42 Grief and Loss Across the Lifespan
Infertility
Infertility is defined as a year of unprotected heterosexual intercourse that
does not lead to pregnancy (Greenfield, 1997). It is experienced as a perinatal
loss (see Gilin reading in Walter & McCoyd, 2009). The rate of infertility in the
United States is hard to estimate and seems to vary based on race, social class,
age, nulliparity (whether one has ever been pregnant before), and other demo-
graphics, but is estimated to affect 7% to 15.5% of “eligible women,” (women
who are trying to get pregnant) (Thoma et al., 2013). With more women post-
poning pregnancy due to changing economic and social norms for emerging
adults (see Chapter 6), the rate of unwanted infertility likely will rise as more
women who want children age beyond their optimal fertility.
These women and couples feel the loss deeply when they are unable to
become pregnant. Many people begin to visualize the hopes they have for
pregnancy long before they pursue it. Infertility is an assault to these expecta-
tions and creates losses including an increased sense of vulnerability, a loss
of self-esteem, and a belief that one’s body is defective and/or has betrayed
one (Lind, Pruitt, & Greenfield, 1989). This is a silent, disenfranchised loss
that brings little support from others. The financial and emotional expenses
are seldom recognized even by people who are supportive. The reading by
“Elizabeth” at the end of this chapter captures some of the stresses involved
in infertility treatment as every period (menses) is viewed as another loss,
sometimes compounded by the complications attending assisted reproductive
treatments.Assisted Reproductive Technologies
Full discussion of the many available assisted reproductive technologies
(ART) is outside the scope of this chapter, yet anyone using ART experiences
the loss of the “normal/typical/customary” way of creating their family. In
the United States in 2010, approximately 1.5% of all births were due to ART,
with states such as New Jersey, New York, Massachusetts, and Connecticut
accounting for the highest rates (between 3.5% and 4% of live births in each
of those states) (Sunderam et al., 2013). Using the definition of Sunderam et
al. (2013), ARTs encompass any measures that require handling of both eggs
and sperm. They do not count ovulation promoting medications that may
enable typical coitus to produce a pregnancy with a heterosexual partner, or
insemination with donor sperm, even though these are also fertility treatments
that entail medical assistance and a sense of loss. Now, it is possible through
In-Vitro Fertilization of one woman’s egg with a man’s sperm, subsequently
gestated in a second woman, and raised by a third woman to create a child
with three mothers, one genetic, one gestational and one social/adoptive—
see this link to a New York Times story illustrating this: http://www.nytimes.com/
interactive/2010/12/22/magazine/20101222-twiblings-audio.html?ref=
assistedreproductivetechnology&_r=0.
At each level of technology, losses include: a changed sense of body
integrity and function; changes in the relationship with one’s partner; losses of