† Materials and Methods
ORIGINAL ARTICLE Psychology
Psychosocial characteristics of women
and men attending infertility
T. Wischmann1,3, H. Scherg1, Th. Strowitzki2, and R. Verres1
1Centre for Psychosocial Medicine, Institute of Medical Psychology, University of Heidelberg, Bergheimer Strasse 20, D-69115 Heidelberg,
Germany2Department of Gynaecological Endocrinology and Reproductive Medicine, Women’s Hospital, University of Heidelberg,
3Correspondence address. E-mail: firstname.lastname@example.org
table of contents
background: Little is known about the psychosocial characteristics of infertile couples seeking psychological help. This study describes
couples attending infertility counselling.
methods: Questionnaires pertaining to socio-demographic factors, motives for wanting a child, lay aetiology of their infertility, dimen-
sions of life and partnership satisfaction, and a complaints list were completed by 974 women and 906 men. Of those who indicated an
openness to counselling, almost half actually attended infertility counselling, and two groups, ‘no counselling’ (358 women and 292 male
partners) and ‘taking up counselling’ (275 women and 243 male partners), were therefore compared.
results: More couples with stressful life events were found in the counselling group. For women taking up counselling, psychological
distress, in the form of suffering from childlessness and depression as well as subjective excessive demand (as a potential cause for infertility),
was higher in comparison to women not counselled. The higher distress for men in the counselling group was indicated by relative dissatisfac-
tion with partnership and sexuality and by accentuating the women’s depression.
conclusions: Infertile couples seeking psychological help are characterized by high levels of psychological distress, primarily in women.
The women’s distress seems to be more important for attending infertility counselling than that of the men.
Key words: psychology / counselling and couple therapy / life satisfaction / infertility
In the majority of cases, involuntary childlessness has a strong impact
on the emotional situation of infertile couples (Menning, 1980). Many
women consider infertility to be the most serious emotional crisis of
their life (Freeman et al., 1985). Reproductive medical treatment can
involve major additional emotional stress (Boivin and Takefman,
1995), which often increases with the number of unsuccessful treat-
ment trials (Beutel et al., 1999). For ?15–20% of these couples,
the emotional distress is so serious that they need psychological coun-
selling (Boivin et al., 1999).
Several studies have indicated that women suffer more seriously
from involuntary childlessness than their male partners (e.g. Daniluk,
1988; Berg and Wilson, 1991; Stanton and Dunkel-Schetter, 1991;
†Presented in part at the 22nd Annual Meeting of the European Society of Human Reproduction and Embryology, Prague, Czech Republic, 18–21 June 2006.
& The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.
For Permissions, please email: email@example.com
Human Reproduction, Vol.24, No.2 pp. 378–385, 2009
Advanced Access publication on December 1, 2008doi:10.1093/humrep/den401
Wright et al., 1991; Abbey et al., 1992; Wischmann et al., 2001) and
that they are more receptive to psychological counselling than men
(Baram et al., 1988; Daniluk, 1988; Wischmann et al., 2001;
Wischmann, 2008) because they are more predisposed than men to
adopting a coping strategy based on social support (Abbey et al.,
1992; Stanton et al., 1992). However, there are only a small
number of studies in which infertile couples attending psychosocial
counselling have been compared with couples who do not make
use of this offer. Shaw et al. (1988) studied 60 infertile couples, of
whom 52% expressed the wish for extensive counselling. No psycho-
logical differences were found between women who expressed such a
wish and those who did not. Men who asked for counselling showed
more (trait and state) anxiety, more ‘hopefulness’ concerning the
outcome of medical treatment, and they described their partnership
as more harmonious than those who ‘refused’ an offer of group coun-
selling. In a study by Paulson et al. (1988), 27 of 150 infertile women
actively sought counselling during the investigation. However, this
group showed no differences in the scores achieved in psychological
tests compared with the remainder. Edelmann and Conolly (1987) ret-
rospectively investigated some 600 women and men at an infertility
clinic and described gender-specific predictors for the expression of
a need for help. For males, the variables guilt, frustration, marital pro-
blems and lack of confidence were established for potential attend-
ance of professional counselling sessions. For females, the variable
isolation replaced the frustration felt by males. Further indications
on the psychosocial characteristics of couples before infertility coun-
selling arose from interventional studies in the framework of the
German infertility research network. The study by Pook et al.
