Dealing with a Blocked Parenthood Goal: The Association of the Imaginability of Alternatives and Stress in Women and Men in Fertility Treatment

Jasmin Passet-Wittig, Federal Institute for Population Research
Norbert F. Schneider, Federal Institute for Population Research

In societies like Germany, where the age at first birth is continuously increasing, the risk of experiencing at least temporary blockage of the parenthood goal due to infertility is also increasing. For many of those who experience problems procreating, assisted reproductive technologies are nowadays a very apparent option and oftentimes the first choice. The experience of infertility but also of fertility treatment, however, is stressful for the couple, as a large body of research consistently shows.

In this paper we investigate whether the ability to imagine adoption, foster care and life without a(nother) child protects from stress caused by infertility and treatment experience. We use data from a self-administered prospective cohort study of infertile couples at the beginning of fertility treatment in Germany. The analysis sample consisted of 441 respondents at baseline and 142 one year later. Most women and men cannot imagine alternatives to fertility treatment. Adoption and/or foster care is preferred over life without a(nother) child. We find that those can imagine alternatives at the beginning of treatment are less stressed at baseline and during follow-up. We argue that openness to alternatives to fertility treatment can facilitate disengagement from the blocked goal and reengagement with other goals. This is especially important for those who experience infertility and refer to fertility treatment, because the chances to have the desired child are relatively low even with medical help.

Research Question

Having children can be considered a central life goal for most adults of reproductive age. Infertility, defined as the experience of problems getting pregnant for at least a year, represents a major source of goal blockage in the process of attaining the parenthood goal. This type of goal blockage is almost universally experienced as rather stressful (Brkovich/Fisher, 2009). In societies like Germany, the age at first birth keeps increasing. Thus, the risk of experiencing infertility and such stressful life phases also increases. Assisted reproductive technologies are nowadays the preferred option when it comes to help-seeking for infertility. However, a considerable group will not be able to reach their parenthood goal with medical help as success rates are low.

In this paper we study the imaginability of alternatives to fertility treatment in a sample of women and men at the beginning of fertility treatment in Germany. Firstly, we aim to know if patients at fertility clinics can imagine alternatives to fertility treatment and if this is the case which alternatives they prefer. Secondly, we ask if the imaginability of alternatives protects from stress at the beginning of treatment and 1 year later.


Social psychology has a long tradition of studying processes of developmental self-regulation across the life span (Brandtstädter/Rothermund, 2002; Freund/Baltes, 2000; Heckhausen et al., 2010). Similar to rather sociological approaches to the life course these theories assume that individuals are the producers of their own well-being. People usually find ways of handling that can not be reached. In the case of infertility, two strategies are particularly helpful (Kraaij et al., 2009, 2010; Salmela-Aro/Suikkari, 2008; Thompson et al., 2011): goal disengagement and goal reengagement. The former means to let go of a goal that cannot be achieved; the latter describes the capability to reengage in other meaningful life goals. The availability of alternative goals facilitates the application of both strategies (Wrosch et al. 2003). We hypothesize that the imaginability of alternatives it is associated with perceived stress. More specifically we assume that the imaginability of alternatives has the capacity to protect from stress.

Data and Method

We use data from a German a multi-purpose prospective cohort study of couples in fertility treatment (Passet-Wittig et al. 2014, 2016). All clinics in the federal state of Rhineland-Palatinate (n = 5) and the clinic in Wiesbaden, the capital of Hesse, participated in the study. At baseline self-administered questionnaires were handed out at the fertility clinics. One year later the participants who had agreed to be contacted again received the questionnaire by mail. The analysis sample at baseline consists of 441 and the longitudinal sample of 142 women and men.

The COMPI Fertility Problem Stress scale (COMPI-FPSS) was used at baseline to assess stress specific to the experience of infertility (Schmidt, 2006). For the follow-up, the wording of the question was adapted to better represent the personal evaluation of treatment-related stress in the last year. The scale includes 9 items and ranges from 0 to 29, a higher score indicating more stress.

The imaginability of alternatives was examined by asking participants at baseline if they could imagine adopting a child, fostering a child and continuing to live without a(nother) child. A 5-point response key ranging from 1 (not at all imaginable) to 5 (very well imaginable) was used. For the values 4 and 5, the alternatives were coded as imaginable. The final variable had four categories: no alternatives imaginable, adoption and/or foster care imaginable, life without a(nother) child imaginable, and both alternatives imaginable.

Main Findings

We find that approximately two thirds of all respondents cannot imagine any of the studied alternatives at the beginning of their treatment. Adoption and foster care are strongly preferred over life without a(nother) child; only few can imagine both.

The cross-sectional analysis shows that compared not perceiving alternatives as feasible imaginability of a life without a(nother) child is associated with lower fertility-related stress. This is also the case when both, life without a(nother) child and adoption/foster care, are imaginable. In the longitudinal model we find that the imaginability of adoption and foster care and of life without a(nother) child at baseline is associated with lower treatment-related stress at follow-up. The association is not moderated by the experience of a pregnancy or birth between waves.

Our study provides initial evidence that the imaginability of alternatives is a resource that protects from stress. This can be especially helpful as chances to have a child using assisted reproductive technologies are low. For counselling of infertile couples we suggest to encourage openness to alternative ways to having a child or to the possibility of a live without a(nother) child. It helps fertility patients to maintain control over one’s life and potentially increases wellbeing.

Presented in Session 1227: Sexual and Reproductive Behaviour