PART I. OVERVIEW 1 Psychology of Infertility

Yearning for children and the heartbreak of barrenness have been a part of life since the beginning of mankind, chronicled throughout history by religious accounts, myths, legends, art, and literature. Whether driven by biological drive, social necessity, or psychological longing, the pursuit of a child or children has compelled men and women to seek a variety of remedies, sometimes even extreme measures. In fact, in all cultures involuntary childlessness is recognized as a crisis that has the potential to threaten the stability of individuals, relationships, and communities. Every society has culturally approved solutions to infertility involving, either alone or together, alterations of social relationships (e.g., divorce or adoption), spiritual intercession (e.g., prayer or pilgrimage to spiritually powerful site), or medical interventions (e.g., taking of herbs or consultation with ‘medicine man’).[1] While spiritual and medical remedies for infertility are common and often used early on by infertile couples, social solutions demanding the alteration of relationships have been shown to be the last alternative individuals or couples usually consider.[1] Typically, infertile couples are reluctant to jeopardize or disturb close relationships (perhaps because social changes are usually permanent) because they hope or believe infertility will be a temporary problem. By the same token, reluctance to consider solutions may be due to the hope and promise often attributed to medical and/or spiritual interventions. Nonetheless, infertile couples use all three measures – social, spiritual, and medical – as remedies for their involuntary childlessness; numerous examples of these remedies exist throughout history and across all cultures.[1] One of the most renowned social solutions to involuntary childlessness is King Henry VIII of England, who changed the religion and laws of a country to accommodate the need for a child (albeit a male child). Divorce, polygamy, and extramarital affairs remain, as they have long been, social solutions to infertility, as do various forms of adoption and fostering. Examples of other social solutions include the continuing practice in some cultures of multiple wives in response to infertility (or lack of a son) or the custom in some cultures requiring a sibling (usually an eldest son) to provide one of his children to a younger, childless sibling. Community involvement in the realignment of social relationships is exemplified by the native peoples of two small islands off the coast of South America in which infertility was addressed by raiding the neighboring island to steal small children for childless women. Demonstrable in each of these examples is the social and emotional distress and expense of solutions involving the alteration of social relationships, thus explaining, in part, the reluctance of individuals to pursue these alternatives until other remedies have been exhausted. Since antiquity, the appeal of religious faith and the power of belief in spirits and gods as a remedy for infertility can be found in all cultures. Fertility symbols, special gods, and fertility rites and customs are apparent from the highly erotic art of India, to the Celtic goddess of fertility carved into stoned walls of ancient Irish castles, to specially shaped and painted Navajo pottery. In ancient Greece, a common offering to the gods was terracotta votives in the shape of the affected organ (e.g., vagina, uterus, or penis).[2] In addition, the special spiritual power of certain places to enhance fertility can be seen in a phallic-shaped rock on the island of Maui in Hawaii, as well as in the pilgrimages made by infertile women of the Carib tribe in Mexico to Isla de las Mujeres (Island of Women) and by many infertile Roman Catholic women to Medjugorje in Bosnia-Herzegovina. Nevertheless, the importance of faith either as a means of solving infertility or as a