(2000) investigated 86 couples with (idiopathic) andrological sterility
interested in cognitive-behavioural therapy for stress reduction.
While women showed slightly higher depression tendencies compared
with the norm values of the questionnaires, men also displayed slightly
higher anxiety and somatization. The authors pointed out, however,
that these differences had no clinical significance and that the quality
of partnership was rated as high. Only 17 of the couples in this
study actually took up the couple therapy. In the study by Strauß
et al. (2000), the 61 women and 51 men attending counselling
showed lower scores for various areas of life satisfaction and more
psychological and somatic complaints compared with a group of 89
women and 86 men not involved in the counselling study. However,
statistical details were not provided. Ho ¨lzle et al. (2002) indicated
that infertile patients taking up couple counselling (n ¼ 74 women
and men) were slightly less satisfied with sexuality, self-esteem and
attractiveness and showed more depressive symptoms than a com-
parison group of 570 patients undergoing in vitro fertilization (IVF)
treatment. In this study, data of women and men were not analysed
The findings on the psychosocial characteristics of infertile women
and men before infertility counselling are inconsistent because of
different psychological measurements and different samples (couples
who are willing to attend counselling versus couples taking up or
already in counselling or psychotherapy). So it still remains unclear
what psychosocial characteristics couples attending counselling
display compared with the couples who do not (Edelmann and
Conolly, 1986; Golombok, 1992; Boivin, 1997). The first results on
men actually taking up infertility counselling came from the study of
Pook et al. (2001). The 94 male patients who participated in couple
counselling in their study showed higher scores for depression and
anxiety (as well as higher numbers of impaired sperm parameters)
compared with 134 unselected infertility patients. Female partners
were not investigated in this study.
The aim of our cross-sectional study was to describe psychosocial
characteristics of infertile women and men indicating openness
towards psychological counselling and actually taking up psychological
help in contrast to couples indicating openness towards counselling
but not using this opportunity which was offered to all of them.
Materials and Methods
Design of the study and sample size
The study was carried out in two phases. In the first phase (from May
1994 to November 1996), all infertile couples (without pregnancy after
at least 1 year of trying to get pregnant) contacting the Heidelberg Univer-
sity Women’s Hospital for the first time were asked to complete a set of
questionnaires. All couples were routinely offered psychological counsel-
ling at the Institute of Medical Psychology. In the second phase (from
December 1996 to July 1999), this offer was extended to include all infer-
tile couples in the region seeking psychological help, regardless of the clinic
or medical practice in which they were given medical treatment, and of
diagnosis or the stage of medical treatment. The entire study consisted
of 1039 women and 949 men. Questionnaires fully suitable for evaluation
remained for 974 women and 906 men.
Our counselling intervention followed a two-step approach. First, two
counselling sessions were offered to discuss possible stress connected
with infertility and, if necessary, to inform the participants about further
psychological help available. Where indicated, and if the couple expressed
the need for more psychological assistance, we offered a subsequent 10 h
of couple therapy. The framework of the counselling and the couple
therapy is described in detail in Wischmann et al. (2002) and in
Stammer et al. (2004).
The acceptance rate for counselling (34%) could be computed only in
the first part of the study with the defined basic population of n ¼ 564
couples. With regard to all infertile patients contacting the University
Women’s Hospital for the first time, we assume that at least 17% of
these patients actually received our counselling offer because the percen-
tage of returned questionnaires was ?50%. Medical records were also
available for 526 couples of this group only. A female factor only was diag-
nosed in 36% of these couples, and a male factor was diagnosed only in
16% of the couples. Medical findings had been established for both
partners in 21% and 27% of the couples were diagnosed as idiopathically
infertile (Wischmann et al., 2001).
All couples in the study indicated their consent to participate. The
attendance of counselling or couple therapy sessions was independent
of medical treatment measures. It was voluntary and free of charge for
all couples. All questionnaires had code numbers and were free of per-
sonal data of the couples (e.g. names or birthdays), so that the analysis
could be done anonymously. The design of this study and the selection
of these questionnaires were approved by the Ethics Committee of the
Medical Faculty of Heidelberg University.
