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The meaning and lived experience of permanent childlessness as a result of infertility Hood, Leslie 2000

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T H E M E A N I N G AND LIVED EXPERIENCE OF P E R M A N E N T C H I L D L E S S N E S S AS A R E S U L T O F I N F E R T I L I T Y by LESLIE HOOD B . A . , M c G i l l University, 1989  A THESIS S U B M I T T E D IN P A R T I A L F U L F I L L M E N T OF T H E R E Q U I R E M E N T S F O R T H E D E G R E E OF M A S T E R OF A R T S in T H E F A C U L T Y OF G R A D U A T E STUDIES (Department of Educational and Counselling Psychology and Special Education)  W E A C C E P T THIS THESIS A S C O N F O R M I N G TO THE REQUIRED  STANDARD  T H E U N I V E R S I T Y OF B R I T I S H C O L U M B I A September 2000 © L E S L I E H O O D , 2000  In  presenting  degree freely  at  this  the  available  copying  of  department publication  of  in  partial  fulfilment  University  of  British  Columbia,  for  this or  thesis  reference  thesis by  this  thesis  or for  her  of  The University of British Vancouver, Canada  DE-6 (2/88)  Columbia  I  I  further  purposes  gain  the  shall  requirements  agree  that  agree  may  representatives.  financial  permission.  Department  study.  scholarly  for  his  and  of  be  It not  is  that  the  Library  an  advanced  shall  permission for  granted  by  understood be  for  allowed  the that  without  make  it  extensive  head  of  copying my  my or  written  Abstract The purpose o f this study was to examine infertile couples' subjective experience of permanent childlessness after they elected not to pursue other parenting options. This study involved the secondary analysis o f data from a phenomenological study exploring the transition to biological childlessness for infertile couples (Daniluk et al., 1996). In that study, a qualitative phenomenological methodology was used to guide the data collection and analysis. Data were gathered through four unstructured, in-depth interviews over a period o f three years with a volunteer sample o f nine infertile couples from different regions i n Canada. Participants were between the ages o f 29 and 48 when the study began. A l l couples had ended infertility treatment and considered their childlessness to be permanent. To explore the lived experience o f permanent childlessness after failed infertility treatment, the data were analyzed according to Colaizzi's (1978) method o f phenomenological data analysis. Seven common themes emerged, which included the following experiences: (a) a need to protect themselves; (b) a sense o f lessening emotional intensity; (c) a sense o f regaining control; (d) a need to revision life and identity; (e) a sense o f appreciation for the strength o f their relationship; (f) a sense o f recognition and reconciliation to their fate; (g) a need to make sense o f their experience. These findings led to specific recommendations for future research, as well as implications for the counselling profession with respect to working with infertile couples.  T A B L E OF CONTENTS Abstract  ii  Acknowledgements  v  CHAPTER ONE: INTRODUCTION  1  Socialization to Have Children  2  Purpose o f the Study  6  CHAPTER TWO: REVIEW OF T H E LITERATURE  8  Psychosocial Effects o f Infertility  8  Review o f the Literature on Permanent Childlessness  12  Statement o f the Problem  33  CHAPTER THREE: METHODOLOGY  35  Method Selection  35  Personal Assumptions and Bracketing  36  Participants  38  Procedure  40  Data analysis  40  Limitations  42  C H A P T E R F O U R : FINDINGS  44  Couple Biographies  44  Identified Themes  58  A Need to Protect Themselves  59  A Sense o f Lessening Emotional Intensity  67  A Sense o f Regaining Control  .'  75  A Need to Revision Life and Identity  84  A Sense of Appreciation for the Strength of Their Relationship  100  A Sense of Recognition and Reconciliation to Their Fate  106  A Need to M a k e Sense of Their Experience  112  C H A P T E R F I V E : DISCUSSION  116  Introduction  116  Implications for Practice and Research  131  REFERENCES  133  Acknowledgements I would like to thank my thesis supervisor, Judith Daniluk, for generously making her data available to me for this study, and for her tireless support, creativity, and flexibility throughout the research and writing process. Her assistance was crucial, timely, and deeply appreciated. To the members o f my committee, I extend thanks for their efforts to read the document in a very short timeframe, as well as for their enthusiastic support i n improving the quality o f the finished document. For Scott and Kate, the deepest love and gratitude. Your patience and grace inspire me daily. Your tireless adjusting o f your own needs to accommodate the "student" in your midst was humbling. Thank you for having confidence i n me during the days when I could not find it for myself, and for understanding when the deadline i n the sand shifted "just once more". Lastly, I am grateful to the participants who so freely gave o f themselves i n this research. I regret not having had the opportunity to meet them personally. I hope that I have helped to give voice to their experience, and that this voice may be heard by those who would seek to give comfort and counsel to infertile couples.  1 Chapter One Introduction A number o f gaps exist i n our knowledge about the experience o f infertility and its impact on couples' lives. One gap involves what couples go through when treatment fails and they elect not to pursue other parenting options. Although researchers have studied couples who have become parents as well as couples who never wanted children, few people have examined whether infertile couples go on to lead fulfilling lives as childfree couples after treatment fails, and how they reach that destiny (Matthews & Martin Matthews, 1986). This is a question that may become more pressing with time. Infertility i n North America currently affects 1 in 6 couples (e.g., Seibel, 1996). About 40% to 60% o f infertile couples eventually become parents through medical means, adoption, or simply trying to conceive over a longer period o f time (Sewall, 1998). The rate o f conception has not increased drastically in the last few decades despite the advent o f increasingly sophisticated reproductive technologies (May, 1995). Only about 2 5 % o f couples adopt and this figure is dropping (Carter & Carter, 1989), partly due to fewer numbers o f available healthy infants (May). O n the other hand, the rate o f childlessness i n North America seems to be on the rise. Sewall notes that i n 1993 the statistic was 16% and some analysts have projected it could reach 20% by the year 2000. These figures don't distinguish infertile women from those who are childless due to circumstances other than infertility, and it does appear these numbers are increasing (May; Sewall). A l s o , there is a strong recent trend to delay childbearing until later i n life, and age is a factor i n increasing fertility difficulties (Levitan, Belous, & Gallo, 1988; Seibel). M a y says that infertility-  2  related doctor visits rose from 600,000 in 1968 to 1.6 million i n 1984. In the 1990s, new reproductive technologies have led to women in their 40s and older considering motherhood. In response to this changing cohort, some doctors have suggested an increase to an age cut-off o f 50 for women seeking to have a baby by ovum donation (Sauer & Paulson, 1992). A n older cohort trying to conceive, fewer adoptions, and consistently average success rates o f fertility treatments may result i n more couples finding themselves on the poorly charted path to childlessness. Childlessness is not a destiny that typically offers couples a lot o f support. Social norms strongly encourage parenthood and tend to denigrate childlessness, involuntary or otherwise (e.g., Ireland, 1993; Lisle, 1996). These norms shape personal identity and our conception o f appropriate gender roles (e.g. Ireland; Matthews & Martin Matthews, 1986; Safer, 1996). Such a context appears to present a number o f challenges to couples who attempt to live satisfying, childless lives after failed treatment, and to the clinicians who assist them with this challenging process. This process o f adapting to permanent involuntary childlessness due to infertility is the focus o f this study. To contextualize this process it is useful to discuss gender socialization around parenthood. This socialization appears to have a major impact on how men and women respond to infertility and by implication, how they may experience biological nonparenthood. Socialization to Have Children It has been argued that the powerful desire to parent is biological. However, it is certainly at least partly social. In fact, Lisle (1996) suggests that motherhood " . . .appears to be more a social than a biological construct, since it is desired only under certain conditions and usually disapproved o f [during difficult times such as war and  3  depression]" (p. 101). A s well, growing numbers o f voluntarily childless couples are testing the assumption that the urge to procreate is on the same level as other biological drives such as sex (May, 1995). However, Daniluk (1988) and M a y (1995) suggest that the dominant social assumption is still that normal adults w i l l marry and have children. Parenthood i n the 20  th  century is associated with powerful symbolic benefits that signify the culmination o f adult development. It is seen as the primary adult pathway to personal fulfilment, social acceptance, religious membership, sexual identity, and psychological adjustment (Daniluk); marital success (Marsh & Ronner, 1996); emotional fulfilment and happiness (Ramu & Tavuchis, 1986); even the fulfilment o f patriotic duty (May). Parenthood operates as the yardstick against which all other adult life options are measured. The notion o f parenthood also operates at the level o f an unquestioned, largely unconscious social discourse. Whereas voluntarily childless couples typically consider their decision very carefully, most married couples view having at least one child as an inevitable consequence o f marriage, and give the decision little thought (Clark, Henry, & Taylor, 1991; Mahlstedt, 1985; Edelmann, Humphrey, & Owens, 1994). They also see childlessness as undesirable for themselves and others (Greil, 1991). These views are reported even among couples who claim that children are not necessary for a happy marriage, and i n spite o f studies suggesting that modern childrearing is an economic burden, and that parents with dependent children experience less marital satisfaction and poorer health than childless couples (May, 1995). It seems likely that the social rewards attached to parenthood encourage couples to invest themselves in this role.  4  Gender role socialization also appears to contribute to the decision to parent, especially for women. Wirtberg (1992) defines gender identity as "the individual's personal definition o f self as a sexual being that is developed in interaction with the social network" (p. 62). She defines a gender role as an individual's response to social rules and expectations around what constitutes acceptable masculine or feminine behaviour. A s discussed, parenthood is a strongly expected gender role o f adult men and women. However, socialization around this role appears to affect adult men's and women's gender identities very differently. A growing number o f women have made explicit i n their writings the patriarchal social norm that ties the appropriate expression and fulfillment o f female gender identity to motherhood (Anton, 1992; Ireland, 1993; M o r e l l , 1994; Safer, 1996; Sewall, 1998; Wirtberg, 1992). They assert that this idea continues persistently to shape many o f our culture's notions about women and female identity. Examples range from the psychoanalytic theory o f women's psychological development that caricatures non-mothers as emotionally frigid, selfish and deviant, to some branches o f contemporary feminism. Such feminist writings suggest either that women alone possess the biological qualities o f being relational and nurturing, or that they are uniquely equipped to learn these skills through mothering, and further, that motherhood is the highest expression o f these skills. Through these ideas, the social norm continues to entrench motherhood as the cornerstone o f feminine identity. Safer suggests that the role o f mother confers a sense o f identity to women because it is imbued with the notions o f social status, self-esteem, structure, and meaningfulness. These are indeed powerful notions. The primacy that motherhood has thus acquired may help to explain why women who wish to have children  5  tend to report valuing all its aspects, including conceiving, pregnancy, childbirth, and childrearing (Kitzinger, 1992). M o r e l l (1994) says that gender socialization around the parenthood role ignores the reality o f growing numbers o f women who, by choice or by destiny, face the question of what constitutes a positive childless female identity. According to Ireland (1993), under current social conditions the identity o f a woman who is childless for any reason is associated with ideas o f emptiness and absence. She is likely to be defined by what she doesn't have and what she can't or won't do. O n the other hand, fatherhood, an important marker o f adult status, responsibility, and respectability, is not the most important male gender role or source o f male gender identity (Mahlstedt, 1985; M a y , 1995; Russo, 1976; Safer, 1996). The most exalted social role for men is that o f worker and family provider (e.g. Leiblum & Greenfeld, 1997; M a y ) . According to Sewall (1998), men are usually driven to create their roles and identities according to social standards o f material and economic success that confer prestige and status. The one facet o f gender identity that appears intimately connected to parenthood for men is their ability or lack thereof to impregnate their wives. It appears that for many men virility is equated, and often confused with, masculinity (Mahlstedt, 1985). M o r e l l (1994) suggests that gender socialization limits both sexes in terms o f developing and integrating both agentic and nurturing qualities. The degree to which men and women are able to develop the flexibility in their gender roles that M o r e l l advocates may influence how infertile couples experience involuntary childlessness. The effects o f gender socialization around parenthood help to form the backdrop against which my study o f how infertile couples experience permanent involuntary  6  childlessness is situated. The effects o f gender socialization suggest that childless couples "swim against the social current", which has implications for how they come to terms emotionally with their childlessness, reconstruct a positive gender identity, and create a sense o f meaning in their lives. A s I discuss in Chapter Two, the literature on infertility also suggests that many women and men find infertility a difficult experience that causes pain and strain on physical, emotional, social, sexual, and financial levels. These phenomena suggest that the experience o f permanent involuntary childlessness may be a challenging one for some or many couples. However, it is an experience about which we currently know little. Purpose o f the Study Since little is known about permanent childlessness among infertile couples, exploring the subjective experience o f such couples w i l l help to increase our knowledge and understanding o f this phenomenon. The purpose o f this study was therefore to examine the lived experience o f permanent childlessness and the meaning o f this experience for couples who elect not to pursue other parenting options after failed infertility treatments. In order to examine the lived experience o f permanent childlessness with rigour, a phenomenological research method was used (Colaizzi, 1978; Osborne, 1994). Researching infertile couples' experiences o f permanent involuntary childlessness w i l l add to the limited available literature on childlessness and may provide useful information to couples who are faced with this potentially profound and challenging life experience. This research may also help clinicians working with infertile couples to  7  understand more o f the nature o f this experience as it is lived by infertile couples, and to devise effective ways o f assisting the process o f adjustment to childlessness.  8  Chapter Two Review of the Literature Clark, Henry and Taylor (1991) suggest that an "ideal adjustment" (p. 158) to childlessness through infertility involves two distinct processes: accepting the loss o f biological children through mourning, and then finding a way to redefine oneself and one's life. For Clark et al., redefinition means understanding the goals and needs that would have been served by having children, regaining a sense o f personal choice and agency, and re-prioritizing parenting goals based on what is achievable and meaningful. This perspective reflects the dominant themes in the extant literature that examines how childless women and couples make successful transitions to nonparenthood. In this review I discuss this literature, which is both anecdotal and research-based. I also reflect on what this literature might mean for my study. In order to set the stage for this discussion, it is useful to briefly discuss some o f the main psychosocial effects o f infertility. This w i l l help the reader to contextualize some o f the struggles that men and women may face in adjusting to permanent involuntary childlessness. Psychosocial Effects o f Infertility According to Carcio (1998), medical science defines infertility as the failure to conceive after a year o f unprotected intercourse i f the woman is younger than 35, or after 6 months i f she is older. After this period, medical investigation and treatment, an oftenlengthy process, may begin. Female fertility problems are diagnosed i n about 35% o f these cases, male factors in about 35%, factors affecting both spouses in about 20%, and the factors i n about 10% o f cases are unexplained. The most common male factors involve defects in, or insufficient numbers o f sperm. Female factors include the failure to  9 menstruate or ovulate normally, endometriosis, early ovarian failure, and poor egg quality. Couples increasingly delay parenthood until both partners have established careers. Age negatively impacts the quality both of ova and sperm, meaning that age is becoming a factor in fertility problems for both men and women (Carcio). For about 10% of infertile couples no cause is ever found (Carcio, 1998), which may be especially upsetting as there is no "problem" on which to focus coping efforts (Daniluk, 1991; Leiblum & Greenfeld, 1997; Wiley, 1993). In general, as Daniluk (1997) notes, a substantial body of literature exists that consistently finds that infertile people display greater distress than fertile men and women. The distress reported on receiving an infertility diagnosis is like the response to an acute life crisis (Menning, 1982). This often includes initial reactions such as shock, denial, and disbelief (e.g., Leiblum & Greenfeld, 1997). Subsequent responses may include uncertainty and anxiety (e.g., Berg & Wilson, 1991); resentment and anger (Leiblum & Greenfeld; Ulbrich et al., 1990); and shame and guilt (Lalos, Lalos, Jacobsson, & Von Schoultz, 1986; Wirtberg, 1992). Questions may arise about the fairness and meaning of life (Daniluk, 1991; Greil, 1991). A major theme in infertility is that of multiple losses. These can include the loss of the imagined child, the parent role, and the expression of feelings and values that having a child would facilitate. Grief and emptiness are common reactions (Daniluk, 1996; Lalos et al., 1986; Mahlstedt, 1985; Sewell, 1998; Wirtberg, 1992). Mahlstedt suggests these losses are experienced in relationships, health, prestige, self-esteem, self-confidence, security, fantasy, and meaning. Social isolation and loss of support may be felt because the losses are largely invisible to others and because the couple has lost expected membership in a dominant, mainstream peer group (Anton, 1992; Carter & Carter, 1989).  10 Loss o f control is another pervasive theme. It may be particularly acute at the time the couple realizes their fertility is in question, and as treatments erode the spontaneity and privacy o f various life areas, particularly sexual functioning and satisfaction (Daniluk, 1988; M a y , 1995). Couples often need to make decisions about treatments at these times, which may result in conflict and increased emotional distress (Daniluk; Boiven, Takefman, Tulandi, & Brender, 1995). However, Leiblum (1997) notes that i n some studies infertile husbands and wives report improved communication and greater closeness rather than heightened conflict. It does appear that most couples experience some disruption o f sexual satisfaction or functioning, although the findings are also mixed in this area. Leiblum suggests that the inconsistent findings i n these areas may be due to differences in marital and sexual adjustment prior to infertility, or to problems with research methods and instruments. Gender differences appear to affect the experience or expression o f infertilityrelated effects. Daniluk (1997) says the available research finds that women consistently report more distress and feelings o f personal responsibility for the infertility, even i f their husbands are in fact infertile. They are also more likely to view infertility as "a direct assault on their self-image and self-esteem" (Daniluk, p. 105). Women commonly express feelings o f being somehow defective, different from, and inferior to others (Daniluk; Lalos et a l , 1986; M i a l l , 1985). These feelings may be related to the extent that women see having children as central to their sense o f expressing and fulfilling their identities and gender roles (Daniluk, 1996; Ireland, 1993; M i a l l ; M o r e l l , 1996). Some infertility researchers report that both husbands and wives see having children as more important to women than to men, and that men may therefore feel less upset about infertility  11  (Edelmann, Humphrey, & Owens, 1994; Wirtberg, 1992). M a n y traditional male work roles and leisure activities also offer a respite from infertility. Women's work, leisure activities and social contacts, on the other hand, often focus on children or the practices o f motherhood, which serves to remind them o f their childlessness (e.g. Lalos et al., 1986; Wirtberg, 1992). However, Daniluk (1997) notes that some studies suggest that infertile men respond similarly to infertile women. She suggests that gender differences i n communication as a result o f socialization may account for some o f the variation in men's and women's reported distress levels in the research, as could methodological problems. Daniluk has also summarized a group o f studies that find that men are more isolated i n the experience o f infertility and are more likely to use avoidance or denial as a coping strategy than are their spouses. Most o f the authors whose work I review i n this chapter suggest that communication difficulties between spouses make the transition or adjustment to permanent involuntary childlessness more difficult (Carter & Carter, 1989; Ireland, 1993; Matthews & Martin Matthews, 1986; Wirtberg). Gender differences may also influence the course o f infertility treatment. W o m e n tend to initiate the treatment process and report making most o f the  treatment-related  decisions (Greil, Leitko, & Porter, 1988), although treatment is more painful, invasive and riskier for them than for their husbands (e.g. Cooper, 1997). M e n may also be able to stop treatment more easily than their wives and experience less difficulty adjusting to permanent childlessness (Edelmann, Humphrey, & Owens, 1994). A s I w i l l discuss further, willingly ending treatment is seen as an important step in coming to terms with permanent childlessness.  12  Overall, the literature on infertility suggests that the experience potentially entails pain and pervasive feelings of loss and failure regarding at being unable to do something that is highly valued i n our society yet also largely taken for granted. Diagnosing and treating infertility also often involves a lengthy, arduous and uncertain medical process that can drain an infertile couple financially and emotionally. Finally, husbands and wives may have quite different feelings and reactions to the experience o f infertility. These points form the backdrop to the study o f infertile couples' lived experience o f permanent childlessness after failed treatment, and suggest that it may be a significant and challenging experience. Review o f the Literature on Permanent Childlessness In the literature about permanent involuntary childlessness, a variety o f terms are used to refer to this experience, including terms such as "making the transition to nonparenthood" (Matthews & Martin Matthews, 1986), or "choosing childfree" (Carter & Carter, 1989). I w i l l use these terms when discussing the works that they refer to, but i n the rest o f this thesis, I have endeavoured to use the term "experience o f permanent childlessness". This is done to remain true to the emotional tone o f the descriptions by the infertile couples i n this study, as well as to the intent o f the research question. L i n d a Hunt Anton's (1992) book "Never to Be a Mother" is a self-help book for women who wanted but didn't have children due to infertility, delayed childbirth, not having a suitable partner, and so on. Anton advertised in local and national publications and directly contacted friends and acquaintances to participate. She conducted telephone and face-to-face interviews using a self-developed questionnaire that explored early and current life experiences as well as personal and social aspects o f involuntary childlessness  13  that were currently affecting the participants' lives. Her participants were an unspecified number o f women o f diverse backgrounds, ranging from 24 to 78 years o f age. N o t all the women were childless due to infertility, but all considered themselves to be involuntarily childless. It is unknown how long any o f the women had been childless. A n t o n derived the 10-step model o f resolution she presents from her own as well as from these women's experiences. Anton describes resolution as " . . .living the many days o f your life as well as y o u can, as fully as you can; it means minimizing the losses o f childlessness and maximizing the assets o f your life" (p. 65). The process o f resolution entails accepting and making sense o f the losses o f involuntary childlessness, then re-focussing one's perspective and energies i n new directions that are personally fulfilling. While Anton presents a sequential step model, she emphasizes individual differences in how women experience involuntary childlessness and i n how they may experience and work through the tasks she presents. The steps i n her resolution model are: (a) acknowledging and experiencing the loss; (b) understanding the loss; (c) surviving the loss; (d) letting go o f blame; (e) talking to significant others; (f) using available resources; (g) rechanneling mothering energy; (h) including children i n your life; (i) maximizing the advantages o f childfree living; and (j) embracing the quest for feminine wholeness. The first few steps o f the model discuss accepting the losses entailed by permanent involuntary childlessness by acknowledging, mourning, and making sense o f them. Anton (1992) notes that not all women find involuntary childlessness devastating but suggests that many women may experience a variety o f painful feelings because they grieve multiple, losses o f invisible yet important things. These losses often include the  14  imagined child and the part o f oneself that would have been a mother. Women might also grieve losses relating to family continuity, friendship with one's child, being part o f a particular social network, the mother-child love bond, and the loss o f experience and opportunities for personal development. Because these losses may feel overwhelming, Anton notes that some women may struggle with denying or minimizing their losses i n order to cope. However, this initial grief process paves the way for the later tasks o f resolution and cannot be glossed over. To help make sense o f the losses o f permanent childlessness, Anton (1992) encourages women to gain awareness about their needs and reasons for wanting a child. These reasons might be psychological, social, or existential. They might be simple or complex, evident or hidden from awareness, and might require a process o f self-inquiry or therapy to bring them forth. Anton also suggests that as they come to accept and understand the losses they have experienced, women can invite a change to occur i n their views o f themselves and their future. The shift in a woman's view o f herself from being a victim to a survivor determined to make a better life, is the beginning o f redefining her life in terms other than the failure to have a child. A part o f this shift is being able to acknowledge anything she did that contributed to her childlessness while being able to let go o f blame toward herself, significant others, medical institutions and personnel, adoption agencies, or God. The later steps i n Anton's (1992) model appear to focus on how permanently childless women create new and satisfying life goals and relationships. These steps involve opening new channels for nurturing or mothering energy, as well as developing new interests and ways o f being that are not related to mothering. Anton suggests that  1  some childless women may need to connect with others who are supportive o f their decision not to pursue motherhood further. This helps to counteract the isolation and vulnerability experienced by many women without children, as well as a reluctance to speak about childlessness for fear o f hurting others' feelings or incurring their censure or pity. Anton also suggests that resources such as books, therapy, or other childless women can offer support and help to women who wanted but did not have children in finding fulfilling life goals that may or may not include being involved with children. Anton (1992) suggests that childless women who consider themselves to have strong maternal energy, which Anton casts as a biopsychosocial construct, expand the concept o f mothering to include other adults, causes, and creative pursuits. Examining why they wanted children may help these women find ways to satisfy child-related needs within this larger context. Anton notes that some women may need to work through gender socialization issues that limit mothering to taking care o f people before they can perceive or accept alternative outlets for maternal energy. She also suggests that women can take on varied and important roles with other children such as the adult playmate or big sister. These roles can benefit their own development as well as that o f the children they enjoy. Since contact with children can remind some women o f the pain o f childlessness, Anton suggests that focussing on the gift o f the present moment increases aliveness and joy, and is the only place life can be lived. Anton (1992) suggests that while involuntary childlessness may entail many losses, it can also become a satisfying lifestyle on its own merit. She uses the term "childfree l i v i n g " (p. 157) to describe a lifestyle in which women without children are able to perceive, enjoy, and make use o f the unique advantages it confers. Such  16  advantages include more disposable income, time, and energy; a focus on selfdevelopment and significant relationships; and greater freedom and spontaneity. Finally, childfree women don't endure the heartaches o f motherhood. Anton suggests that comparing motherhood to childfree living to determine its benefits is not appropriate as " . . . [it is] a question o f the relative merits o f two different things" (p. 157). In the final step o f her model, Anton (1992) addresses the issue o f how women who did not become mothers re-establish a whole, feminine identity i n a patriarchal culture that equates female identity with motherhood. Anton suggests that women actively question this assumption i n order to develop the sense that".. .being a woman is many different things; motherhood is just one possibility. When we accept that our value as a human being is not tied to having children, we give ourselves permission to be childless" (p. 169). Permission to be childless appears to result i n permission to create a satisfying, meaningful, childfree life, which for Anton and the women she interviewed, represents the completion o f the resolution process. Anton's (1992) book may be valuable to infertile women who elect to remain permanently childless primarily because it is one Of very few resources available to involuntarily childless women. She also gives a clear sense o f the work that childless women might do to achieve a positive transition to nonparenthood without presenting her model in a lockstep manner. Her interviews illustrate and lend weight to the steps i n her model and may reduce childless women's feelings o f isolation and increase hope. Finally, she suggests techniques to help achieve the steps that may be useful both to women who read the book and to clinicians assisting childless women.  