Does the Self-Identifier Matter? Self-Identifying As Having a Fertility Problem and Depressive Symptoms Among U.S. Couples

Arthur Greil, Alfred University
Julia McQuillan, University of Nebraska-Lincoln

Infertility can contribute to emotional distress. The medical criteria for infertility are a year of regular, unprotected heterosexual intercourse without conception. This definition assumes a heterosexual couple with a desire for a child; yet half of those meeting criteria are not trying to conceive, and people can self-identify as having a fertility problem but not meet criteria, and many who meet criteria do not self-identify. The assumption that couples have infertility is also tricky – in about 30% of couples the cause is from combined male and female factors, but for 50% of infertility cases the cause is female and for 20% male factors. The social construction of infertility suggests that self-identifying may be more relevant for distress than meeting medical criteria. Infertility can be associated with elevated depressive symptoms, but most studies focus on women, therefore it is unclear if both partners experience higher distress even if only one partner self-identifies. We use a U.S. nationally representative sample of 926 heterosexual couples (women ages 25-45) (National Survey of Fertility Barriers) to assess if those who self-identify have higher distress than those who do not, if both partners experience elevated distress even if only one partner self-identifies, and if women or men who self-identify experience higher distress. Most couples do not have a partner who self-identifies (58%); of those who do, 71% women only, 9% men only, and 19% both partners self-identify. Adjusted for cohabiting, age, parental status, relationship length, education, race/ethnicity, religiosity, social support, importance of parenthood, and medical contact, those who self-identify have significantly higher distress than those who do not, and partners who do not self-identify do not have higher distress. Women have higher distress than men in couples in which both identify, men have higher distress than women in couples in which only one partner identifies.

Introduction

Mostadults in the United States want to become parents, therefore the inability todo so can be associated with emotional distress. The medical criteria forinfertility are a year of regular, unprotected heterosexual intercourse withoutconception. This definition assumes a heterosexual couple with a desire for achild; yet half of those meeting criteria are not trying to conceive, and peoplecan self-identify as having a fertility problem but not meet criteria, and manywho meet criteria do not self-identify. Individuals and couples can facenon-biomedical barriers to pregnancy (e.g. financial difficulties, not having apartner, being in a same –sex couple, jobs incompatible with parenthood, ornon-reproductive medical barriers to parenthood).  The assumption that coupleshave infertility is also tricky – in about 30% of couples the cause is fromcombined male and female factors, but for 50% of infertility cases female andfor 20% male factors contribute to infertility. The social construction ofinfertility suggests that self-identifying may be more relevant for distressthan meeting medical criteria. Studies that find associations of infertility withemotional distress usually focus only on women, therefore it is unclear if bothpartners experience higher distress even if only one partner self-identifies ashaving a fertility problem. The goal of this study is to determine if couples inwhich at least one partner self-identifies a problem have higher distress thancouples in which neither partner self-identifies, if partners experiencedistress when only their partner self-identifies (i.e. couple phenomenon), andif men and women in couples in which at least one partner self-identifiesdiffer in level of distress.

            Manystudies of the experience of infertility focus on couples seeking treatment forinfertility, and therefore cannot compare those who with or without a problem.With a population study of couples it is possible to categorize couples intofour groups: those in which neither partner self-identifies, those in whichonly the woman self-identifies, those in which only the man self-identifies,and those in which both partners self-identify.

Data,Concepts, Methods

Inthis paper we use the couple subsample of the National Survey of FertilityBarriers (NSFB), a U.S. nationally-representative survey of 4,796 women and asubset of couples (n = 926 for the analytic sample), collected between 2004 and2007. We measure distress using the 10-item modified version of the Center forEpidemiologic Studies – Depression Scale (CES-D). Example questions: “In thepast two weeks…I was bothered by things that don’t usually bother me;” “I feltdepressed;” and “My sleep was restless.” Measured on a 4-point Likert-scalewith responses ranging from 0 (never or rarely) to 3 (all of the time). Becauseof skew, we logged the scale, thus the coefficients for the self-identity couplegroups indicate the percentage difference from couples in which neither partnerself-identifies. Because couples with fertility problems may differ from those withoutthem, we adjust for several relevant characteristics (cohabiting vs. married,age, parental status, relationship length, education, race/ethnicity,religiosity, social support, importance of parenthood, and medical contact forhelp getting pregnant). We use a multilevel-model to estimate his and herdistress as latent variables at level 1, and the partner models with parallelsets of independent variables at level 2, with correlated errors for partners,and equality constraints to tests differences between men and women.

Results

In mostcouples neither partner self-identifies as having a fertility problem (Table 1). In more couples only women (30%) than only men (4%) or both partners (8%)self-identify. Distress is lowest for those who do not identify and highest forwomen in couples in which both perceive a problem.  In the full model withcontrol variables (Table 2), those who self-identify have significantly higher distress(Men = .12; women = .08; difference is significant) than those who do not, andpartners who do not self-identify do not have higher distress. Women (.10) havehigher distress than men (.08) in couples in which both identify. Adjusting for controlvariables, partner distress scores are correlated (the correlation of the errorterms = .21).

Conclusion

 

Consistentwith prior research, we find that having a fertility problem is associated withhigher distress than not having one. Even though fertility and infertility arecouple phenomena in many ways, fertility problems are distressing only forthose experiencing them, not for their partners if the partner does notself-identify. Because there is more emphasis on women’s experience ofinfertility, we were surprised that among couples in which only one partnerself-identifies,  men have higher distress than women. This is in contrast tothe couples in which both partners self-identify a problem; in these coupleswomen have higher distress than men.

Presented in Session 1168: Fertility