Comprehensive reviews show that infertility can affect nearly all psycho-
logical aspects of a person’s life, such as self-esteem, partnership, life sat-
isfaction, mood and social relations (Greil, 1997; Eugster and Vingerhoets,
1999; Henning and Strauß, 2002). In this study, a set of approved ques-
tionnaires pertaining to socio-demographic factors, motives for wanting
Characteristics of infertility counselling attendees
a child, dimensions of life satisfaction and couple relationships, physical and
psychological complaints, life events and a personality inventory was
applied. As described in Wischmann et al. (2001), the selection of the
questionnaires given below was the result of several consensus meetings
of the members of the German infertility research network.
(i) The documentation sheet for socio-demographic data (SOZIODAT;
E. Bra ¨hler et al., unpublished) includes demographic and sociological
information, i.e. questions on age, family status, duration of partner-
ship, educational and professional status, residential status and occu-
pational stress. This questionnaire was used for the description of
(ii) In the questionnaire on the case history of the desire for a child
(‘Fragebogen zur Kinderwunschanamnese’, KWA; C. Ho ¨lzle, unpub-
lished), the participants were asked how long they have been
wanting a child, their acceptance of various potential kinds of infer-
tility treatment (including ‘counselling’ and ‘psychotherapy’) with the
response options ‘yes’, ‘no’ and ‘don’t know’, and their subjective
assessment of their pregnancy chances with or without treatment,
respectively. The questionnaire was supplemented with the follow-
ing two questions: ‘How strong is your wish for a child right now?’
(i.e. ‘Intensity of desire for a child’; a five-point rating scale ranging
from 0 ¼ not at all to 4 ¼ very strong) and ‘How stressed do you
feel by the unfulfilled desire for a child?’ (i.e. ‘Suffering from childless-
ness’; a seven-point rating scale ranging from 0 ¼ not stressed at all
to 6 ¼ extremely stressed).
(iii) The questionnaire on the desire for a child (‘Fragebogen zum
expectations and apprehensions in connection with pregnancy, birth
and parenthood, using 20 rating questions (1 ¼ not at all, 5 ¼ very
strong). A factor analysis of the FKW generated three factors: (a)
enhancement of self-esteem (example item: ‘I find the idea of being
able to create new life wonderful’; Cronbach’s a ¼ 0.77), (b)
emotional stabilization (example item: ‘I would be very lonely
without a child’; Cronbach’s a ¼ 0.80) and (c) ambivalences about
parenting, partnership, career and self-realization (example items: ‘I
am afraid of the demands made by a child’, or ‘A child might interfere
with my career prospects’; Cronbach’s a ¼ 0.73).
(iv) The questionnaire on subjective theories concerning the cause of
infertility (‘Fragebogen zur subjektiven Ursachentheorie’, SUBURS;
Goldschmidt et al., 1998) was used to assess lay beliefs concerning
aetiologies of infertility. It includes 36 example ratings for the state-
ment ‘Our involuntary childlessness could be co-determined by ...’.
Each is measured on a five-point rating scale ranging from 0 (¼
surely not) to 4 (¼ quite sure). These items belong to the dimen-
sions psychosocial, naturalistic, health behaviour, partnership and
sexuality, and fate. A factor analysis of the SUBURS generated two
factors, which were gender independent: (a) subjective excessive
demand (example items: ‘... others putting pressure on us’ or ‘...
my depressed mood’) and (b) causes related to partnership and
sexuality (example items: ‘...unsolved conflicts between us’ or
‘...our unfulfilled sexuality’). Higher scores on the two scales of
the SUBURS mean higher subjective stress. The internal consist-
encies (Cronbach’s a) are 0.88 for the first scale and 0.82 for the
(v) The questionnaire on life satisfaction (‘Fragebogen zur Lebenszufrie-
denheit’, FLZ; Fahrenberg et al., 2000) measures various aspects of
life satisfaction. Information on satisfaction in different areas of life is
elicited by means of 63 seven-point items on the scales Health, Pro-
fessional and Vocational Life, Financial Situation, Leisure and
Hobbies, Marriage and Partnership, Self-Esteem, Sexuality and
Living Situation. Higher scores on the scales indicate more
satisfaction with the different areas of life. The internal consistencies
(Cronbach’s a) of the scales vary between 0.82 and 0.94.
