interpretive methods of research, particularly the narrative approach, seemed most suitable to address this research. They provided the opportunity for empathic, 22 personal interaction with the couples. The use of a qualitative approach elicited data grounded in the lived experience of the participants and was responsive to the feelings, needs and experiences of the couples engaged in the research. This methodology also facilitated the establishment of a more respectful and comfortable environment for participants as they recounted their experiences. Sandelowski (1993) in_her work, With child in mind chose "narrative knowing" (Polkinghorne, 1988) as her method of inquiry because it" is an essentially biographical and historical form of inquiry that involves capturing people in flux and life events in context" (p. 2). Since the stories of the participants, in this study unfolded over a three and half year time period, a narrative approach to the analysis seemed fitting. According to Cochran (1990), and Cochran and Laub (1994), there is tremendous value in studying "actual lives as they are lived" with a narrative approach resulting in rich and rare information recognizable to those in a similar position as well as counselors working with them. Recruitment and Participants The participants who are the focus of this study were selected from Daniluk's (1996) 3-year longitudinal study on the "Transition to Biological Childlessness." Participants were recruited through notices placed at various infertility clinics, newspaper stories and radio interviews with the principle investigator. The criteria for inclusion in the study was the following: that the participant be a member of an infertile couple, have no biological children, not be requesting a reversal of a voluntary sterilization or not be actively pursuing pregnancy (e.g. had terminated all medical treatment efforts), and that they did not have a history of psychiatric problems. 23 Of the 99 participants (57 women, 42 men) who began the study forty-six women and 38 men completed the study, which involved in-depth interviews and questionnaires 4 times over a 3.5-year period (CORE Group). Nine women who were participating without their partners withdrew before completing all four sets of questionnaires, and 3 couples were required to withdraw because of pregnancy. The diagnostic status of the participants in the CORE group was as follows: 54.1% unexplained infertility, 8.2% male factor, 30.6% female factor, and 7.1% combined male and female factor. On average the participants were middle-class, Euro-Canadian individuals with a mean age of 36.5 years, who had been trying to conceive for an average of 6.7 years when the study began. Procedure All couples in the CORE group participated in four in-depth, unstructured, tape-recorded interviews following completion of a set of standardized questionnaires which included: the Bern Sex Role Inventory (BSRI - Bern, 1974, 1981), the Derogatis Sexual Functioning Inventory (SFI - Derogatis, 1975; Derogatis & Melisaratos, 1979), the Dyadic Adjustment Scale (DAS - Spanier, 1976), the Revised Ways of Coping Scale (WOCS-R - Folkman, Lazarus, Dunkel-Schetter et al., 1986; Lazarus & Folkman, 1984), the Life Satisfaction Scale (LSS - Warr, Cook & Wall, 1979) [the independent measures], the Rosenberg Self-Esteem Scale (RSES - Rosenberg, 1965), and the Derogatis Symptom Check List (SCL-90-R - Derogatis, 1975), Experimenter-Generated Personal Data Sheet (PDS) and the Medical Data Sheet (MDS) [the independent measures]. The interviews were conducted for the purpose of learning more about how couples live with and integrate the experience of infertility and biological childlessness into their lives and 24 begin to construct a future life without biological children. Husbands and wives were interviewed in their homes by the same interviewer on each occasion (a counsellor trained in phenomenological data collection) with each interview lasting approximately 134 to 2 hours. Daniluk's (1996) research was unique in her use of standardized measures and the incorporation of in-depth interviews at 10 month intervals, beginning with 2 months of the termination of their procreative efforts, with both partners jointly putting forth their respective perspectives of their shared experiences of their adjustment to biological childlessness. This offered the rare opportunity to have a mutually constructed story of each couple's present reality and the advantage of retaining the clarity and intensity that is often forfeited when stories are told retrospectively or questionnaire data alone is collected. The compilation of their "present reality" at four time periods over three and half years provided the exciting opportunity to witness, first hand in a sense, the process of these couples as they experienced and negotiated the intrapersonal and interpersonal challenges involved in adapting to life without biological children. Selection of Participants for My Study Of the couples who met Daniluk's (1996) inclusion criteria and completed the four interviews, I selected two infertile couples to be the focus of my study. After working with some of the couples for the duration of Daniluk's study as an interviewer and analyst, I realized that the story lines of the couples tended to take one of two directions. Consistent with Menning's (1977) observations, the couples in this study either investigated or proceeded with alternative parenting options 25 such as adoption and more rarely surrogacy, or they chose to remain childless. As such, I selected a couple who represented each of these paths because I felt they might bring forth not only an understanding of the common experiences in the transition process to biological childlessness but also provide an awareness of the different paths to resolving and living with biological childlessness. Both couples have 'unexplained infertility,' are of Euro-Canadian heritage, middle class and in their mid-thirties. I was not involved in the interviewing of these couples, and therefore, came to the data and their stories with a fresh and objective perspective. Many of the couples in the study were open, articulate and willing to share their stories. The couples hoped that their experiences might help other infertile couples going through this process, heighten the awareness and sensitivity of medical practitioners regarding the emotional and psychological impact of infertility during and after treatment ends, and assist counselors in their work with infertile couples. The decision to select the two couples out of so many worthy, heartfelt and rich stories was not easy. However, I selected two couples who seemed to offer the most in-depth, intimate, articulate and vivid descriptions of adaptation to life without a biologically-related child once treatment was terminated and it was time to "move on." Another strength of the interviews with these two couples was that the partners contributed equally during the research process. Finally, I favoured these two couples because of the specific nature and content of their stories represented the two pathways available to couples confronted with the likelihood of biological childlessness. One couple, Terry and Cory seek and become parents to an adopted 26 child, while Jane and Stephen determined that what was best for them now was to shape a meaningful life without children. The names, Terry, Cory, Jane and Stephen are pseudonyms I have given to individuals from Daniluk's study for the purpose of anonymity and confidentiality. : Analysis Each of the four interviews by each of the two couples (eight interviews in all) were transcribed verbatim. Narrative accounts of each couple's journey were constructed through synthesizing the information from the tapes and transcriptions so my analysis represented a coherent story of their process of adapting to biological childlessness. The accounts were written from the participant's experiential viewpoint, using the words and expressions of the participants as much as possible. The analysis proceeded by deeply and thoroughly examining the narrative accounts until the flow of the each story was established and distinctive "streams" or "threads" progressing through the four time periods emerged. Finally, a description of how the "streams" interrelated in a common structure was derived for each story, and then discussed with respect to the findings from the two stories. Limitations of the Study The focus of this study was limited to an exploration of the experience of two infertile couples adaptation to biological childlessness and each story must stand alone as valid. However, the small sample size and the demographic makeup of participants in this study (white, Well-educated, middle class individuals) limit the ability to generalize to a more diverse socioeconomic or ethnic population. The stories of couples and individuals who forego medical treatment for infertility or 27 who are denied treatment due to limited financial resources remains to be documented. Also, the experience of the transition process for lesbian or single individuals who are unsuccessful with fertility treatment or couples who perceive that their separation or divorce is connected to fertility has yet to be addressed. The two stories depicted are certainly not meant to be definitive of all infertile couples' adaptation to biological childlessness post treatment, but merely an initial exploration of this transition process. I would hope that this work might inspire or provoke further research into the nature of the process of adaptation to biological childlessness for couples who become adoptive parents or remain childless when the medicalized procreative process fails. Additional research is needed to substantiate my findings and elaborate on the similarities and differences of those who forged a similar or significantly different life path. 28 CHAPTER FOUR: RESULTS Narrative Accounts In a series of four interviews over a three and half year period, we are privileged to have told to us the stories of two infertile couple's adaptation to life without having a biological child after terminating infertility treatment. The findings from the study are presented by providing a narrative account of each couples journey, followed by an analysis of the process of adaptation to biological childlessness indicating common aspects of adaptation as well as describing the particular experiences of adjusting to an alternative life path as an adoptive or childfree couple. Jane and Stephen Jane and Stephen were both forty years old at the time of the first interview and had attempted to have a genetic child 'naturally' and then via medical means for the past 7-years. Diagnosis for their fertility problem was inconclusive but they felt compelled to opt for medical treatment for 'unexplained infertility' for four years without success. Although we enter their story after the termination of their active treatment efforts, we are privy to the bulk of this history of infertility and treatment as the couple reflects on this time in their lives during the first interview. Their story progresses from a time when their lives centered on the pursuit of parenthood, both biological and adoptive, to accepting a non-parenting life path. Loss and Determination (1st interview). Jane and Stephen decided to take a 'break' from active treatment after four years of humiliating medical procedures, 29 insensitive interactions with medical personnel as a couple, in addition to the 'severe' side effects Jane suffered from the fertility drugs. Although they were on the 'waiting list' for in vitro fertilization, they contemplated just 'resigning' themselves to a life without children. However, the unexpected, persuasive, urgent pleading of a single, pregnant, young woman to parent her soon-to-be-born baby, 'turned their life around'. Neither Jane nor Stephen ever anticipated adoption but they shifted gears in four weeks, and took on the responsibility of parenting the baby. Stephen was especially unprepared for the immediate attachment he felt for "their little girl." Parenthood moved from the realm of fantasy to a deeply felt reality, and they "loved her like we had her ourselves." Tragically, for Jane and Stephen, four days after they had taken custody of their daughter, the birth mom returned for the child. For a very brief time, parenthood "made every thing complete" and because of that experience the loss was all the more profound. The loss fuelled the 'baby imperative' and they refocused their energy on treatment while keeping the 'risky' adoption option on the back burner. Both seem rejuvenated and optimistic as they re-engaged in the efforts to achieve biological parenthood. Pursuing treatment, "instead of just sitting and rotting," resurrected hope and provided some relief from the pain as well as a distraction from the grief and the despair of having come so close to realizing their dream of parenthood. The failed adoption happened on the heels of years of unsuccessful attempts to have a biological child and brought out memories and feelings connected with their negative experiences of infertility and treatment. They both expressed anger, frustration, hurt and bitterness that seemed to simultaneously tap into current 3 0 losses as well as previous ones associated with infertility that had not been fully grieved. Recollections of the infertility process included times when the home front became like a "war zone" and an emotional 'land mine' with the effects of the drugs, pressure and discomfort from social interactions, stress from the emotional roller coaster associated with monthly menses and treatment cycles and "just waiting all the time." Infertility began to "take up our whole life" affecting their sex life, creating strain and friction in the marriage, as well as tension, awkwardness and even isolation from friends. Although they believed they were careful not to assign blame, each of them experienced feelings of blame and a sense of failure. They felt like infertility and the baby quest consumed them: "you feel like you're obsessed with it." It seemed inescapable: "it's like a ball and chain" that's with you wherever you go. Stephen referred to the "longing and yearning that's always there" like an "addiction." They took on the role of the "infertility junkie." Both mentioned how infertility "is a real test to the marriage" and yet, the challenges brought them closer together. They applauded their strengths as a couple for surviving such an arduous ordeal. Certain aspects of their individual personalities proved helpful to their relationship as a whole during this time. She relied on his for support when she was low, and he benefited from her drive to get him going "to do that one more bit." Still, they remained confused about where to draw the line for themselves in this whole process. "You can't put a price on it (a child) but you can't go on doing it forever." Stephen expressed resentment, frustration, a sense of futility, and disappointment, given all the time, money and effort invested, only to come up 31 empty handed and to some extend even worse off because of the "phenomenal" stress. Nevertheless, driven by the "baby imperative" once again, they jumped back on the emotional roller coaster in pursuit of other treatment options by putting their name on the list for in vitro fertilization. Stephen said, this time it is "a means to an end" suggesting an end to their goal by either succeeding or, should they fail, an end to the pursuit of parenthood with no regrets down the road. Recovery and Hope (2nd interview). At this point in the transition process Stephen and Jane were 'back to normal' feeling happy and hopeful having survived the tragedy of the previous year's loss. Proceeding with treatment, although they had not yet completed an in vitro fertilization cycle, had restored a degree of hope and optimism about the future, "we're going forward, moving on, seeing what's around the next corner." Jane and Stephen felt that they had adopted a more 'serious' attitude toward the treatment option. Although anxious about the "emotional roller coaster' of treatment, they believed the experience they gained prepared them to coping differently with the medical aspect this time around. Motivating factors included the pressure of the biological clock, the fear of life without a child and being "burned" by adoption, avoidance of future regrets but primarily their appreciation of children, "you realize how precious that gift of life is" and their hope and desire to parent. With the reoccurrence of feelings of despair and desperation as they invested time, money and emotions in the initial medical IVF workup, they admitted to the eventual necessity of assessing their 'reality' Stephens said, 32 It comes to a point in your life where you sit down and you either say, OK, I'm either gonna go full blown on this issue or I'm gonna stop it here and now. Because I'm far enough and it is time to sit down and say enough is enough, no more, for get it. Now, we're not at that point. The support of friends was a source of strength, comfort, and encouragement but also burdensome and difficult at times. Sharing their situation sometimes meant having to repeat the disappointment and exposing themselves to events that made them feel like "failures" (i.e., friends and family members were getting pregnant and getting on with the next stage of their lives). A source of resentment and frustration was the insensitive comments by some people, and the overall lack of social/public recognition for their efforts and sacrifices to try to become parents. However, they were grateful for the unconditional acceptance and support that friends and family had given them regarding their relationships with their kids. During the time between the first and second interview, feelings associated with the loss of their adopted baby girl resurfaced as they caught a glimpse of her with her birth mom in a shopping mall. A friend helped Jane reframe her relationship to the baby and detach ownership of the child by saying, "she isn't her anymore, sitting in the stroller wasn't the baby that was in the bedroom.' Jane attempted to put the pain and unfairness of their loss in perspective by looking at others who were'worse of f than they were. Adoption remained an option but they were still feeling vulnerable to the potential for loss, and were reticent to engage in