17  However, Anton's (1992) model appears to lack empirical validity. She doesn't describe her interview methodology, so we don't know i f it is rigorous. Because Anton doesn't present her sampling strategy, her sample could be a homogenous, self-selected group o f women who had dealt successfully with involuntary childlessness. This would limit its applicability. Also, we don't know how long the women had been childless before being interviewed. There may be differences over time in how women experience or respond to involuntary childlessness. These validity issues mean that Anton's work may be limited i n helping women to understand and cope with this experience. Two other aspects o f Anton's (1992) work may also limit its applicability to infertile women's experience o f permanent childlessness. First, infertile women who undergo time-consuming, painful, invasive, risky, and expensive medical procedures in order to try to conceive usually greatly desire a child. This may make their experience o f childlessness quite different than it might be for women who lack suitable partners or who delayed childbearing. Anton suggests that women who wanted but didn't have children respond differently in terms o f the pain and loss they feel. If so, perhaps resolution as Anton describes it may not be part o f the experience o f permanent childlessness as described by some or all o f the infertile women i n my study. Second, infertility is usually regarded as a couple's problem (Daniluk, 1997). It has been mentioned that husbands' responses are believed to affect wives' adjustment to childlessness, and it may be that the reverse also occurs. I think it therefore makes sense to study how couples make the transition to permanent childless rather than to look only at women's adjustment. The following book does consider the transition to permanent childlessness as a process that infertile couples must undertake together.  "Sweet Grapes", a self-help book by Carter and Carter (1989), is similar i n several ways to Anton's (1992) book. I discuss these after summarizing the model that Carter and Carter call a model o f adjustment to living "childfree" (p. 15). In this model, Carter and Carter (1989) emphasize decision-making because they assert that a couple must make a mutual life decision i n order to leave infertility behind. They contend that permanently childless couples who avoid making deliberate, conscious decisions to end their treatment, to not adopt, and to choose a childfree life on its own merits ultimately end up as "drifters" (p. 58). Drifters continue indefinitely to endure the losses and lack o f control inflicted by infertility. Carter and Carter suggest that most permanently childless couples who don't adopt become drifters. In essence, to decide is to regain control. Carter and Carter also see the decisions that must be made as separate. Ending treatment doesn't necessarily mean a couple w i l l adopt. Childfree living is not what remains after deciding against adoption. Each option must be a deliberate choice that a couple has come to want for its own sake, instead o f a poor consolation for the truly wanted thing that can never be had. Carter and Carter (1989) regard these choices that permanently childless infertile couples must make in the context o f Rubin's (see Carter & Carter, p. 61) decision-making model. The tasks o f the model are to overcome blocks to making a decision, to set priorities that guide the decision, and to commit to the decision by making it public and then acting on it. Some blocks to decision-making are emotional. Depression, denial, resignation, guilt, or blame can delay a couple's mourning and acceptance o f biological childlessness. Other blocks appear to involve limited perspectives. For example, one or both spouses may be unable to make a decision because they feel obsessed with making  19  the right decision, one they won't regret in the future, or because they fear that choosing w i l l be more painful than what they are already enduring. Some partners or couples can't stop unsuccessful fertility treatments despite years o f debt and failure to conceive, believing that a miracle w i l l happen i f they just keep trying. Carter and Carter say that being able to gain a fresh perspective is essential i n order for the couple to see they do have options, one o f which can be the ability to live a happy life without children, despite having wanted them very much. Carter and Carter (1989) suggest that establishing mutual, clear values and priorities supports making these decisions and also helps couples to redefine themselves as whole. Priorities may include such things as money, health, social contribution, and so on. Carter and Carter suggest that couples whose top priority remains having a child need to come to understand whether the experience would have met needs such as creating change, stability, meaning, or the chance to nurture, and then seek other ways to fulfill these needs. According to Carter and Carter (1989), the decision to live childfree usually comes as a dawning awareness after much thought and communication that the decision has been made and feels right for both spouses. The authors suggest the couple then "register the decision" (p. 61) by celebrating and making it public i n some way, followed by "investing i n the decision" (p. 61), where the couple takes action to make the potential gains o f childfree life a reality. This step might begin with an act o f closure to the couple's infertility such as having a vasectomy. Carter and Carter suggest that at this point the couple finds that " a l l the energy that had been sucked away by being infertile (is) released to be applied in other directions" (p. 70).  20 Carter and Carter (1989) note that making the choice to be childfree takes a lot of thought, communication, and time. Because the choice is so emotional, and because childless husbands and wives often react differently to the idea of being childfree, the authors provide guidelines for communicating effectively around this decision. The guidelines consist of accepting each other's feelings and ideas, using negotiation skills, and accepting that the decision-making process involves exploration and ambivalence. Patience is also important as the decision may take months or years to make. Carter and Carter say that men in particular, if they see infertility as a woman's problem, or because they are socialized not to share their feelings, may need to work to honestly find and share what the experience means for them instead of relinquishing the process to their wives. The authors also regard communication as essential because their anecdotal data indicate that husbands are more likely to get stuck in denial, unable to mourn the losses of permanent childlessness. Finally, Carter and Carter note that communicating and making the choice to be childfree will be more challenging, although still possible, when a spouse who wanted children badly from an early age is married to a more ambivalent partner. Both Carter and Carter (1989) and Anton's (1992) works are based on the authors' own stories of adjustment to permanent childlessness, as well as the experiences of others. In Carter and Carter these experiences appear to have been derived from letters written to them by other permanently childless couples, but the authors are extremely vague in describing their sample and methodology. Carter and Carter and Anton also describe fairly similar outcomes in their models of childfree and resolution. Both models involve perceptual shifts to seeing life as complete and fulfilling despite having deeply wanted and yet not had children. Both emphasize regaining a sense of control, releasing blame,  21 recognizing and seizing the distinct advantages o f childless living, and recreating meaningful identities that may involve children or other channels o f nurturance, creativity, and growth. Carter and Carter's process o f becoming childfree is also similar to Anton's steps o f resolution. Both suggest that grief, which can initially involve attempts • to minimize or deny the losses in order to cope with them, precedes the experiencing o f shifts in perception about one's infertility and childlessness. The next stage entails acting on the new ideas and feelings that develop from these shifts. Both models move from a more passive state o f allowing grieving to a very agentic state o f making a new and fulfilling life happen. Where Carter and Carter differ significantly from Anton is that they emphasize the communication and decision-making processes that they say couples need to employ to make a successful transition to childfree. A s with Anton (1992), Carter and Carter (1989) provide little information about how they obtained information from childfree couples, or any demographic data about these couples. This work may also have limited generalizability and validity. O n the other hand, it may also suggest some salient aspects o f the lived experience o f permanent childlessness for the infertile couples in my study. It may be important to remain attentive to couples' descriptions o f communication styles and skills, decision-making, and roles and goals, in order to understand more about how these aspects inform their experience o f childlessness. Both Anton (1992) and Carter and Carter (1989) suggest that there is a lot o f variation i n the adaptation to permanent childlessness. That is, experiences ranging from an ongoing sense o f loss, grief, and lack o f control, to emotional healing, renewed control, and agency may be possible. However, we know little about what infertile couples do i n  22  fact experience when they decide not to pursue parenting options after failed infertility treatment. The potential variation in how people may experience permanent involuntary childlessness, and the fact that it has been given little study to date, suggests that it makes sense to more systematically examine this experience for those who view their childlessness as a choice, as well as for those who do not. A n article in the Journal o f Marriage and Family departs from the works above i n several ways. Matthews and Martin Matthews (1986) present a conceptual framework in which they describe three inter-related psychological tasks that infertile, permanently childless couples may need to complete in order to experience a successful, albeit unwilling, transition to nonparenthood. The authors draw upon social constructivist literature as well as a number o f studies on the nature o f the transition to parenthood and the psychosocial effects o f infertility. The interconnected tasks that they describe are: (a) reality reconstruction; (b) identity transformation; and (c) role readjustment. Matthews and Martin Matthews (1986) incorporate Berger and Kellner's work on social reality construction in their model. This work, which is not based on research with childless couples, suggests that most married couples define themselves as parents-to-be, that significant others usually expect and encourage this definition, and that by marrying couples aim to create a private world that is under their control. Matthews and Martin Matthews suggest that infertility strips couples o f that control and forces a private and public redefinition o f themselves as a married couple without children. The culmination of the task o f reality reconstruction is the couple's acceptance o f this redefinition. A couple's ability to accept their new reality is affected by several factors. One is the extent to which they have developed "shared constructs" (p. 644) that they use to weather the  23  strains o f infertility. A s well, how quickly and completely they redefine themselves as childless is affected by their willingness to make it a public as well as a private reality. Finally, Matthews and Martin Matthews suggest that the support or censure o f significant others around the couple's infertility and childlessness greatly affects the extent to which they can redefine themselves. To explain how infertility affects infertile couples' identities, Matthews and Martin Matthews (1986) draw on symbolic interactionist theory. In doing so, they suggest that people experience a sense o f self relative to each social role they occupy, so that each person ends up with multiple "role identities" (p. 645). The most important role identities are those that provide the greatest opportunities for status, gratification, support, and performance as defined by the person. Feeling highly committed to a particular role identity also increases its perceived importance, as does social support from significant others for that role. Couples whose identities and self-esteem are most at risk from involuntary childlessness are therefore those who have the greatest personal commitment to, and social support for, the role o f parent. Such couples may feel compelled to offer excuses for their failure to perform in this key role. A s a result o f this blow to identity, couples who make the transition to nonparenthood successfully w i l l alter their role identifications. Matthews and Martin Matthews (1986) define a role as "the constructed behaviour o f persons i n social relationships, and the focus is on how actors 'play' roles in the context o f the normative expectations held by others" (p. 646). Identifications involve aligning and connecting with people who are perceived to be like oneself. Being able to explore an alternative role may help an involuntarily childless couple see benefits to that role, which may then  24  encourage greater identification with and commitment to that new role. The hierarchy o f role identities would thus be re-organized. A s well, experiencing a certain amount o f role strain at being childless helps motivate couples to make these changes, according to Matthews and Martin Matthews. However, i f the strain is too great, it w i l l likely impede the process. The concept o f shifting role identifications may be similar to what M o r e l l (1994) advocates that men and women do to stretch the narrow confines o f gender socialization that limit men to being the aggressors and women the nurturers. Matthews and Martin Matthews' (1986) theoretical framework, i f sound, suggests that it may be important to remain open to descriptions by the couples i n my study o f their sense o f roles and goals including the parent role, as well as their perceptions o f social support, control, and their sense o f identity. These may be salient aspects o f their experience o f permanent childlessness. Because the study that forms this thesis extended over a 3 year period, it may be that couples' descriptions o f their experience may also change over time, as Anton (1992), Carter and Carter (1989), and Matthews and Martin Matthews suggest. Matthews and Martin Matthews (1986) acknowledge that the concepts they present have not been empirically tested and that their framework should be viewed as a basis for research on the transition to biological nonparenthood. A s such, the framework is a potentially valuable contribution. Several limitations with this framework do, however, exist. First, the authors treat the couple as a homogenous unit. Given the differences i n how men and women experience infertility and the socialization to parent in terms o f identity and primary roles, significant gender differences may also exist i n couples' experiences o f making the transition to nonparenthood. Second, this article and  25  the literature that informs it are at least 15 years old, and various aspects o f the infertility experience have likely changed during this time. Third, the authors consider the possible social consequences o f infertility but do not speculate about the emotional impact o f infertility on completing any o f the tasks they describe. Ireland (1993) conducted a study o f women's adjustment to permanent childlessness and its impact on female identity development and female gender roles. One hundred American women ranging from 38 to 50 years o f age were selected from a group that responded to T V news segments and a newspaper article about the study. Ireland used the Bern Sex Role Inventory and the focussed in-depth interview method. She found that the 31 women who were childless due to poor health or infertility were different in several respects from the voluntarily childless women or those who were childless due to delay. I examine her findings on the adjustment to childlessness for this group o f 31 women, whom Ireland labelled "traditional." Ireland (1993) suggests that because motherhood is the female cultural norm, women orient their sense o f self either toward or away from it. However, women also have differing degrees o f maternal feelings and "allegiance to cultural norms about what feminine attitudes and behaviors should be" (p. 116). So, while the Bern Sex Role Inventory results indicated that the 31 traditional women in the study supported a stereotypical female gender role, Ireland also found variations i n individual adjustments to childlessness i n this sub-sample. However, on the whole this group did report more reactions o f feeling damaged and a failure as a result o f being unable to bear a child. Ireland associates this finding with the strong connection these women have made between motherhood and their fulfillment as adult women. Based on her findings, she  26  suggests that childlessness may cause infertile women more pain than that experienced by other women who are involuntarily childless. This pain may be exacerbated by the oftentraumatic medical process o f infertility treatment and the sense o f failure that infertile women commonly report. Adapting to permanent childlessness for the women i n this study involved shifting creative and nurturing energies from motherhood into alternative roles. Ireland (1993) sees the goal o f these shifts as developing a "satisfying, nonmaternal sense o f s e l f (p. 22). Work became a focus for most o f the traditional women's energies. Some women shifted from taking jobs that they could leave once they had children to investing themselves i n finding personally meaningful careers. Some o f these women seemed to have come to view work as central to their sense o f identity, while others did appear to see work as second-best to motherhood. More traditional women reported having mentors at work than did the other women who did not have children. Ireland speculates that this may be due to the fact that many o f the traditional women did not have an intrinsic motivation to have a career prior to their childlessness and so looked for outside guidance when they began to invest themselves in work. M a n y o f the 31 infertile women in Ireland's (1993) traditional group also reported shifts i n their relationships. Some took on non-parenting relationships with children such as fostering or befriending other women's children. Many o f the women also developed friendships with nonmothers. Ireland suggests that these shifts help a woman develop identifications with things that are not traditionally feminine, and this facilitates the experience o f positive internal shifts i n her identity. These findings lend weight to Matthews and Martin Matthews' (1986) role readjustment and identity transformation  27  constructs as well as Anton's (1992) and Carter and Carter's (1989) suggestion o f developing alternative goals in which to invest the energy that would have gone into parenting. Ireland (1993) also found that the traditional women whose marriages survived the transition not only perceived themselves as having forged some new roles but also saw their husbands as having shifted in their own roles i n order to support the women's new directions. Priorities may influence this: one woman specifically attributed her and her husband's successful adjustment to their shared priorities and values. This finding echoes Carter and Carter (1989), in which the decision to be childfree is founded on mutual priorities and values. A l s o , one woman in Ireland's study whose marriage did not survive the transition noted that she and her husband never resolved their opposing views about adoption. Carter and Carter have also suggested that making a mutual decision about adoption must occur before an infertile couple can choose to be childfree. Ireland also found that the infertile women who more easily developed a positive alternative sense o f self had friends and family, and especially husbands, who affirmed that they were whole despite not having children. A s mentioned, Matthews and Martin Matthews (1986) also emphasize the importance o f social and family support to couples' attempts to reconstruct reality, realign roles, and transform their identities. It appears the women i n Ireland's study who reported noticing their husbands making role shifts experienced this as a supportive response to their own changes. Ireland includes in her book two detailed case studies o f women who mourned their infertility and then re-created a new positive female sense o f self. She doesn't explicitly describe whether there were any women i n her sample who did not make this adjustment, but implies it by suggesting that women who are  28  unable to make the shift continue to feel damaged and less than whole. This has also been suggested by Anton (1992), Carter and Carter, and Matthews and Martin Matthews. Given Ireland's (1993) findings, variations may exist i n the experience and meaning o f childlessness among infertile women, based on the extent to which they have been able to find goals that they consider worthy alternatives to motherhood. Such alternatives might include a newly important career or new relationships. Their experience may also be influenced by their marital satisfaction. However, i n my study it is possible that there may be women i n my study who don't fall into the "traditional" category, that is, infertile women for whom motherhood would have played an important but less than central role i n their conception o f themselves as women. Their experience o f the impact o f their childlessness on their work and relationships could be quite different than it was for Ireland's sample. Ireland's (1993) study is valuable because it represents a fairly systematic, methodologically sound exploration o f women's transition to biological nonparenthood. However, Ireland's findings are limited for the same reasons as Anton's (1992). I f the support o f husbands is so important to wives' adjustment to childlessness, then it makes sense to study both partners in relation to each other. A l s o , presumably husbands have their own adjustments to make, and this may well form a reciprocal process with their wives' transitions. The best starting place to understand how each sex adapts to nonparenthood is i n studying the spouses in relation to each other. One exception to this gender-exclusive focus is a study by Wirtberg (1992), which contains some data on a small number o f infertile couples who elected to remain childless after treatment failed. Wirtberg (1992) explored and described the impact o f childlessness  29  on 29 rural, married Swedish couples who had been involved in infertility treatments between 1 and 5 years. Each spouse completed a questionnaire and a semi-structured individual interview at the outset o f the study and a semi-structured interview at a followup 2 years later. Spouses were interviewed consecutively on the same day. A small subset o f this sample, 6 couples, had stopped treatment and decided to remain childless by the second interview. Wirtberg describes their experience and compares it to a group o f couples still in treatment at that time. These 6 couples, as well as the others in the study, supported traditional male and female gender roles i n terms o f domestic duties, interests, and attitudes toward childrearing. They had strongly wanted and expected to have children as a part o f marriage. Wirtberg (1992) notes that at the second interview these couples generally appeared to be adapting to nonparenthood, albeit with sadness and resignation. Interestingly, these couples tended to report less sexual satisfaction than couples still in treatment. However, they also reported greater ease in communicating about their childlessness than did the couples i n treatment. One woman out o f 6 reported that she felt she would never adapt to childlessness. However, 5 out o f 6 wives appeared not only to be reaching acceptance o f their childlessness, but were doing so earlier than their husbands. These wives said they "compensated for not having children rather w e l l " (p. 155) by developing new interests and exploring their lives. Wirtberg found that they felt relieved to have ended treatment and were less distressed by proximity to children than were 8 women who were still i n treatment. Only one o f the 6 husbands, by contrast, reported satisfactory adjustment, with a new job and a new hobby. The other 5 husbands reported that they were more concerned with their childlessness than they had been at the  30  first interview. They reported confusion about how the decision to end treatment had been made, and a sense o f unfairness about being childless. The situation seemed unreal to several. Some voiced concerns about loneliness and meaninglessness i n old age, as well as whether they could have taken a more active part in helping to overcome the couple's infertility. They noticed their wives' new developments and appeared to feel left out. They reported trying to cope through problem-solving or hiding their own feelings so as not to cause further upset. The shift toward acceptance by these men's wives confused them and they began to focus more on their own reactions to their childlessness. O n examining the reactions o f husbands whose wives were still in treatment at the second interview, Wirtberg found that they were focussed on their wives' feelings and seemed fairly uncommunicative about their own reactions. This finding suggests that gender differences do appear to exist in the process o f coping with, and responding to, infertility and permanent childlessness. Wirtberg (1992) also examined the family sociology concept o f "joint projects" (p. 156) in her study. According to this literature, joint projects facilitate common goals and increase a couple's cohesiveness. Wirtberg found that 4 o f the 6 couples who decided to remain childless regarded their dogs as joint projects. Wirtberg suggests that these joint projects provided the couples with outlets for their nurturing energies. I would also suggest that engaging in joint projects involves the mutual priorities and values that help couples make a successful transition to nonparenthood, according to Carter and Carter (1989) and to one o f Ireland's (1994) participants. Joint projects may also give couples opportunities to explore and solidify new role-identities, one o f the tasks proposed by Matthews and Martin Matthews (1986).  