(vi) The German version (Franke, 1995) of the Symptom Check List 90
(SCL-90-R; Derogatis et al., 1976) encompasses 90 items assessed
for severity on a five-point scale (0 ¼ not at all, 4 ¼ extremely).
Evaluation is undertaken in terms of (a) nine thematic subscales
depression, anxiety, anger/hostility, phobic anxiety, paranoid idea-
tion, psychoticism) and (b) three global categories comprising the
Global Severity Index (fundamental psychological stress), the Posi-
tive Symptom Distress Index (intensity of response), and the
Positive Symptom Total (number of stress-inducing symptoms).
The Psychoticism scale was disregarded for methodological
reasons (Wischmann et al., 2001, p. 1757). Higher scores on the
scales of the SCL-90-R mean a higher degree of pathology.
Cronbach’s a of the scales vary between 0.79 and 0.89.
(vii) A personality questionnaire, the ‘Giessen Test’ (GT; Beckmann
et al., 1991), is geared to partner assessment and inquiring after self-
image concepts (‘How I see myself’; self-evaluation) and image of
the partner (‘How my partner sees me’; evaluation by the
partner). The 40 bipolar items are grouped in five scales: (a)
Social Response, where low scores indicate negative social response
(e.g. unattractive) and high scores indicate positive social response
(e.g. attractive); (b) Dominance, with the poles dominant (e.g.
likes being domineering) and submissive (e.g. likes being submissive);
(c) Self-Control, with the poles uncontrolled (e.g. able to let go) and
compulsive (e.g. unable to let go); (d) Basic Mood, with the poles
hypomanic (e.g. lets anger out) and depressive (e.g. suppresses
anger); and (v) Permeability, with the poles permeable (e.g. trustful)
and retentive (e.g. mistrustful). The mean of Cronbach’s a for the
scales is 0.86. GT data were collected in the first 2 years of the
study only, therefore leading to smaller sample sizes.
(viii) A questionnaire on stress-inducing events in the couples’ lives (FLS;
Wischmann, 1998) wasincluded.
demographic features of the parents and siblings, this questionnaire
also inquired into specifics of the family status of the parents (separ-
ation, divorce, death and the year in which these occurred). Three
open-response questions were included, each with example items,
related to (previous and present) stressful events in the family of
origin and in the respondents own childhood. In each of these open-
response questions, the patients were asked to indicate duration
(from-to), intensity (on a scale 1 ¼ little stress to 7 ¼ strong
stress) and person affected. The naming of stressful events was cate-
gorized by means of a rating system. Subsequently, responses to the
questions on the FLS enquiring into instances of stress in the family
of origin and problems in childhood were classified as ‘early’ stress if
such an event occurred before the age of 16 years and a score ?5
was recorded on the Stress scale. Persons who indicated two or
more events were classified as ‘vulnerable’.
The data were evaluated using the statistic program SAS for Windows 9.1.
Statistical analysis included x2-test for frequency differences and t-tests for
the comparison of the mean scores for the two groups of couples (‘not
counselled’ and ‘taking up counselling’) on the psychological scales. To
assess the ‘clinical’ relevance of differences between the two groups,
effect sizes (ES) were calculated by the differences between the means
of the two groups divided by the common standard deviation within
these two groups. ES between 0.20 and 0.50 were designated as small,
between 0.50 and 0.80 as medium and .0.80 as large (Cohen, 1988).
Wischmann et al.
To identify the variables most significant for the allocation to one of the
two groups, stepwise discriminant analyses were computed.
Of the entire sample, 633 women (65%) and 535 men (59%) indicated
openness towards psychological counselling on the KWA. However,
these data were obtained from both phases of the study, and partici-
pants in the second stage included patients, at any stage of treatment,
who sought psychological help. From those indicating an openness to
counselling, two groups were compared here for their measurements:
(i) the 358 women and 292 male partners from couples who did not
take up any counselling or therapy later (group ‘not counselled’), and
(ii) the 275 women and 243 male partners from couples who attended
counselling/psychotherapy (group ‘taking up counselling’). Table I lists
the mean scores on the psychological scales in the two comparison
groups and the results of x2-test and t-tests as well as ES computation.