a process that was likely to 33 subject them to personal scrutiny and judgement. However, the failed adoption experience came to be viewed as having a purpose or meaning in the greater scheme of things: "everything happens for a reason." As a couple they felt "stronger, happier" because they had pulled through together, and had survived a real test to their marriage. They were also beginning to make "themselves" a priority in the midst of their child-seeking quest by "treating" themselves and taking more care of each other so they didn't feel so much like "damaged goods." Acceptance of Biological Childlessness (3rd interview). Jane and Stephen characterized their situation at this stage of the process as living "out of the closet ... like out of denial and in the acceptance phase. We've decided that we'll probably be childless." A number of factors over the previous ten months had factored into their decision, including: the financial and emotional investment in something with such a low probability of success; their age (late thirties); resentment about feeling like "guinea pigs"; and a growing desire to change the focus in their lives. A work-related separation of several months duration forced them to put in vitro fertiliztion (IVF) "on hold" and during that time Jane investigated special needs adoption. When the time came to make a firm commitment to the adoption process, she realized she couldn't "go through with it." Re-evaluation of treatment had also led to a change in priorities. The previous year, they were prepared to do three IVF cycles, but now: "we're making long-term plans ... about us" which included taking a holiday, buying a car and getting a house. A shift in focus occurred from 'baby' to 'us ' as a couple, and while there were some lingering 34 regrets and times of grieving, they found that periods of "thinking about" baby and parenting were getting "shorter and shorter." Taking birth control pills and selling the baby furniture were symbolic acts of acceptance, closure and letting go, "its like another page." They described themselves as being in the "rebuilding, regrowth stage and looking forward in a bright way" and appreciated the advantages of childlessness. The physical and emotional distance of being separated due to work lent perspective to their situation, "a reality check" and time for reassessment. They found that they were more appreciative of their relationship, "it just seemed like too precious to even waste anymore time." The separation put a halt to functioning as a couple in terms of the daily routines, provided a break from the parenting quest, and gave them the space to rediscover themselves as individuals. Jane found she "discovered a whole new me that I didn't know existed," a woman who was more autonomous and self-sufficient. The opportunity also reawakened old interests such as physical fitness, which she incorporated into her daily life style. As Jane developed a broader field of vision, she was able to put the 'baby thing' in perspective. She said, "I guess that's when you realize that, what we were doing was not the only thing in the world. Like there's other facets to it that we didn't know existed. Cause we really got obsessed with it [the baby thing]." They experienced some discomfort and guilt about making "self" a priority in their decision to stop pursuing parenthood, but began to realize that the costs "emotional", "financial", "mentally," "the whole picture" outweighed any hope for success. They felt they had accepted "that maybe that's never ever gonna 35 happen again." At this point in the process, they were trying to make sense of it all: "everything happens for a reason." With excited anticipation, they were beginning to look forward to more change and a brighter future. Stephen captured in a brief story his determination to 'solve' their infertility and his eventual acceptance that despite all his best efforts this was one situation that was not within his/their control: I'll tell myself, it is like a gold rush. Someone says, there's gold in Prince George. Okay you go to Prince George, and the guy in Prince George says, that guy got it wrong, it's in Kamloops. So he went to Kamloops, and he says no, no, it's not there. So you get tricked and then you think where the hell is this gold. There isn't any. Once he became aware of his limits, he realized he had a choice to continue on this same path or to determine a different one. He asked himself, "Do I need to be trucking after this gold when it may not be there or it may be there. Why don't I start going on a path where I know where I'll be, rather than this?" The desirable path for him at this point was one that maximized the possibility of control over his success. He began writing a book and working actively with young offenders; two concrete and attainable tasks and goals that would yield positive returns for him, in terms of an increase sense of control and accomplishment. Another significant accomplishment was the attainment of their Canadian citizenship. Stephen recognized that the whole experience of infertility, treatment and the failed adoption had altered his perception of himself and his way of being in relationship to the world. 36 I quite amazed myself, cause I'm one of these guys that for every problem there's a solution and I've never been one of these where whatever will be will be, its not meant to be ... but I'm finding myself in that position. For both of them their new life path offered a chance for social reconnection through career enhancement, physical fitness and volunteer activities and holidays. As their world began to expand to include other interests, they were less concerned with, and had less time to think of their need to nurture. They began to feel for the time being, that a dog would help to fulfil their need to be "responsible for and care for and look after" another life, and would give them unconditional positive regard, while fully acknowledging that a pet is not a substitute for a child. During this period of transition, in light of their decision to remain childless, Stephen felt at a loss and wondered what to do with his excess energy. He offset his concern by recognizing the freedom and flexibility available to him now. He had doubts about their motives sometimes for their current pursuits and wondered if they were exploring new options as compensation for the emptiness of not having a child in their lives. The distance of time enabled them to reflect on the extremely traumatic and significant event of the failed adoption and in so doing, both came to appreciate and comprehend "how difficult it was." Jane was more struck by the length of time it took "to get over it ... almost a year." During the months before this interview, Jane brought closure to the whole experience of the failed adoption by writing to the birth mom's mother (a personal friend who had originally been responsible for arranging the adoption), and then 37 meeting with her where "we got it all out in the open." Eighteen months after the loss of the baby, Jane was given the option of seeing the baby and did. She said, I wanted to scoop the baby up and run away but part of me knew that that's not the same baby that we had. Really, basically that's how I separated it. Wasn't it like, that's not my baby, that's their child. Jane was proud of having faced her fears and pain in order to heal; "it was a good thing to face it head on." Lack of acknowledgement or understanding by others was still hurtful for them and sometimes still served to create a barrier between them and others. As they had said, the blueprint they had for life that "just exploded" with infertility, followed by "pain that was real" but unacknowledged by others, and with the pain came acceptance too, "its pain to say to yourself, this is the way it is and it's not gonna change." They still felt annoyed and frustrated by people who suggested they had control over their fertility, "well if you try hard enough you can." They were able to be more objective about these things and not be so offended and tried to take these comments as 'well-intentioned' attempts to help them. On occasion, they experienced awkward moments when dealing with invasive questions and offensive perceptions of couples as being "weird" that they didn't have children or were not trying to become parents. She recalled the insensitivity of others who suggested that Stephen and Jane needed to "get a life," when really, what they needed was time to grieve. They resented the way society made them feel inferior for being infertile instead of acknowledging their loss as a "tragedy" and an uncontrollable reality. "There's not a damn thing you can do about it." As time 38 passed, motherhood issues diminished as did the pain: "it's not hurting as much." The fact that they "gave it a damn good shot" helped them to accept things as they were and move forward. Positive Life Path as a Childless Couple (4th interview). The fourth and final interview marked approximately nine years since their first attempts to conceive and parent a biological child. The hardships of infertility, treatment, and the failed adoption were, for the most part, behind them. They decided to make themselves a priority, to "live for us now" and declared that they had had a "productive" ten months. Present interests and activities were satisfying, rewarding and provided a sense of accomplishment as well as increasing their feelings of control and contributing a sense of purpose to their lives. Jane won accolades by co-workers, friends and family as a top marathon runner, while Stephen had become a writer, computer "expert" and a mentor to young offenders. They were in the process of buying a house, adopting a couple of dogs and were planning to travel more. In contrast to their experiences with infertility and efforts to achieve parenthood where "you have nothing when you're going through that process," their current activities yield predictable, tangible and favourable "results." Since relinquishing their quest for a child, they had re-established connections with parents they had not seen for a while, fostered relationships with children of family and friends, and Stephen developed new nurturing outlets in his relationships with young offenders. They had no "regrets" about their decision not to pursue IVF and 'let go' of parenthood but sometimes just "wishes" that "it [biological parenthood] could have 39 been." That lingering unfulfilled desire sometimes made her vulnerable to suggestion and refantasizing on occasion, about trying treatment again. Stephen however, was not inclined to open that door at all. Their new pursuits served a dual purpose of distancing them from the losses by "taking your mind off what you're leaving behind in your life," forcing them to push themselves in other ways that were positive and nurturing of their spirits^ their physical and psychological selves, and their relationship. While infertility and parenthood took up far less space in their lives, they realized that it is "never over" and would be a part of their lives for a long time. One example of ongoing adjustments associated with being infertile arose when a friend and co-marathoner of Jane's became pregnant. The news was disconcerting for Jane, not only because she felt "jealous" toward her friend for achieving motherhood, but also because of the potential of losing a friend and running partner. Jane found a sense of camaraderie with this woman based on interests outside of children and motherhood, and the pregnancy at first posed a threat to this friendship. Jane expressed frustration and anger about women who had 'no identity' once motherhood entered the picture. However, she regained confidence about their friendship surviving the changes, with reassurance from her friend. The long term implications of infertility also became salient on another occasion when Jane witnessed seniors in an extended care facility. Struck by their vulnerability and dependency on others, she was overcome with sadness and loss about the children who would not be there for her in her old age. Infertility touched Stephen's life in every day interactions as well. For example, an old oriental man asked him "what he worked for if he didn't have a 40 family" and Stephen had no answer to give, at the time, regarding his purpose in life without children. They believed, however, that they had come to a place of acceptance about who they are, as a childless couple, and were beginning to assert themselves, "we not going to keep trying, this is the way we are." They were tired of the one-sided nature of relationships where they had, in the past, always been the accommodating ones, because they didn't have kids. Now, they were prepared to leave "good friends behind" who did not respect or value their time and life equally. They felt stronger as a couple and as he says "I don't take shit from anybody." Self-confidence and self-respect had been restored and enhanced over the past year, as evident by Jane's words, "But now I know I am a real person. I can achieve things on my own. I need a bit of help but that'll be all." Their response to seeing the birth mom in a restaurant was to remain rather than take flight from the situation. Before, Jane said she would have panicked and left without even consulting with Stephen, but instead they determined as a couple to assert their right to be there and face whatever happened. The 'shift' to a childless life had brought relief in some ways. They realized they were both glad to be out of 'the twilight zone' where they felt stuck, uncertain, and desperate about their parenthood and their future, having no sense of control over either, and feeling terribly alone, "there's only you there, no one else." On the other hand, Jane states "I wouldn't have chosen it. Even though I'm quite happy with the way things are going that I know that we'll probably have a lot more than a lot of other couples do." One of the pleasant surprises for Jane in 41 pursuing this new path was that "life isn't the same as before only without kids," and Stephen adds, "it's not dismal but in fact quite positive" in that "we've gone down a totally different path." In reflecting on the whole process they identified two factors, their temporary work-related separation and the interviews, that were particularly helpful in facilitating their transition to biological childlessness. In short, the separation enabled them to 'break the cycle' and consequently discover that they could cope and engage in new possibilities. The rapport with the interviewer enabled them to articulate to each other things that they believed they would have avoided talking about but needed to raise, and the interactions with the interviewer and each other allowed them to clarify their experiences and have them validated. They had regained a sense of optimism about the future, restored their belief in themselves, and assumed control over their lives. As Stephen said, "life's what you make it." Terry and Cory Terry and Cory were in their mid-thirties and had spent four of their nine years as a married couple, trying to fulfil their dream of having a biological family, naturally and then with the assistance of medical treatment. They were diagnosed with unexplained infertility. We meet this couple, for the first time, as they began the adoption process after ceasing active pursuit of a biological family through medical treatment. In subsequent interviews we bear witness to their process of adaptation to biological childlessness as they pursued parenthood through adoption. Pursuit of Parenthood (1st interview). Their story of infertility and treatment was recalled as two or three years of "hell." The monthly emotional roller coaster of hope and despair, followed by the demands of the medical process in British Columbia and Seattle, involving temperature charts, semen analyses, hormone and injections were particularly taxing for Terry, but difficult for both of them. Terry experienced "excruciating pain" on the fertility drugs and uncomfortable and upsetting side effects (weight gain, skin blemishes, bloating). She said "they were killing me." Cory recalled that the most difficult part for him was not the medical tests on himself, but the helplessness he felt as he witnessed the emotional and physical hardship on Terry. He said, "It affects me if I see my wife in pain and agony and all this grief and sorrow, it really bothers me." Terry and Cory were grieving the loss of their fertility and their biological child. Terry's sorrow and tears were a testament to the pain and suffering she endured as a result of the medical process but also the profound loss of the opportunity to experience pregnancy, childbirth and parenting a biological child. As she said, "it just got to me. My period came, and I'm not pregnant, I'll never get pregnant in all my life, and I'd get upset." After numerous false (pregnancy) alarms, she recounted a time of utter despair, partially due to drugs and partially grief. "I remember Cory came home from work and I was sitting on the stairs and I just said, "'I can't, I don't like this anymore.' I got my period, and I thought I should kill myself." This was also a time of total disintegration of her faith in a God who "cheated her." Cory realized that they had reached their limits in terms of coping with the situation on their own and needed help. "We try and help each other, but there's only so much you can do, a little outside help is good." They turned to their faith, and found support from their minister. 