31 Finally, Wirtberg (1992) explored whether significant events had changed the perceptions o f the 14 couples in the study who were childless at the second interview. Nine couples (31%) indicated that they had had experiences that had helped them decide to end treatment or initiate adoption proceedings while still in treatment. These experiences were usually unexpected, spontaneous, and out o f the couple's control. They were also diverse, including things such as accidents, dreams, medical prognoses, treatment waitlists, pain, and the study interviews. Carter and Carter (1989) and Anton (1992) have suggested that changes i n perception are an essential step i n resolving permanent childlessness, and Wirtberg seems to be trying to extend this by exploring what might trigger such shifts. The works critiqued in this literature review suggest that infertile couples may have quite different experiences o f permanent childlessness, that men and women may experience childlessness differently, and that the experience may change over time. Salient aspects o f the lived experience o f permanent childlessness might include experiences o f loss and grief, the value placed on parenthood, goal reformation, role flexibility, perceptions o f support, communication and decision-making processes, unexpected life events, and marital satisfaction and mutuality. Wirtberg's (1992) findings suggest that it w i l l be important to be alert to the possibility that a significant number o f husbands in my study may describe a more challenging experience o f permanent childlessness than their wives. Unfortunately, we don't know from Wirtberg's study whether the experience changed over time for the 5 husbands who appeared to be having difficulty in the follow-up interview. This finding is also interesting i n light o f the mixed research findings on adjustment to infertility, much  32  o f which suggests that men have less investment in parenting and adapt more easily to infertility than do their wives. Carter and Carter (1989) suggest that some husbands are more likely to become stuck in the grieving process. This could presumably lengthen their transition period i f not derail it altogether. However, another possibility given Wirtberg's findings is that i f a husband initially copes by supporting his wife, then this may affect the timing o f his own experience o f their childlessness. He may only appear to be stuck when his adjustment is compared with hers at a certain point. A husband's primary concern for and focus on his wife's adjustment may also be related to what some o f Ireland's (1994) participants perceived as their husbands shifting roles i n order to support them. Finally, gender socialization may influence a husband to focus on his wife's adjustment i n order to avoid his own emotions. Clearly, more needs to be known in this area. Sorting out these complexities in my proposed study could be challenging as Carter and Carter (1989) and Wirtberg (1992) suggest that men may be reticent about their own emotional process. This may be either because they are unsure what their feelings are, or because, through gender socialiation, they are hesitant to express them. In this study, which is based on in-depth interviews with infertile couples, it may be that the men i n the sample w i l l be less able or inclined than their wives to verbalize their own experience o f lived childlessness. Wirtberg's (1992) study contributes to what is known about the topic o f accepting and adjusting to permanent childlessness by providing data on gender differences with respect to timing. Her comparisons between the 6 couples in the sub-sample and the couples still i n treatment at the follow-up support the contention that ending treatment is an important facet o f acceptance. They also suggest that acceptance goes hand i n hand  33  with redirecting nurturing energies into other life areas and projects. This i n turn lends support to the other models described i n this review. In terms o f limitations, Wirtberg's (1992) sample is very small and homogenous and the findings thus can't be generalized. The female interviewer may have had a gender-bias effect i n that the women may have been more inclined than the men to reveal themselves during the interviews. Despite this possibility, we don't know whether the women experienced any felt changes to their feminine identity. A s well, while some couples i n the study suggested that certain events influenced their perceptions and decision-making, we don't know whether the process they went through resembles what Anton (1992) or Carter and Carter (1989) have proposed. It seems reasonable to assume that the women who ended treatment had a more positive sense o f themselves and their lives given that they were interested i n exploring new things. However, we don't know i f this is so, or how it fits with the sadness and resignation they expressed to Wirtberg. Statement o f the Problem Interest appears to be increasing as to the nature o f the experience infertile couples undergo when they elect to remain childless or choose not to pursue other parenting options after failed infertility treatments. However, the number o f existing studies or articles that explore this experience and what it means to infertile couples is very small (Anton, 1992; Carter & Carter, 1989; Ireland, 1993; Matthews & Martin Matthews, 1986; Wirtberg, 1992). There are also several problems with the available literature. First, most o f it lacks rigour, so we can conclude little about the validity or generalizability o f the findings. It is important for clinicians to base their interventions with infertile couples on theoretical models that are backed up by sound research. Second, we still k n o w little  34  about the experience o f deciding to remain permanently childless and what it means to infertile married men and women because the studies tend either to examine only women or to treat the couple as an undifferentiated unit. Only one study (Wirtberg, 1992) explored with some empirical rigour the experiences o f and differences between infertile husbands and wives i n their adjustment to childlessness. However, the number o f couples was quite small and not necessarily representative o f infertile Canadians. Overall, we still know little about the nature and meaning o f the experience o f husbands' and wives' adjustment to permanent childlessness once they choose not to pursue other parenting options, or how that experience may change over time. It is reasonable to study this experience for married infertile couples i n greater . depth for two reasons. First, most people who experience permanent childlessness after failed infertility treatments at this time are married heterosexuals. Second, there are still very few studies that explore the differences between husbands' and wives' experiences of permanent childlessness after infertility, and how they influence each other i n living out and deriving meaning from that experience. Gender socialization around parenthood, for example, may mean that men tend to find the experience o f permanent childlessness to be less difficult than their partners. Studying how infertile couples decide to remain childless after failed infertility treatments and how they experience this path i n life may help us to understand more about their counselling needs.  35  Chapter Three Methodology Method Selection The purpose o f this study was to examine the lived experience o f permanent involuntary childlessness and the meaning o f this experience for couples who have chosen not to pursue other parenting options after failed infertility treatments. A qualitative phenomenological method was considered appropriate for this type o f investigation - one that seeks to elicit the meaning o f a human experience as given to it by the person or persons who have experienced it. Qualitative phenomenological methods generally help researchers to illuminate phenomena and to bring forth thematic meanings o f a human experience (Osborne, 1994). These methods do this through focussing intensively on an individual's subjective experience, feelings, personal views o f the world and self, and private concepts (Colaizzi, 1978). Because little is known about the nature o f the lived experience o f permanent childlessness and how infertile couples make this transition, this study was exploratory and descriptive. According to Colaizzi (1978), the necessary first step i n identifying and understanding any phenomenon is to describe it i n detail as people have experienced it. Phenomenological methods facilitate the understanding o f a lived experience by allowing for meaningful contact with people who have experienced a phenomenon through eliciting their feelings, descriptions, and attitudes regarding the phenomenon. A l s o , these methods entail observing and describing as closely and carefully as possible those elicited feelings, descriptions, and attitudes toward the phenomenon, in this case permanent  36  childlessness after infertility, which help the researcher render a faithful account o f the participants' lived experience (Colaizzi, 1978; van Manen, 1984). Personal Assumptions and Bracketing Colaizzi (1978) defines objectivity in qualitative research as close attention to the phenomenon itself, through the feelings, descriptions, and attitudes o f people who have experienced it. Nevertheless, he acknowledges that researchers are unable to be purely objective. Personal interests and views inevitably colour and may distort research activities and interpretations. Through a process o f "rigorous self-reflection" (Osborne, 1990, p. 81) known as bracketing, it is important for the researcher to make clear her interests and assumptions in order to be aware o f possible biases i n interpreting the findings, and so that readers can take her perspective into account in evaluating whether the study has been faithful to the participants' lived experiences. In terms o f bracketing my own assumptions, I became interested i n the experience of permanent childlessness around the time I became a mother. Personally, I was ambivalent about trying to having a child, and experienced feelings o f pressure to do so. I also witnessed friends and family, some o f whom struggled with heartbreaking experiences o f infertility, others who seemed to accept their inability to have biological children with relative equanimity, and still others, presumably fertile, who clearly expressed satisfaction in not having children. Through witnessing this and experiencing my own joy when I did decide - and was able - to become a mother, I became sensitized to, and curious about, the emotional intensity surrounding the "to parent or not to parent" decision. M y ambivalence toward motherhood prior to my daughter's birth, and the importance I have always placed on other life roles such as work and personal growth,  37  suggested to me that my own gender identity has been shaped i n some ways that are not considered traditionally female in my culture. I tend to value equally a diverse array o f meaningful outlets, including mothering, for my energies. I believe that, had I not had a child, I could have been content as a childless woman. I also highly value change and have experienced my own life transitions as periods o f great growth, particularly those that were often the most painful. Finally, my orientation as a counsellor is narrative and feminist. I emphasize creating space i n which to gain a view o f how one is affected by oppressive social practices and then to seek ways to stand up to those practices and create more satisfying realities. These beliefs and experiences may have influenced me to make assumptions or judgements about what the adjustment to permanent biological childlessness ought to look like. Additionally, they may have combined with my reading o f the literature on infertility and involuntary childlessness to influence what I expected to find i n this study. M y most pronounced expectation was that there would be wide diversity i n couples' reported adjustment to the decision to remain permanently childless. I expected that the greatest ease i n making the transition would be reported by couples where both partners had a goal that was equally or more important than a child, such as work or their relationship, while any couples who seemed to make little or no progress during the study would have struggled to find any meaningful alternative to parenthood. I also expected that the couples i n my study who took responsibility for their lives by demanding appropriate treatment and respect from medical professionals, and who sought information and knowledge about their situation would report an easier adjustment to permanent childlessness.  38  In terms o f differences between husbands and wives, I expected to see conflict or less closeness between couples whose priorities didn't mesh, such as couples where one spouse highly valued parenthood and the other did not want to adopt. Generally, I expected that the husbands would report an easier transition to nonparenthood than their wives and that they would be less forthcoming about their own emotional experience, although my personal assumption is that this would have more to do with gender socialization than lack o f emotional investment in fatherhood. O n the whole, however, I assumed that most i f not all couples would resolve at least some o f the problematic aspects o f their experience o f childlessness over the length o f the study. One potential bias stemming from my beliefs and assumptions is that i n analyzing and reporting the data, I may have under-emphasized the difficulty inherent in living the experience o f permanent childlessness. However, my orientation as a counsellor may also have helped me to be more alert to the social context that shaped the experience o f permanent childlessness for the couples in this study and informed some o f its themes. Participants The participants i n this study were a subset o f a larger group who participated in a longitudinal qualitative and quantitative study exploring infertile couples' adaptation to permanent biological childlessness once they had decided to end medical fertility treatments (Daniluk, Taylor, & Pattinson, 1996). The participants i n Daniluk et al.'s study were recruited from several major Canadian cities. Recruiting was done v i a newspaper stories, radio interviews with the principal investigator, and notices placed at infertility clinics. O f the 38 couples in Daniluk et al.'s study, a subgroup o f 9 couples had chosen  39  not to pursue other parenting options such as adoption, in contrast to the rest o f the couples. These couples were the focus o f this study. The 9 couples met the inclusion criteria for Daniluk et al.'s (1996) study, which included: (a) being a member o f an infertile couple with no biological children; (b) having terminated all medical infertility treatments; (c) having no history o f psychiatric problems; (d) not requesting the reversal o f a voluntary sterilization procedure. The participants ranged i n age from 29 to 48 at the time the study began. The lower range o f combined annual household income was $15,000 - $25,000 and the upper range was over $50,000. A t the beginning o f the study, 6 o f the 9 couples considered their childless status to be permanent, while two saw it as uncertain. In the final couple, the husband viewed it as uncertain, while the wife saw it as permanent. A l l the couples intended not to pursue any other parenting options. Three-quarters o f the participants, who were all o f European descent, stated that having children was an important value in their families o f origin. In phenomenological research the focus is not on the quantity o f information but in richness, or description o f sufficient depth to capture a lived sense o f the experience for the participants (Colaizzi, 1978; M c L e o d , 1994). Given that i n many cases 5 participants constitute an adequate sample size in which to observe data clustering around central themes, with no new themes emerging i n subsequent interviews (Osborne, 1994), it was expected that 4 interviews with each o f the 9 couples would amply illuminate the phenomenon o f lived permanent childlessness after infertility.  Procedure  40  This study involved the secondary analysis o f data that were gathered through a phenomenological study that explored the meaning and lived experience o f the transition to biological childlessness for infertile couples (Daniluk et al., 1996). A l l the participants in that 3 year, longitudinal study completed a questionnaire package as well as in-depth, unstructured, tape-recorded interviews at four different intervals: within the first 2 months after they ended medical fertility treatment; and again at 11 months, 21 months, and 31 months after the termination o f treatment. Each interview was conducted by a female interviewer who was a counsellor trained in phenomenological data collection. O n every occasion, each couple was interviewed together i n their own home after completing the questionnaire package, and each interview lasted approximately 1.5 to 2 hours. The focus o f the interviews was on "learning more about how couples live with and integrate the experience o f infertility and biological childlessness into their lives and begin to construct a future life without biological children" (Daniluk et al., p. 6). The procedure used in Daniluk et al.'s study is consistent with the research question in this study that explores how the couples who elected not to pursue other parenting options lived with the experience o f permanent childlessness and how they too began to reconstruct their future lives. Data Analysis Because o f the nature o f this study, only the qualitative interview data were considered. Each o f the interviews i n this study was transcribed verbatim and analyzed using Colaizzi's (1978) method o f phenomenological thematic data analysis. For each transcript, or protocol, the following process was used. First, the entire transcript was read in order to gain a sense o f the whole. Second, significant phrases or words were gleaned,  41  and statements or headings were then created to capture the meaning o f each phrase. Similar statements o f meaning were clustered into themes. This part o f the process constituted a within-persons analysis (Osborne, 1994). After each protocol had been analyzed, the researcher then conducted an across-person analysis (Osborne), i n which common themes were identified across the 9 couples' experience at each o f the 4 stages o f the study. The next stage i n the data analysis involved enriching and validating the identified themes. This was done through a process o f repeated discussions and dialogue about the identified themes between this researcher and the primary researcher o f the Daniluk et al. (1996), combined with repeated returning to the protocols to ensure that the developing analysis remained true to the participants' experience. A s well, this researcher also read the thematic analyses o f up to four co-researchers in the original study to check that the emerging themes were consistent. This process was conducted i n order to deepen the analysis, bringing forth both the overt and implied meanings o f the lived experience o f permanent childlessness for each couple at the four stages o f the study. Consulting with the primary researcher and co-researchers' work, and paying very close attention to the protocols themselves was important i n order to ensure that the thematic analysis truly represented the lived experience o f the participants. This was important given that validation interviews with the participants were not possible due to the amount o f time that had elapsed between the original study and this one. However, it should be noted that in the original study, a validation process did occur in which a number o f couples from across Canada were consulted and validated the themes o f the original study. The themes that emerged i n this study describe the participants' lived experience o f permanent  42  childlessness i n greater detail and depth than did the original study, and are also consistent with the themes that emerged i n that analysis. Finally, as rich an account as possible was distilled from the results o f this thematic analysis i n order to develop an "exhaustive description o f the investigated topic" (Colaizzi, 1978, p. 61) to illuminate the lived experience o f permanent childlessness by infertile couples who had decided not to pursue other parenting options. This account was validated by the primary researcher in the study by Daniluk et al. (1996). Limitations Some o f the limitations o f this study were similar to those in Daniluk et al.'s (1996) study. One such limitation was the fact that there was relatively little demographic variation among the study participants. The majority o f participants i n this study were white, well-educated, middle and upper-class Canadians o f European descent. The lived experience o f permanent childlessness may be quite different for couples who, for example, are from other cultures or who lack the financial resources to pursue medical treatments for infertility i n the first place. The experience may also be different for lesbian couples or couples whose relationships don't survive the stresses o f infertility. Daniluk et al. (1996) noted that the number o f couples whose cause o f infertility was unexplained was disproportionately high i n their study (54% versus 10% in the general population o f infertile people), and that their results may not be generalizable to other couples who are involuntarily childless. The same limitation exists for the sample used i n this study, as 8 o f the 9 couples had received a diagnosis o f unexplained infertility. The results may therefore not be generalizable to infertile couples who have received a definitive diagnosis and who elect not to pursue other parenting options.  43  Another possible influence on the data in this study may result from the interview procedure. The fact that couples in this study were interviewed together may have skewed the data i f one spouse did not wish to reveal information i n front o f the other that they would have revealed to the interviewer alone. Because little is known about the phenomenon o f permanent childlessness after failed infertility treatments, this study is exploratory in nature. According to Colaizzi (1978), the results o f a single phenomenological study can be neither conclusive nor generalizable. However, Colaizzi also suggests it is through an accumulation o f such exploratory studies that theory and future research around any given phenomenon are shaped. The fact that this particular study involves 9 couples from whom data were gathered over a 3-year period helps to make it more robust than many phenomenological studies which involve fewer participants at a single cross-section o f their experience. The fact that it was not possible to directly validate with the participants the themes that emerged i n this study, may constitute a limitation to its validity, although significant measures were undertaken to minimize the effects o f this limitation.  44  Chapter Four Findings Introduction In this chapter, I explicate the significant themes that emerged from analyzing the interviews with the couples in this study. A l l or almost all o f the couples made comments that related to each o f the identified themes. These themes are therefore considered to be relevant to all or almost all o f the couples in this study. However, significant differences were found between some spouses, as well as across couples, in terms o f how these themes operated in their lives with respect to their adjustment to permanent childlessness. These differences w i l l also be brought forth. Generally, the themes that w i l l be discussed are: (a) the need to protect themselves; (b) a sense o f lessening emotional intensity; (c) a sense o f regaining control; (d) a need to revision life and identity; (e) a sense o f appreciation for the strength o f their relationship; (f) a sense o f recognition and reconciliation to their fate; (g) a need to make sense o f their experience. Couple Biographies Couple One - Roberto and Carol. Roberto and Carol had been seeking medical assistance to have a biological child for 20 years, substantially longer than any other couple i n the study. Carol is Canadian and Roberto is Swiss. They have a combined family income o f $15,000 - $25,000 per year, and live in an urban area i n Alberta. Carol was not working at the time o f the study. Both indicated that having children was an important value in their families o f origin. They were 42 and 43 years old respectively at the time the study began. Carol and Roberto had received a diagnosis o f unexplained infertility. They referred to infertility treatment as having been a nightmare for them,  45  with Carol experiencing rare drug reactions and devaluation by her doctors. They had attempted drug therapy using an experimental fertility drug, and after Carol's negative physical reactions, had tried drug-free I V F . This couple appear to have traditional gender identities and roles. Roberto clearly values having a biological child in order to continue his family's bloodline as well as to experience fatherhood. He could not accept adoption as a valid parenting alternative, saying he was afraid he could not bond with a child that was not his own. H e appeared to have closed the door on the couple's infertility by the study's end and, while he continued to feel the loss, refocussed his energies on the couple's cats and his hobby o f repairing clocks. Carol, on the other hand, grappled throughout the study with a deep sense o f meaninglessness and pain, seeing childlessness as her failure to fulfill her purpose as a woman. For her, adoption was a valid alternative to biological motherhood. She stated i n the final interview that, for her, acceptance o f the couple's infertility could only come through a biological or adopted child. The couple appeared to experience increasing tension over time regarding their divergent desires around adoption, as well as Roberto's sense o f helplessness i n the face o f Carol's additional traumas. There was a sense that these traumas continued the assault on Carol's self-esteem and self-image that began with infertility. A debilitating illness that eluded diagnosis for a long time, quashed her plans to return to school and forced her to leave work. These losses were coupled with her sense o f rapidly fading youth. She did appear to make some gains in terms o f her self-esteem, as she took responsibility for managing her illness and found satisfying alternative treatments from respectful practitioners. She also sang and found it to be a very therapeutic hobby that she said helped to ease the dark times. B y the  46  end o f the study, Carol appeared to have found her grief over the couple's childlessness to be somewhat less intense. Both spouses appeared to focus a lot o f energy on coping with Carol's difficulties and losses. Roberto urged her to accept their childlessness, and sought ways to give her practical help with her other difficulties. When he perceived that his efforts were having no effect, he experienced great frustration and anger later i n the study. H i s feelings, plus Carol's lingering sense o f desperation for a child, led to their decision to get counselling. They described this time as a crisis in their marriage. Through counselling, she began to experienced some relief from her despair, while he realized his need to claim and express his own feelings. A s well, Carol and Roberto appeared to experience their lack o f social contact as yet another loss. They described having some social contact but also expressed a clear sense o f not fitting in with people, and o f working very hard to maintain the connections they did have. They were hampered i n their efforts to make new contacts by her illness, their need to protect themselves from too much contact with children, and a move to a new city. Overall, although there was a sense that this couple was beginning to heal i n some areas o f their lives, and that they appreciated the strength o f their marriage, their experience o f biological childlessness and the other setbacks in their lives continued to challenge their relationship and their individual self-images. Couple T w o - Chas and Jill. Chas and Jill sought medical assistance to try to conceive for 5 years before ending treatment, and indicated that having children was an important value i n their families o f origin. They had been given a diagnosis o f  47  unexplained infertility. They ended treatment after drug therapy, surgery, and two I V F trials i n which fertilization had not occurred. Chas was 42 years old and Jill was 41 when the study began. Canadian-born urban-based professionals who live i n B . C . , they have a combined income o f over $50,000 per year. They were relieved to end treatment but both felt it was hard to close the door on having children. Jill experienced several bouts o f depression early i n the study, and both spouses reported feeling a loss o f energy or interest for things that once gave them pleasure. Over the course o f the study, Jill and Chas did appear to accept their childlessness and to begin to rebuild their lives and sense o f self. For Chas, this process was complicated by the death o f his mother, which seemed to further enervate h i m during a time when Jill was regaining her energy and optimism and enjoying her work with renewed vigour. However, by the final interview he too described feeling renewed through work and his hobby o f photography. Both partners believed that consciously choosing to move on with their lives i n spite o f their childlessness was an important factor in their adjustment. For J i l l , giving herself permission to take care o f herself, to enjoy creative pursuits, and to balance work and other aspects o f her life also appeared to be important i n her healing. She found that she no longer distanced herself emotionally from the mothers and children in her chiropractic practice, as she had needed to do earlier i n her adjustment. Both spouses, by the study's end, appeared to be shifting from feeling defensive and passive to feeling assertive and active. They were very conscious o f seizing the opportunities they perceived i n a childless life. There was a sense that the loss o f not having children would never be gone entirely, but that it had become more peripheral. Throughout the study, Chas and Jill enjoyed and highly valued their relationships with  48  their relatives' children. Although through most o f the study they had felt a lack o f social connection and community, by the final interview they appeared to be reaching out more and to be less vulnerable to negative social judgements around their childlessness. The greatest struggle for this couple in their experience o f adjusting to involuntary childlessness appeared to be around their divergent desires regarding adoption. Jill wanted to explore the option in order to maintain her sense o f control and choice, while Chas appeared first to want to avoid it, and then to actively resist it, leading to a sense o f strain in the relationship. B y the end o f the study, Jill had chosen not to let this difference hold her back from getting on with her life, and appeared emotionally to be fairly peaceful with the decision, although she said she had not fully let it go. Couple Three - Claude and Cindy. Claude was 34 and Cindy was 29 when the study began. They had received a diagnosis o f unexplained infertility, and had ended treatment after 5 years. They had had drug therapy and surgery, ending treatment due to the prohibitive cost o f I V F . The couple have a combined income o f over $50,000 per year and live in an urban area. Cindy said that having children was not an important value in her family o f origin, while Claude said that it was. Both spouses have a high school education. A notable aspect about the interviews with Cindy and Claude was the clear sense they had o f themselves as a family. They described having parent-type relationships with their nieces and nephews. Claude and Cindy saw themselves as making important contributions to the children's happiness and well-being, and this, as well as caring for their pets, appeared to absorb much o f their nurturing energy and cushion the blows o f  49 infertility and childlessness. This couple also appeared to experience strong social and family support around their infertility and childlessness, with few exceptions. Nevertheless, Cindy still grieved the loss o f a biological child, and said that she thought their childlessness was her problem, despite their unexplained infertility diagnosis. There was a sense that Claude's steady support and refusal to blame her for their infertility was a source o f comfort and pride for her. For his part, Claude appeared to reconcile himself to the couple's childlessness with greater ease. He said their marriage had always been more important to h i m than parenthood, and that he had known when they married that Cindy believed she was unable to have children. Both appeared w i l l i n g to adopt i f a child were offered to them, but were not prepared to register for adoption, saying they did not want to put their lives on hold as they had during treatment. A s they came to accept their childlessness, Cindy and Claude talked less about parenting a child o f their own, and more about the possibility o f foster parenting or assuming guardianship o f one o f their nieces and nephews. Claude also stated that he now preferred to think o f them as a career couple. Cindy seeemed to struggle for a time with recreating her sense o f identity as a childless person. During this time, she also described feeling that her self-esteem had been assaulted through the social insensitivity o f an acquaintance regarding their childlessness, and conflicts at her job. She quit work and moved to a ski h i l l