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79 FOUR The Psychologization of Infertility Frank van Balen One of the most intriguing aspects of the study of infertility is its relationship with psychology, in particular, the various contrasting ways in which the causality of the relationship between psychological problems and infertility has been interpreted. Since biblical times, it has been noted that involuntarily childless women, such as Sarah, the wife of Abraham, frequently showed behavior that would be interpreted today as a sign of psychological problems. As there was in the past little knowledge about the process of human reproduction, various ideas about the origin of infertility have existed throughout Western history. One of these was the idea that, in one way or another, the woman caused her own infertility—for instance, through bad behavior or a disturbed mind. And in many parts of the world these ideas are still shared by a considerable segment of the population (cf. Inhorn, 1994). In the past five decades, modern biomedicine as it pertains to infertility has taken amazing steps forward. In the early 1950s, almost no cures existed , except for artificial insemination with donated sperm (AID), and many mechanisms of infertility were not understood. The most important breakthrough regarding female infertility was the introduction in the 1950s of oocyte induction by hormonal or chemical treatment. Then, in 1977, in vitro fertilization (IVF) was first applied successfully, leading to the birth in 1978 of Louise Brown in Britain. Initially, IVF was a solution for women with tubal blockage, who before that time were mostly treated surgically (a form of treatment that generally was not very successful). Later on, IVF was also applied for many other indications, such as unexplained infertility and male infertility. During the past decade, the spectacular breakthrough of intracytoplasmic sperm injection (ICSI), a variant of IVF in which one sperm is injected directly into the oocyte, has provided a real opportunity 80 DISCOURSES AND DEBATES to overcome what were once considered untreatable male infertility problems . These advances in modern biomedicine are impressive, and, as a consequence , we know much more about the mechanisms of infertility, including its somatic and genetic causes. Nonetheless, psychological explanations of infertility linger in the literature and are reminiscent of ideas that were put forward nearly a half century ago. In this chapter I trace the ideas about the relationship between infertility and psychological problems as they developed in the past half century within Western culture. For this analysis, I restrict myself to scientific papers and volumes in social science and medicine. I classify the explanations about the relationship between infertility and psychological problems according to four models and discuss the main line of argument of each. The four models are (1) the full psychogenic model; (2) the model that postulates the psychogenesis of unexplained infertility; (3) the psychological consequences model; and (4) the cyclical model. Although I have discerned these models based on analysis of the infertility literature, I must note a major problem with that literature: namely, many of the publications dealing with infertility and psychological problems do not clearly state the supposed direction of the relationship. In these cases I have attempted to uncover the implicit assumptions of the authors. I also discuss the adherence to and influence of these various models since the end of World War II. For the sake of clarity, it must be stated that the rise and fall in popularity of the models cannot be demarcated clearly; thus different models have coexisted for some time. However, I try to relate the influence of the various explanatory models to important changes that were taking place in the last five decades, especially concerning new biomedical discoveries and the patient empowerment movement. I must emphasize here my own view that research regarding the psychological causation of somatic conditions such as infertility is valid and may improve our understanding of the intricate relationships between mind and body. However, as will be clear in the following sections, my intention is to put forward a challenging critique of the often unquestioned assumption of the psychological origin of infertility, as found in the scientific literature over the past fifty years. FULL PSYCHOGENIC INFERTILITY In the full psychogenic model, it is supposed that all cases of infertility or sterility1 are basically caused by psychological problems or psychological mechanisms (see fig. 1). Psychological disturbances of various kinds are perceived as generating infertility. Generally, only the female mind and [13.58.151.231] Project MUSE (2024-04-25 00:05 GMT...

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