43 Their infertility affected them in many ways and took its toll individually, in their marriage, and their interactions with others. They felt vulnerable and sensitive to the constant reminders (the pregnant women, the television baby ads, family and friends children, women's talk of labor stories) of the child they wanted and didn't have; insensitive comments and behaviors of others; and experienced feelings of inadequacy, embarrassment, shame, blame, isolation and loss of control. They saw the "stigma and the shame" attached to infertility as "one of the biggest hurts you can have." They remembered marital tension caused by infertility, often feeling "real edgy" with each other and times when she felt he was insensitive, Terry primarily took the responsibility of the infertility on her shoulders even though it was 'unexplained' and once suggested that Cory seek a divorce and marry someone else who could have a baby. With the objectivity of time, they were less harsh in their assessment of people and willing to accept that perhaps they weren't intentionally mean, but just unaware of how hurtful their words could be when they as a couple were feeling "just really sensitive." In reflecting on the years spend pursuing a pregnancy, they described themselves as being in a state of "desperation," trying various things hoping to improve their chances of achieving pregnancy, such as seeing a naturopath who used heat-treatment, adapting reproduction techniques used with chickens; and, a Chiropractor who believed that a healthy back would help their reproductive impairment. They expressed frustration and bitterness about the injustice of infertility that robbed them of their life dream. They were frustrated, as well, with a social system that "discriminates" against infertile couples by denying full coverage for 44 fertility treatments, and a medical system that was unable to give them answers or solve their infertility. The losses and the painful memories evoked tears and she grieved her experience of "wanting to have kids so bad" and being subjected to the humilities and frustration of the "production line" to try and realize their dreams. But, healing had begun to take place, and in telling this story, she realized how different her emotional state was now, compared to the period during treatment, "but I can deal with it now. I can talk about it. Well, most of the time." The gains resulting from their experiences included improved interpersonal communication, a sense of satisfaction and confidence because they "got through it," and a "stronger" relationship. While there still was this "little hope" that a pregnancy may happen naturally, and they had not completely closed the door on IVF down the road, they decided to focus their energy, time and money on adoption as the means to having a family. The combination of having "just had it with testing" realizing that the biological option was a remote possibility, and of being exhausted by the emotional roller coaster, resulted in them favouring the adoption route as more likely to render results. He felt convinced that they needed to pursue something more positive in order to give them some hope of parenting at all. When they first embarked on this route, Terry was very reluctant because she was not ready to abandon the old dream in favour of a child that could not "replace a real maternal baby." However, an initial meeting with other infertile couples seeking adoption provided an opportunity for shared grief and for Terry provided a hit of reality about 'letting go' of the dream. 45 Through adoption services they met other couples experiencing infertility and formed a support group which "has been really positive for us," resulting in friendships and a sense of normalcy, "everyone is infertile, we're all in waiting." They began to view the adoption option as a positive outlet for their energy. As he stated, "we're both goal-oriented, like, if we want to have a child, we knew that we would do whatever it takes to have a child...we knew we had to do something." She said, "we knew that we would get a child. I thought, well, wouldn't that be the best way for us to make sure we have a family, and the other way had so many grey areas and unexplained infertility." Terry turned a corner for herself after the laparoscopy when she found out "well, I'm normal. I'm not going through any more medication. I just can't handle it." Terry "came to terms" with herself and decided that "this is what you've to do (adopt)." Terry and Cory were really excited about adoption (private) and had taken a number of steps to accomplish this such as completing their homestudy, doing the AIDS test, and having a criminal record check. The homestudy was a source of anxiety and stress but they alleviated their fears by reassuring themselves that they 'would be good parents'. They viewed the hurdles before them as manageable and felt confident that this was the right decision, "We're on an active file now for pregnant couples/moms to review" and we "feel ready" to parent. Terry said, "I'm ready to be a mom. I've given my boss warning at work with regards to possible maternity leave." They and their family had begun preparing for the arrival of a child, "I have a crib selected" and the immediate family has collected toys and clothes. There were moments when they had doubts about 4 6 adoption but they continued to find encouragement from the stories of others who had adopted. They reflected on the value of the infertility process and saw themselves as being more compassionate people, more aware of infertility and more understanding and patient with each other. Cory saw himself as a. better communicator and willing to share his knowledge with "other people with the same challenges." Terry felt more confident about her husband's love for her. Their advice to others was "to learn as much as you can about your infertility ... but you don't have to keep going, and remember, there's other options." They viewed information and support groups as crucial to coping with the emotional aspectsof infertility, especially to overcome the isolation. Awaiting adoption (2nd interview). For the most part their infertility was no longer central to their lives, although there were times when they reported getting "blue no matter what" and getting "frustrated" but these times were not as intense and didn't last as long, "only a couple of days." One positive outcome of the infertility experience for Terry was that she was more assertive with the medical profession and no longer "intimidated or scared." The infertility support group that had previously been their "little lifeline" was no longer "so important" because "I think we've learned how to deal with it." Terry and Cory were on the active list for adoption but had not yet been 'picked'. They found themselves doubting their chances and even their appeal as a couple to the birthmoms. The waiting was hard, "every now and then it just hits you, you just, it kind of gets to you now and then." They coped with the "waiting" by staying active, establishing goals and pursuing them, such as fighting legislation 4 7 to abolish private adoption. While lobbying/Terry "didn't worry about my having a baby or not getting a baby. We were fighting for a goal." They acknowledged a "sense of urgency" because time was passing and they were getting older. To reduce their sense of powerlessness and to ensure that they wouldn't have any regrets, they pursued available leads. They set a limit of a year and as that date drew nearer, they began "checking out options" such as foster parenting, international adoption, surrogacy, and even IVF. Although they were "pretty well against that (IVF)" for fear of severe physical and emotional reactions on her part, as their faith in other options waned and/or stories of successful treatment touched their lives, they found themselves reconsidering treatment. Also, they did not discount the possibility of a natural conception but were not "compelled" anymore and "don't even keep track" of the monthly cycle. In their efforts to parent, first with infertility and now with adoption, they experienced insensitive comments from friends and strangers. However, they were more likely to "sluff it off" now whereas a year ago, Terry particularly, would have been very upset. They had taken the initiative to educate family and friends about "what we're going through" with the infertility and adoption, so "they don't say (hurtful) things like that anymore." They discovered a whole new set of issues relating to international adoption, including understanding and dealing with their own as well family and friends perceptions and reactions to this possibility. While they felt optimistic about acceptance within the family, words of encouragement were appreciated. They recalled the man at the adoption meeting who said, "You take a baby into your house, who isn't gonna love a baby?" More frequently, they have taken a stand on 48 things important to them, "if people are gonna worry about it (race), well, they don't have to come around then" and were more confident about handling the consequences. Personal preparation included collecting adoption stories, following leads and information regarding the paper work, looking into legalities, and building their financial reserves. Compared to where they were emotionally 10 months ago, they said they were "much better" in that Terry's torrent of tears everyday had all but stopped, 'self-care' was more of a priority, and their communication was healthier. The 'waiting' was the hardest part and their patience was growing thin, inability to act was frustrating, especially when the goal of parenthood remained elusive yet still crucial to them. "I can't picture it [life] any other way. I just don't look at it any other way." The impatience, however, was different from the desperation that they were feeling ten months prior to this second interview. Adoptive Parents at last (3rd interview). Two and half years after Terry and Cory began the adoption process, they had finally adopted a baby boy. They were both "tickled pink really" to have their adopted son, "ecstatic" with their new roles. They bonded with their son immediately and both agreed that adjustment on the whole had been "great." Interaction with their son and caretaking gave them feelings of contentment, satisfaction and appreciation. As Cory said, "I try to spend as much time as I can right now with him." Both experienced "so much fun," joy, and play in their lives and found that they were totally absorbed and engaged in the day to day experience. Parenting had brought an end to the isolation, a feeling pf belonging, normalcy and acceptance, as well as a sense of connectedness to society. As Terry said, 49 I feel so much more socially accepted. I just felt so out of place or different cause I couldn't have children and now I just feel like I'm normal. I have a baby and I don't care where it came from, if it came from me or from someone else. He's a baby and he's just so, it,just feels so much better to have a baby now .. .We're normal now, we're normal now. They had a sense of achievement and personal accomplishment, "we kept striving and doing and wanting to do this, eventually we did." Although at times, the adoption process was a "trying time", they declared that "it's worth it." They took this opportunity in the interview to share their adoption story. They received a call from local agency with news that a birth mom had selected them. Terry felt confused and overwhelmed when the call came, "I totally went blank," experiencing anxiety and excitement simultaneously; "I was freaking out." Her greatest fear was that they would jeopardise the adoption, "I didn't know, like if I opened my big mouth and say the wrong thing we're not gonna get a baby." The first meeting with the expectant birth parents was anxiety provoking but also "helpful" in that the. birth couple shared many things that they found favourable in Terry and Cory's profile. The meeting provided a sense of acceptance, belonging, and validation, "our families seems to be similar to theirs." For five weeks they waited to hear from the couple and then notification came that they would be getting their son on Monday. At the eleventh hour Social Services phoned and said, "it's not looking good." They endured an agonizing wait, "an emotional ringer" and basically tried to cope with the anxiety and feelings of powerlessness by withdrawing into themselves and keeping busy by cleaning everything in sight. 50 When no word came by evening she said, "I just cracked up, I started crying and it was awful" and he added, "we were just wiped out." Finally, late that night the birth mom agreed to sign the adoption papers in the morning. For a few days just before the baby was born the two couples had spent time together walking and talking, which eventually seemed to reassure the birth mom that she was doing the right thing. Terry and Cory expressed disbelief, wonder and relief when "it finally, finally happened, bringing closure to a process that appeared unending. They recalled a very emotional time when the baby was placed in their arms to take home. "She [the birth mom] went and got him and she handed him to me and she didn't let go. I had my hands under him, I was ready to take him and she wasn't letting him go. So I took my hands back... She kissed him for about a half an hour. And then she finally gave him to me and I held him." The birthmom 'let go' literally and symbolically when she presented them with a cross-stitch hanging she had made in her son's honour. Terry and Cory felt the phrase "precious moments" chosen by the birth mom was "a sign" that the baby boy was 'meant to be' because these were the words inscribed on their wedding cake. The families have communicated and inquired about ongoing contact, which Terry and Cory have been "fine" with. She had "just a bit of fear" about the future regarding: loss of her son to the birth mom down the road, possible compromised control and legitimacy of their parental status, and vulnerability regarding involvement of the birth mom and her family in their lives. As a couple, they were treading a new path with many unknowns and they sought books and communication with others as ways of attaining guidance and maximizing control. For example, they provided family members with literature on 51 infertility and adoption so they would have a better understanding about what they were going through. Terry chose to share her news of the adoption at work, "I was so stunned, I couldn't work. And I went out and told everyone and we're all crying and it was neat." They reflected on the difficult times in their struggle just prior to the adoption, "I had a real rough February, ... I had real problems with not having a baby around, and I was quite depressed." The cumulative impact of repeated failures and disappointments, frustration, powerlessness, lack of control over this important life goal contributed to her 'depression'. "I think being doers, we always got what we want...And I always got what I want and I couldn't get a baby." The wait was draining and debilitating but they drew on their experience with infertility to reassure them that" "we'd get through this but its hard." They attributed their success in surviving the ordeal in some measure to their persistent plodding, "it was tough, and you know like where are we going, we're still going through this so, let's just keep moving and doing our thing." Parenting an adopted child has helped heal the pain and bring closure to their infertility. Cory said, with adoption the pain of infertility "ended for me" and she concurred, "its all gone now ...I haven't had a day where I've thought about having a child (biological)." They were freed from the pain of all those years, "totally gone" but "you remember, like its there" and they respect the pain, "we don't make fun of it or anything." They also acknowledged that acceptance of their infertility and the potential of a childless lifestyle was an important step for them to begin to heal and move on, "we came to the point we kind of reluctantly said to ourselves...we may not get a child. We might just have to be childless, be 5 2 our family to ourselves and live with that." Mutual support and intimacy was an important aspect of their ability to cope, "we're very close...if we weren't that close we might have more challenge with it." They were still doing battle with myths, ignorance and insensitive comments, "well now that you've adopted you'll get pregnant" or "(he's adopted) oh, that's too bad." Dealing with remarks suggesting that adoptive parenting is inferior or second best, and comments inferring that adoption is dirty or "taboo." At times Terry and Cory chose to educate people so "they don't say anything more" but there are times when they just had to let things go. In retrospect they realized that their ability to weather and handle the barrage of issues and uncomfortable interactions with others regarding adoption was in part due to the strength of their own conviction that adoption was a positive and desirable alternative to biological parenthood. Terry and Cory were beginning to articulate certain advantages of being an adoptive family. They believed that their son benefited from the expansion of the family to include 'extra parents" who love him, and they found personal satisfaction in developing a "truthful and honest' relationship with all those concerned, 'even though there may be things that may be hard to deal with at least it's there." They experienced a great deal of compassion and respect for the birth mom during this difficult time. Of real concern to them was the birthmoms ability to be a 'peace with herself and they were open to assisting her in this process. For example, out of respect for the child's biological connection to his birth mom, they retained the name she gave him. 53 The idea of a second adoption elicited mixed feelings as they contemplated the task of having to start the process of adoption 'all over again.' While having another child to complete their family was appealing, they resented engaging in a process that required them to repeatedly prove themselves worthy of parenthood; subjected them to scrutiny and evaluation, invaded their privacy and heightened their sense of vulnerability as they strove to attain their goal. They also reflected on and favourably acknowledged the 'real stretching experience' of infertility and adoption, individually, as a couple and a family - ' like everything we did and how we went through it and grew and it's amazing. It's amazing what you go through and our families." Positive Life Path as an Adoptive Couple (4th interview). By the fourth interview, they had a sense of being in a much healthier place, as a result of "a lot of positive changes" and felt "more (well) rounded as couple...we support each other much better." They continued to enjoy the challenges of parenthood and even felt "ready" to consider a second adoption. They had set a three-year limit on the second attempt and were prepared to accept the outcome either way because the 'pressure was of f now that they had their son and were parents. Relationships with members of the adoption support group had evolved into friendships as the couples' lives transformed into adoptive family units. Although parenting reduced their social isolation, association with adoptive parents was still important to help normalize their experiences, "it was neat to share all those different feelings and emotions there cause you always feel so alone, when get with that group and you just feel, oh well, here we are...we're normal. We aren't weird." 