For reasons of clarity, only differences with ES ? 0.20 will be specified
in the results section.
Couples who took up counselling were notable for their higher level
of education. Of the women in this group, 38% had a university degree
or similar. For the men, the corresponding figure was 54%. Both part-
ners estimated their chance of getting a child as the result of infertility
treatment as marginally lower than women and men in the group ‘not
counselled’. Women in the counselling group were about 1 year older
than women not being counselled (all ES small). For women attending
counselling or couple therapy, remarkable psychological findings were
higher scores on ‘depression’ in the GT partner image (ES ¼ 0.46),
suffering from childlessness (KWA; ES ¼ 0.44) and on the SUBURS
scales ‘subjective excessive demand’ and ‘partnership/sexuality’ as
well as lower ‘social response’ in the GT self-image (all ES . 0.30).
Furthermore, women in counselling showed lower scores in satisfac-
tion with ‘self-esteem’, ‘professional/vocational’, ‘sexuality’ and ‘part-
nership’ (FLZ), but all differences showed small ES. All of the women’s
higher levels of ‘depression’ in SCL-90-R and GT (self-image) and of
‘obsessive/compulsive’ in SCL-90-R had small ES too. Women in
the counselling group were seen as less positive resonant and more
retentive by their male partners in the GT partner images as well
(both with small ES).
For the men, the differences between the two groups were less
pronounced. Men taking up counselling showed lower scores for sat-
isfaction with ‘sexuality’ (ES . 0.30) and ‘partnership’ in the FLZ and
higher scores on the SUBURS scales ‘partnership/sexuality’ as a
potential cause for infertility. In the self-image of the GT, these men
saw themselves as more retentive. All of the men’s variables
showed small ES only. Women and men with higher stress scores
on the FLS were more frequent in the group ‘taking up counselling’:
36.2% of the vulnerable women (versus 24.1% of the other women;
P , 0.01) and 39.2% of the vulnerable men (versus 25.9% of the
other men; P , 0.001) were found in this group (Wischmann et al.,
2001). For the couples where medical records were available, there
were no differences in the psychosocial variables between the two
groups (data not shown).
To further concentrate the results, two stepwise discriminant ana-
lyses were computed with each data record including both female and
male variables, first for all psychological scales with GT scales excluded
because of different sample sizes, and then a second one for the GT
scales only. To keep the number of missing values low, 16 couples
with missing values for more than 15 scales were excluded. For the
remaining couples, missing values were replaced by sex-specific
mean scores. Thus, we obtained a data set comprising 431 couples.
Only psychological variables with statistically significant differences
between the two groups [marked with asterisk(s) in Table I] were
included in the discriminant analyses. The significance level for
inclusion or removal of variables was set at P , 0.05.
The variables selected for the discrimination between the two
groups (questionnaires without GT) were two variables of the
women: ‘suffering from childlessness’ [partial F(1, 428) ¼ 11.93, P ¼
0.0006] and the SUBURS variable ‘partnership/sexuality’ as a potential
cause of infertility [partial F(1, 428) ¼ 9.76, P ¼ 0.0019]. The variable
selected by discriminant analysis of the GT data only was women’s
‘depression’ in the GT partner image [partial F(1, 227) ¼ 13.85, P ¼
0.0002]. Variables of the men were not selected in any of the two dis-
criminant analyses. Therefore, the variables most significant for the
allocation to one of the two groups were (in this order): women’s
‘depression’ in the GT partner image, women’s ‘suffering from child-
lessness’ and women’s subjective beliefs that difficulties in ‘partner-
ship/sexuality’ might cause infertility.
This study demonstrates that the degree of psychological distress on
women as a result of involuntary childlessness (and the side-effects
of reproductive treatment) seems to be the crucial factor in the
decision to take advantage of infertility counselling. The women in
our study suffered notably from the unfulfilled desire for a child and
from depression, whereas their partners were (at the time in question)
relatively dissatisfied with the sexuality and the couple relationship and
seemed to worry about their partners’ depression. Both were recep-
tive to a psychosocial perspective on the potential causes of infertility.