where Claude worked in the winter. Here, she struggled to carve out a meaningful role for herself. However, during this difficult time, she also appeared to be optimistic and to have found a very fulfilling pursuit i n song writing. B y the end o f the study her plan to go to University had become a very important goal for her.  50  Couple Four - Archie and Denise. Archie was 39 and Denise was 38 years old at the beginning o f the study. They had received a diagnosis o f unexplained infertility and had ended treatment after 11/2 years o f infertility workups and tests, due to the emotional strain o f the process and the disruption o f their sex life. They had been trying to have a child for about 6 years altogether. Both spouses are University graduates from Britain, with a combined income o f more than $50,000 per year. They live i n an urban centre i n B . C . Denise said that having children was an important value in her family o f origin, while Archie said it was not. The most salient struggle for this couple focussed on their frustration and anxiety around revisioning their future lives and identities after a series o f traumatic critical events. While they stated fairly early i n the study that they were moving toward a coupleonly family and had put their infertility behind them, they also appeared to feel paralyzed by the sense o f having too many options now that their expectations o f their future lives had been shattered. Further, Denise began receiving medical and psychiatric treatment for mysterious health problems that were ultimately diagnosed as depression, while Archie was fired from his job. They were also affected by the deaths o f several friends. B y the end o f the study, this couple appeared to be coping with these multiple critical events by normalizing their day to day lives, putting their energies into self care and weekends away with each other. They were also reinvesting some energy into activities such as skiing, and Archie appeared to be exploring how to develop self-esteem and a sense o f identity from roles other than work. Emotionally, Denise and Archie appeared to have moved from a state o f anxiety to feeling calmer about living with an ambiguous future. They had a sense that their future held very big changes, possibly in terms o f leaving the city and  51  taking up a new line o f work together. They stated that infertility was a closed issue that no longer affected their lives. This couple also appeared to enjoy a keen sense o f solidarity and mutual support in their relationship, despite the stresses they were under. Couple Five - Peter and Alice. This couple, Peter and A l i c e , had ended their attempts to have a child after 4 years o f infertility treatment, including drug therapy, surgery, and artificial insemination. They had received a diagnosis o f unexplained infertility. Peter said that having children was an important value i n his family o f origin, while A l i c e said it was not. British-born university graduates who became Canadian citizens during the study, they live in an urban centre and have a combined income o f over $50,000 per year. They were both 35 years old when the study began. A l i c e and Peter had been given an infant to adopt, but the birth mother had taken the baby back after only 4 days. Where they previously felt they had been moving toward accepting their childlessness, the grief and love they experienced for this baby re-ignited their longing for a biological child, and they put their names on an I V F waitlist. This decision resulted in a sense o f renewed energy and hope i n their second interview, as well as some distance from the trauma o f the failed adoption. They experienced their social network as supportive, but occasionally felt burdened by the expectations they perceived that others had for them to obtain a child. When Peter and A l i c e experienced a 6 month separation for Peter's work, they appeared to pull back from their struggle for a child and gain a perspective that resulted i n the decisions to end treatment and not seek adoption. They said that they based these decisions on the low likelihood o f getting a child, and their need to begin putting themselves first in their lives. This need was sharpened by the perception that they were  52  nearing an age where parenthood no longer fit their image o f themselves. A s a result o f the separation and o f deciding to move on with their lives, Peter and particularly A l i c e developed significant new interests, writing a book and running marathons, respectively. They also described a sense o f great personal growth. B y the end o f the study, they appeared to have be living a satisfying, couple-oriented lifestyle. They had also reassessed their social relationships, leaving behind several who were unsupportive o f their new focus, and making new friendships and connections. During this process, Peter and A l i c e were not always in sync. B y the third interview, Peter was in transition with respect to reinvesting his energies, while A l i c e described herself as thoroughly energized and fulfilled by running marathons, as well as by her discovery that she was a capable individual with leadership qualities. B y the end o f the study, both partners did appear to be in the same place in their lives, having both resolved to create fulfilling futures without children. They had purchased a n e w home and vehicle, as well as two dogs. A t no time i n the study did their different rates o f growth and adjustment appear to be a problem for them. Couple Six - David and Tracey. David was 41 and Tracey was 32 when the study began. They have a college and a University education respectively, and a combined income o f $25,000 - $50,000 per year. David farmed and Tracey worked as a nurse i n the small town in Winnipeg where they lived for most o f the duration o f the study. D a v i d said that having children was not an important value i n his family o f origin, while Tracey said that it was. They had been given a diagnosis o f unexplained infertility and had sought medical treatment for 4 years. Their treatments had included drug therapy and surgery.  53  Tracey and David appeared to move toward acceptance o f a child-free life after a painful adjustment i n which David, who did not particularly want children, resisted adoption, while Tracey found not parenting to be a bigger loss than not bearing a child. After D a v i d agreed to adopt for Tracey's sake, she realized she did not want to go through with it without his full committment. Tracey saw resolution as choosing her husband over a potential child. David appeared to accept their childlessness easily, describing himself as being more aware o f the responsibilities than the joys o f parenthood. A s this couple began to consider how to create a satisfying lifestyle without children, they talked more about the advantages o f not having children, as well as the struggles o f parents they knew. B y the final interview, they had sold their farm and were contemplating a retirement-type lifestyle. This appeared to be somewhat disconcerting for Tracey, who was 9 years younger than David. The motivation to sell the farm appeared to stem from David's revisioning around what to do for work without an heir to inherit the farm, as well as some economic difficulties that appeared to negatively impact his self image and self esteem. Tracey was concerned about David and, near the end o f the study, described his happiness as a major goal for her. The other salient struggle for this couple lay in their sense o f social isolation and rejection. The circumstances o f their work, rural living, and two deaths i n the family, contributed to their feelings o f being very much alone. Isolation and feelings o f rejection were particularly hard for Tracey to incorporate into her self-image as a popular and friendly person. She struggled with this throughout the study, although some healing was apparent when she began to perceive other possible reasons for people's behaviour toward  54  her. D a v i d found their isolation less troubling than Tracey, but did appear to value and enjoy social contact when the opportunity arose. Couple Seven - Ira and Sarah. Sarah was in her early 40s whereas Ira was 48 when the study began. They had received a diagnosis o f unexplained infertility and their medical treatment had been terminated after 7 years, when Sarah turned 40. During treatment, Sarah had had drug therapy and extensive surgery, due to the same investigations being repeated at different clinics. Sarah was not employed at the time o f the study, while Ira earned $25,000 - $50,000 per year. Both are Canadian and they live i n a city in central Canada. Having children was described as an important value in both families o f origin. Through the first half o f the study in particular, Ira and Sarah grappled with anger and emotional pain around the loss o f a biological child and what they perceived as medical mismanagement o f their infertility treatment. That their treatment had been terminated by the clinic when the Sarah turned 40, rather than being their choice, had been especially painful. Sarah recalled being briefly hospitalized around that time because she had felt suicidal. Ira and Sarah sought a support group and, finding none in their area, formed their own. The group was a success, and the support they were able to give as well as receive appeared to be extremely gratifying. One o f the most notable things about this couple was the effect o f Sarah's decision to have a hysterectomy. She had experienced a number o f setbacks during the study including depression and an injury from a car accident. A s well, she had been diagnosed with osteoporosis and learned that she would continue to have periods under hormone replacement therapy. She convinced her doctors to do a hysterectomy. Finally being able  55  to have some control over the medical process, and to be freed from her body's reminders of childlessness, allowed her to put some closure to their infertility. Ira had also had a vasectomy which he called a gesture o f resolution. He appeared to mourn the loss o f a biological child, but believed that his grief was milder than Sarah's - more resolved - and he felt he had begun the process o f resolution earlier than she had. He also stated that he had not married until 40, so that for him, resolving childlessness meant going back to his previous lack o f expectation regarding parenthood. After Sarah's hysterectomy, the couple continued to express anger about the way their treatment was handled, but were beginning to move on with their lives. Their childlessness was also a less central issue for them. They talked about seeking meaningful work goals for Sarah, as well as how to define themselves in more positive terms than they felt they could during the infertility process. However, Sarah also stated that childlessness would never be a fully resolved issue for her, and disagreed with the notion o f choosing to be childfree, saying that it denied the seven years they struggled to have a child. Ira and Sarah appeared to have very little support from anyone outside o f their infertility support group, and said that they had experienced much social insensitivity and job discrimination because they had no children. Sarah's family appeared to be oblivious to their losses, which had included three miscarriages. Not surprisingly, a substantial part of each interview was given to her anger and frustration at trying to get her family to acknowledge and validate their struggle. They found Ira's family marginally more supportive, but by the end o f the study had distanced themselves from both families out o f  56  frustration. There was a sense that this perceived lack o f respect and support made their healing more challenging. Couple Eight - Randy and Tina. Randy was 37 and Tina was 36 when the study began. They have university and college degrees respectively, and a combined income o f over $50,000 per year. Having children was an important value i n both o f their families o f origin. They had received a diagnosis o f male factor infertility, which treatment apparently resolved. They had also had other surgeries, drug therapy, and intrauterine insemination. They then achieved two pregnancies over the course o f nine I V F cycles, but both ended i n miscarriage. Tina and Randy ended their treatments after 8 years. A t the first interview, they described themselves as having chosen childfree living. Tina and Randy expressed some feelings o f depletion and disequilibrium early in the study, especially i n terms o f being unsure about how they wanted to revision their future. However, they generally appeared over the course o f the study to have adjusted very well to a childless life. They seemed to perceive numerous advantages o f childfree living and to have similar coping styles and values. For example, both Randy and Tina said that although parenthood had been an important goal, their relationship with each other was the main reason they were together. Both also said that they did not view their identity in terms o f parenthood. Further, when they realized they would not have children of their own, both partners continued to enjoy relationships with their relatives' children. Essentially, Tina and Randy appeared, throughout the study, to be focussed on living i n the moment and to be tentatively exploring their options for the future with a sense o f optimism.  57  Their family and social network had been consistently stable and supportive, and Randy and Tina had had relatively positive experiences during their infertility treatment. The only significant difference this couple expressed was early i n the study when Tina wanted to disclose their infertility to people i n order to educate them, to Randy's discomfort. They appeared to communicate effectively around this difference and later in the study it became less o f an issue as Randy expressed diminishing concern with others' judgements about their infertility. In the last interview, they described their infertility as being a past issue and, because o f this, were eager to end their participation in the study. Couple Nine - Chuck and Margaret. Margaret and Chuck were both 29 years o f age at the beginning o f the study and have college and University degrees, respectively. Margaret earns less than $15,000 per year and Chuck earns over $50,000 per year. They live in a small town i n northern Ontario. The couple ended their infertility treatment after 5 years. They had attempted intrauterine insemination four times, as well as having drug therapy. Having children was an important value in both o f their families o f origin. In the first interview, both Margaret and Chuck appeared to be grieving the loss o f a biological child. Margaret in particular experienced strong emotional reactions that left her shaken, including a total aversion to children and people with children. She described this as being very difficult for her as all o f her nursing coworkers have children. She expressed great relief at realizing, through reading and the limited counselling she could get i n the small town where she lives, that her reactions were normal. B y far the most significant event over the course o f the study for this couple was Chuck's bout with cancer between the first and second interviews. This critical event shifted their perspective on their childlessness, facilitating a greatly heightened awareness o f and  58  appreciation for their present lives. It also improved their perception o f the medical establishment. For Margaret, Chuck's cancer not only helped her to let go o f the hope for a child and choose to move on with her life, but appeared to facilitate her focus on what she wanted to do i n terms o f work. Initially, she felt that work had become more important to her because she needed the security it would provide i f Chuck died, but by the final interview she was focussed on finding a more fulfilling career. Another significant challenge that Chuck and Margaret faced during the study was social isolation. Surrounded by couples with children in an isolated small town, the absence o f a stable support system, not surprisingly, appeared to challenge them i n their adjustment to infertility and childlessness. Interestingly, they found that this situation improved significantly when Chuck had cancer because their struggle i n this case was visible and relevant to more people. B y the end o f the study, Margaret and Chuck had begun to enjoy new friendships with older couples whose children had grown, but were also contemplating moving to another province to seek a more stable economic as well as social situation. Identified Themes The themes that are discussed below reflect the themes that are common to the couples i n this study. Direct quotes from the couples' interviews are used wherever possible to support and enrich the themes. It should be noted that the order i n which the themes are presented is not intended to represent a particular sequence i n terms o f couples' adjustment to permanent childlessness. The identified themes are: (a) a need to protect themselves; (b) a sense o f lessening emotional intensity; (c) a sense o f regaining control; (d) a need to revision life and identity; (e) a sense o f appreciation for their  59  relationships; (f) a sense o f recognition and reconciliation to their fate; (g) a need to make sense o f their experience. A Need to Protect Themselves. This theme seemed most salient in the initial interviews with these couples, and the frequency and intensity with which couples described this need diminished in later interviews. The theme appeared to encompass both the couples' desire to limit their exposure to the full extent o f their emotional pain, and to impose some degree o f control over the unpredictability o f the back-and-forth adaptation process. M a n y o f the couples reported strong feelings o f grief that were often described as close to the surface, and easily and unpredictably triggered. They also talked about dealing with these feelings o f loss in a landscape crowded with friends and family members with children. They often reported experiencing insensitivity or intrusion with respect to their childlessness. Distracting themselves by keeping busy, distancing themselves physically from child-oriented conversations and events, and avoiding discussions about their situation with others appeared to be the main ways these couples sought to protect themselves. A s w i l l be discussed, in the earlier interviews most couples described finding this hard to do. However, there were also variations noted i n the intensity o f this need. These variations appeared to be related to factors such as gender, the degree o f perceived social support, and the degree o f importance placed on parenthood by each participant and their respective partner. In the first interview or two, many o f the couples in the study described keeping busy or avoiding reminders o f children or childlessness in order to protect themselves from being confronted with the full emotional intensity o f their loss. One woman, clearly grieving, said:  60  "I guess it's still hard to accept. I think what we both have been trying to do is just be busy bees, trying to fill our lives with everything that comes along. Just so we don't have to think about it anymore." Another woman, who had previously enjoyed contact with children, appeared confused by the strong need she now felt to avoid them: " N o w it's like I don't want to have anything to do with kids. They're not part o f my life and - and like there's girls who are getting pregnant at work and it's like, yeah that's fine. A n d I don't want to have anything to do with them anymore. It's I find I've gone completely the opposite. I don't know, maybe one day I ' l l mellow out again." Another woman spoke o f learning to distance herself emotionally from the children and mothers she worked with, since she could not physically avoid them: "People would come in with their babies and y o u ' d have to feel like you've had to almost put this mask over your face, put on the health practitioner's face, rather than the person's face." M a n y o f the couples in the study also felt vulnerable to insensitive comments or negative judgements and attitudes o f friends and family about their childlessness. They appeared to seek ways to protect themselves by limiting their exposure to others. These couples generally perceived insensitivity as stemming from other people's discomfort, from malignant social assumptions about childless couples, or from the fact that infertility is an invisible loss that others simply don't comprehend. For example, one man clearly valued having children and spoke o f feeling a great loss o f vitality and self-esteem at being childless. He struggled with the assumptions made by others about his personhood and values, based on his childless status. He said: "The assumption is that you're selfish, that you're somehow hoarding a massive amount o f money and then enjoying it in all sorts o f devious ways while they're having to take the kids to soccer. That's the implication that's made, often."  61  Such encounters with others' insensitivity appeared to feed the participants' feelings o f anger, pain, and loneliness, as well as their sense o f failure. Their desire to avoid this kind o f pain fueled their need to protect themselves. For example, a number o f couples reported avoiding special occasions or family gatherings where they knew they would be likely to face insensitivity. However, avoiding everyday occurrences o f insensitive treatment appeared quite difficult to do. Most o f the couples talked about trying to deal with painful comments and questions at work, in job interviews, i n ordinary family encounters, and other places that were difficult, i f not impossible, to avoid. Moreover, these couples appeared to feel more emotionally vulnerable to others' lack o f sensitivity at this time than they did i n later interviews. M a n y reported struggling, sometimes unsuccessfully, to find responses that would allow them to validate themselves and their experiences. For example, one woman spoke o f her difficulty responding to unspoken messages that she was somehow deviant for being childless: "It's weird because you don't know what to say when someone says, oh how many kids have you got? A n d you say, oh I don't have any. A n d they kind o f look at you cause they know I ' m at that age like I should have a child or I've made a decision never to have any, so therefore I ' m a weirdo." One woman had three painful miscarriages during six years o f attempting to have biological children. She talked about how her parents and siblings with children seemed oblivious to the reality o f these losses no matter how she tried to explain her pain to them; "I mean basically what we have to do is pretend that nothing happened because that's how they see it. Whereas to us it was a big something." While most couples in the study said that over time they were able to formulate more satisfying responses to others as their  62  emotional pain diminished, this woman continued to feel wounded by her family's invalidation and, i n the last interview, was contemplating breaking off contact altogether in order to protect herself. Some participants were more concerned with protecting their partners than themselves from social insensitivity. One man, who described himself as not particularly invested i n parenting, said: "I don't believe it's an issue for men like it is for women. I know that i f we go to (her) homecoming class, the women are going to say how many children and here's little Johnny and it would be ... very devastating.... Society still judges your success by the number o f children you have." A s a result o f these kinds o f encounters, most o f the couples were extremely careful about letting down their guard. M a n y entrusted a carefully chosen few, protecting themselves as necessary from others: "Not every friend is the same but sometimes I just have to keep my distance away from her because that's the way she is sometimes, you k n o w . . . . she's another one that thinks we've got money coming out o f our ears." Pity was another reaction that participants sought to avoid, as it did little to help them feel understood or supported: " Y o u don't want to just blurt out to everybody because people are like, oh, I ' m sorry. It's like a loss kind o f thing, because they go oh god you're going to be childless. Y o u ' r e going to be so lonely when you're o l d . " Most o f these couples also appeared to feel the need to protect themselves from an uncertain future full o f the potential for further loss and lack o f control. This need appeared especially pronounced with respect to their decision-making around adoption. Virtually all participants expresssed at least some degree o f resistance to embarking on another "rollercoaster" process after having so recently ended infertility treatment. For all  63  of these couples, treatment had been associated with arduous and, often, very negative experiences. These included dramatic mood swings between hope and despair, a sense o f life being both on hold and out o f control, and ultimately, failure and grief despite their very best efforts. Most o f the participants also spoke o f experiences o f feeling devalued or disrespected by the medical professionals whom they assumed were acting i n their best interests. So powerful were these experiences that several participants talked o f being afraid for their own, or their partner's mental health, by the end o f treatment. These couples viewed adoption as a system akin to the medical establishment, and feared the same process and outcome. A s a result, most o f the participants appeared to want to protect themselves emotionally by avoiding the process, i f not the actual act o f adopting a child. For example, one woman considered herself open to parenting an adopted child, but couldn't bring herself to put her name on the waitlist: "It took me a lot to get off the plan, to carry on and just be [us]. I never took the initiative to sign up for it because then it's the waiting game again... i f somebody phoned up and said here, we've got a baby, I ' d take it, there's no anticipation, no anxiety..." Some participants appeared to resist adoption to protect themselves from further failure. The husband i n a couple who had been through 2 unsuccessful I V F treatments, said, "I don't want to go through a convoluted process after having been through one and seeing it come to nothing." M a n y o f the couples also appeared to resist adoption to protect themselves from the possible losses or regrets that might accompany raising an adopted child. For instance, one man, who appeared generally to be anxious about what the future held for himself and his wife, said:  64  "There's a certain amount of fear around adoption. There's the unknown, you know not to say that having your own child is a known entity, but I think there's something different about it and I think part of it was gee, I don't know." A common sentiment among these couples was the fear of regret once an adopted child became a teenager. For instance, one woman said: ".. .If your own child is a rotten teenager you can sort of handle it but if an adopted child is a rotten teenager are you gonna feel like, God I wish I'd never done this as some of our friends had said." Another very common fear was losing an adopted child to its birth mother after bonding with it. In the words of one man, who articulated a number of concerns about adoption. "It's like you go to these adoption agencies and you're matched with a child, you live with this child for X number of years, and then all of a sudden the birth mother decides they want them back and the courts uphold that." A few couples also appeared to avoid discussing adoption with each other to protect themselves from the pain of loss, or conflict, around that issue. In the words of one woman who had actually adopted an infant, only to see her returned to the birth mother 4 days later: "I think there probably is (something there) that we haven't really discussed. Maybe it's a bit of we're scared that we might get burned again. You know? And we haven't really brought it to the surface yet." Another couple said they had implicitly decided not to adopt by avoiding the discussion; "And I think there's all those sorts of fears that we didn't want to look at and so just ignored it basically. We just didn't - didn't even think about it." There appeared to be some gender differences among the participants with regard to the theme of self-protection. Generally, the wives were more likely to indicate a need to protect themselves than their husbands were, and more often reported emotional distress at being in situations where they were unable to do so. Two factors appeared to account  65  for this difference. First, the majority o f the men, while grappling with sadness, confusion and upheaval i n the early stages o f adjusting to permanent childlessness, tended to report less intense emotional distress overall than did their wives. Several said that having children had always been less important to them than their relationship with their spouse, which might account for the lessened intensity o f their responses. Second, the women tended to report more frequent, painful exposure to child-oriented occasions such as baby showers, and to intrusive questions from friends and family about having children. Work also often tended to expose them to painful reminders o f childlessness. Most o f the men worked i n areas that were not child-focussed, and indeed, several called work a respite from childlessness. However, most o f the women who were working during the study had jobs where they came into frequent contact with mothers or children. One was a family chiropractor, and two were registered nurses i n rural communities who sometimes had to work in labour and postpartum wards, and whose coworkers were all mothers. Some gender differences also emerged with respect to the couples' need to protect themselves around the issue o f adoption. A s mentioned, almost all participants i n the study expressed a desire to protect themselves against further loss or regret by avoiding the process or the relationship with an adopted child. However, most o f the husbands voiced such concerns more often and more strongly than did their wives. Several couples also found themselves at odds, with the husbands resisting adoption and the wives wanting to explore it as an option. The men's resistance or avoidance i n some cases seemed to have been due to their need for self-protection. For example, one couple had polarized desires regarding adoption. The wife described herself as periodically desperate for a child, biological or adopted. The husband talked about feeling great sadness at  66 knowing that he was the end o f his family line. He was at least somewhat open to the idea o f parenting a genetically unrelated child, however, he was clearly unwilling to adopt because the rules o f the process might result in their losing the child: "I have a hard time when something's taken away from me. I guess it's because a few people have been taken away from me, passing away and whatever else. A n d I guess I ' m kind o f trying to hold on now to the few things we have. Maybe it's a fear." There was also some variation among the couples regarding the need to protect themselves