54 Occasionally, an experience dealing with infertility, such as reading a novel, still brought tears, but they were tears of empathy rather than tears of recurring grief. They were mostly relieved that the trauma was behind them "we never have to go through that again" because "it was just awful." She "had three days where I felt bad about not getting pregnant in this last year, and that's it." These moments were less painful now and of a shorter duration, "it went away, instantly." As they reflect on the adoption process, they recalled times of doubt, "I was sure we weren't going to adopt," and self criticism "why would they pick us, we're faulty, there's something wrong with our home study." They remembered when they were so anxious to secure parenting that they almost agreed to take twins shortly after adopting their baby son. However, they decided they had their hands full and found reassurance in knowing their son Was enough for now, "we're fine, we'll spoil the hell out of Mark." During this process, parenthood had been reconceptualized to mean parenting a child either a biological or an adopted child. They experienced growing impatience with those who seemed unable to full appreciate their adopted children because they still yearned for a biological child. Their own positive experiences of adoption enabled them to offer comfort and encouragement to others. For example, one couple said that they "could never adopt, we could never love another person's child" and Terry responded "you should think about it cause I love Mark so much. I said look at him, how could you not love him?" One of the greatest challenges of being adoptive parents has been to work out a mutually beneficial relationship with the birth mom and her immediate family. 55 They recalled a "nerve-wracking" time when they were anticipating the first visit with the birth mom's family. Terry's family in particular "had a real hard time with this concept, the open adoption" fearing that the birth mom would change her mind. But once they all met and spent time together these fears were alleviated. Acceptance with open adoption was not automatic for them either, but research into the issue removed most of their anxiety. They had become comfortable involving the birth Mom in their lives. By knowing his history they feel their son will have peace, and the birth Mom will have the reassurance that Mark is doing well. The contact between the adoptive and biological families of the baby seemed to reinforce everyone's belief that "she made the right decision for him." During this final interview, they were prepared to disclose more of the details of the worst part of the last three years. The incident on the stairs where she 'couldn't go on' was a major turning point for them. They were forced to confront and acknowledge the limits of their ability to cope and to rethink parenthood. The minister raised the possibility of adoption. She said, "I don't want to adopt, I can't adopt, I don't want to take somebody else's baby." Cory insisted that "we've got to do something because we can't sit around here and wait for all this stuff that's not gonna happen. The memory was still painful, still resonated for her, "It brings tears now." For him the worst part was the powerlessness to lessen his wife's pain, "the hardest part was seeing my wife go through pain like that...knowing how helpless I was I could only go so far. I couldn't, I couldn't make it better." They began to investigate adoption, to "get your mind on a goal and it kinda made it better. But it still, it was so hard." 56 Facing the reality of their situation, the unlikelihood of a biological child and their need to get on with their lives enabled them to begin grieving and letting go. "At that point we had a little mini funeral, you know. Like it was, we had accepted how hard it was but we had accepted that, you know, physically, biologically maybe we're just not gonna have our own children." He said, "a little burden came off. There was still pain there but." They also altered their way of coping, to open up to outside help, family, and friends, and to include them in their life's plans and struggles. They expressed residual anger still at doctors and at the lack of information about the whole infertility process. Cory felt their pain was prolonged by hope and not knowing, and believed that brutal honesty and truth is essential. For the most part they had lost faith in medical profession, " I learned that the medical profession is totally lacking something to help people through this. There are no morals for it. My family doctor never once ever said, how are you doing emotionally." Terry and Cory agreed that, "getting Mark" was the best part of their whole ordeal of the last few years, "he just fits in our family like a glove." Parenting and the adoption process "made us closer. Like we went through hell and back and you're only gonna get closer or break and I really feel we got closer and we made new friends through our support group." The adoption helped to restore her spirituality; "it brought me closer to God, for sure. I mean for me he worked in there and directed me in a way and brought Mark to us on a sacred night, it was just unbelievable." 57 They attributed some important learning to their experiences of the last few years. He said, "I learned to be more attentive and caring and to be a better person generally." Terry felt more "rounded", "confident" in her ability to cope with difficulties and able to take charge, and gained self-knowledge, "I thought maybe I would feel differently cause I didn't have a child biologically, but now it makes no difference." The experience proved to them that as a couple they could survive a crisis, "we got through a real hard part of my life. I didn't think we were gonna make it sometimes." The expertise and skills they acquired have enabled them to provide assistance to others, "I know how to talk to people who are going through this." They felt safe and comfortable with the interviewer and found it helpful to share their experiences, "I think it's neat to talk about it. I don't like to bring up the bad parts, but I feel really comfortable with you and I've enjoyed talking to you and. if this helps somebody, it's been worth it." He concurs, "if this can help anybody or a group of people or a lot of people, that's great. If it touches one person and it makes a difference, then it's all worth it. The study, also, provided a chance for them to evaluate their progress in relation to the issue of infertility and adoption; "it's the only time we've ever done anything like this. Actually to talk about it in a way kind of brings back memories on where we came from and where we are now and it just reaffirms how happy we are now." Analysis In the process of adaptation to biological childlessness, we witnessed two infertile couples' journey of leaving behind their life long hopes and dreams of a 58 biological family and reconstructing a new life for themselves as a couple. In the course of this process, the couples' attitude toward childlessness shifted from "not having a life without biological children' to 'having a life without biological children." Prior to the shift, their lives were defined by what was 'missing,' and was organized around trying to achieve biological parenthood. For both couples, a life without a biological child was mostly negatively perceived and experienced. The couples in this phase of the transition described their lives as being "incomplete" and "empty." After the shift, their lives were defined by 'what they have' while accepting their loss. A life without a biological child became positively perceived and experienced. The couples' expressed a sense of their life and themselves as being "complete" and "whole." The longitudinal nature of the study enabled us to see and appreciate the multi-layered aspects of the process of adaptation to biological childlessness. I hope to do justice to this complex, dynamic process by discussing the transition aspects associated with three major phases that I refer to as Letting Go of the Biological Parenthood Quest. Recovery and Discovering Life Options, and Making and Living a New Life Path. The three phases were derived from a sense of movement from viewing biological childlessness as not having a life without biological children, to being receptive to change and then acceptance of having a fife without biological parenthood. Phase one of "Letting Go of the Biological Parenthood Quest" is described in relation to the aspects that created resistance as well as contributed to breaking the cycle of the pursuit of biological parenthood. The phase of "Recovery and Discovering Life Options" involved the following aspects: 59 interpersonal and intrapersonal changes, acceptance of biological childlessness, seeking and restoring balance, and grieving and resolution. Aspects of the phase "Making and Living a New Life Path" included: assessing options unrelated to biological parenthood, grieving and making sense of infertility and biological childlessness, assessing positive aspects of being biologically childless, and acceptance and living the new life path. Most of the aspects involved in the phase, "Letting Go of the Biological Parenthood Quest," occurred during the four years prior to the study. However, we were privy to the bulk of the couples' experiences relating to this phase in their account of their history of infertility and treatment and the first months of post-treatment adjustment, during the first interview. Aspects of the "Recovery and Discovering Life Options" were experienced mostly during the first fifteen to eighteen months of the study, between the time of the first and third interviews. The couple that pursued adoption experienced the majority of these aspects during the first year of the study. The aspects of adaptation described in the 'receptivity' phase for the couple who remained childless and who experienced a failed adoption, are experienced over the first eighteen months. Aspects of 'Making and Living the New Life Path' phase occurred during the remaining fifteen or eighteen months, predominantly between the second and fourth interviews. Letting Go of the Biological Parenthood Quest One of the major difficulties experienced by the two couples in this study was relinquishing their hope and dream of having a family by experiencing the conception, pregnancy, delivery, birth and parenting of a genetic child. For a number of years the 'presence' of a biological child had shaped the lives and i 60 identities of the couples as they imagined and prepared for a time when they would become a father or mother to their 'own child.' Infertility posed a threat to their ability to achieve this important life goal and both couples responded to this major disruption in their lives by pursuing medical options. Powerful resistance to relinquishing their dream and breaking the cycle of the pursuit of biological parenthood through medical intervention was rooted in their 'hope' of salvaging their dream as well as a 'fear' of living a biologically childless life. The experience of infertility was the first 'pivotal change event' that forced a reorientation of the couples' lives with respect to being biologically childless. What was once perceived as a temporary and preferred state of being 'biologically childless' while they established a.lifestyle conducive to 'having a family,' now threatened to be a permanent and bleak reality. Unlike their experience prior to infertility when they felt optimistic and in 'control' of their biology and their destiny, the couples were confronted with pursuing a valued life goal under duress with no road map to show them how or if they would succeed. Uncertainty, instability and anxiety replaced the security, sense of order, and confidence that came with expecting to continue to live out a 'normal' life plan. Resistance to 'giving up' biological parenthood and considering other life options emerged from their negative experiences of infertility and treatment that eroded their self-confidence, self-esteem, and sense of efficacy. Their lived reality of infertility and biological childless was one of frustration, powerlessness,. vulnerability, humiliation, loneliness, isolation, and despair. The couples came to view life without biological children from within the "black cloud" of infertility and believed that their life would be continuation of this "dismal" existence. Both their 61 inability to perceive any desirable alternatives to biological parenthood plus the heavy emotional and psychological demands of the medicalized procreative process that left little energy and resources to invest elsewhere formed a significant part of their resistance to breaking the cycle. Also, the ambiguity of 'unexplained infertility' sat in the back of their minds as a remote possibility of having a biological child 'naturally' and served to prop open the door of hope and maintain the focus on the option of achieving biological parenthood. The process of infertility and treatment also escalated the 'parenthood imperative' by heightening their sense of loss, making 'giving up' the quest all the more difficult. The experience of being infertile and non-parents made them acutely aware of what it meant to be 'childless' in a fertile, family-oriented world. Also, the couples invested heavily emotionally, physically, psychologically and financially in this goal, and this accumulated debt made it more and more difficult for them to quit or in their words "give up." Jane and Stephen identified with the label 'infertility junkies', addicted to the infertility/treatment process in hopes of hitting the jackpot. The option was a painful withdrawal involving a sense of failure, humiliation and loss of their goal and their resources. The "obsession" with infertility and biological parenthood constricted their world vision and limited their identity to this one focus, leaving them very personally and socially vulnerable should fertility treatment fail. Other factors sustaining their resolve to follow the biological parenthood path included personal beliefs about themselves and assumption about how to manage in the world. For a time, both couples perceived themselves as "achievers" and "doers" who, with enough "willpower" and resources (financial, physical and 62 emotional) could overcome obstacles to attaining any goal. Their approach to coping with their circumstances was to 'do' something to try and get control over their lives. Denial of their 'reality' (i.e. low probability of medical success) and their conviction about an inevitable solution if they 'tried hard enough' contributed to their persistence in pursuing biological parenting options. For one couple, Jane and Stephen, the failed adoption was a second 'pivotal change event' that fuelled their resolve to parent and resume treatment for a genetic child. The experience of briefly 'sampling' parenthood moved them from the realm of fantasy to something deeply and personally felt. They discovered in a real sense their capacity to love, their ability to bond and accept their daughter "like we had her ourselves" and for a brief time to feel that their life was "complete." When the adoption fell through, they felt the loss of parenthood and "emptiness" of life without children all the more. They were then "determined to do whatever" to make parenthood happen but choose to refocus the majority of their energy on the pursuit of biological parenthood through treatment instead of the 'risky' option of adoption. On the whole, an imbalance was created for these two couples in favour of continuing the stressful and distressing quest of a biological child even with the increasingly remote probability of success, rather than contemplating the option of a life without biological children. Interlaced throughout the years of pursuing parenthood, the seeds of their discontent with life governed by the 'biological parenthood imperative' were apparent. Although there was heavy resistance to 'letting go' of the goal, the "reality" of their situation began to force their hands. After successive 63 disappointments and failures and in the face of mounting evidence against success, their faith in the medical process as a solution to their infertility began to wane and they became "fed up" with medical procedures. Also, they were exhausted by the emotional trauma, stretched to the limit financially, physically, emotionally and psychologically, and were no closer to their goal. Awareness of the inevitability and necessity to reassess their "reality" and fear of further rejection and failure, as well as physical and emotional hardship, however, was not enough to break the cycle of a medical resolution to biological childlessness. In each of the couples' adaptation story, they identified a 'turning point' that enabled them to finally 'break the cycle' and that the researcher terms a 'pivotal change event' that catalyses a reorientation of the lives of the couples. Jane and Stephen acknowledged the imposed "separation" due to his work as being singularly significant in enabling them to "turn the corner" on the parenthood imperative, and envision a life without biological children. The imposed break from the cycle, as treatment was put on hold, permitted the time and space to step back and take a realistic "check" on their situation and to discover other aspects of themselves disconnected from parenthood. The 'turning point" for Terry and Cory was the day he found her sitting on the stairs in utter despair from the repeated failure to achieve pregnancy. She was overwhelmed by the excruciating emotional roller coaster, a profound sense of hopelessness about their situation, and the perceived purposelessness of a life without children. Alerted to the danger of continuing as they had been doing, Cory initiated and Terry capitulated to alternative ways to cope with their circumstances and that ultimately changed their lifes course. 