Women tended to see the causes as stemming more from subjective
excessive demand, while their partners suspected that they derived
from current problems in partnership and sexuality. These results
support the impression of counsellors that women are depressed by
the infertility problem and feel unattractive, whereas their male part-
ners appear helpless concerning the womens’ mood and somewhat
unsatisfied. This typical allocation and polarization of roles within the
couple can be seen often in infertility counselling (Newton, 1999;
Wischmann et al., 2002). As the results of the discriminant analysis
show, it was mainly the psychological distress on the part of the
women that seems to be the strongest factor in the decision to
seek psychological assistance. These findings are consistent with
those from other projects of the German infertility research
network (Strauß et al., 2000; Ho ¨lzle et al., 2002). This is probably
due to the fact that the same instruments were used in these
studies. Hence, this supports the validity of the findings. Another
interpretation of this role allocation is given by Cousineau and
Domar (2007) inasmuch as the men may suffer silently in efforts to
support their wives, and therefore indicate less psychological distress
in questionnaire scales.
Our results are not directly comparable with the studies by Paulson
et al. (1988), Shaw et al. (1988), Edelmann and Conolly (1986), Pook
et al. (2000) and Schmidt et al. (2003), as these studies inquired into
the potential likelihood of couples availing themselves of assistance
Characteristics of infertility counselling attendees
(n 5 358)(n 5 275)
(n 5 292)(n 5 243)
Questionnaire on socio-demographic data (SOZIODAT)
Questionnaire on the case history of the desire for a child (KWA)
Suffering from childlessness (0–6)4.08+1.42
Intensity of desire for a child (0–4)3.37+0.76 3.39+0.80
Duration of desire for a child (years)4.36+3.014.50+2.70
Chance with treatment60%
Chance without treatment20% 22%
Questionnaire on motives for wanting a child (FKW)
Enhancement of self-esteem
Questionnaire on lay aetiologies (SUBURS)
Subjective excessive demand0.30+0.62
Questionnaire on life satisfaction (FLZ)
Friends, acquaintances, relatives
Living situation 0.31+0.840.25+0.92
Symptom checklist (SCL-90-R)
Interpersonal sensitivity 51.91+12.6954.48+14.15*
Phobic anxiety51.64+15.74 53.43+16.79
Paranoid ideation51.49+12.71 53.19+13.93
Global severity index52.23+14.20 54.85+15.47
Positive symptom distress index52.12+11.06 54.36+12.43
Positive symptom total index 52.17+13.04 54.34+12.98
Giessen Test (GT, self-images)a
Social response 49.73+10.46
Dominance 47.92+10.58 47.81+10.15
Self control 51.08+10.19 50.32+9.73
Table I Comparison of sociographic and psychological variables from women/men not counselled and women/men taking
Taking up counselling Taking up counselling
Wischmann et al.
from psychological interventions, rather than concentrating on patients
actually taking up counselling.
As in the study by Strauß et al. (2000), psychological counselling
and/or therapy was taken up notably by couples with a higher level
of education. This corresponds to general findings regarding the
acceptance of psychotherapy. Participants from the middle and
upper classes are more likely to be receptive to psychological counsel-
ling and notably psychotherapy than participants from lower social
classes (Seligman, 1995).
About one-third of the couples from the Women’s Hospital chose
the low-threshold counselling offer of two sessions. This acceptance
rate is higher than the rate of ?20% frequently referred to in the lit-
erature (Boivin, 1997). There are a number of likely reasons for this.
The offer of psychological counselling was integrated into the repro-
ductive treatment programme from the outset, e.g. via information
booklets, frequent joint information events on medical and psychologi-
cal aspects of fertility disorders and reports on the ‘Heidelberg Fertility
Consultation Service’ in the local media. If psychosocial infertility coun-
selling is an integral part of the treatment, and its goals and course are
made transparent before it starts, acceptance rates up to 80% can be
reached (Emery et al., 2003). In addition, the medical service in our
study included not only traditional medical treatment for infertility
but also complementary methods (such as naturopathy or acupunc-
ture), which may have been attractive for infertile couples interested
in less ‘invasive’ approaches, including psychological counselling. This
hypothesis is supported by the finding that a very large proportion
of the couples were receptive to the idea of psychological counselling
and/or naturopathy (Wischmann et al., 2001). On the other hand, we
must bear in mind the fact that the sample consisted exclusively of
couples who were at least minimally interested in psychological
issues and consequently prepared to fill out the questionnaires.