from social insensitivity. While most couples said they talked to few or no people about their infertility in order to avoid being stigmatized about their childlessness, three reported sharing more openly with others. These couples also tended to express more satisfaction with the quality o f the social support and, i n some cases, the medical support they had received. They also appeared to find others' comments, questions, and attitudes less intrusive or hurtful than did those who reported poor social support. For example, one couple had close and important "parental" relationships with their nieces and nephews. The husband also had a close male friend with whom he talked about the couple's infertility, something no other husband in this study mentioned. H i s wife appeared to view others' questions about their attempts to have children as positive, saying: "There was never any lack o f support. Everybody was always, you know, when are you guys going to you know - when's your turn? Are - aren't you going to have any? A n d whatever. N o w I just tell people it's up to the scientists." The perceived need to protect themselves from feelings o f intense grief, social censure and insensitivity, and the potential losses and regrets o f adoption diminished in intensity i n most couples' later interviews, usually to quite a noticeable degree. However,  67  for two couples, social isolation appeared to negatively influence their experience of childlessness. In earlier interviews, they reported having distanced themselves from a number of friends and social groups they felt were unsupportive. By the end of the study they still appeared>to have fairly minimal social support. Both couples expressed a desire for renewal in this area, but issues such as ill health and rural living made this more challenging. In summary, the couples in this study tended to protect themselves by avoiding people, places, and events that reminded them of the pain of childlessness, or by distracting themselves from their intense feelings through activity. The women appeared more likely to encounter these situations socially and at work than did the men, and more often reported a sense of needing to protect themselves. Some of the men said or did things that indicated they may also have had a desire to protect themselves. Other men were clearly concerned with protecting their spouse from further pain through social insensitivity. The couples who viewed themselves as having strong support from friends or family appeared to experience the need to protect themselves to a lesser degree. A Sense of Lessening Emotional Intensity. In later interviews, these couples reported a sense of lessening emotional intensity in their experiences of infertility and childlessness. This was described particularly with respect to diminishing feelings of sadness and grief. As couples experienced a reduction in their pain and feelings of vulnerability, a significant number reported a shift from passivity and defensiveness to increasingly assertive behaviour, especially with people and situations that related to their infertility and childlessness. There was also a sense that as their pain lessened, these couples experienced more space in their lives for new concerns - that infertility and  68  childlessness were still salient but less central parts o f their lives. Most couples began noticing some or all o f these changes by the second or third interview, and elaborated on these developments i n subsequent meetings. They also tended to express their belief that these changes were indications o f healing. A sense o f gradually lessening emotional pain and reduced vulnerability to that pain were central to this theme. The couples described sadness that was milder than it had been earlier i n their adaptation to childlessness. However, this sadness also continued to resurface unexpectedly. For example, one woman, who viewed herself as adjusting to childlessness fairly well by the second interview, summed up many o f the women's descriptions when she said: "It just comes up at the most unexpected moments. A n d then it goes. It's a momentary thing where you feel a pang and then it just kind o f floats away into nothingness and then comes back sometimes and floats away again." The couples reported a sense o f satisfaction and relief at the reduced intensity o f their grief. For example, one woman related a story o f a friend whom she described as obsessed with having a biological child, noting, "I know what it felt like a few years ago and I feel relieved that I no longer feel that way." Some participants also described how their grief gradually shifted to milder feelings, such as jealousy, that they found easier to bear. For example, one woman described her reactions when a woman older than she became pregnant easily, saying, "I was just plain jealous. But it's not the same as hurting at all." Many participants also appeared to begin to experience ambivalence about their childlessness as their grief ebbed. One woman whose coworkers were all mothers, said:  69  "I'm not angry that I'm infertile. What I do feel angry about sometimes is not belonging to a group of girls who are mothers, or sometimes I guess I envy them a little bit, and other times I'm really happy I'm not a mom." Many participants, particularly the women, talked about feeling released from the obsessive hope to become pregnant. One woman who described herself as adjusting quite well to childlessness said, "If we were ever to get pregnant by some miracle, which I don't think will happen, I think we would adjust to it, but it's not something I crave or anything like that." Some of the couples who had not put closure to their infertility via a vasectomy or hysterectomy described harbouring a faint hope for a pregnancy. However, unlike their experiences during the process of infertility treatment, they appeared to see this hope as a small aspect of their lives that did not interfere with their day-to-day functioning. As well, ambivalence appeared to have taken precedence over hope for most of these couples. As one woman who had very much wanted to parent at an earlier time said, "I think, well what if I did get pregnant at 43, I'd be absolutely anxiety ridden." Another important aspect of the theme of lessening emotional intensity was the sense that the losses around infertility and childlessness were slowly becoming a less central part of these couples' lives. Some couples reported having experienced other stressful events, such as illness, that had become the central focus in their lives, while others did not describe similar experiences. Nevertheless, almost all noted that their childlessness was slowly becoming more peripheral. For example, a husband who had survived cancer during the study, and who had expressed a strong desire and expectation to have kids, said in the fourth interview; "I look at other dads with little kids and there's still a longing there but it's not something I dwell on." The husband of the couple whose adopted child had been taken back by the birth mother said, "You still think of it, but the  70  times that you think about it, the gaps get longer. A n d the actual time that you think about it gets shorter and shorter." Most o f the study participants, particularly the women, also talked about how, as the emotional intensity o f their loss subsided, they became less aware o f reminders o f childlessness, or didn't react as strongly to them as they once had. For example, one woman, who had been treated for suicidal feelings at the end o f infertility treatment, echoed the words o f many o f the wives i n the study when she said: "It's not that I don't think about it maybe once or twice a day, you know, y o u hear a cute k i d commercial on the radio and you get a little pang. But it is not the total focus it was." Another woman, who had felt a strong need to avoid children and mothers earlier i n her adjustment, was surprised to find herself delighted by the birth o f her sister's child: "I've been looking at myself and thinking I should be teary or upset or this should be doing something to me and I was nothing but absolutely overjoyed. I ' m so happy for her that I ' m not unhappy for me and I thought I would be. I can't believe it!" Many o f the women who had expressed a need to avoid anything child-oriented in order to protect themselves, now began to describe a renewed ability to include these situations i n their work and social lives. For example, one woman, a nurse who had tried to avoid working in the maternity ward earlier i n her adjustment to childlessness, said with satisfaction, "I can look after those little babies in the nursery and squeeze them and love them and kiss their faces and not cry. So I have come a long way." Another woman described how the emotional aftermath o f a get-together with pregnant friends had become less intense; "Before, I would have, you know, come home and done myself some major horrible things, but not now."  71  Some participants also described feeling less vulnerable, as their grieving eased, to the social insensitivity they continued to encounter. For example, one man described the shift as follows; "The sadness comes up less often. A n d even people, you get a bit more ready for people." A woman who described her family as providing no emotional support, talked about her gradually decreasing vulnerability to their insensitive comments; " M y father made some crack about Easter being about fertility and I just gave h i m a dirty look and ignored it. Whereas at one point I probably would have been i n tears." Some participants appeared to experience their decreased vulnerability through an emerging ability to stand back from insensitive comments and perceive the positive intentions behind them. For example, one woman, who seemed frustrated but not distressed by the ongoing advice she received on how to get pregnant, spoke about how she had come to reframe it: " M y first instinct was to be insulted and then I thought, no, take it in the way it's meant. It was given in fun but, you know, but they were being kind, they were thinking about it." A s their intense feelings eased, most o f the couples also described a shift from feeling defensive and passive, to feeling and acting more assertively, particularly when confronted by social situations they had previously been upset by or avoided. This shift appeared to go hand in hand with their reports o f feeling more at ease with, or distant from, their emotional pain. Some participants also appeared to perceive less negative judgement from others about their childlessness. For example, one man talked with satisfaction about feeling more at ease with intrusive questions from strangers: " W e were asked, are your children with you or do you have children or who's taking care o f the children. We were able to handle that question a lot more comfortably this time around. A n d people were accepting."  72  Some participants reported greater ease in educating or disclosing to others about their childlessness. One man, who had been loathe to let people know about the couple's infertility, said, "I didn't want them to change the way they treated me because o f some perception they had. I've gotten to the point where I don't care what they think." Almost all o f the participants who continued to report social insensitivity or lack o f support spoke o f being able to respond more assertively to it. For example, the woman who had felt silenced by her family's lack o f validation for the losses she suffered through multiple miscarriages, said, "It is getting that emotional distance I think that, then you can finally say, wait a minute, that was a really dumb thing to say and this is why." A few women who continued to feel the need to protect themselves around child-oriented occasions, also reported feeling more assertive and entitled to set limits around these events. A s one woman said, "They're always saying oh come on over and see the baby. A n d the biggest thing that's helped me now is that I've said, no I don't have to do that." The passing o f time was also mentioned by many couples as being healing. Time appeared to heal by making them feel less vulnerable to reminders o f childlessness. For example, when describing how she was now able to work with women i n labour at the hospital without getting distressed, one woman said; "I thought, I ' m getting more comfortable with this, time is really helping to heal this feeling." Another man described how, as time passed and life went on, more recent events gained precedence over the couple's infertility history: "The most recent negative thing isn't some horrible doctor or some treatment or something that didn't work or some test that didn't turn out, those are all at least two years ago, so you start thinking o f stuff other than that."  73  Other couples cited a combination o f the passing o f time and effort on their part as helping to put some closure on their infertility and childlessness. For example, one woman who had started a support group with her husband, said o f her increasing ability to create a satisfying life; "I guess it's partly just time but partly real effort that is making these changes and it feels good that they're finally happening." A s well, a few couples said that, as they grew older, they experienced less exposure to certain reminders o f childlessness including social insensitivity stemming from others' expectations around parenthood. One man summed it up this way; "I think we are seen as a couple without children. I don't think there is the pressure from society that there was 3 years ago." In terms o f gender differences with respect to the theme o f lessening emotional intensity, this theme again seemed somewhat more relevant for the women, partially due to the fact that, for the men i n the study, their emotions around infertility and childlessness were less pronounced to begin with. The words o f this man appeared to reflect these sentiments: "It was never an all consuming desire for me to be a father. I would be a proud father i f I was a father, but I don't think I ' m any less o f a human being for not having a child." Several husbands talked about being positively impacted by their wives' less intense feelings related to the couple's infertility and childlessness. For example, one husband described the emotional benefits for h i m o f his wife's hysterectomy, which had been very helpful to her adjustment to their childlessness; "It changed for me largely because it changed so much for her. I mean, she's happier, much more content, less, well, ah, angry."  74  For one couple, however, the husband described less intense feelings i n later interviews, while his wife appeared to continue to talk about her pain and loss i n strong terms. This woman had other losses during the study, including illness, lack o f social support, and the loss o f future goals and her sense o f youth. These losses appeared to have exacerbated her grief around her childlessness. She did report diminished hope for a child but related this to her illness and did not appear to see it as healing. She also described an increased ability to deal assertively with the doctors treating her illness, although it is difficult to know i f this assertiveness was linked to lessening emotional intensity or experience with the medical system. Regarding other differences between the couples, one couple appeared to experience mild feelings around their infertility and childlessness throughout the study. In the first interview, this couple described themselves as "choosing childfree" after ending 8 years o f infertility treatment. They described having had difficulty coping with social insensitivity at one time, but were dealing assertively with it by the time the study began. This couple expressed a comfortable conviction that a pregnancy would not occur, and described a secure and stable social network. Both partners said they married mainly for the relationship, although parenthood had been an important goal. The wife also reported that her identity was not related to motherhood. Despite their 8 year effort to attain parenthood, she said o f the couple's attitude; "Our whole life was not focussed on having a family. It wasn't a be all and end a l l . " In summary, for the majority o f the participants, the sense o f lessened emotional intensity was a common and consistent finding. Important aspects o f this theme were gradually ebbing feelings o f grief and sadness which could still be unexpectedly  75  triggered. Couples also commonly reported feeling less vulnerable over time, both to their own feelings and to social insensitivity around their childlessness and i n response to reminders o f their loss. Some couples also began to describe people's comments and questions related to children as being less negative and insensitive than they did in earlier interviews. Reports o f less intense feelings and reduced vulnerability appeared to go hand in hand with accounts o f increased assertiveness i n dealing with social relationships, social insensitivity, and reminders o f the couples' childlessness. Grief and sadness also began to take up less space i n these couples' lives. This was seen i n these couples' descriptions o f how they began to focus less often and less intensely on their childlessness. A s well, many couples appeared to feel new and often mixed feelings about their childlessness as their most intense feelings o f loss diminished. The men appeared to be less likely to report diminished intensity o f their feelings, perhaps because their emotions around their infertility and childlessness appeared to be milder than their partners' to begin with. They also tended to make comments that suggested they did not strongly connect their masculinity with fertility. Not surprisingly, couples who had experienced multiple stressors in addition to infertility and childlessness were less likely to report a sense o f lessening emotional intensity. A Sense o f Regaining Control. Once the intensity o f their emotions had subsided, most o f the couples i n the study reported regaining a sense o f control i n their lives. They did this through acknowledging that they would always be childless and making a decision to move on with their lives i n spite o f this fact. For these couples, regaining control appeared to be associated both with accepting that having children was out o f their control, and with believing that they could control other parts o f their lives. Most couples  76  made comments suggesting that the decision to move on involved shifting their focus to these other, more controllable parts o f their lives. Once the decision to move on was made, a sense o f relief was described. This relief tended to accompany a time-out period in which the couples expressed pleasure at being able to restore normalcy to their day-today lives without being committed to any long-term plans. For some o f the couples, the process o f regaining control o f their lives through deciding to move on with their lives was catalyzed by a critical event. A critical event, such as the death o f a sibling, appeared to lead some o f the couples to a shift i n perception in which an increased appreciation o f what they did have reduced their focus on their inability to have a child. Some participants did not report a critical event, but did articulate a defining moment, often painful, in which they made the conscious choice to accept their fate and move on. Others appeared to be aware o f having let go and moved on with their lives "after the fact." Factors that appeared to account for some o f the differences i n the participants' process o f regaining control in their lives were gender and the amount o f extra stress experienced by the couples related to issues other than their infertility. Regardless o f the process, all the participants who described deciding to move on with their lives reported a renewed sense o f control. A few couples appeared to reinforce the decision to move on with acts o f closure, such as sterilization. W i t h respect to adoption, several o f the wives in the study wanted to adopt but their husbands did not. Some o f these women reported consciously choosing to move on without adopted as well as biological children, rather than remain in conflict or proceed with adoption without their husbands' commitment. For these women, letting go o f the hope to adopt appeared  77  to be a separate decision that related to the fact that adoption, unlike biological motherhood, was an outcome over which they could potentially exert some control. M a n y o f the couples in the study experienced significant, stressful events during the study that they linked to a change o f perspective around their childlessness. These critical events included illness, job loss, injury, and the deaths o f friends or family members. The couples who faced such events gained a renewed appreciation o f the fragility o f life, acknowledged the limits o f their control, and experienced more gratitude for their relationships. Two o f these couples stated that these changes helped them begin to accept their infertility and childlessness. For example, the wife o f the man who had cancer during the study had at one time found any contact with children or mothers too painful to endure. She spoke o f how her husband's illness began to allow her to move beyond her loss; "It's made a big impact. I think it makes you realize, look, you've got this now, you've got your husband now. I think it's made me more accepting o f not being a mom." For another couple, two recent deaths i n the family helped to shift their focus toward the future. The husband, who had not deeply desired children, had been very concerned about his wife's emotional health after they ended infertility treatment. He said, "I think these losses have taken our focus off how to cope with the childfree environment. We're looking at what we want to do and you know, life is uncertain." N o t all o f these critical events were so drastic, however. One couple experienced a 6 month, work-related separation that allowed them to step back from their infertility and realize that they could have a fulfilling life without children. They described how, during this time apart they came to appreciate their own individual potential as well as the  78  precious nature o f their time together. This awareness helped them to let go o f their hope for a child and focus on their own growth and potential. A s the wife put it: " W e realized that what we were doing was not the only thing i n the world. L i k e there's other facets to life that we didn't know existed. Cause we really got obsessed. I know we did, well I did. With the baby thing." Some participants who did not report critical events that catalyzed a shift i n perspective, nevertheless described a clear, sudden moment o f awareness, often during a time o f emotional stress, when they realized that they could choose to get on with their lives or not. One woman recalled it with great clarity and energy: "I was crying all the time, I didn't want to go out with people. We sat on the deck one day and - you were really worried about me. A n d it was at that point I realized I've got to stop ruining my days that I have with bad thoughts and negative feelings, and that i f it's not going to be, it's not going to be, so let's get on with it. A n d for me that was the hump." Similarly, one man who appeared to experience a lot o f sadness over both his childlessness and his mother's death, said: "I think you do move on but y o u choose to do that. N o t everyone chooses to do that." Another woman who described herself as choosing to be childfree i n the first interview, said that she realized she could move forward with her life on her own terms when her husband encouraged her to quit a job she hated: "The realization finally came that I don't have to get pregnant to quit this job, I can quit now and I promptly did. That was a big turning point for me and probably at the same time I realized, i f I don't get pregnant, life isn't going to end." Other participants did not describe a definitive moment o f realization, but on reflection were aware o f having chosen to get on with their lives. One o f these women had, on several occasions, said that she needed to explore the possibility o f adoption to maintain her sense o f control and self-esteem. She ultimately described choosing to move  79  on with her life, accepting both her husband's resistance to adoption, as well as the loss o f biological children. She said: I have no idea when it happened but somewhere along the line there was this almost unconscious decision about w i l l that fit and let's get on with life and living. A n d part o f that I think was with the adoption issue as w e l l . " Another woman, still clearly working through the pain o f this choice, said: " D i d I want a child badly enough to possibly lose the man I love? Obviously not. It's not necessarily fair to be i n that position but you have to think o f where you are and what you have to do to survive. A n d you can choose to be happy or unhappy about it and as I cry (giggle), I choose to be happy about this." Generally, once the couples had regained a sense o f control over their lives through deciding to move on with their lives, they described a deep sense o f relief. This sense had also been expressed by many couples when they decided to end treatment. For example, the husband in the couple who had lost their adopted baby after only 4 days, said o f their subsequent decisions to not pursue I V F and to "live for themselves"; "It's like, phewwww. Thank G o d we're going down the down side o f everything instead o f up." For most o f the couples in the study, the choice to get on with a life without children appeared to be coupled with a determination to orient themselves toward the future and the advantages that a life without children might offer. For example, the woman who felt that she needed to explore adoption to maintain her self-efficacy, spoke about her realization that: " Y o u can still make the most o f what you do have and the opportunities that are open to you now that wouldn't have been open i f you had children. Rather than just be consumed by the fact that you haven't had children and let that destroy you."  80  Despite these couples' future orientation, they did not want to make long-term plans immediately after having regained a sense o f control in their lives. There was a clear sense that a time-out, a period o f rest and respite, was needed now that they were beginning to put the infertility process behind them. For example, one man said, "Thinking in terms o f medical concerns was a very big part o f our lives and so it's a nice luxury to just contemplate the future, even i f it takes us a while to figure it out." Similarly, one woman reveled in her ability to exercise control over her life by simply living in the moment, in contrast to the arduous and dictated process o f trying to have a child. She said, "I couldn't think past the next two months because o f this baby thing and now I ' m not even thinking about the next two months." These couples did not overtly link their disinclination to make long term plans to adoption, however this appeared to have been a factor in most couples' resistance to getting involved with another long-term and uncontrollable process. For example, a woman who described how she and her husband decided not to adopt by avoiding discussions about it, echoed the sentiments o f some other couples when she said, "I don't want to make any decisions right now about anything. I just want to concentrate on very basic things." M a n y couples described focussing on regrouping their energies and restoring balance and normalcy i n their day-to-day lives. For example, a woman who had been i l l described returning to weekend getaways with her husband; " W e rented a video, had a nice hot shower, had something to eat and put on a good movie and that's comfortable. I like that." Another woman described how she was restoring balance in her life after deciding to let go o f the hope for a child and move on with her life:  81  "Trying to do a bit more creative things, a bit more reading, going for walks, trying to do some physical things. Just pushing myself to do that and I think it's helped a lot." A s well, shorter term plans that focussed on changes to the couples' immediate lifestyle and capitalized on their renewed sense o f spontaneity, were often mentioned. For example, one woman who had recovered a sense o f energy and was enjoying a variety o f satisfying interests said, "Just get the house and go, I think. I haven't really thought. W e don't have to be planning." Some participants reinforced their decisions to acknowledge their childless fate and to regain control by getting on with their lives with acts o f closure. Generally, these acts appeared to help test or reinforce these decisions and to emphasize their sense o f control. For example, one woman arranged to see the child she had adopted but whom the birth mother had taken back. For this woman, who then went on to sell the baby furniture she had bought, confronting her loss appeared to help her move on. She said: "I wanted to scoop her up and run away but part o f me knew that's not the same baby we had. So that's how I separated it. It was like, that's not my baby, that's their child." Another couple chose to put closure to their infertility through a vasectomy and a hysterectomy. The wife found her hysterectomy, as well as her power to convince the doctors to perform the surgery, to be a powerful symbol o f her regained control over her life and her body that was very healing emotionally: "It's a matter o f taking back my life. It's no longer in the hands o f the doctors, it's no longer i n the hands o f my unpredictable organs. A n d my emotions are not affected i n the same way they were, to a great extent." Another aspect o f this theme appeared to be the way some o f these couples reinforced their decision to move on with a childless life by comparing their decision to  82  stories o f other people's experience. These stories focussed on people who were unable to end infertility treatment, or who had had negative experiences with adoption. For example, one woman saw her decision to abandon treatment as very healthy, although friends encouraged her to continue due to her relatively young age. She said o f an infertile acquaintance who continued to try to produce a child; " I ' m sorry for her because I remember what it felt like a few years ago and I ' m relieved that I don't feel that way." One o f the husbands reflected on an experience at a seminar when he realized that parenthood also could be associated with significant pain and loss: "They were telling some horrific stories about how the infant had been a gasp away from death and saying, you should be thankful you didn't have to go through that, and I am." W i t h respect to gender differences regarding this theme, some o f the men i n the study described being at least somewhat fatalistic about parenthood. For these men it appeared to be less a matter o f conscious choice than o f an awareness that at some point they had let go o f the hope for a child and moved on. Some o f these men also made comments indicating that their main focus was their wives' emotional well-being. For example, one man said that he hadn't expected to be a father by the time he married at 40, and that