64 Recovery and Discovering Life Options Aspects common to both couples' process of adaptation to biological childlessness that enabled them to be more receptive to pursuing an alternative life option and finally relinquish their dream of biological parenthood included: resigned acceptance of biological childlessness, inter- and intrapersonal change, restoring balance and grieving and resolution. Resigned acceptance of biological childlessness. Overwhelmed by their circumstances and having reached a point of saying, 'enough is enough' the relationship to biological childlessness was expressed as one of "resigned" acceptance. Cessation of active treatment necessitated consideration of an alternative life option such as biological childlessness or adoptive parenthood. A distinction was made between 'resigned' and 'final' acceptance of biological childlessness. While ending treatment forced a refocusing of their lives away from biological parenthood, the couples indicated that they had not yet ruled out the 'little bit of hope' of having their own genetic child by either pursuing 'untried' treatment options for fertility 'down the road', or by succeeding in a 'natural' pregnancy since they had 'unexplained infertility.' 'Final' acceptance of biological childlessness occurred a number of months after treatment and appeared to be a result of a combination of healing experiences and working through the real possibility of adoptive parenthood 'not ever' happening for them. Intrapersonal changes. These four individuals identified particular significant intrapersonal changes that brought them to a new level of awareness of themselves that facilitated 'letting go' of the old path and opened them up to new potentials in their lives. For Jane, the physical separation from Stephen provided an 65 opportunity to discover an autonomous, self-sufficient self, "I'm a real person," separate from her role as wife or potential mother as a result of the 'separation'. Jane attained mastery as a marathon runner and gained a sense of camaraderie with other women in the sport as well as public recognition for her achievements and contribution to a charitable cause through her running. From Janes account of grieving the loss of her adopted child, she gained confidence and improved self-esteem from having carved her healing path, faced her fears "head on," and experienced a point of readiness to dry her tears. Knowing that she had the courage to survive and heal by confronting her fears seemed to give her confidence to face her greatest fear, a life without children. Stephen specified a significant personal change with respect to his concept of self as "problem-solver" and the world as "controllable.' With the repeated disappointment of treatment and adoption, Stephen was "forced" to accept his limits as a 'fixer' of their biological destiny or parenthood, and to establish a more balanced perspective about things within his control. While adoption and treatment was on the back burner, he decided to 'determine is own path' by setting goals and pursuing activities that were attainable and delivered 'results' including mastering the computer, writing a book and working with young offenders. Terry attributed a great deal of importance to pregnancy and childbirth. She reported the anguish and deep despair over the loss of this experience and the 'stigma and shame' associated with infertility. She seemed to take on the responsibility of their 'unexplained infertility'. Plagued by guilt and shame as a Woman unable to conceive, she felt compelled to persist with treatment until they were forced to reassess. When she received confirmation that the laparoscopy was 66 'normal,' she felt justified in putting an end to treatment. She "came to terms' with herself that she had done everything worth doing. Acceptance of herself and the situation removed one more bit of resistance to breaking the cycle and enabled her to be more receptive to the option of adoption as the next logical step in trying to achieve parenthood. After the crisis of "hitting the wall" Cory insisted that as a couple they break their secrecy and isolation and establish contact with others who could offer them support. Cory found the feeling of helplessness intolerable and seeking a solution for his partners distress, also lead to a more 'positive way of coping' for him. By becoming more open and communicative, Cory experienced personal growth in terms of becoming more attentive, carrying and "a better person, generally" by interacting and sharing with other infertile couples. Seeking and Establishing Balance. The couples expressed an explicit need to re-establish a balance in their lives in terms of having positive experiences to offset the largely negative orientation that they have been living under for the past few years. The couples began to shift from the singular focus of their lives on the goal of parenthood to include a broader range of individual and relationship needs and interests. Tired of sacrificing time, money and emotional energy to the baby quest, both couples decided to make "us" a priority occasionally. Resources previously solely allocated to the baby quest were freed up to "treat" or "care" for themselves as a couple or to address personal needs. One couple at first felt guilty about being "selfish" for investing in self-care but came to accept the necessity of paying attention to their own well-being and to nurturing their relationship. 67 The couples specifically sought ways to engage in positive personal experiences and events that bolstered their self-esteem and self-confidence. Stephen and Jane pursued activities that firmed up their identities as "separate [individuals] but together [as a couple]'. Pursuing individual interests de-emphasized the couple's reliance on the elusive role of parenthood to give them a sense of purpose or meaning to their lives. For example, Stephen found a social community and an outlet for his nurturing needs through his involvement with young offenders and Jane established friendships and a sense of accomplishment through her athletic endeavours. Terry and Cory experienced a sense of belonging and connectedness through their involvement with infertility and adoption support groups. Interaction with others 'like us' normalized their experiences, decreased their isolation, and allowed them to express and share their grief and helped them acquire a sense of control over their lives as they became better informed about adoption issues and resources. Terry reports, "it was neat to share all those different feelings and emotions cause you always feel so alone ... here we're normal, we aren't weird." Renewed energy and hope of achieving parenthood resulted from their involvement in the adoption process and helped them to break out of the slump and negativity caused by the pursuit of biological options. In referring to investigating adoption and letting go of the pursuit of his parenthood, Cory stated, "to get your mind on a goal and it kinda made it better. But still it was hard." Rebuilding a positive self-identity separate from biological parenthood, finding a sense of belonging in a group or club and reconnecting with family or supportive friends seemed to be an important part of enabling these couples to 68 become receptive to an alternative life path. By actively participating in events that they found rewarding and satisfying, the couples also gained confidence in the possibility of having a life without their own biological children or children at all. Also, just experiencing the desire to have a life different from the one they had been living was uplifting, when previously a life without biological children seemed unimaginable. For Cory and Terry the connection with the infertility and adoption group reawakened the desire and gave them confidence to engage in life and interact with the world. Interpersonal changes. The couples noted a number of positive changes within their relationship as a result of the infertility, treatment and the adoption processes as well as their experiences with the interviews for this study. These changes included improved communication, enhanced closeness, an appreciation of the differences that compliment the relationship, a sense of accomplishment and confidence in the partnership because "we got through it together," increased feelings of solidarity and strength as well as a growing sense of responsibility for their health and healing. For years, the couples suppressed their voices to accommodate the requirements and demands of the medical and adoption process and because they feared repercussions by medical personnel that might jeopardise their success. Once they shed the yolk of the pursuit of biological parenthood and experienced more balance personally and in their lives, they began to gradually become more assertive regarding their rights and needs in various arenas but especially with respect to dealings with the medical establishment. 69 In relationships with family members and friends, they began to speak candidly about their intolerance of insensitive comments and negative attitudes by others toward adoptive parenting or their life style choices. The couples also became educators as they began to appreciate the depth and wealth of their own knowledge after surviving the hardships and challenges of infertility and adoption. Armed with information, they sometimes chose to diffuse difficult encounters with others by debunking myths and enlightening them as to the facts and experiences of adoption or involuntary childlessness. The couples acknowledged the value of sharing their stories with the interviewer associated with the study, not only during this phase but over the three and half years. They considered the interview sessions a significant factor in adjusting to their reality of infertility and biological childlessness. They reported that participating in the study made them 'feel good' about themselves because they were given an opportunity to 'help others', and to have their experiences recognized as being of value. Interaction with an empathic and informed third party enabled them: to acknowledge and vent their feelings; to have their experiences clarified, validated and normalized; to improve their interpersonal communications and to evaluate their progress in reconciling and coming to terms with their biological childlessness and constructing a new and satisfying life plan. In combination with the other transition factors discussed, the interview assisted in "letting go" by facilitating grieving and validating the past experiences, and helped them to rebuild a positive sense of self. Grieving and resolution. The experience of infertility, treatment and forging new beginnings left many losses to grieve and resolve, some of which included: 70 the loss of fertility, the loss of biological children, and the loss of adoptive parenthood. Lack of fertility inflicted a double loss specifically on the women, in terms of the loss of the pregnancy and birthing experience, and the loss of a special connection with the community of women who had accomplished this initiation into motherhood. The emotional pain connected with these losses persisted even after the couples relinquished their quest for a biological child, although the intensity and duration of their pain lessened with time. By the fourth interview, Terry had parenting in common with other women, and while that provided a sense of belonging, she still grieved for "only three days" in the year, the loss of the experience of pregnancy. Jane still experienced 'jealousy' when informed of her friends pregnancy because she was 'missing out' on a pregnancy of her own, but also felt her exclusion from the club motherhood. Jane seemed to still hurt on occasion as she witnessed female friends' 'automatic' acceptance among expectant mothers or those who achieved motherhood. Her non-motherhood status required that she create a place of belonging in the world of women where qualifying was not dependent on motherhood. Grieving the loss of a biological child happened throughout their years of pursuing biological parenthood. Tears were shed with each disappointment and failure, and feelings were vented and expressed at various times. The couples felt that an essential condition of 'letting go' was accepting the reality of never having their own biological children. At some point, both couples performed a symbolic act of "letting go." Terry and Cory had a mini-funeral to 'let go' of their dream child. Jane and Stephen, 'let go' of their biological child through the process of grieving the loss of "their little girl" when the adoption fell through. Their ritual to 71 bring closure to parenthood was to clean out the nursery and dispose of the baby furniture, toys and clothes. Bringing closure to their old dreams enabled them to be more receptive to and refocus energy toward alternative life options. For Terry and Cory, the infertility and adoption support group became an important forum for them to share and process their grief associated with their infertility. The experiences and skills derived from the infertility and adoption support group helped them to handle subsequent disheartening moments with the emotional roller coaster of the adoption process. For example, they derived strength from the knowledge that they survived one crisis and that they had more effective ways of coping with a major disruption to their lives and with loss. Acceptance of biological childlessness was a distinctive loss to be grieved in its own right and with the finality of acceptance, old losses were 'newly felt' and deeply experienced because the meaning of the losses to the couple changed over time. The final acceptance of biological childlessness seemed to strike to the very core; like the grief that comes with a death. For example, the losses associated with not achieving a biological child seemed to be grieved, at least by the women, after each failed attempt, but yet were also grieved differently once the door to biological children was finally closed. 72 Making and Living a New Life Path The decision to pursue a life path other than the pursuit of biological parenthood required the preparation necessary to be receptive to alternative options and time to 'check out' these options. In the final phase, the couples made a commitment to their particular new life path and began living it. The adoption and childless life paths are discussed separate with respect to the process of adaptation to biological childlessness in order to expand on the experiences of adaptation relevant to the particular life path. Adjustment to the Adoption Option. Terry and Cory reluctantly turned to the adoption option after 'resigning' themselves to being biological childless. Pursuit of adoption was motivated initially by the necessity to remove themselves from the torment of the emotional roller coaster of biological parenthood and to try and achieve parenthood by taking the most logical 'next step.' The infertility/adoption support group was instrumental in bringing about an attitudinal shift toward adoption as an acceptable and desirable parenting option by providing reassurance and guidance about becoming adoptive parents and by facilitating significant interpersonal changes through grieving their losses, by receiving validation and acceptance, "everyone is infertile, we're all Waiting'. The process of adjustment also involved determining that 'parenting' was their real priority verses having a genetic offspring or remaining childless as well as 'getting comfortable with' the a revised concept of parenthood to include adoptive children (of similar or different cultural origin) and possibly the birth family. Checking out responses with family and friends to the idea pf adoptive parenthood was important. While some offered encouragement and joined in their efforts to 73 adopt others were critical. However, the negative reactions did not dissuade them from proceeding with adoption. Investigating reactions seemed provide an opportunity to test their resolve to adopt and to clarify personal boundaries and rights. They concluded that their choice may be divisive but they were prepared to accept the consequences including the necessity to discourage or dissolve certain relationships with significant people in their lives who were unsupportive. During the preliminary stage of adoption process they were "very excited" about adoption and declared that they were "ready to parent." Acquiring information and accomplishing tasks associated with the adoption option provided an opportunity to regain a degree of control over the direction of their lives and rekindled their hope of achieving parenthood. They had a renewed sense of purpose not only in their pursuit of a baby but also through their involvement with related facets of adoption such as lobbying for legislative change. Being proactive with regard to adoption enabled them to heal as they distanced themselves from the issues of biological parenthood and participated in society in a meaningful way. Terry said, 'I didnf. worry about my not having a baby or not getting a baby. We were too busy fighting the legislation. So I had a good year' and Cory concurred, 'we had a goal...we were involved.' The preadoption waiting period proved to be the 'most difficult part' of the adoption process when there was nothing more for them to do with respect to adoption related projects but 'wait.' The threat of being denied adoptive parenthood intensified as the time frame for achieving adoption neared an end and their assessment of being 'picked' seemed slim since birthmoms had not selected them in the past number of months for consideration. Feelings of residual loss 74 around infertility and biological childlessness resurfaced and added to the weight of her current state of helplessness, powerlessness, anger and anxiety over their inability to accomplish this life goal. Terry particularly suffered bouts of feeling 'quite blue' and during these vulnerable times they temporarily resurrected the hope that their condition of unexplained infertility might yet yield a baby 'naturally' and that medical treatment might yet be the way to resolve biological childlessness. Although they were faced with the uncertainty of achieving parenthood for the second time they noted some important differences in their responses to the two situations. They characterized their current reaction as one of 'impatience" with the process and far different from the state of "desperation" they experienced with infertility and treatment to achieve biological parenthood. For the most part they exhibited a greater sense of agency in dealing with adoption in that they set time limits for the local adoption, prepared a backup plan to investigate international adoption and felt entitled to determine the kind of adoption situation they could realistically handle, 'I donf want to say that well take whatever we can get.' They attribute their ability to cope with their current circumstance in part to the confidence they gained from surviving infertility in that they believed they could 'get through this' even though 'the wait' was 'hard' to endure. Final acceptance of biological childlessness occurred prior to adoption with the impending end of the adoption options, and as they incorporated into their 'reality' the historical and current evidence against the likelihood of attaining biological or adoptive parenthood. Having exhausted the available options without success but also having restored some balance to their lives in terms of positive 75 experiences that facilitated healing and social reintegration, they reached a point of accepting the once 'unimaginable' idea of a life without children. Cory recalled a poignant moment inspired by a passage that helped him to come to the realization that they would have to accept childlessness and that they could live with it: '[the author said] to be truly happy be content with yourself first of all ... and conceivably we would never get a child We might just have to be childless and have to be our own family to ourselves and live with it ... so thats when we said ok well we can live with it.' The adoption of a 'precious' baby boy, by the third interview, helped heal the pain of the adoption process, 'it was all worth it' and resolve the losses associated with biological childlessness, although infertility remained unresolved at least for Terry. Adjustment to Adoptive Parenthood. Parenting brought joy into their lives, 'wefe ecstatic', an end to their isolation, increased their feelings of belonging, normalcy, and acceptance, and helped them feel more connected to society. Terry reported, I feel so much more socially accepted. I just felt so out of place or different cause I couldn't have children and now I feel like I'm normal. I have a baby and I don't care if it came from me or from someone else ... we're normal now. They experienced a significant role adjustment from being an infertile involuntarily childless couple to that of adoptive parents. In describing some of their adjustments, they tended to use biological parenthood as a benchmark to compare with their current reality. Unlike biological parents who have the pregnancy to adjust to idea of being 'three of them' and to being parents, they had the 'sudden' and disorienting experience of having a baby in their lives. At first they attempt to resume life as before but after a few weeks realized that their life needed to be organized around the childs needs rather than their individual needs and schedules. Learning and negotiating their new roles within the marriage as a 'mom' and a 'dad' as well as observing and appreciating their spouses in this new light was another adjustment. As adoptive parents their responsibilities changed not only with respect to parenting a new baby boy but also extended to the birthmom and her family. Being an adoptive family, they felt obliged to fulfil the role of advocate and educator of adoptive parenthood in the community. Both acknowledged fears of loss as adoptive parents that their child might be taken from them by the birthmom or by his own volition When hes older. Their approach to parenting and relationships touched by the adoption such as the birth family and their biological family was to be 'open' and 'communicative.' Overall, they indicated that the adjustments have contributed more to their lives than they have been problematic and that parenthood is just'great.' The pre-placement time was described as an 'exciting' time as parenthood seemed imminent but also anxiety provoking as the birthmom wavered about giving her son up at the eleventh hour. They coped with the twenty-four hours of uncertainty by withdrawing from each other and absorbing themselves in domestic tasks. With the confirmation of the decision to go forward with the adoption by the birth mom and then the actual delivery of the baby into their arms, the couple experienced disbelief but also excitement and enormous relief when 'it finally, finally happened.' The adoption was viewed as having a sense of 'Tightness' about 77 the way things turned out, as though it was 'meant to be" and restored their faith in a 'higher power.' The predominant feeling was a sense of personal accomplishment and achievement for persevering and succeeding in achieving parenthood. Loss Associated with Infertility. In the fourth interview, perhaps due to the security of a new life that enabled him to safely review and have the energy to focus some attention on infertility, Cory resurrected and vented his frustration with the injustice of infertility and the experience with medical. In Terry's case the loss of the birthing experience still lingered but intruded in her life infrequently and with less intensity. Having a Life without Biological Children. Terry and Cory arrived at a place of knowing that they could have and were having a life without biological children. They approached the challenges ahead with a confidence born of surviving tragic life experiences and with a solidarity as a couple that comes of being "tested" to the limit and finding a way "through it together." They spoke with the passion and compassion of people who have been there, and have some thing to say and to give back. The gains and benefits, more than the losses and costs, became the legacy of infertility and biological childlessness particularly their decision to pursue and ultimately to construct a life as adoptive parents. A Positive Life Path as a Childless Couple Jane and Stephen ceased pursuing their biological and adoptive parenting options, and had made a firm commitment to building a life without children by the third interview. This couple embraced life freed from biological childlessness, out of the "twilight zone" where they felt stuck, powerless, uncertain and desperate about their destiny and terribly alone, 'there's only you out there, no one else." In contrast, they experience their current reality in positive terms and came to view childlessness as a 'desirable' choice. Jane and Stephen stated that they were "coming out of the closet of denial ... and into the acceptance phase" and ready to have a life as a childless couple. Final acceptance Was linked to the moment that the option to invest in adoption again was presented and she decided that she Could 'not go through With it' and realized she no longer had the will or desire to continue to pursue parenting. Adaptation to Life as a Childless Couple. Restoring stability and safety after the disruption to their life plan and the emotional disequilibrium of the past few years was a major focus of their energy and time. They pursued activities that were satisfying and rewarding provided a sense of accomplishment and control and a renewed sense of purpose to their lives. In contrast to their experiences with infertility and efforts to achieve parenthood where "you have nothing when you're going through that process," their current activities yielded predictable, tangible, and favourable "results." Their pursuits served a dual purpose of putting distance between themselves and their losses by "taking your mind off what you're leaving behind in your life" and nourished their spirits, their physical and psychological selves, and their relationship. Liberated from a life that 'controlled' them, Jane and Stephen became more assertive about shaping a life according to their desires, preferences and needs as individuals and as a couple. With personal acceptance about "who. we are, a childless couple" there was an increased sense of personal rights and entitlement. For example, they established with friends and family that they expected to be 79 given the same respect as any couple with or without children in terms of valuing their time, personal preferences and resources equally. Rebuilding a life also involved making new plans and constructing joint projects congruent with their childless life-style such as buying a new house, adopting a couple of dogs, and travelling more extensively. Strengthening social connections that provided them with a positive and supportive environment was important, and they accepted that some old relationships may not survive and would necessarily be "left behind." In the absence of creating a larger family unit, they seemed to value opportunities to re-establish relationships with members of their biological family and renewed contact with parents. The implications of being infertile and biological childlessness as a non-parenting couple affected Jane and Stephen in different ways from the couple who became adoptive parents. Concerns of generativity, old age care and security, and purpose in life as well as feelings of guilt for having a life without children became more acute for Jane and Stephen. They were quite confident about having most of their nurturing needs met through relationships with the children of family, friends and organizations (i.e. Stephens work with young offenders). However, they occasionally felt the loss of being the significant other in a life-long relationship with a child in their care, the opportunity to pass on personal and family values and knowledge and ensured biological or 'social continuity.' They handled and coped with these concerns by reframing their investment in children and young people within their sphere of influence and care as being an important and valued contribution to society and a way of participating in the nurturing the next generation without children of their own. 80 Adjustment to womanhood without motherhood still posed difficulties for Jane but the incidents were not as devastating or even very disruptive to her life. There were times, however, when exclusion or threat of the loss of women friends as they became mothers created anger and hurt, so Jane preferred friendships with women whose lives were based on interests outside of children and motherhood. To remove the ambiguity of having 'unexplained infertility' and solidify their commitment to biological childlessness, Jane and Stephen decided to take birth control measures. Having a Life without biological or adoptive children. One of the pleasant surprises for Jane in pursuing this new path was that 'life isn't the same as before only without kids.' Stephen added, 'it's not dismal' but in fact quite positive in that we've "gone down a totally different path." Optimism about the future, confidence in themselves, and a sense of control over their lives characterized their experience of life as a nonparenting, as Stephen said, ''life's what you make it." Summary. Both couples found that progressing through the phases of 'Letting go of the biological parenthood quest' of the pursuit of biological childlessness, becoming 'Recovery and Discovery Life Options' and the 'Making and Living a New Life Path' was an arduous journey but survivable and that their life as an adoptive or non-parenting couple was equally rich and "whole." 81 CHAPTER FIVE: DISCUSSION The present chapter includes a restatement of the purpose of the study, and a summary and discussion of the results. I conclude with a discussion of the implications for research and counselling. Restatement of the Purpose The purpose of the study was to capture the spirit and essence of two couple's journeys as they adapted to biological childlessness once infertility treatment was no longer a viable option. The hope of the researcher was to contribute to the sparse research on the process of adaptation by those who remain biologically childless and pursue alternative life paths as an adoptive couple or as a childless couple. Discussion In this study I explored the dynamic evolving process of how two infertile couples adapted to biological childlessness by describing their journey in the narrative accounts and providing an analysis of their stories. Many of the issues and phenomenological findings in the research on infertility and post-treatment adjustment were supported in the narrative accounts and these are discussed below. Although there is little in the literature to compare with this study's findings regarding the process of adaptation to biological childlessness over time, some of the themes identified with the three phases are linked to existing research. 82 The findings in the phase of 'Letting Go of the Biological Parenthoood Quest' concurred with the following claims by other researchers in the field of infertility. One, that infertile couples viewed biological parenthood as an important and highly desirable life goal (Mahlstedt, 1985; Menning, 1980; Sandelowski, 1993; Wirtberg, 1991) and sought medical treatment when threatened with the loss of this valued social role. Secondly, the experience of infertility and treatment had a significant psychosocial impact on individuals and on the couple (Bresnick, 1981; Daniluk, 1988, Mahlsteadt, 1985; Menning, 1980; Reimer, 1991; Sandelowski, 1993; Wirtberg, 1992). Thirdly, couples eventually reached a point of having to reassess their 'reality' and weighed the toll on them personally (emotional, physical, psychological) and financially against the low-probability of successfully achieving biological parenthood and prior to terminating treatment (Glazer & Cooper, 1988; Wirtberg, 1992). Fourth, that one spouse (specifically the male in this study) within the partnership may be more motivated and 'ready' to end treatment (Glazer & Cooper, 1988) before the other. Fifth, couples resistence to 'letting go o f their life-long dream of a biological parenthood was connected to their genuine desire to fulfil personal and social expectations around parenthood (Daniluk, 1996; Mathew & Mathew (1986); Menning, 1982). What my research illuminates is perhaps that the process of infertility and treatment heightened their loss and fear of living a life without biological children (Carter & Carter, 1989). Also, the impact of the loss, fear and the fact that they perceived no acceptable life path alternatives to biological parenthood increased resistence to 'letting go of the hope and dream of biological parenthood.' 83 Aspects associated with the phase 'Recovery and Discovering Life Options' are supported in the literature on infertility and on the transition to biological childlessness for those couples who are unsuccessful in their attempts to parent a genetic child. Grieving the losses associated with the life they had envisioned, the biological child, parenthood (either biological and/or adoptive), and infertility, helped the couples to 'let go' of their pursuit of biological parenthood and be receptive to new life path options (Carter & Carter, 1989; Glazer & Cooper, 1988; Menning, 1980; Sandelowski, 1993). However, this research tended to support the research that challenged the necessity of resolving their infertility and biological childlessness as a prerequisite to deciding to pursue other life paths such as adoption (Brodzinsky, 1997). In this study, investigating other options such as adoption and shifting focus from biological parenthood was instrumental in coping with the loss associated with the decision to terminate treatment. For one couple, seeking an alternative life path led to the discovery of an infertility and adoption support group and interaction with the group facilitated grieving their losses as an infertile couple. The following findings are consistent with Wirtbergs research. Couples reached a point of 'resigned acceptance' of biological childlessness once active treatment was terminated. However, the couple in this study also described another level of acceptance that the researcher has referred to as achieving, 'final acceptance' of biological childlessness. This phenomenon seems more a kin to Mennings (1977) description of 'acceptance' after couples have 'fully grieved' their infertility. In this study, final acceptance happened as a result of a combination of having reached their personal limits regarding parenting options 84 both biological and adoptive, healing through grieving, and having positive experiences individually and as a couple disconnected from their desired role of parenthood that gave them confidence again in the possibility of a life without children. Based on one year post treatment according to Wirtberg (1992) couples tended to still harbour feelings of anger, frustration and disillusionment with the medical experience. In this study, couples but particularly the men vented residual feelings of frustration about the medical process and personnel, long after couples grieved and accepted biological parenthood and ventured into a life as adoptive or childless couple. Wirtberg (1992) found a number of gender differences with respect to adaptation to biological childlessness with couples that adopted and remained childfree. This study supports the finding that initially post- treatment, the men tended to respond to their spouse's state rather than considering how biological childlessness affects them personally. Unlike Wirtberg's findings, however, concerns about biological childlessness and infertility remained more of an issue for the women than the men for the duration of this study, although both genders eventually acknowledged and grieved their loss. Like Wirtberg (1992), womens experience of infertility differed from mens specifically because of their loss of the experience of the birthing experience. One female participant in this study who became an adopted parent supported a view expressed by Sandelowski's (1993) and Glazer and Cooper (1988) that becoming a mother is not a "cure" for infertility. The loss of the opportunity for pregnancy and the birthing experience needed to be grieved for itself. For both women healing 85 from infertility was a gradual process that continued over the 3.5-years. While the magnitude and intensity of the pain diminished within approximately two years of ending treatment each had less intense and short-lived pain of infertility revisit them in connection with circumstances associated with