This study has some limitations. It does not examine a homo-
geneous set of participants (e.g. couples embarking on IVF treatment
only) but rather a heterogeneous group of infertile couples at different
stages of medical diagnostics and treatment, couples undergoing
‘natural’ and ‘conventional’ infertility treatment, and couples from
private medical practices and from the University hospital. Further-
more, the high proportion of academics in our sample means that
the results of this study cannot readily be generalized to other settings.
As in most studies on psychological interventions for infertility
patients, the characteristics of patients before counselling remained
unclear for couples from lower social strata or for couples with a
different mother tongue. Above all, the results of this study say
nothing about psychosocial characteristics of infertile couples not
seeking at least brief medical treatment. Also, the counselling and
therapy were offered expressly for couples. This obviously restricts
the relevance of our findings for those infertile men/women preferring
individual or group counselling/therapy or self-help groups.
to the increasing recourse to reproductive treatment in the western
threshold counselling offer should be available for women and men at
any stage of infertility treatment, especially at the beginning and upon
its (unsuccessful) completion. As Boivin et al. (1999, p. 1390) have
pointed out, couples ‘may want reassurance that psychosocial services
would be available if needed, even though such services may never be
used’. Written information or video presentations about common
emotional and psychosocial reactions to infertility in women and men,
about coping with this condition and about typical issues in infertility
counselling should be provided to the couples from the beginning of
selling should so be made transparent (Wischmann, 2008). To identify
‘vulnerable’ couples, it could be useful to develop a checklist with
typical statements of couples in infertility counselling (such as ‘My wife
is devastated for days after the onset of the menstrual period. As her
partner I feel only helpless and I withdraw completely’). Summarizing
their affirmative answers, infertile women and men could evaluate
their need for infertility counselling. These items could also be part
of key questions in the doctors’ examination of the infertile couple
(Kentenich et al., 2002).
Implications for research
Since ‘the traditional stress models with their individual nature do
not fully appreciate the dyadic context of infertility’ (Pasch, 2001,
Not counselled (n 5
358)(n 5 275)
Not counselled (n 5
292)(n 5 243)
Giessen Test (GT, partner images)a
Social response 52.13+9.24
Self control53.29+9.83 54.61+9.74
Basic mood 59.97+9.75
Table I Continued
Taking up counselling Taking up counselling
Values are mean+SD.
Mean of reference population ¼ 0 for FLZ, FKW and SUBURS and 50 for SCL-90 and GT; SD of reference population ¼ 1 for FLZ, FKW and SUBURS and 10 for SCL-90 and GT.
aParticipants not counselled: n ¼ 207 women and n ¼ 160 men; participants taking up counselling: n ¼ 149 women and n ¼ 132 men.
*P , 0.05; **P , 0.01; ***P , 0.001; mean differences with ES ? 0.20 are marked bold for participants taking up counselling.
Characteristics of infertility counselling attendees
p. 562), it is necessary to consider the couples’ evaluation of the
infertility distress. As our study could show, the partner image of
the women’s depression was much more accentuated than the
women’s self-image of her depression. In further studies on the
impact of infertility distress therefore, questionnaires concerning
the couples’ views should be administered. Prospective study
designs could help to show if psychological distress emphasized by
the partner might be a ‘predictor’ variable for uptaking infertility
We are grateful to the patients for their willingness to participate in
This study was funded by the German Federal Ministry of Education
and Research as a part of the research network ‘Psychosomatic Diag-
nosis and Counselling/Therapy for Fertility Disorders’ (grants
01KY9305 and 01KY9606).
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Submitted on July 21, 2008; resubmitted on October 10, 2008; accepted on
October 15, 2008
Characteristics of infertility counselling attendees