resolving childlessness for h i m more or less meant going back to his previous lack o f expectation, although he did mourn the loss o f a child for a time. Comparing his process to his wife's, he said: " M i n e was much more gradual, and started much earlier. W e ' d both love children but that's not going to happen so at some point I was sort o f hoping for it for her sake, and when the end came, it was a relief for me." A few men described urging their wives to seek counselling to try to facilitate acceptance o f their situation. One husband explained it this way; "I was fairly certain o f where I was  83  with regards to parenthood. A n d it wasn't the same direction she was going in. A n d I was concerned about her mental health, in honesty." W i t h respect to the differences between the couples, two couples appeared to be affected differently by critical events than were the others who faced them. In one case, the wife was i l l , while the husband was suing his previous employer for wrongful dismissal. This couple, who described feelings o f lethargy, ennui, and anxiety, which they deemed worse than the effects o f infertility and childlessness, stated that, in light o f these events, they felt their infertility was behind them. However, the other couples found critical events to facilitate a positive shift that brought relief, while for this couple emotional distress and a sense o f exhaustion were the result. The husband said, "This past year has been so difficult. Y o u just don't have any interest in, I mean there's just no enjoyment in life, in general, really. Y o u just sort o f lose it." For the other couple, the husband stated he had accepted their childlessness and wanted to move on with their lives. However, his wife viewed motherhood as the crux o f her sense o f self and saw herself as being on a "perpetual grieving program" in which her identity had been assaulted through infertility, illness, and other losses. For both o f these couples, there was a sense o f being stuck. It appeared that an overload o f stressful events were delaying or preventing them from moving on with their lives. A s well, none o f the couples who experienced critical events in their lives reported a sense o f relief and respite. Emotionally, they appeared to move directly from coping with their infertility and childlessness to coping with their new challenges. In summary, most o f the couples regained a sense o f control i n their lives from giving up the struggle to have children and making a decision to move on. For many  84  participants, this decision entailed a conscious turning point that, for some, was catalyzed by a critical event. For some others, particularly the men in the study, the process was more subtle. Once they had decided to move on, the couples described feelings o f relief and pleasure i n being spontaneous and living in the moment. M a n y couples also began to consider what the advantages might be o f a childless lifestyle. Some couples reinforced their decision to move on with their lives with acts o f closure as well as by comparing their decision to stories o f other people's negative experiences with continued fertility treatment or adoption. In terms o f differences with respect to this theme, the men not only described a milder experience in terms o f regaining control, but some also talked more about their wives' ability to move on with a childless life than their own. For some o f the women who wanted to adopt when their husbands did not, choosing to move on with their lives meant deciding to leave not only biological motherhood but also adoptive motherhood - over which they had more potential control than biological motherhood behind. Couples who had personally experienced multiple critical events including job loss, illness, and injury, were less likely to talk about moving on with their lives than were couples who experienced a single event or who were less directly affected, such as couples who had lost a friend or family member. A l l o f the couples who experienced critical events were less likely to report a sense o f relief or a time o f respite, apparently due to the continued stress i n their lives. A Need To Revision Life and Identity. During the 3 year course o f the study, all o f the couples expressed a need to revision their lives and aspects o f their identity. This theme appeared to become became salient once these couples began to put their infertility behind them and move on with their lives. Generally, it encompassed the couples' need to  85  reconstruct a life vision that was satisfying and meaningful now that they were beginning to accept that they would not be parents. Part o f this was the process many couples described o f reassessing their current goals and priorities i n light o f their decision to move ahead with a childless life. Couples also talked about developing alternative meaningful goals. A l s o , most o f the participants appeared to revision who they were as a couple and many appeared to reassess who they were as individuals. For many, but not all o f the couples, the urge to revision their lives appeared to include an optimistic future orientation, coupled with renewed energy and a sense o f agency. For a few couples, disequilibrium and anxiety appeared to be connected with the need to revision. Feelings o f loss continued to resurface but did not block this process. The couples generally expressed the need to revision their lives and their sense o f themselves i n terms o f reinvesting their energies into satisfying creative labours, revisioning their future in terms o f lifestyle and long-term goals, and reconceptualizing the meaning o f family and parenting. This last aspect appeared to result in many o f the participants entering into other kinds o f nurturing relationships. A s mentioned, the urge to revision their lives and identities appeared to be connected for many couples with renewed energy, optimism, and agency. M a n y couples also appeared energized by the plethora o f options they perceived were now before them. For some, these feelings emerged after a period o f transition where they talked about drifting or feeling anxiety about the uncertainty that a wide open future entailed. For example, one couple said they had accepted their childlessness and were determined to get on with their lives. In the third interview, however, both spouses also appeared to be unsure about what the future would hold. The husband appeared to be more relaxed about  86  this, however the wife described struggling with not knowing what might fulfill her, now that she had given up hope for a child and had quit a job she disliked. She said, "The more balanced my life is, the less things are going to affect me negatively, so it's a working process for me to find more things to put my energies in now." B y the last interview, this woman had taken a job that she viewed as a stepping stone to something better. She described herself as still uncertain about her future but now appeared to enjoy exploring her many options; " Y o u have all this opportunity and potential and it's just there whether you go looking for something or something just presents itself to you. That's kind o f exciting." In another couple's third interview, the husband also seemed to be i n a transition regarding the future, while his wife had taken up running marathons and was finding it to be a source o f great satisfaction and achievement. However, he appeared to feel confident that he would find his own avenues o f fulfillment; " I ' m seeking some other path. But I ' m looking at it as a bright future." In the last interview, this man went described how contemplation turned to action as he became engaged in writing a book: " Y o u hit a point where you say, O K , I ' m going to make some goals. A bit like N e w Year's resolution. A n d I don't know whether this is all i n your mind or not but i f you put your mind to something you can really do it." For many couples, some o f the options they perceived before them were the advantages specifically afforded by a childless lifestyle. For example, one woman who had begun to enjoy her work and hobbies with renewed zest, echoed the sentiments o f many participants when she described the advantages o f childlessness as she saw them: "Lots o f freedom. Being able to just go somewhere i f I want. Being able to work i f I want for as long as I want or as short as I want. Probably the emotional freedom o f not having to look after teenagers."  87  Another woman described it this way: "There's a certain pleasure i n thinking, well O K I ' m not going to have kids, but there's a lot o f things I can do with my life. A lot o f people are probably sitting there wishing they could do those things while looking after children." Discovering and investing themselves i n creative labours such as hobbies, appeared to help many participants recover a sense o f competence and self-esteem that had been damaged by the infertility process. A s well, they described hobbies and leisure activities as ways o f increasing the satisfaction and fulfillment in their lives. Participants engaged i n these types o f pursuits tended to talk less about feelings o f stress and disequilibrium around who they were. Some directly related taking on new interests or hobbies to developing a positive sense o f self now that they would not be having children. For example, one woman reflected on her motivation for expanding her interests; " I f I ' d had more before, maybe my whole self worth wouldn't have been tied up with being a mother." Another example o f this reinvestment was apparent for the couple who experienced a work-related separation. After they made the decision to remain childless, the wife began to run marathons, while the husband started writing a book. Both partners expressed a clearer and more positive sense o f themselves as individuals by the end o f the study. The wife said: " W e ' v e become our own people. Before we weren't, we were just a couple. Y o u know, what he did I did, and what I did, he did. But now I run, I go off to the g y m and you do your own thing and when we're together, we're together."  88  Another woman, who appeared to question her competence i n some areas o f her life, had begun to study music and had written a song that did very well i n a contest. She called music her "baby", saying: "I have this life I ' m living, so I was trying to make the most o f it and I do a job I don't particularly like so I have to find something else. I used to feel jealous o f anyone who could make music. That's why making that song was really important." Some participants not only talked about seeking new creative labours, but also about going back to pursuits that they had put on hold or lost pleasure i n during their infertility. For example, one woman explained how she had now given herself permission to do pleasurable things she had denied herself during treatment, such as playing her harp: "It was like, I won't get into this because I ' l l have a child to look after. But the reality is it's not going to happen. So now I ' m looking to enjoy m y life i n different ways so I ' m trying to get into playing some music and doing some crafts." A l l the couples in the study also appeared to feel the need to create a new vision o f a life without children that would be meaningful as well as satisfying. Most o f them appeared to reassess their current lifestyles and life goals and begin to explore what might be suitable changes to these goals. This also inevitably resulted in changes to their identities. For example, a couple who had recently gone through the husband's bout with cancer said o f their urban lifestyle; "We're working but there doesn't seem to be any meaning to it. Maybe i f we had a farm or something like that there might be a bit more meaning to it." Another husband described the couple's explorations around changing their wills i n order to leave a meaningful legacy; " W e ' v e thought, maybe we could set up a research grant for infertility."  89  The process o f reassessing their current lifestyle and goals i n terms o f creating a meaningful life without children appeared to involve a time o f introspection and tentative exploration o f ideas. A few couples appeared to follow up on this with more active planning and the implementation o f new goals, and the sense o f a shift i n identity. However, most o f the couples remained tentative i n exploring their future life goals during the course o f the study. This was probably in part because these goals were seen as being long-term. A s well, this revisioning appeared to be anticipated as a profound change by some couples, and they appeared, understandably, hesitant to rush the process. For others, revisioning also meant dealing with major life issues i n addition to childlessness. For example, the husband in one couple was at midlife and beginning to consider retirement. He was also grieving his father's recent death. He described as follows his motivation to sell their farm that had been passed down to h i m by his father: " I ' m i n my mid-40s and that's where the childless part comes i n - when you're this age and you don't have a son or daughter to take on the family farm. Y o u sit back and you say well, what are we doing this for and for who?" Some couples considered or made changes that would result in a more pleasurable lifestyle that would allow them take advantage o f the freedom and spontaneity afforded by their childlessness. For example, one couple sold their townhouse and bought an island cottage, spending many hours together fixing it up. The husband said, "It was something that we enjoyed instead o f some money making thing. It was more o f a lifestyle choice than a think kind o f choice. It was nice." A n important area o f revisioning life and identity for many o f the participants was their focus on who they would be i f they were not to be parents. Most o f the couples described re-conceptualizing family and parenthood, as well as reassessing their needs to  90  nurture. They also appeared to find other ways to nurture i f these needs were seen as important. A significant related shift that some couples described involved the sense that part o f revisioning themselves as non-parents meant ceasing to define themselves by their infertility. For example, one couple talked about how infertility was an important part o f their lives that was shrinking, allowing space for a broader self-definition; " W e don't have children, and we would like to have children, but that's not the full definition o f us. We're also people with a leak in the basement..." A s their definition o f themselves expanded, some o f these couples also appeared to begin to define themselves more positively as a couple-only family instead o f a family that had failed to materialize. There was a clear sense that they were beginning to give themselves permission to be childless and to refocus on their lives as they were, or as they could shape them. For example, one man said: "We're really starting to think o f our future as "us" and not as our future as "us but wouldn't it have been great i f w e ' d had", although w e ' l l always feel that, but not so much confining ourselves by the negative." This revisioning o f themselves as a couple-only family appeared to have occurred through the shift many couples described, o f making investments i n their needs and happiness. For example, one husband i n a couple who had bought a house, acquired pets, and taken up new hobbies said, "We're going to live for us now." One woman who had experienced much frustration trying to establish social contacts i n a small town where most people were very busy with their children, described beginning to focus on creating her own contentment: "Let's do the things that make us happy. Let's plan to get away every second weekend, then w e ' l l still have these social interludes to look forward to whether it's with other people or with ourselves."  91  A s well, many couples described putting their needs and priorities as a couple ahead o f accommodating the lifestyles o f people with children. Some talked about this reprioritizing with respect to their families o f origin. For example, one woman said: " W e really used to make an effort to be around for the kids' birthdays. W e were so busy that it ended up that the only weekend we could get away was to other kids' birthdays and I thought, well you know, really we have to do stuff for ourselves and i f this is the only weekend we're free to go away ourselves, we're going to go." Other couples also talked about making their needs a priority with friends and acquaintances; "We're not bothered anymore, we're not going to try anymore, this is the way we are, and you find you've actually grown away from them. But we've moved on and met other people." One couple appeared to anchor this shift through creating new, couple-oriented holiday traditions. The woman who felt invalidated by her family's exclusive focus on grandchildren at every family occasion, talked about how she and her husband were beginning to make holidays more meaningful and enjoyable for themselves; "We're taking back Christmas because it's always been a difficult time when you're so conscious of it being for children. We're making it our own again, which is a good step." A s well, almost all o f the couples i n the study appeared to find a way to reconceptualize parenthood. There was a sense for many couples that the appropriate time to parent was ending or had passed due to their increasing age. This shift i n perspective appeared to help them accept their childlessness and revision other ways o f meeting the needs that would have been met by parenting. There was a sense that the idea o f parenting after the age o f about 40 no longer fit with their vision o f themselves and their lives that  92  they had had while trying to conceive, or with the newly forming vision o f their future. For example, one man, who with his wife seemed to have become quite comfortable with childlessness, said, "I just didn't see myself in 10 years time, being in my 50s and worrying about a 9 year-old child. I don't think it's fair to me and it certainly wouldn't be fair to that child." Another man who also appeared to be moving on with his life, mentioned the impact on the couple's relationship o f parenting in later years; " Y o u know, then you start to think, well, O K i f I have a child at 40, when that child's 20, you're 60. A n d , you know, what about us?" The women who were in their late 30's or early 40s during the study also talked about being disinclined to go through the risks o f pregnancy and childbirth at a later age and appeared to focus on the risks rather than the benefits o f a possible pregnancy. One woman described the shift in her feelings from hope to anxiety as follows; " M y period was about a week late and I kept thinking, no. O h no, it couldn't be, could it? A n d then it came (giggle)." Almost all o f the couples appeared to revision parenting i n terms o f seeking new avenues that could fulfill their needs to nurture outside o f parenting a biological or adopted child. Some appeared to find mentoring a way o f meeting these needs. A few appeared to reconsider the depth o f their urge to nurture and turned their energies toward other satisfying pursuits. However, most couples focussed on relationships with relatives' or friends' children, or with children in organizations such as B i g Brothers. A s one husband, who very much enjoyed the time he and his wife spent with their niece and nephew, said, " W e decided we should invest more time with kids we knew rather than worrying about the kids that we didn't know." The men and women who chose to, and were able to develop bonds with other people's children, appeared to find these  93  relationships fulfilling and rewarding. There was also a sense that these relationships were seen as important in their own right, not as a compensation for the couple's childlessness. For example, when talking about spending time with his sister's children, one man said, "It wasn't the second best option, it was something that was quite positive and which we wanted to do. I enjoyed it." Some o f these couples also talked about valuing the contributions they could make to children's lives that were distinct from parenting, such as being a sounding board or role model. For example, one woman hoped to be a confidante to her niece: "When she's older she's not going to want to tell her parents everything and i f there's someone like me around that she might feel free enough to tell, especially i f it's something that might be a danger to her, then it's really good to have me as that second person." Another man described his satisfaction i n being able to have a positive influence i n the lives o f his niece and nephew; " W e ' d get the boy making bread rolls and stuff. D o i n g our own little breaking down o f gender stereotyping." The couples who talked about developing alternative relationships with children appeared to no longer need to protect themselves from reminders o f their own childlessness. However, some described anxiety around these relationships, based on the tenuous nature o f a connection to someone else's children. For example, one woman who talked o f her surprise and pleasure when her niece sought contact with her, said, "One thing I've had a little difficulty in is wondering where the boundaries are. It could so easily be taken away." Other couples, however, did not appear to be as concerned about the possible risk o f losing a relationship with a child. One wife said o f time spent with  94  nieces and nephews; "It's fun. Just because we don't have any doesn't mean we can't enjoy them." A few o f the participants in the study appeared to be finding alternative paths for nurturing when they talked about taking on opportunities to teach or mentor adults or children. One woman clearly hoped to mentor a younger coworker; " I ' m thinking gee I have so much I can teach this kid, and I really want to bring her along and give her opportunity." Another man, whose hobby was skiing and who enjoyed computers, appeared to value teaching i n these areas, especially after he lost his job. H e said, "I sort of showed people how to ski, and I played a bit with the computer, showing some people how to do some things with computer systems and I really enjoyed that." Some participants appeared to shift their nurturing energies to pets. For the most part, these participants appeared to see having pets as an opportunity to nurture that was not a substitute for children. One woman said to her husband; " Y o u would get pleasure from a dog. Y o u would enjoy teaching it to do things. It would fill something inside you." One man joked about pets as a substitute for children: "Instead o f adopting children, we adopt pets." A s a result o f forming relationships with children, or o f hearing o f problems parents had with their children, many o f the couples i n the study appeared to reconceptualize parenthood in terms o f becoming more realistic about the strains and heartaches o f raising children. This appeared to facilitate acceptance o f their childlessness for some couples. For example, one woman, who spoke in glowing terms about her relationship with her niece, said, "I see the other side too, that you can't expect that i f w e ' d had children it would have been perfect. There could have been a lot o f heartache  95  and who knows what." Further, this realization seemed to help some couples revision parenthood by making them aware o f the benefits o f other kinds o f nurturing relationships. For example, one man, who enjoyed being a B i g Brother, said, "The interesting thing about being i n the B i g Brother program is you have all the fun o f kids and none o f the responsibility." In terms o f gender differences with respect to the theme o f revisioning, more o f the women i n the study, particularly those who did not have satisfying jobs, expressed a need to revision their lives in terms o f work and educational goals than did the men. Most o f the women who said they did not have satisfying jobs also said that they had expected to give up work once they had children. For these women, there was also a sense that work or educational goals had become important in their own right. They appeared to relate these goals to developing a new sense o f meaning and identity i n light o f a childless future, and did not view them only as compensations for their childlessness. For example, a nurse who was not particularly satisfied with her work, talked about such a shift i n her view o f her job: "I think my job has become more important now. Before I was going to have children and stay home. A n d even now by some miracle i f we did have kids I would probably stay home but go back to work sooner." Similarly, another woman who appeared to regret not having gone to university, said o f her plans to do so; "Even i f we did have kids between now and my degree, I'd do correspondence or whatever it took to get it. That's my goal now." The several men who spoke o f revisioning their lives i n terms o f work also had other factors affecting their work, such as job loss or economic uncertainty. For these men, childlessness appeared to factor into their revisioning o f work goals from the  96  perspective that they saw themselves as having fewer responsibilities to provide financial care or a legacy, and therefore perceived that they had more options to choose from. However, many o f the men in the study appeared to have stable or fulfilling jobs which would have continued i f they had become parents. Therefore, they did not need to revision their lives i n terms o f work. One man, a writer, described the difference with respect to work between himself and his wife in this way: "I have a fulfilling job and I've been able to retreat into that all these years, whereas her career has been focussed on this childbearing thing. So now i f she can get a similar kind o f fulfilling artistic kind o f career going, that would be great." The men i n the study also did not appear to see their investment in work as having changed with the decision to move on with a childless life. For example, one man said, "I don't think my investment in work has changed from what it has been. I kind o f assume i f I had children I'd probably invest less." Interestingly, most o f the men did not appear to need to revision their lives in terms o f work, but some described how they had regained a sense o f competence and self-esteem through work, creative labours, or nurturing relationships, that had been lost during the infertility process. For example, one man said, " M y sense with the infertility process is you feel incompetent. But getting a chance to get competent in other ways was important really." Another gender difference was apparent with respect to revisioning parenting. Specifically, just over half the women in this study did not describe developing alternative nurturing or mentoring relationships, while most o f the men did. Some but not all o f these women appeared to still want to limit their contact with children. One woman, who had not talked about needing to protecting herself around children, and who appeared to find great satisfaction in running marathons, said, "The needs to nurture are still there  97 but I keep busy all the time. I work and I go to the gym and I ' m running. I have about one day off a week." It is also important to note that some o f the spouses were not always i n sync during the revisioning process. Where most o f the men appeared to emotionally accept the couple's infertility and childlessness sooner and more easily than did most o f the women, in two cases the wives appeared to be revisioning their lives i n terms o f finding new and satisfying creative labours during a time when their husbands seemed to still be i n transition with respect to finding fulfilling interests. In one case, this difference appeared to be related to the man's grief over his mother's death. In terms o f differences between the couples with respect to revisioning parenthood, the need to nurture children or other people was deemed relatively minor by a few participants. Interestingly, these participants did tend to be involved i n mentoring or other potentially nurturing relationships. One man said: " I ' m in a job where I get to pass on what I've picked up in the past and introduce people to new contacts, but the real need to have something to nurture doesn't really enter into my thoughts." Another difference was apparent for the couple who described themselves as a family and who had "parental" relationships with their nieces and nephews. This couple often took these children into their home and cared for them for extended periods o f time. The closeness o f their bonds with these children and their sense o f making a significant contribution to their lives, appeared to be very stable parts o f this couple's identity and life vision, and no significant revisioning was apparent in this area. The husband said several times during the study; "I think o f myself as a parent cause I've got all these nephews and especially my niece - she's such a big part o f my life."  98  In terms o f differences among these couples with respect to this theme, by the end o f the study, most o f the couples were still tentatively but optimistically exploring their options. Only one couple appeared to have reached the point o f having not only revisioned their future goals but also were actively engaged in making the new vision a very satisfying reality. This was the couple who had bought a new house, vehicle, and dogs, and who were pursuing several very fulfilling new interests. This couple considered the changes they had made to their lives to be total and profound. A s the husband said: "I imagined that when we stopped trying for kids, that we would be just exactly the same as we were. A n d we're not, at all. We're totally different. I thought w e ' d do the same things, have the same friends, and life would be the same. B u t we've gone down a totally different avenue." The couples who had experienced multiple critical events appeared to be feeling the need to revision their lives, but also were still feeling anxious and emotionally drained. There was a sense that for these couples the process o f exploring new goals was still very tentative as they coped with the other challenges in their lives. One o f these couples in particular also described a strong need to be able to control things, and a fear o f making "wrong" decisions. The husband described their sense o f revisioning their lives as follows: " N o w it's time to think o f something else and now you haven't quite decided because you always thought your life would turn out a certain way. W e l l now that's no longer there so where are you going now? H o w are you going to live the next 45 years o f your life? That's a big chunk o f life ahead, you know." For one o f these couples, rural living was another factor that challenged their revisioning process. They lived in a small town where they lacked fulfilling work and close social connections. The wife said:  99 " W e l l I think the thing is now I know I ' m not going to be a mom. I have to do something with my life. It gives me opportunities. But I just don't see much opportunity here to do anything." In terms o f differences among the couples with respect to revisioning their