their particular life path. For example, the participant who remained childless had to cope the final reality of never-to-be-a-mom and with the pain of being excluded from the lives of other significant women in her life who have made the transition to the world of motherhood (Daniluk as cited in Leiblum, 1997). Similar to Wirtberg's (1992) research, the couple's in this study experienced a significant/pivotal change event that contained a meaning for the person concerned and this meaning helped them move toward resolving biological parenthood (verses those who did not have a significant change event and persisted in pursuing biological parenthood). The pivotal change events identified by one couple was the work related "separation" and the failed adoption, and the other couple flagged two events, the day Terry bottomed out emotionally after her 'period' indicated another failed attempt to conceive, and secondly, adopting their baby boy. A finding common to other research was the complication of having 'unexplained infertility' that held couples hostage to the possibility of having a biological child. As Brodzinsky (1997) found that the experience of 'unexplained infertility left couples feeling helplessness and directionless while other authors stated that couples experienced difficulty bringing closure to their infertility and biological childlessness ( Sandelowski, 1993). While 'unexplained infertility' did not prevent the couples in this study from pursuing an alternative life option, the 86 condition hampered their ability to bring closure to their infertility and was a factor in prolonging their pursuit of biological parenthood. One female participant decided to take birth control to put an end to the uncertainty once they as a couple decided to remain childfree. The couples in this study experienced many losses but also acknowledged "gains" from the process of infertility and treatment (Carter & Carter, 1989; Reimer, 1991; Wirtberg, 1992) including: "better" communication; satisfaction and sense of accomplishment for "surviving" the ordeal with their marriage intact and in fact "strengthened;" a greater "confidence" in their ability to cope with other difficult challenges; and a sense of solidarity as a couple. The result of the study associated with 'Making and Living a New Life Plan' are similar to many of the experiences of adapting to biological childlessness and constructing a life as an adoptive or childless couple found in the limited research. Reimer (1991) study on the transition to adoptive parenthood shares several themes common to the pursuit of the adoption option experienced by the participants in this study including: the yearning for a biological child; emotional and physical despair; painful acknowledgement of reality of loss; increased intimacy with the marriage partner; heightened interpersonal sensitivity; and acceptance of adoption. While the experiences of both couples were similar to the ones noted above, only one of the couples in my study 'arrived at acceptance' of the idea of adoption as a choice over childlessness and actively pursued the adoption route. The other couple 'agreed' to the adoption option having had the opportunity thrust upon them, and when this failed, were unable to risk the chance of another failed adoption attempt. 87 These results also concur with findings associated with the adoption process. Both couples in this study experienced a sense of loss of control over their destiny, as one couple waited to be 'picked' during the preadoption waiting period and the other suffered the loss of their baby when the birthmom reclaimed her. Both couples resented the scrutiny, invasion of privacy and the feeling of being judged that came with the territory of wanting to adopt. They expressed anger and hurt about the unfairness of life in having to prove their competence and desire to parent, whereas parenthood achieved naturally requires no criteria for qualifying. The couple who succeeded in adopting, like Reimer's co-researchers, had a sense of "imminent culmination" (p. 70) as they anxiously and excitedly anticipated an end to their long wait after receiving news of being picked. They also vividly recall a "profound moment in time" (p. 71) when the baby boy was released into their arms. They experienced euphoric relief that the moment had finally arrived, and gratitude toward the birthmom and God for making/letting this finally happen. As with Reimer's adoptive parents, this couple spontaneously as well as deliberately shared their news with co-workers, family members and friends. They, too, were sensitive to how others responded but they also showed a determination to confront those who made undesirable or judgmental comments. The sense of the "rightness" (p. 74) is reflected in their expressed belief that this was "meant to be" and he "'fits like a glove in our life" and supported by symbolic "signs" from their past and their birth mom gift to them. They, too, felt that the outcome was worth the interminable wait and the emotional trauma they experienced. 88 Some other similarities with Reimer's findings are that the couple who adopted expressed profound joy at being parents and they felt their family was complete even if they were not able to adopt a second time. Before their son arrived they declared a "psychological readiness" to parent an adopted child. When their son became a reality in their home they experienced an abrupt adjustment to their lifestyle. At first they were trying to fit him into their previous life, and then realized that they needed to reprioritize and work activities around him. The insensitivity of others continued to be a source of frustration and hurt but they were more tolerant of others and sometimes made an effort to educate them. They were "ecstatic" with their son and the shared joy he brought to their relationship. The have been stretched individually and as a couple working out the ongoing relationships with the 'birth family' and concerns of their family regarding the open adoption but also feel confident about developing a healthy relationship. Parenting a biological child verses their adopted son was not an issue and infertility is almost "non-existent." On many levels they have experienced positive personal growth including a restoration of spirituality. This couple in this study emphasized the importance of having a sense of belonging in society, and express relief and excitement about being "normal" now that they have a child. Consistent with Carter and Carters (1989) work, the couple who remained childless as well as the adoptive couple achieved a better balance in their lives with respect to their own self-worth and confidence, a sense of belonging in the community, and assurance of nurturing outlets, as well as acceptance of "who they are." They had restored stability and a sense of order again about life, but 89 with the balance that comes with the insights gained from living and surviving life's tough lessons. The findings in this study are also similar to the claims made by Carter and Carter (1989) in regards to a childfree life after infertility. The couples in this study achieved "acceptance" about their biologicaly childlessness, acknowledged "gains" from the experience of infertility, as well as an increasing awareness of the "advantages" of life options such as adoption and being childfree. The combination of "letting go" while experiencing "positive" aspects to life disconnected from biological parenthood, enabled couples to feel that they made a 'real choice' when they decided to refocus their energy around a new life-style without biological children. One of the pleasant surprises in this study for the couple who remained childless was to find that "life isn't the same as before only without kids ... but that we've gone down a totally different path" and that life is "not dismal" but positive and exciting. Mathews and Mathews (1986) stated that the process of adjustment to biological childlessness requires couple to undergo reconstruction of reality by partners and family members, identity transformation, and role adjustments. Every aspect of the couple's lives in this study was affected by infertility, medical treatment, and the process of adaptation post-treatment. Each of the participants identified significant personal growth experiences as a consequence of the process which assisted them in adjusting to, and accepting, biological childlessness. Both couples reconceptualized the meaning of parenthood to include adoptive parenthood. They also reached a point where their self-identity became disconnected from parenthood. These childless couples particularly reconstructed a 90 positive life path where social roles were fulfilled through other means than biological parenthood, including nurturing outlets like working with young offenders and becoming adoptive parents. In conclusion, the researcher feels that the most significant findings from this study are based on the insights gained from the benefit of doing a longitudinal study. The couples provide evidence that infertile couples are able to arrive at a point of acceptance of biological childlessness and experience positive adaptation to an alternative life as an adoptive parent or by non-parenting. Secondly, the loss of fertility and biological parenthood changes over time in terms of the intensity and duration of the pain but also the significance and relationship to their lives, and that resolution may be a life-long process. For example, while satisfied with their life as a childless couple, feelings of loss were reactivate as one couple contemplated their old age without children. A third finding that stood out over time, was the necessity to re-establish balance in their lives to offset the negativity of the pursuit of biological parenthood and that helped them to reach acceptance of biological childlessness and a new life path. Implications for Research The focus of this research was on the process of adaptation to biological childlessness after ceasing active pursuit of a biological child for heterosexual, middle class, Caucasian Canadians between 35 and 40 years of age who experience 'unexplained infertility' and never parented. The findings based on an exploration of the process of adaptation over time for two couples needs to be substantiated and fleshed out with a larger and more diverse population. Commonalties and differences need to be identified based on culture, class, sexual 91 orientation, age and infertility status (secondary fertility, male factor, couples where one of spouses has a biological child from a previous marriage). this research helped to explicate the unique journey of two couples who adapted to biological childlessness by pursuing different life paths, adoption and remaining childless. While research on adoptive parenthood after infertility is growing, those who decide to remain childless/free post-treatment and those who refuse treatment requires more investigation. Some infertile couples are "forced" to remain childless by default due to limited financial resources. Medical treatment usually requires repeated investment in drugs or treatment cycles over months and sometimes years. The adoption process is also an expensive proposition lasting a minimum of a year. Neither avenue offers any guarantee of success so some couples find they are stretched to limit and beyond financially as they try one then the other option without success and must withdraw from the pursuit of parenthood. Financially depleted by treatment some couples are then also eliminated from the adoption option. Some couples may be denied treatment or adoption because of lack of financial resources altogether even though they would have liked to pursue parenting options. Another neglected area of research involves an examination of couples who actively choose to remain "childless" or "childfree" early on after a diagnosis of infertility, and decide not to pursue extensive treatment because of factors such as advanced age, as well as moral, ethical or spiritual reasons based on cultural or religious beliefs or values. The couples in this study mentioned that apart from hoping to achieve a genetic child, one of the motives for entering treatment was their hope of eliminating 'future regrets" about the possibility of parenthood if they 92 had not tried some form of fertility treatment. Investigating those who do not pursue treatment may answer the question as to whether they share a similar apprehension and if not, why not? and provide an understanding of hoW each groups motives for refusing treatment impacts or shapes their adjustment to biological childlessness. Implications for Counselling The process of adaptation to biological childlessness encompasses the experiences and events from the time of the first major disruption in the couples lives caused by infertility into the period of adjustment to a new life path, be it adoption or living childfree. These findings suggest that while couples are pursuing biological parenthood and as they turn the corner to begin a new life as adoptive parents or remain childfree, they experience a period of prolonged emotional disequilibrium, uncertainty and instability in their lives. The couples in this study suggested that counselling would have been helpful to them while they were going through the treatment process and the literature on counselling for infertile couples who pursue treatment supports their belief (Menning, 1977, Daniluk, 1988). The couples experienced numerous losses, low self-esteem and self-confidence, feelings of loss of control over their lives, stress and strains on the marriage and in their social interactions with friends, family and co-workers. Counsellors should be well versed in the range of emotional and psychological issues resulting from the experience of infertility and treatment but also the consequence of the drugs associated with the medical protocol. The greatest difficult experienced by the couples was to end treatment and relinquish their hope and dream of achieving biological parenthood and abandoned 9 3 treatment when they became overwhelmed by their circumstances. Counsellors working with infertile couples prior to treatment or during treatment might investigate with couples their personal limits with regards to how far they are prepared to go before considering alternative life options. Couples may not be 'ready' to stop but assessing the impact to date and raising awareness about options may be useful information for them to have when they begin to question further involvement in the medical process. The couples identified aspects of their experience with the interviewer during the research process they found beneficial to them over the 3 . 5 years and have implications for counselling. Interaction with an empathic and informed third party enabled them: to acknowledge and vent their feelings; to have their experiences clarified, validated and normalized; to improve their interpersonal communications and to evaluate their progress in reconciling and coming to terms with their biological childlessness and constructing a new and satisfying life plan. Information and education was identified by the participants as a source of comfort and enabled them to feel a little more in control of their lives not only with regard to infertility but also with respect to the adoption options. Counsellor provide a forum for information to be disseminated both on the practical aspects of the particular process or procedure, on the emotional and psychological implications for infertile couples and on adjustment to life post-treatment depending on the life path that the couples are considering or chose. Information and talking through the relevancy of this information can provide clarity, normalcy and sense of some control (i.e. options they may not have considered) of their lives. 