Breaking bad news concerning fertility.

Introduction The subject for this opinion paper is breaking bad news, a complex and integral part in the area of infertility. From the couple’s point of view, involuntary childlessness is not a question of once receiving bad news but repeatedly receiving bad news during the infertility investigation and treatment. Already before seeking medical attention, the couple will have had monthly bad news in the form of unwanted menstruation. To exaggerate a little, one could say that there is, in this respect, only one form of good news for the couple – that of a successful pregnancy. From research regarding the impact of infertility it is obvious that both the infertility itself and the medical process evoke many feelings in the couple (Lalos et al., 1985a; Kentenich, 1989; Möller and Fällström, 1991). In most cases, the woman is the first to recognize infertility as a problem and to initiate open discussion on the subject. Usually she also arranges the first medical contact. Both from reports and daily clinical work, it has been established that couples attending infertility clinics generally experience feelings of frustration and inadequacy and show signs of emotional stress (Collins et al., 1992; Reading, 1992; Laffont and Edelman, 1994). The ability to control fertility is often taken for granted, both in the medical profession and by the public at large. Perhaps the impact of medical interventions has left us more vulnerable to disappointment; there is a prevailing ideology of curability which influences both the medical staff and infertile couples. Most couples assume that they can have children if and when they desire, and there are both internal and external motives for wanting a child (Lalos et al., 1985b; Wikman et al., 1992; van Balen and Trimbos-Kemper, 1994). Although great progress has been made with medical investigation and treatment of infertility, it is still often a protracted and time consuming process, with many couples never getting their desired child. The somatic aspects are generally considered in great detail, but in too many cases little or no attention is paid to the psychological, social and sexual consequences of infertility.