sense o f identity, a few participants said that they did not see their identities as having been significantly impacted by infertility and childlessness, and made few specific comments about revisioning identity. However, they did describe revisioning their lifestyles, life goals, and how to meet their needs to nurture, which suggests they may have experienced an identity shift on some level through their involvement in new roles and activities. For example, one woman who was actively exploring her options with respect to finding more meaningful work said, " M y whole life is not focussed around becoming a mother. I ' d like to think there's more to me. I ' m an individual without having children." Conversely, another woman who clearly linked her sense o f identity with motherhood, spoke o f having great difficulty revisioning who she was or what she might do. She said, "I couldn't have kids and now I can't go to school and I had to quit my job and I mean, what's my purpose here? I ' m just a person on this earth existing." In summary, the theme o f revisioning life and identity was salient for all o f the couples. There was wide variation i n terms o f where couples were with respect to creating and implementing a new life vision during the course o f the study. Most couples described optimistically exploring their longer-term goals and lifestyle i n order to create greater meaning i n their lives, while increasing their pleasure and satisfaction by investing energy i n new creative labours and interests. Some participants found that existing goals and activities such as work or hobbies that had been put aside during infertility had regained their importance or taken on new meaning. M a n y couples talked about  100  beginning to revision themselves as a couple-only unit, which entailed making their own needs, schedules, and traditions a priority. Most also reconceptualized parenthood as a result o f accepting their childlessness and having the sense that the "right" time to parent had passed. The revised and met their needs to nurture by forming or maintaining relationships with other people's children, mentoring, or acquiring pets. Fewer women i n the study described forming these alternative nurturing relationships than men. The women i n the study were also much more likely to describe revisioning their lives through forming new work or educational goals than were the men. However, a number of men did describe regaining their self-esteem and competence through their existing work or leisure interests once they began to put infertility behind them. For couples who experienced multiple critical life events, the need to revision their lives was marked by anxiety and disequilibrium, and their exploration o f new goals and interests appeared to be delayed. A Sense o f Appreciation for the Strength o f Their Relationship. Throughout this study, all o f the participants expressed a sense o f appreciation for the strength o f their relationship with their spouse. The main aspects o f this theme included the sense the couples had that they had weathered a tough process, that they had emerged intact, and that they now felt more committed to the relationship than ever before. Some couples also talked about how their relationship had improved in terms o f strength and intimacy from having survived infertility and childlessness. A s well, many couples talked about how communicating effectively with each other was crucial in order to come to terms with their infertility and childlessness, and to be able to move forward with their lives. The  101 ability to communicate well appeared for these couples to be a hard-earned source o f pride. A n aspect o f this theme that all the couples described was the sense o f having survived a very tough process that had tested their marriage. The emotional residue o f this process was evident i n many o f the comments these couples made. For example, one woman who had weathered multiple losses i n addition to infertility and childlessness, said, " W e still love one another and the love is strong, i f not stronger than it was when we first got married, I think. But it got lost there a little bit." Most couples appeared to be o f the opinion that coming to terms with their infertility and childlessness was the most difficult thing they had faced as a couple. One man, who appeared to have a style o f coping and communicating that was similar to his wife's, said, "When people ask us about emigrating to Canada, I say ' T r y it, but it w i l l test your marriage.' But that's nothing compared to infertility." Some couples had faced the additional test o f having experienced conflict around adoption. For example, one man was 9 years older than his wife and beginning to contemplate retirement. She was attempting to move on with her life despite having deeply wanted to adopt. He described how, while they considered themselves to be closer than ever, the process continued to be challenging: "She's in her m i d 30s and she's seeing a door closing that she doesn't really want to have closed on her. So I ' m seeing a door opening and she's seeing a door closing on each o f our individual desires." Some o f the women i n the study appeared to find their appreciation for the quality o f their marriage helpful i n reconciling themselves to not adopting. One o f these woman said,  102  " W e have a good marriage, a strong marriage and I think that in itself is almost more than you could really ask for." Some couples appeared to have undergone an unnerving process o f re-evaluating their marriages i n light o f their childless future. The husband in one couple who described themselves as thoroughly committed to each other, said, "What happens when you get married, you have children, right. If you're not going to have children, you have to really take a look at why did you get married." Most o f the couples described experiencing a strong sense o f solidarity and confidence i n their relationship as a result o f having survived the strains o f infertility and childlessness. A sense o f pride and gratitude radiated from many o f their comments. For example, the wife i n a couple who had experienced multiple critical events said, "I don't think we would have gotten through this without each other." M a n y couples talked about how overcoming their struggles during infertility had actually improved their relationships. One man described how, after a number o f difficult hurdles in their infertility process such as the lack o f support from their families and having had no choice in ending their treatment, he and his partner were closer than ever: "One o f the things that has helped or resulted from all o f this is the feeling that we've been through the wars together and we survived that and so let's head down the highway together and that's gonna be it." The husband in another couple who had experienced multiple traumas i n addition to infertility said that, as a result o f talking everything through; "It's made us even more open. It's forced us to become much more open about how we feel and to talk about it." Another couple who had appeared to feel quite wounded by the process o f coming to  103  terms with their childlessness and had experienced conflict around adoption. The husband said i n the final interview: "We're better now because we see potentials for us to do. A l s o we are three years further down the road in our marriage and still enjoying each other's company and so I think we're relying on each other more." The husband in a couple who appeared to be revisioning their lives with confidence, summed up the changes i n their relationship with these words: " O h , closer, stronger, happier." Most o f these couples also appeared to appreciate how their experiences with infertility and childlessness had allowed for personal growth within the relationship. For example, the woman i n the couple who were becoming involved i n a variety o f new life goals and interests after having had a 6 month work-related separation said, "I learned that I was a person." Another participant described her appreciation for her own changes as she learned to communicate with her husband about their childlessness; "I've had to learn to listen to voices other than my own and that's been a growing up process." Another aspect o f the theme o f appreciating their relationship was the sense o f mutual support and respect these couples described. For several couples this focussed on their respective lack o f blame for their infertility. For example, one man said, " W h e n you get married you are expected to reproduce and when you can't, is that where the blaming comes in, 'it must be her fault or his fault'. But we've never blamed." Another woman, who appeared to hold herself responsible for the couple's infertility, spoke in glowing terms about her husband's lack o f blame and constant support; "I found out what true love is. Because a lot o f people I don't think would have put up with it."  104  Couples also talked about their mutual support in terms o f allowing for different ways o f coping with the infertility process, or being in different places with respect to accepting childlessness and moving on. For example, one man who saw his role i n the relationship as being a support to his wife while she continued to grapple with childlessness and other losses, although he himself felt he had moved on, said, "This is the reason we're together. She'd do the same for me." The final aspect o f the theme o f appreciating the strength o f their relationships was expressed by o f these couples with respect to the importance o f good communication in coming to terms with infertility and childlessness. There was also a sense that communicating around these issues had been, and at times continued to be, challenging as well as necessary and rewarding. For example, one woman described a turning point i n the couple's communication after they had a blowup about trying to conceive immediately after a miscarriage; " W e talked about everything after that. If it stays under there and everybody's simmering away and harboring resentment, it's not very good." Another man who appeared to have a very intellectual coping style whereas his wife was very emotional, said: "I think we get frustrated i f the other doesn't understand our viewpoint but we're probably trying to rationalize, now you understand why I ' m saying this. It might not change things but at least we share our viewpoints." Another woman who very much wanted to parent while her husband was more reluctant, said: "We had to really talk to each other. A n d because one o f us, being me, was so passionate about it, it took all o f my power not to just get angry. I think we communicate much better now because o f it."  105  Some o f the couples also talked about learning to compromise or accept differences i n how often they needed to talk things through. For example, one woman said: "He knows me well enough to know I needed to talk a lot about it and I know h i m well enough to know he wasn't not going to verbalize a lot o f it, so he'd listen when I needed to be listened to, and I'd shut up when he needed me to shut up." Another difference in communication that the couples described working through, involved the husbands' hesitation to discuss topics that caused the wives pain. For example, one woman described her appreciation for her husband's willingness to participate i n these talks even though she believed he would prefer to avoid them: "I always felt I was more willing to talk about it. A n d that a lot o f times you would rather have me not talk about it because you knew it was hard for me. A n d yet you would participate willingly when we got into the discussion." The man who described his role in the couple's relationship as supporting his wife, spoke o f his difficulty in claiming and articulating his own feelings, particularly his anger and frustration about her struggle to leave their infertility behind. He said: " I ' m still working on it. Relationships are ongoing things and I forget that sometimes, I feel you sign the paper and that's it for life and o f course it doesn't work like that. Human beings need to be conversed with." Other than the fact that several couples noted that the husbands tended to be less likely to initiate conversations about infertility and childlessness, or wanted to talk about it less often than the women, there were no gender differences noted i n any other aspect o f the theme o f appreciating the relationship. In addition, all o f the couples in the study expressed at least some degree o f appreciation for the strength o f their relationship. Even two couples who had struggled with other significant issues were determinedly trying to get their relationships back on an even keel. For example, one o f the wives said o f the  106  couple's conflict around adoption and her illness; " W e ' v e gone through a relationship crisis and we're sort o f stepping out o f it. We have some setbacks and we have to crawl back up again and work on it." In summary, the couples in this study appeared to see the strength and resilience o f their relationships as a factor that helped them cope and come to terms with their experiences o f infertility and childlessness. A s well, many described improvements i n the quality o f their relationship with each other as a result o f having survived their infertility intact and having learned to communicate more effectively and to deal with differences i n communication needs. This learning appeared, for many o f the couples, to be a crucial aspect o f getting through infertility and childlessness, and was considered an accomplishment. These couples also talked about appreciating the support given and received by their partners, and their experiences o f individual growth within the relationship. Even the couples whose relationships continued to be tested by other traumatic experiences appeared to be working hard to get their relationships back on an even keel, while appreciating their ability to weather the process thus far. A Sense o f Recognition and Reconciliation to Their Fate. A theme that emerged i n this study was the sense that these couples recognized and were reconciled to their childless fate. This theme therefore encompasses the development o f a broader perspective on, and acceptance of, their childlessness that most couples began to express. They tended to describe his sense around the second or third interview and continued to elaborate on this theme i n subsequent sessions. Aspects o f this theme included the recognition that, while the losses around infertility and childlessness would never be totally resolved, healing had taken place that allowed the couples to accept what they  107  perceived as an unjust and uncontrollable fate. Some talked about developing a perspective i n which they situated their particular fate in the context o f a universal human condition i n which everyone has burdens to bear. Many o f the couples also articulated their determination to make the most o f childless living, even though it was not what they would have chosen. Finally, several o f these couples talked about the difficulty that a diagnosis o f unexplained infertility presented i n terms o f reconciling themselves to their childlessness. Part o f the theme o f reconciling to their fate was the belief and acceptance on the part o f the participants that, while the pain and loss o f their infertility and childlessness would continue to recede, it would never completely vanish from their lives. For example, one woman who saw herself as looking forward to the future with anticipation, spoke for most o f the other participants when she said o f her sense o f loss; " O h yeah, it crops up every now and then. I expect it w i l l always crop up every now and then." Another woman who saw herself as seizing the advantages o f childless living by the end o f the study, described how her yearning for a child had become something she could live with emotionally; "It's not a regret, no it's just, oh I wish, I wish that it could have been me." M a n y participants predicted that feelings o f loss would resurface during normative life transitions and special occasions in the future. For example, one woman said: "I don't really think I ' l l ever be able to experience a Christmas without some pangs of, you know, and I ' l l watch my sisters get into grandchildren and things like that, it's never going to go away completely." The participants also voiced concerns about loneliness and isolation i n old age. In the words o f one woman, who came to see herself as generally having a bright future; " I f I  108  have to go i n a home, who w i l l be there to visit me and take me outside. Nobody, cause I don't have kids. That was one thing...." Another aspect o f the theme o f accepting their childless fate was the sense most o f the couples described o f coming to terms with the limits o f their control over an unjust fate. For example, one wife who had come to terms with the fact that her husband did not want to adopt as well as with their biological childlessness, said, " Y o u ' r e not always going to get what you want, life isn't always going to be fair. W e ' v e learned that you can try and try and try and eventually you have to let go." Another woman who described herself as having been very distressed at having to listen to her coworkers' conversations about their children, said, "I've made up my mind I have to get used to people talking about their kids because it's not gonna change. It'll always be that way." There was also a sense that acknowledging their lack o f control over the outcome of the infertility process also freed participants from feeling that infertility was somehow their fault. For example, one woman said: " Y o u can take an active part in treatment. But so much o f it is things that are not within your control and you have absolutely nothing to do with what was going to happen. It just happened." There was a sense that this acceptance was a deep change, affecting the self-image of some o f the participants. For example, one man spoke about how his accepting the limits o f his control had changed his sense o f himself; "I've never been one o f these where, okay, que sera and whatever w i l l be and it's not meant to be. I've not really been like that and yet I ' m finding myself in that position." Another woman described the change i n terms o f her self-image; " I ' m coming to terms with the fact that I w i l l always be just a little bit different than friends or family."  109  About half o f the couples in the study also made comments about recognizing that everyone has burdens to bear in life. There was a sense around these comments o f a broad perspective that depersonalized the issue o f infertility somewhat by putting it i n the context o f a universal human fate. For example, one wife was talking about being shaken out o f her focus on infertility by meeting a woman who was finding her fertility a burden. Her husband reflected that: "Maybe whatever we've got individually is our burden and whatever somebody else has got is what we want." This perspective appeared to help couples feel less victimized or singled out by their infertility and childlessness. For example, one woman said, when talking about how many people had revealed their own infertility struggle to her; "Everybody has their crosses to bear. I don't look at it like it's why me, you know." Couples talked about how, as they came to reconcile themselves to their childlessness, they became more empathic about the suffering o f others and shifted their focus to helping others in the same state. For example, one man described how he could tell that his wife, who had started and run a support group with h i m , had come to some acceptance o f their childlessness; "It was when she stopped looking at every scrap o f newspaper related to infertility and saying that sounds like me. A n d started saying, the group would be interested in this." Some couples also talked about a shift to a broader and more positive interpretation o f the world around them as a result o f healing and reconciling themselves to their fate. For example, one woman who had struggled with feeling unsupported and socially rejected, described how she had become more inclined to see people as having positive intentions but simply being too busy to initiate social contact. She said:  110 "I think while you're really into your infertility you're thinking of yourself only and maybe as you come out of it, you look around and that's why I'm seeing more positives around me. I think I've opened my heart." A further aspect of reconciling to the fate of childlessness appeared to be the determination that was voiced by several couples to seize the advantages of childless living, even i f such a life would not have been their choice. The wife in the couple who by the end of the study had bought a house and found meaningful creative pursuits said, "It wouldn't bother me if I couldn't have a brand new car or a holiday here or this or that. But if that's all I've got to choose from, then I'll go for it. And enjoy it." One man described the couple's determination to focus on what did and could work in their lives with a metaphor: "It's like you wallpaper a room and it looks fine, but you know there's one seam in the corner that isn't right and that's what you zero in on and the whole room isn't right because of it. But in fact, one seam isn't right, and the rest of it is acceptable." Another woman, who said later in the study that she had chosen to move on with her life, summed up most aspects of the theme of reconciling to a childless fate when she said, "There will always be a bit of a hole there, but there are good things out there. In time you will come to know them and that's all. There's no magic, it's just the way it is." Four of the couples in the study also described how the diagnosis of unexplained infertility had hampered their efforts to come to terms with their childlessness. The sense of pain and difficulty putting the issue to rest because of unanswered questions was most evident in this comment by one of the wives, who saw her whole identity as a woman thrown into question by the couple's childlessness: "I guess acceptance will never come until I'm 99 or when I know pregnancy is absolutely impossible. I never knew the reason for our infertility, and i f I had  Ill  something that I knew was wrong, then I think we could place it i n its proper area and deal with it." Three o f these four couples, including the one above, also made fewer comments that suggested reconciliation to their childlessness. However, these couples also reported facing multiple critical events. In fact, one couple said that facing several stressful events at the same time was significantly more painful and distressing than coping with infertility. Another couple did appear to be moving forward with their lives once the wife had a hysterectomy. However, they continued to feel tormented at times, not only about their lack o f a definitive diagnosis, but also about the lack o f closure stemming from their perception that they might i n fact have conceived i f their infertility treatment had been handled differently. The wife said, "Not knowing goes on forever. It's hard. It's like being fired but not being told the cause." Another couple, on the other hand, appeared to have accepted their childlessness and to be moving on with their lives fairly smoothly, despite their unexplained infertility. This couple said that having a child was a important mutual goal but their relationship was the primary reason for the marriage. The wife described their perspective on their life without children as follows: "I would say to him, what's our life going to be like without children and he said well what are you worried about because our life is without children now so i t ' l l be the same but different. The big change would have been i f w e ' d had children." In summary, the theme o f recognizing and reconciling to their childless fate appeared for the couples i n the study to encompass the development o f a broader perspective on their childlessness that helped facilitate acceptance. This perspective allowed couples to accept that the loss o f children would be a permanent part o f their lives  112  and to see it as one o f the burdens that are part o f the human condition. Couples also acknowledged that they had never had control over their destiny to be childless, and therefore did not have to continue to struggle with it. A number o f couples also spoke about making the most o f what fate had handed them by seizing the advantages o f a childless life. For some, their diagnosis o f unexplained infertility appeared to have been challenging i n their experience o f reconciling themselves with their fate to be childless. A Need to Make Sense o f Their Experience Another theme that emerged during the study was the need on the part o f some couples to make sense o f their experiences o f infertility and childlessness. Generally, these couples appeared to do this by articulating explanations for or a sense o f purpose around their experiences. One area i n which they sought to make sense o f their experiences involved the question o f why they, i n particular, were destined to be infertile. The other area involved making sense o f the trials they had endured through infertility and childlessness. Some couples appeared to do this by articulating what they had gained in terms o f wisdom and growth as a result o f these experiences. Some couples appeared to make sense o f their experiences o f infertility and childlessness by reaching the conclusion that their fate was part o f a grand life design created by a higher power. One woman echoed the sentiments o f several others i n the study when she said: "Nature just intended for me to be that way." Similarly, in attempting to make sense o f their childlessness, one o f the husbands, who enjoyed close relationships with nieces and nephews, said: "Maybe that's why we weren't meant to have kids, we have so many kids around us that need us."  113  A number o f participants also talked about the personal gains they had experienced as a result o f weathering their infertility and childlessness. Some described a sense o f personal growth. For example, the woman i n the couple who appeared to be engaged i n a new life vision and to have experienced great personal growth by the final interview said, "Infertility was a price worth paying cause I don't think I would have ever reached this. I would have been a parent and what would that have made m e . . . " Another woman who described infertility as having become a coping tool, talked about having gained more confidence that she could deal with other big losses i n life; "I know when one o f my parents dies i t ' l l probably be two years out o f my life that'll be a black blur, but I ' l l get over it." Several participants also described gains in terms o f having clarified their priorities and values. Most o f these participants described how they no longer "sweated the small stuff." One woman summed it up as follows: " Y o u value the things that are important and you don't worry about the rest. W e spend time with our nieces and nephews and don't worry about whether we get the right colour o f drapes for the living room." A few participants also talked about having gained meaning through educating people about infertility, or helping other infertile couples through the process. For example, one woman said o f the infertility support group that she and her husband had started: "There are probably a couple dozen people that really changed the way they looked at the whole process because o f it. I ' m sorry we had to go through infertility to do that, but at least we can put the experience to some sort o f positive thing." Others talked about making gains i n terms o f having a broader and more relaxed perspective on other issues, as a result o f having survived infertility and childlessness. For  114  example, one woman described infertility as having helped others to view her as an accessible person: " A lot o f people are starting to know about our infertility. A n d now I think they're seeing me as human. They're seeing us as, well, they don't have everything they want, they do have their pains in life, they are like the rest o f us." This same woman also appeared to find meaning in the idea that she could be a role model for a positive childless life to the next generation: "Maybe they'll be able to say we remember them and they didn't have kids and they were happy. Y o u know, by being happy and having a positive outlook on life, getting involved with things, they can identify with someone who didn't have children." In terms o f differences among the couples with regard to this theme, for one, couple the husband appeared to have accepted their childlessness and was wanting to move on with life, while the wife continued to struggle. This was the couple where the wife described her self as being lost due to her inability to bear children as well as other traumatic losses. She appeared to be unable either to accept or make sense o f their infertility and childlessness. The husband appeared to try to make sense o f the resulting limbo i n which they found themselves: "I always felt the man is an outsider, he's on standby like on a flight, going somewhere, maybe I can get on, maybe another two hours, maybe another day. Y o u stand around and you wait and see what's going on but you really can't do much. I ' m still on standby and I w i l l be until we're done." The other couple who had experienced multiple critical events made few comments that suggested they were beginning to make sense o f their situation. When the interviewer queried them about the meaning they gave to their experience, the wife said: "There's not any sense to be made o f it. It's just a situation and you just have to live with it."  115  In summary, the couples who appeared to have experienced some emotional healing around their infertility and childlessness, and who had not only decided to move on with their lives but had begun to actively revision their lives by reinvesting their energies i n creative pursuits and exploring new life goals, appeared also to want to make sense o f the experiences they had gone through i n their quest for a biological child. Some couples had found satisfactory answers for themselves as to why they were singled out for infertility, while others made sense o f their experience by focussing on the personal growth and confidence they had gained for dealing with the rest o f their lives.  