94 The counsellor may in some cases be either the first or only person that the couples confide in because the usual support systems of family and friends are not helpful, they 'just don't really understand,' or because the couple prefer to maintain their privacy. The participants lives were fragmented and compartmentalized by the very nature of the systems and process they had to be a part of, and at times they felt that everyone else's agendas or needs came first, be it the doctor's, birthmom's, or family's. Also, the invisibility of their tragedies left them grieving alone without the acknowledgement and sometimes awareness of the losses and disruption going on in their lives. Therefore, establishing a caring, authentic, genuine relationship where couples are able to have the experience of being top priority as a person and a couple, to be heard, acknowledged, and their experiences validated is critical. Although there are many approaches and techniques counselors can draw on, the researcher wishes to acknowledge one possibility specifically connected to the study. Counselors should be willing and prepared to allow couples to tell their story, their unique history of infertility and treatment, adoption or being childfree. We see from the interviews that this enabled the couples to piece together their lives, to grieve the losses they had not grieved, and to gain insights about themselves as individuals and as a couple. The counsellor and the couple may identify 'fissures' in the relationship as a result of the stresses and strains of their experiences or inadequate coping skills for the situation that can be addressed, as well as the strengths that enabled them to survive and could serve them in future. The issues of adjustment that continue to cause some difficulty, although they have in many ways 'happily' embraced a new life course include resolving infertility 95 such as pregnancy and childbirth for the woman, the experience of medical process for both spouses, residual feelings of hurt and anger regarding the injustice of it all, as well as indifference overall by society to their pain and loss. These feelings must be worked through by identifying the meaning and significance of the experience to the individuals and the couple and grieving the respective loss. In some cases the counselor may become an advocate or at least an ally for the couples by seeking resources or following-up on concerns with other parties (doctors, social workers, family) if everyone is comfortable with that option while preserving anonymity if desired. The process of trying to achieve parenthood and adjusting to childfree living takes bites and sometime huge chunks out of the heart, soul, spirit and pocketbook of infertile couples and the only return may be the 'gifts' of self-knowledge, personal growth and marital solidarity. These gifts need to be acknowledged by the counselor and valued as a useful aspect of their healing journey by building self-confidence in their abilities. This research indicated the need to respect the interconnectedness of the many factors involved in the process of adaptation, and that some things can not be 'let go' until others things are done with. Although grieving their loss was a important part of the process, grieving their losses in and of itself does not enable couples to 'let go' of their dream and embrace a new one. Grieving may have facilitated the ability of the couples in this study to reach a decision to 'let go' but the decision to refocus their lives away from biological parenting and toward a new life was the catalyst that enabled them to fully grieve that loss. The couples reached a point of readiness by establishing a degree of balance in their lives by 96 experiencing positive feedback and rebuilt self-confidence and sense of control as well as acknowledging the likelihood of a life as a childless couple. Counsellors may encourage and explore with couples ways to re-establish balance in lives instead of the singular and sometimes 'obsessive' pursuit of biological parenthood. Summary This study involved exploration of the process of adaptation to biological childlessness for two couples, as they shifted from an experience and perception of biological childlessness a not having a life without biological children to having a life without biological children. The process of adaptation to biological childlessness after treatment was no longer a viable option spanned almost a decade for the two couples in this study. While each couple began their journey with the hope of a biological child, they each pursued a different life-path when treatment failed. One couple successfully adopted while the other couple decided to pursue a life without children. The process of adaptation as described in the three phases, "Letting Go of the Biological Parenthood Quest", "Recovery and Discovering Life Options", "Making and Living a New Life Path" show how the couples evolve to a point of readiness to 'let go' of their old life plan and began constructing a new one. The aspects associated with the three phases of the transition included the interview, pivotal life events, interpersonal and intrapersonal changes, seeking and establishing balance, acceptance of biological childlessness, and grieving and resolution. The process of adaptation from a negative to a positive experience and perception of biological childlessness is a dynamic, evolving process that happens as a result of the interactions involving these factors and the individuals involved. The two couples in this study survived a long 97' and difficult process of adapting to biological childlessness, discovered that it is possible construct a life worth living as an adoptive and as a childless couple. 98 REFERENCES Abbey, Andrews, & Halman (1991). Gender's role in responses to infertility. Psychology of Women Quarterly. 15(2). 295-316. Adler, J . , & Boxley, R. (1985). The psychological reactions to infertility: sex roles and copino styles. Sex Roles. 12(3/4). 271-279. Akhtar, L. (1978). Obsessional neurosis, marriage, sex and fertility: Some transcultural comparisons. International Journal of Social Psychiatry. 24. 164-166. American Fertility Society (1991). in vitro fertilization/embryo transfer (IVF-ET) in the Unites States: 1989 results from the IVF/ET Registry. Fertility and Sterility. 55. 14-24. Andrews, F., Abbey, A. , & Halman, L. (1991). Stress from infertility, marriage factors, and subjective well-being of wives and husbands. Journal of Health and Social Behavior. 32. 238-253. Andrews, F., Abbey> A. & Halman, L. (1992). Is fertility-problem stress different? The dynamics of stress in fertile and infertile couples. Fertility and Sterility. 57(6). 1247-1253. Berg, B. J . , & Wilson, J . F. (1991). Psychological Functioning Across Stages of Treatment for Infertility. Journal of Behavioral Medicine. 14(1). 11-26. Berg, B., Wilson, J . , & Weingartner, P. (1991). Psychological sequelae of infertility treatment: the role of gender and sex-role identification. Social Science Medical. 33(9). 1071-1080. Berger, D. M. (1980). Impotence following the discovery of azoospermia. Fertility and Sterility. 34. 154-156. 99 Bresnick, E. (1981). A holistic approach to the treatment of the crisis of infertility. Journal of Marital and Family Therapy. 7(2). 181-188. Bresnick, E., & Taymor, M. (1979). The role of counselling in infertility. Fertility and Sterility. 32(2). 154-156. Brodzinsky, D. (1997). Infertility and adoption adjustment: Considerations and Clinical Issues. In S. Leiblum (Ed.), Infertility: Psychological issues and counseling strategies (pp. 246-262). Toronto: John Wiley & Sons, Inc. Burgwyn, D. (1981). Marriage without children. New York: Harper & Row. Burns, L.H. (1987). Infertility as boundary ambiguity: one theoretical perspective/Family Process. 26. 359-372. Carter, J . W. & Carter, M., (1989). Sweet Grapes. Philadelphia: Perspectives Press. Cochran, L. (1990). The sense of vocation: A study of Career and Life Development. Albany: State University of New York Press. Cochran, L. & Laub, J . (1994). Becoming an aoent: Patterns and dynamics for shaping your life. Albany: State University of New York Press. Collins, A . , Freeman, E., Boxer, A. , &Tureck, R. (1992). Perceptions of infertility and treatment stress in females as compared with males entering in vitro fertilization treatment. Fertility and Sterility. 57(2). 350-356. Cook, E. P. (1987). Characteristics of the biopsychosocial crisis of infertility. Journal of Counseling and Development. 65. 465-470. Corson, S. (1983). Conquering infertility. Norwalk, CT: Appleton-Century-Crofts. 100 Daniluk, J . C. (1988). Infertility: Intrapersonal and interpersonal impact. Fertility and Sterility. 49(6). 982-990. Daniluk, J . C. (1991). Strategies for counseling infertile couples. Journal of Counseling and Development. 69(4). 317-320. Daniluk, J . C , Leader, A. , & Taylor, P. T. (1987). Psychological and relationship changes of couples undergoing an infertility investigation: some implications for counsellors. British Journal of Guidance and Counselling. 15(1). 29-36. Daniluk, J . , Mitchell, J . , Pattinson, H. A. (1991). Adjustment to parenthood following in vitro fertilization. Daniluk, J . (1996). Reconstructing a Life: The transition to biological childlessness for infertile couples. Health Canada through the National Health Research and Development Program (NHRDP). Daniluk, J . (1997). Gender and Infertility. In S. R. Lieblum (Ed.), Infertility: Psychological Issues and Counselling Strategies (pp. 103-125). Toronto: John Wiley & Sons, Inc. Denber, H. C. (1978). Psychiatric aspects of infertility. Journal of Reproductive Medicine. 20(11). 23-29. Deutsch. H. (1945). The psychology of women: Motherhood (Vol. 2). New York: Bantam Books. Downey, J . , Yingling, S., McKinney, M., Husami, N., Jewelewicz, R., & Maidman, J . (1989). Mood disorders, psychiatric symptoms, and distress in women presenting for infertility evaluation. Fertility and Sterility. 52(3). 425-432. 101 Eisner, B. G. (1963). Some psychological differences between fertile and infertile women. Journal of Clinical Psychology. 11. 391-395. Erickson, E. (1950). Childhood and Society. New York: Norton. Feuer, G. S. (1983). The psychological impact of infertility on the lives on men. Dissertation Abstracts International. 44. 706A-707A. Freud, S. (1905). Three essays on the theory of sexuality. In The standard edition of the complete psychological works of Siamund Freud: Vol. 8, London: Hogarth Press, 1953. Forrest, L. & Gilbert, M.S. (1992). Infertility: An unanticipated and prolonged life crisis. Journal of Mental Health Counselling. 14(1). 42-58. Freeman, E.W., Boxer, A .S . , Rickels, K., Mastrioanni, L. Jr., & Tureck, W. (1987). Emotional and psychological factors in follow-up of women after IVF-ET treatment. Acta Obstetricia et Gynecologia Scandinavia. 66. 517-521. Garner, C. H. (1985). Pregnancy after infertility. Journal of Gynecologic Nursing. 58-62. Glazer, E. S. & Cooper, S. L. (1988). Without child: Experiencing and resolving infertility. Lexington Books: New York Glick, P. C. (1977). Updating the life cycle of the family. Journal of Marriage and the Family. 39, 5-13. Grantmyre, J . E., & Hanson, P. (1992). Investigating the male role in reproductive failures. Canadian Journal of Diagnosis. 9. 45-60. Greil, A . L. (1991). Not vet pregnant. Rutgers: New Brunswick and London. Greil, A . L., Leitko T. A. and Porter, K. L. (1988). Infertility: His and hers. Gender and Sociology. 2. 172-199. 102 Harkness, C. (1992). The infertility book: A comprehensive medical and emotional guide (2nd ed.). Berkeley, CA: Celestial Arts. Hirsch, A. M., & Hirsch, S. M. (1989). The effect of infertility on marriage and self-concept. Journal of Obstetric. Gynecologic, and Neonatal Nursing. 18(1). 13-20. Ireland, M. S. (1993). Reconceiving women: Separating motherhood from female identity. New York: The Guildford Press. Kraft, A. D., Palombo, J . , Mitchell, D., Dean, C , Meyers, S., & Schmidt, A. W. (1980). The psychological dimensions of infertility. American Journal of Orthopsychiatry. 50(4). 618-628. Kaufman, S. J . (1968). Impact of infertility on the marital and sexual relationship. Presented at the World Congress on Fertility and Sterility, May 20-27, 389-391. Kedem, P., Mikulincer, M., Nathanson, Y., & Bartoov. (1990). Psychological aspects of male infertility. British Journal of Medical Psychology. 63. 73-80. Koropatnick, S., (1993). Infertility: a non-event transition. Fertility and Sterility. 59(1). 163-171. Lalos, A. , Lalos, 0. , Jacobson, ! . , & van Schoultz, B. (1985). Psychological reaction to the medical investigation and surgical treatment of infertility. Gynecologic and Obstetric Investigation. 20. 1-9. Leader, A. , Taylor, P .J . , & Daniluk, J . C. (1984). Infertility: Clinical and psychological aspects. Psychiatric Annals. 14. 461-467. 103 Leiblum, S. R., Kemmann, E., & Lane, M. K. (1987). The psychological concomitants of in vitro fertilization. Journal of Psychosomatic Obstetrics Gynecology. 6. 165-78. Leiblum, S. R., & Hamkins, D. E. (1992). To tell or not to tell: Attitudes of reproductive endocrinologists concerning disclosure of offspring of conception via assisted insemination by donor. Journal of Psychosomatic Obstetrics and Gynecology. 13. 267-275. Leiblum, S. R., Kemmann, E., &Taska, L. (1990). Attitudes toward multiple births and pregnancy concerns in infertile and noninfertile women. Journal of Psychosomatic Obstetrics and Gynecology. 11. 197-210. Leiblum, S. R. (1997). Infertility: Psychological Issues and Counselling Strategies. Toronto: John Wiley & Sons, Inc. Lilford, R. J . , & Dalton, M. E. (1987). Effectiveness of Treatment for Infertility. British Medical Journal Clinical Research Edition. 295(6591), pp. 155-6. Link, P. W., & Darling, C. A. (1986). Couples undergoing treatment for infertility: Dimensions of life satisfaction. Journal of Sex and Marital Therapy. 12. 46-59. Mahlstedt, P. (1985). The psychological component of infertility. Fertility and Sterility. 43(3). 335-346. Marquis, K. S., & Detweiler, R. A. (1985). Does Adopted Mean Different? An Attributional Analysis. Journal of Personality and Social Psychology. 48(4). pp. 1054-1066. 104 Mathews, R., & Mathews, A. M. (1986). Infertility and involuntary childlessness: The transition to nonparenthood. Journal of Marriage and the Family. 48, 641-649. Mathews, R., & Mathews, A. (1986). Infertility and involuntary childlessness: the transition to non-parenthood Mazor, M. D. (1984). Emotional reactions to infertility. In M. D. Mazor & H.F. Simons (Eds.), Infertility: Medical, emotional, and social consequences. New York: Human Sciences Press. Mazure, C. A. , Takefman, J . E., Milki, A. A. & Polan, M. L. (1992). Assisted reproductive technologies: 11: Psychological implications for women and their partners. 1.(4). 275-281. McEwan, K. L., Costello, C. G., & Taylor, P. J . (1987). Adjustment to infertility. Journal of Abnormal Psychology. 96(2). 108-116. McGrade, J . , & Tolor, A. (1981). The reaction to infertility and the infertility investigation: a comparison of the responses of men and women. Infertility. 4(1). 7-27. Menning, B. E. (1977). Infertility: A guide for the childless couple. New Jersey: Prentice-Hall. Menning, B. E. (1979). Counselling infertile couples. Contemporary Obstetrics and Gynecology. 13. 101-108. Menning, B. E. (1980). The emotional needs of infertile couples. Fertility and Sterility. 43(4). 313-319. Menning, B. E. (1982). Infertility: A guide for the childless couple. Englewood Cliffs, 105 Menning, B. E. (1982). The psychosocial impact of infertility. Nursing Clinics of North America. 17(1). 155-163. Morse, C , & Dennerstein, L. (1985). Infertile couples entering an invitro fertilization programme: A preliminary survey. Journal of Psychosomatic Obstetrics and Gynecology. 4. 207-219. Mullens, A. (1990). Missed conceptions: Overcoming infertility. Toronto: McGraw-Hill Ryerson. Nachtigall, R., Becker, G. & Wozny, M. (1992). The effects of gender-specific diagnosis on men's and women's response to infertility/Fertility and Sterility. 57(1). 113-121. Newton, C. R., Hearn, M. T., & Yuzpe, A. A. (1990). Psychological assessment and follow-up after in vitro fertilization: Assessing the impact of failure. Fertility and Sterility; 54(5). 879-886. Newton, C. R., Hearn, M.T. , Yuzpe, A. A. , & Houle, M. (1992). Motives for parenthood and response to failed in vitro fertilization: implications for counselling. Journal for Assisted Reproduction and Genetics. 9(1). 24-31. Pfeffer, N. and A. Woollett, (1983). The experience of infertility. London: Virago. Pohlman, E. (1969). The psychology of birth planning. Cambridge, Massachussetts: Schenkman. Polkinghorne, D. E. (1988). Narrative Knowing and the Human Sciences. State of University of New York Press. Reimer, J . (1991). A Circle of Life: Transition from infertility to adoptive parenthood. University of British Columbia, Faculty of Graduate Studies. 106 Rosenfeld, D. L , & Mitchell, D. (1979). Treating the emotional aspects of infertility: counselling services in an infertility clinic. American Journal of Obstetrics and Gynecology, 135-177. Salzer, L. P. (1991). Surviving Infertility: A compassionate guide through the emotional crisis of infertility. Harper Perennial: New York. Sandelowski, M. (1993). With child in mind. University of Pennsylvania Press: Philadelphia. Sandelowski, M., (1987). The color gray: Ambiguity and infertility. Journal of Nursing Scholarship. 19(2). 70-74. Sandelowski, M., Harris, B. G., & Holditch-Davis, D. (1989). Mazing: Infertile couples and the quest for a child. Image - The Journal of Nursing Scholarship, 21(4). 220-226. Sandler. B. (1968). Emotional stress and infertility. Journal of Psychosomatic Research. Seibel, M. M., &Taymor, M. L. (1982). Emotional aspects of infertility. Fertility and Sterility. 137(2). 137-145 Shangold, G. A. & Schreiber, J . R. (1988). Emotional needs in infertile couples. In C-R Garcia, L Mastrioanni, R. D. Amelar, & L. Dubin (Eds.), Current therapy of infertilitv-3 (p. 289-293). Toronto: B. C. Decker. Shapiro, C. H. (1982). The impact of infertility on the marital relationship. Social Casework: Journal of Contemporary Social Work. 63(7). 387-393. Shapiro, C. H. (1986). Is pregnancy after infertility a dubious joy? Social Casework. 306-313. 107 Shapiro, C. H. (1988). Infertility and Pregnancy Loss. Jossey-Bass: San Francisco. Shapiro, C. H. (1993). When part of the self is lost. Jossey-Bass: San Francisco. Singh, J . R. & Neki, J . S. (1982). Psychogenic factors in some genetic and non-genetic forms of infertility. International Journal of Gvnecoloov Obstetrics. 20. 119-123 Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family. 38. 15-28. Stanton, L., Tennen, H., Affleck, G., & Mendola, R. (1991). Cognitive appraisal and adjustment to infertility. Women & Health. 17(3). 1-15. Takefman, J . , Brender, W., Boivin, J . , & Tulandi, T. (1990). Sexual and emotional adjustment of couples undergoing infertility investigation and the effectiveness of preparatory information. Journal of Psychosomatic. Obstetrics and Gynaecology. 11. 275-290. Taymore, M. L. (1978). Infertility. New York: Human Sciences Press. Tennan, H., Affleck, G. & Mendola, R. (1991). Causal explanations for infertility: Their relation to control appraisals and pyschological adjustment. In A. L. Stanton & C. Dunkel-Schetter (Eds.) Infertility: Perspectives from stress and coping research (pp. 109-131). NewYork: Plenum. Tennen, H., & Herzberger, S. (1985). Ways of Coping Scale. In D. J . Keyser & R. C. Sweetland (Eds.), Test critiques: Vol. 3. (pp. 686-697). Kansas City, Mo.: Test Corporation of America. 108 Ulbrich, P. M., Coyle, A. T., & Llabre, M. M. (1990). Involuntary childlessness and marital adjustment: His and hers. Journal of Sex and Marital Therapy. 16(3). 147-158. Valentine, D. P. (1986). Psychological impact of infertility: Identifying issues and needs. Social Work in Health Care. 11(4). 61-69. van Balen, F., & Trimbos-Kemper, T. C M . (1993). Long-term infertile couples: a study of their well-being. Journal of Psychosomatic Obstetrics and Gynecology. 14. 53-60. van Balen, F., & Trimbos-Kemper, T .C.M. (1994). Factors influencing the well-being of long-term infertile couples. Journal of Psychosomatic Obstetrics and Gynecology. 15. 157-164. Veevers, J . (1973). the social meaning of parenthood. Psychiatry. 36. 291-310. Veevers, J . (1980). Childless by choice. Scarborough, Ontario: Butterworth. Wright, J . , Allard, M., Lecours, A. , & Sabourin, S. (1989). Psychosocial distress and infertility: A review of controlled research, international Journal of Fertility. 34(2). 126-142. Wright, J . , Duchesne, C , & Sabourin, S. (1991). Psychosocial distress and infertility: men and women respond differently. Fertility and Sterility. 55(1). 100-108. Zoldbrod, A. P. (1993). Men. Women & Infertility. Lexington Books: NY 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0054021/manifest

Comment

Related Items