116  Chapter Five Discussion Introduction The problem that this research study attempts to address is the nature o f the lived experience o f permanent childlessness and the meaning o f that experience for infertile couples who elect not to pursue other parenting options when infertility treatment fails. In the first section o f this chapter, I highlight the significant findings from this study and compare them to the literature on this topic that was reviewed i n Chapter Two. In the second section o f this chapter, I examine the implications of these findings for clinical practice with infertile couples considering, or i n the process of, adjusting to permanent childlessness, as well as addressing the considerations for future research. The first significant finding is that, over time, most o f the couples in this study appeared to accept their childlessness and moved toward developing fulfilling lives without children. This finding appears to support what Ireland (1993) found with respect to infertile women's adjustment to permanent childlessness. It also supports Wirtberg's (1992) finding with respect to women's adjustment over a two-year period, but contradicts her findings with respect to men's adjustment. This is discussed in more detail below. In terms o f the finding that most couples appear to accept their childlessness and begin to move on with their lives, the experiences described by most o f the couples i n this study appear to lend support to the processes and tasks described with respect to women's adjustment to childlessness by Anton (1992), Carter and Carter (1989), Ireland (1993), and with respect to couple adjustment as suggested by Matthews and Martin Matthews  117  (1986). A s well, while it was not the specific intention o f this researcher to explore the lived experience o f permanent childlessness as a process that unfolds over time, because there were 4 interviews conducted over a 3 year period, a temporal sense does emerge in the themes. This sense in turn appears similar to what is suggested in the literature described in Chapter Two. For example, the finding that couples' descriptions tended to emphasize grieving, followed by reaching emotional acceptance, regaining a sense o f agency and control, and making external changes in their lives, tends to support the models by Anton and Carter and Carter, as well as the findings by Ireland and Wirtberg (1992) with respect to women's adjustment. These works all suggest that grieving precedes the acceptance o f childlessness, and that acceptance is necessary before revisioning o f life goals and roles can occur. A s well, the issues that appeared to make the lived experience o f permanent childlessness more or less difficult for the couples i n this study also lend support to the existing literature on this topic. For example, the perceived presence o f social contact and support appeared to be important to these couples in terms o f their ability to cope with their childlessness and begin to rebuild their lives. This is also suggested by Anton, Matthews and Martin Matthews, and Ireland. The sense o f having actual or potential meaningful goals that were not parenting-related was another facet o f experience that appeared to influence how challenging couples perceived their experience to be. This lends support to the concept o f reorganizing priorities which Carter and Carter emphasized. It also appears to support the linked concepts o f role readjustment and identity transformation, in which couples explore and identify with new roles and goals (Matthews & Martin Matthews). However, one wife who reported coming to terms quite well with their childlessness, also described regaining pleasure i n a fulfilling job she  118  already had. This extends Matthews and Martin Matthews' model by suggesting that new goals are not always developed, and that a person's role hierarchy may be simply reorganized around existing goals, provided they are meaningful. The finding that most couples describe moving on with their lives also extends what is known from the available literature in that the husbands appeared to have many o f the same experiences in adjustment as did their wives. For example, both sexes tended to describe needing to emotionally accept their childlessness before they felt the urge to revision their lives. The men also described similar needs to their wives i n terms o f revisioning their futures and the role o f parent. These common experiences appear to lend support to Carter and Carter's (1989) model as well as to Matthews and Martin Matthews's (1986) theoretical assumptions that relate to how couples adjust to nonparenthood. However, in this study, significant gender differences were also found in men's and women's lived experience o f permanent childlessness. These findings significantly extend our knowledge of the adjustment process and are discussed below. The finding that most participants, particularly the women, continued to feel periodic, recurring feelings o f sadness and loss over the 3 year course o f the study supports the other literature on the adjustment process. The finding supports the models by Anton, (1992), Carter and Carter (1989), and the findings by Ireland (1993) and Wirtberg (1992), in suggesting that moments o f emotional loss continue to be felt i n the lived experience o f involuntary childlessness due to infertility, even among couples who come to see their lives as being very fulfilling without children. It also extends the model by Matthews and Martin Matthews because it strongly suggests that the emotional  119  sequelae o f infertility are significant and need to be considered in the process o f making the transition to nonparenthood. A further aspect o f the finding that most couples adjust to permanent childlessness over time, which extends what we know from the available literature on this topic, is the variation in how couples described their experience o f childlessness over time. Wirtberg (1992) explored the differences i n couples' experiences over time by conducting initial and 2 year follow-up interviews with her participants. The findings in both studies suggest that many infertile couples come to accept their childlessness, and may begin to reinvest in new goals and revisioning their sense o f identity, between 1 and 2 years after ending infertility treatment. However, in the present study, one couple reported having reached emotional acceptance o f their childlessness in the first interview, while one other couple was clearly still struggling i n the final interview. A s well, some couples appeared to reach acceptance but become stuck when they began to feel the need to revision their lives. This suggests that there may be greater variability i n terms o f some couples' experiences o f and adjustment to permanent involuntary childlessness than was previously thought. This variability appears to support the contention by Anton (1992) and Garter and Carter (1989) that couples may become stuck at the early stage o f grieving, and extends it by suggesting that some couples may become stalled at any point in their experience o f living with childlessness, particularly i f other life stresses are present. A s well, greater emotional difficulty was reported by couples who lacked social support and, i n one case, where the wife was unable to shift her identification away from the parent role. Consistent with Matthews and Martin Matthews (1986), it appears that placing high value on the parent role, having low role flexibility, and experiencing social  120  pressure to have children may well make the lived experience o f permanent childlessness very challenging. The impact o f critical events is another finding in this study that appeared to account for some o f the variation in couples' descriptions o f their experience o f their childlessness. A critical event appeared to be one that was stressful and out o f the couple's control. A significant number of couples reported a shift i n perception around their childlessness that was catalyzed by one or more critical events. In some cases, these events facilitated couples' emotional acceptance o f their childlessness by increasing their appreciation for their present lives. However, other couples who personally experienced multiple critical events with a prolonged negative impact, such as chronic illness, reported great difficulty in moving on with their lives. These couples appeared to have experienced a very high degree o f stress that negatively impacted their overall functioning and, as a result, their ability to accept or move on from their childlessness. The possibility that critical events might impact couples' experience negatively as well as positively extends Wirtberg's (1992) work on significant events. It also adds another dimension to the models o f adjustment proposed by others (Anton, 1992; Carter and Carter, 1989; Ireland, 1993; Matthews and Martin Matthews, 1986), by suggesting that the experience o f permanent childlessness takes place within a broader context that needs to be considered. This may be especially relevant for couples who face permanent childlessness in their 30s and 40s, since as they age they become more likely to encounter critical events such as illness. Another significant finding in this study is that gender differences appear to exist in the lived experience o f permanent childlessness. Both the men and women i n this study  121  tended to report similar experiences i n terms o f accepting their childlessness and moving on to positively revision their lives, but several important differences were consistently noted. Methodological issues that could have been a factor in these differences are discussed in the next section o f this chapter. The most significant gender difference is that all o f the husbands appeared to reach emotional acceptance o f their childlessness sooner and more easily than did their wives. This contradicts Wirtberg's (1992) finding that the men i n her study were more upset by their childlessness at follow-up than were their wives. Far fewer husbands than wives in this study described their decision to move on with their lives as a conscious choice made after a struggle. A s well, more o f the men reported developing alternative nurturing relationships during the course o f the study than did the wives, a difference that may mean that the process o f revisioning the parenting role and redirecting nurturing energies is more difficult or lengthy for the women i n these infertile couples. Some o f the women in this study indicated that they harboured a residual hope for a pregnancy, while a few still appeared by the final interview to find contact with children to be a reminder o f their loss. Finally, these women had received a diagnosis o f unexplained infertility, which may make it more difficult to put closure to the issue o f whether biological children may be possible. These factors may have impacted their ability or desire to form other nurturing relationships. Another gender difference was found in the way that many o f the husbands appeared to focus their emotional energy on their wives' adjustment. This was particularly noticeable among the husbands who suggested that they had reached acceptance prior to their wives. Wirtberg (1992) also found that during the interviews for her study, most o f the men focussed on their wives' adjustment. However, the finding i n  122  this study that most husbands described having accepted their childlessness, suggests a different interpretation than Wirtberg's. That is, the husbands i n this study may have focussed on their wives' ability to move on with their lives because they had already reached acceptance and not because they needed to avoid their own emotions. Both the men and women in this study appeared to revision the role o f parent, developing other kinds o f nurturing relationships, however the men were less likely than the women to describe revisioning their lives in terms o f work. The husbands in this study who did describe revisioning their work goals were facing not only their childlessness, but also other factors such as job loss or being at mid-life. A l s o , one or two husbands described gaining a new sense o f themselves, primarily through leisure goals, but most described regaining a sense o f confidence or competence that they had previously enjoyed. Most o f the women in the study enjoyed creative labours but lacked satisfying work and stated that work or education had become important goals i n their own right. Through comments they made regarding wanting to contribute to society or gain self esteem, it appeared that these women attached a lot o f meaning to work or education as a way o f redefining themselves. The woman in the study who reported the greatest difficulty adjusting to childlessness saw herself as a failure for being childless. She had been forced to abandon her alternative goals o f work and school. This connection between work and identity appears to support Ireland's (1993) findings about how the women i n her sample who supported a traditional gender identity tended to recreate their sense o f self through work, although it is likely that at least some women in this study, given their comments, would have been inclined toward a less traditional gender identity. This  123  finding also suggests that revisioning identity may be less salient i n men's experience o f permanent childlessness, unless other issues are also present. This is because, through gender socialization, men may be more likely to perceive their identities i n terms o f work, and the men i n this study did not revision their work as a direct result o f infertility and childlessness. Further, this may mean that, for the wives in infertile couples, reality reconstruction, identity transformation, and role readjustment (Matthews & Martin Matthews, 1986) are equally meaningful and important parts o f their experience. For husbands, reality reconstruction and role readjustment with respect to parenting may be more salient than identity transformation. Some gender differences with respect to communication were also found in this study. Most o f the couples described the willingness and ability to communicate effectively with each other as crucial to getting through the adaptation process intact. Many also talked about having worked through differences in their communication styles. Some o f these differences included women's reports o f their husbands being less likely to initiate a discussion about their childlessness or not wanting to talk about it as often as they did. This finding supports Carter and Carter's (1989) ideas with respect to mutual communication. However, many o f the men in this study were strongly opposed to adoption and this apparently influenced some couples' decision-making, extending what we know from Carter and Carter. That is, while the majority o f the couples in this study did appear to mutually decide not to adopt, for four couples this was not the case. T w o o f the women chose to accept their husbands' resistance to adoption. They were able to formulate alternative goals and both couples appeared to be moving on with their lives despite the lack o f mutuality in this area. The two other couples described continuing  124  emotional turmoil, but these were also the couples who had experienced multiple critical events. In fact, one o f these couples decided against adoption by mutually avoiding the topic. In any case, this finding may raise some questions about the necessity o f mutual decision-making (Carter & Carter), particularly when both spouses perceive that satisfying alternative goals exist. It may be that what couples find important is not so much experiencing a mutual process but rather, feeling the benefit o f mutual support and effective communication during experiences that may be different for each gender. In any case, the gender differences found in this study suggest that the models proposed by Carter and Carter (1989) or Matthews and Martin Matthews (1986) may need to specifically address these differences in order to more accurately capture the experience o f permanent involuntary childlessness for infertile men and women. The final significant finding in this study is the way that couples who were able to emotionally accept their childlessness and had begun to revision their goals and identities, also began to describe meaning-making around their experiences o f infertility and childlessness later i n their adjustment. This finding has not been raised in the available literature on involuntary childlessness, although it is related to the shifts o f perspective suggested by Anton (1992), Carter and Carter (1989), and Ireland (1993). This finding extends what is known from the existing literature by suggesting that meaning-making may be another aspect o f the lived experience o f permanent involuntary childlessness. It also provides some information about the forms that such meaning-making may take. These include couples' making sense o f why they were singled out to be infertile, or articulating what has been gained as a result o f surviving and adjusting to infertility and childlessness. This finding suggests that the sense o f having moved on with their lives  125  may be anchored by a couple's constructing a narrative o f their experiences that satisfies their needs for meaning and control. Because meaning-making was described by a few couples late i n the study, this experience needs further exploration over the long term. Implications for Practice and Research In this section, the implications for clinical work with infertile couples adjusting to permanent involuntary childlessness are examined with respect to each significant finding in the study, along with implications for future research. In considering the implications of these findings, it is, also important to consider the limitations o f this study. For example, the participants in this study were all middle and upper-middle class, white European-Canadians within a relatively narrow age range. A l l of them had received a diagnosis o f unexplained infertility. These findings may not be generalizable to participants with different demographics, or whose infertility has been definitively diagnosed. This sample was also self-selected, and the experiences o f these couples may not represent the experiences o f other infertile couples. Further, as the methodology o f this study is phenomenological and exploratory, the results should not be considered to be conclusive. Replication o f these results, preferably with larger samples with more demographic variation, w i l l help to determine i f these findings are transferable to other infertile couples. Continued research w i l l also help to validate and refine the themes identified in this study. Finally, the interviewing procedure may have influenced some o f the findings i n this study. Recognizing that an interview is a co-construction between researcher and participants which is inescapably influenced by the personalities and gender o f all the participants, it is also possible that there were gender effects on the data as a result o f interviewing the spouses together instead of separately.  126  Relative to the finding that most infertile couples do appear to accept their childlessness and move on with their lives, counsellors working with infertile couples who are considering or adjusting to permanent childlessness are i n a position both to offer hope and to provide information to their clients. This information should include an explanation o f what the couple might be likely to confront, such as grieving, coming to accept their biological childlessness and regaining control o f their lives, and revisioning their future goals and nurturing needs should they decide not to adopt. Counsellors might also talk to their clierrts about the possibility that integrating their experience o f childlessness and moving on could take several years or more, depending on the presence of other life stressors and the importance placed on parenthood. It w i l l also be important for clinicians to elicit clients' expectations o f resolution, and to share with them the likelihood that they w i l l continue to experience recurring, albeit lessened, feelings o f sadness and loss. Given that many o f the couples in this study described experiences that appear to support the information in the available self-help books written about this topic (e.g. Anton, 1993; Carter and Carter, 1989; Ireland, 1993), clinicians may also be able to be more confident in recommending these books to infertile couples as a source o f useful information. However, it w i l l also be important for counsellors to assess the factors that may make a couple's experience o f their childlessness more challenging, and not to make assumptions about that experience based on how much time has passed since they ended treatment. Further research is needed to determine i f the finding that most couples do accept permanent childlessness and move on can be replicated, and whether it may also apply to infertile couples with different demographic profiles. For example, two factors that  127  strongly influenced the degree to which these couples, the women especially, found the experience o f childlessness to be difficult, included making shifts to take on nonparenting related goals and activities, and having social support for that reinvestment. Infertile couples from cultures where having children is more central to identity and adult social status than it is i n Canada, for example, may find the experience more difficult, or the nature o f the experience may be quite different. A s well, the couples i n this sample were self-selected, and so may not reflect the experience o f most infertile couples. Further, many o f the participants were in their 30s or 40s when the study began, and their sense that the appropriate time to be a parent was ending appeared to help them to accept their childlessness. Younger couples may be less inclined to shift their perspective o f parenthood i n this way and so their experience may be different. Finally, all but one o f the couples in this sample had chosen to end their infertility treatment, and all regarded ending treatment as an important element of regaining choice and control. The experience of childlessness may therefore be different for couples whose treatment has been terminated against their w i l l or who have not had the financial resources to pursue treatment. Further research is therefore needed with these different groups in order to determine whether the finding that most couples in this study accepted their infertility and childlessness and moved on with their lives is transferable to other infertile couples. Another finding was that that critical events may impact couples' experience o f infertility and permanent childlessness positively or negatively. Given this finding, it w i l l be important for clinicians to assess the incidence o f critical events in their clients' lives, as well as the emotional and psychological impact o f these events on the couple's overall functioning. If critical events appear to impede the couple's ability to accept their  128  childlessness, or to revision new goals and roles, normalizing these events and explaining their effect on the process of adjusting to infertility may be helpful, as w i l l counselling for these issues themselves. Further research is needed to replicate these findings and to get a better sense o f what constitutes a critical event. Research w i l l also help us understand more about the experiences that infertile couples with different demographic profiles might have i n response to similar kinds of events. It is also not clear in this study whether critical events that make the experience o f childlessness more difficult do so by impacting a couple's healing around their childlessness specifically, or by impeding their overall functioning. Further, all o f the couples in this study who described being negatively affected by critical events also described other things that made their childlessness a challenge, such as a perceived lack o f social support, so the relationship between critical events and other life experiences is far from clear. With respect to clinical practice and the findings around gender differences i n the experience o f permanent involuntary childlessness, the primary implication is that clinicians must be prepared to encounter and work with these differences among their clients. In practice, this would mean normalizing the fact that spouses may have different experiences o f childlessness, and working with the meaning o f those differences to the clients. For example, a counsellor might explain to a couple that i f the husband has accepted the couple's childlessness relatively easily, this may indicate the effects o f socialization around male gender identity, rather than a lack o f caring. Clinicians should also focus on helping clients to communicate i n a way that meets their needs to connect and work things through, but also allows for differences in communication styles, such as  129  an agreement to have periodic breaks from talking about childlessness, for example. It may also be beneficial for clinicians to talk about the fact that one or both spouses may become stuck in terms o f moving on with their lives, as well as possible reasons that this might happen, such as gender identity issues around parenthood. Finally, it may be helpful for counsellors to raise the issue o f adoption with their clients who do not do so, and the findings in this study suggest that some clients are likely to avoid the topic. It w i l l be important to assess and work through conflict around this issue, as it may cause considerable strain in,the relationship. It is possible that a methodological difference between this study and Wirtberg's (1992) may have resulted in the contradictory finding with respect to men's experience o f their childlessness. That is, i f the husbands in this study were disinclined to reveal their true feelings, either out of concern for their wives' emotional well-being, or because o f gender socialization, the finding that they had reached emotional acceptance o f their childlessness before their wives may be skewed by the fact that the spouses were interviewed together! The couples in Wirtberg's study were interviewed separately. However, a number o f the men in this study did express and describe feelings o f frustration, anger, and anxiety in front o f their wives. This suggests that they allowed at least some degree o f emotional expression. O n the other hand, some men did say they tended to not share their feelings when they judged that this would not help resolve a situation. Further research where the spouses are interviewed consecutively, may help us gain a different perspective on men's and women's relative experiences o f childlessness. Another possible reason for this contradictory finding may involve timing. Wirtberg's first interview was conducted while the couples were still in treatment.  130  Because the first interview i n this study was conducted post-treatment, the discrepant findings may simply be a reflection o f how the experience o f childlessness may change over time. Further research, over an extended period with larger sample sizes, w i l l help to provide more information about the relative timing o f couples' adjustment. A s well, the self-selected sample in this study may represent more positive experiences o f permanent childlessness than other infertile couples would report. Finally, we do not know whether the men in this study would have defined themselves as having traditional gender identities, as did the husbands in Wirtberg's study, nor, indeed, the extent to which male gender identity influences men's experience o f and adjustment to permanent childlessness. Studies that specifically include male gender identity as a factor i n adjustment, as Ireland (1993) did with the women in her study, may help us to understand more about the role that this factor plays in men's experience o f invountary childlessness. In terms o f the finding that couples may need to make sense or create meaning around their experience o f infertility and permanent childlessness, it would be helpful for clinicians to facilitate a process o f asking questions to explore the potential positive changes or gains that couples might have made as a result of having survived infertility and permanent childlessness. However, the timing o f such a reflective process would be important, since it appears that some healing needs to have first occurred. That is, couples appear to need some time to experience their grief to the point that they have begun to emotionally accept their childlessness, and to have done some revisioning o f goals and roles, so that they can step back and reflect on where they have been, compared with where they find themselves now. Couples who are immersed in grief or struggling with the lack o f closure presented by an indefinite diagnosis, for example, may well find that  131  the situation makes no sense at all. The same difficulty may occur for couples who have emotionally accepted that they w i l l never have children, but who are having difficulty restructuring their lives. It is important for clinicians to normalize this confusion, while offering their clients hope that the ability to make sense o f their struggle can come with time. The findings in this study, as well as the other literature on this topic, mean that counsellors may be better able to offer their clients a road map o f the possible experiences they w i l l undergo in living with permanent childlessness as a result o f infertility. Given that the, exploration o f infertile couples' perceptions o f the meaning o f permanent childlessness has just begun, further research is needed to determine i f this finding is valid and generalizable to other infertile couples. Infertile couples with different demographics may not experience meaning-making in the same way as the couples i n this study. A s well, research that includes follow-up interviews over a longer period o f time would help to provide more information about differences in meaning-making over time, including whether there are couples who ultimately are unable to make sense o f their experience o f childlessness, or who are in fact unable emotionally to come to terms with it. Personal Statement For the most part, the findings that came out o f this study were in line with what I expected, based on my reading in this area, my counselling background, and my own life experience. The greatest surprise to me was the finding on how the several couples who were conflicted about adoption resolved their impasse. M y assumption was that these couples would have all made mutual decisions not to adopt. I assumed this because I believed that, i f the wife in an infertile couple really wanted a child, her husband would  132  most likely concede, given our culture's pervasive gender socialization around the importance o f motherhood. In fact, one husband did reluctantly agree to adopt i n this study, but his wife then decided not to, having realized she was unwilling to adopt i f her husband wasn't equally committed to adoption. During the time I was reading the couples' interviews and writing the findings chapter, I had feelings of regret that I had not personally met and known the participants. I feel connected to them through their stories, I admire their stamina and fortitude in weathering the varioujs challenges o f their adjustment to childlessness, and I am concerned about the couples who had difficulty moving on with their lives. I hope that their stories and experiences w i l l contribute something o f value to the field o f research into infertility and involuntary childlessness, and that the couples who participated i n this study w i l l become aware of the contribution they have helped to make.  133 References Anton, L . H . (1992). Never to be a mother: A guide for all women who didn't-or couldn't-have children. N Y : Harper Collins. Berg, B . J., & Wilson, J. F. (1991). Psychological functioning across stages o f treatment for infertility. Journal o f Behavioral Medicine, 14, 11-26. 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