Infertility is both a psychological and physical problem faced by many couples across the world. There are at least 60-80 million people suffering from infertility worldwide, and that number could be higher as many people do not report their infertility or seek help to resolve it. (Cassidy & Sintrovani, 2008) The National Survey of Family Growth defines infertility as failure to conceive after at least 12 consecutive months of unprotected sexual intercourse. (Kessler, Craig, Plosker, Reed, & Quinn, 2013) Many people try for years to have children of their own without success, which causes many psychological problems with both infertility and treatment options. There are a number of reasons why men and women cannot have children. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay Although there are many biological factors that attribute to infertility, the most limiting of these reasons appears to be an increase in reproductive age, as this cannot be reversed despite all the advances in treatment options. Many couples and women choose to postpone having children to pursue a career and a more stable financial situation. This could be a potentially harmful decision for a couple trying to conceive as women reach peak fertility in their early to mid 20s and it steadily declines with age and men become increasingly difficult to have children when they reach mid-30s and beyond. (Kessler et al., 2013) Beyond the advanced age of the parents, there are an almost overwhelming number of biological reasons why a couple is unable to have a child. Women may experience a blockage or abnormality in the fallopian tubes due to endometriosis or sexually transmitted diseases that have left scar tissue. Pelvic inflammatory disease could also be the problem. When there is a blockage in the fallopian tubes that may prevent sperm from reaching the egg or allow an egg to reach the uterus even though the sperm has managed to reach the egg and fertilized it. The problem could also lie in the ovaries themselves or in the woman's ovulation. These could be caused by an imbalance in the woman's hormones, growths, problems with too high or too low body weight, cysts in the ovaries, or any other problem. (Herdt & Petit, 2014) Men also experience infertility due to issues including, but not limited to, low sperm count, low sperm movement, or even malformed sperm. The reasons are endless and can be biological or environmental. (Herdt & Petit, 2014) Infertility is perceived as a life crisis with profound psychosocial impacts. (Onat & Beji, 2012) When someone experiences infertility or is told they cannot have children naturally, they experience symptoms typically associated with significant loss. Many people have reacted to an infertility diagnosis as they would to a disaster. (Waltzer, 1982) In a study of 200 couples in a fertility clinic it was found that 50% of the women and 15% of the men said that infertility was the most upsetting experience of their lives. (“The Psychological,” 2009) These symptoms include, but are not limited to, stress, anger, depression, anxiety, problems within the marriage, and feelings of worthlessness, incompetence, and even defectiveness. Couples or single partners also experience a sense of loss and decreased self-esteem. (Deka & Sarma, 2010) When someone is told they are infertile, they are technically mourning the loss of the children they thought they could have,which has a huge impact on emotions and mental health. A study conducted in Sweden found that three main factors play a role in this psychological stress and include: “Having children is one of the main goals in life”, “female role and social pressure” and “the effect on sexual life ”. (Deka & Sarma, 2010) When a couple discovers that they cannot have a child they experience lower levels of satisfaction in their sexual life. (Lykeridou, Gourounti, Deltsidou, Loutradis, & Vaslamatzis, 2009) These difficulties in their sex life can be attributed to a number of different things, including blaming their partner for the infertility, blaming themselves, or even anxiety. ("The Psychological", 2009) In some cases the sterile spouse thinks of leaving his partner because he is unable to give him a child. (Onat & Beji, 2012) If a couple is found to be completely infertile, they reported feeling isolated because unlike other people they cannot have genetic children, angry at having no control over their body. Infertility causes a great deal of stress when couples or individuals realize the high cost associated with treatment. Over 40% of couples who seek help for infertility never complete treatment. If someone cannot afford to continue treatment, or their insurance does not cover the treatment, or they cannot hire a surrogate mother or bear the financial burden of adoption, they will have to mourn the loss of the child and will lose any hope they may ever have. a child, which can be emotionally crippling. (Kessler et al., 2013) Social pressure to have a child is everywhere. As soon as a couple gets married, people wonder when they will start having children and don't care much about whether or not a couple is physically capable of having children. Couples reported being pressured, excluded and treated badly by their families because they have no children. (Onat & Beji, 2012) In one study a couple reported avoiding staying in places with children so as not to face questions related to their pregnancy. Societal pressure to have children is so great that couples isolate themselves from it. (Onat & Beji, 2012) If a couple is dealing with infertility, they may avoid social interactions with friends or family who already have children or are pregnant. (“The Psychological,” 2009) Not only is there pressure on couples, but many cultures expect women to have children and there seems to be a stereotype that this is not the case in the United States, but in reality pressure on women to conceive exists Still. American culture stigmatizes a childless woman as less than a “real woman,” deviant, abnormal, and sometimes even selfish. These women should not only reproduce, but they should also want to reproduce, as it is their “social duty”. (Cassidy & Sintrovani, 2008) In the past, if a couple was found to be infertile, the only option for having children would be adoption, but several techniques have been developed to help people in their child-rearing efforts. Couples can choose to have children through adoption, a surrogate mother, egg donors, in vitro fertilization, gamete intrafallopian transfer, zygote intrafallopic transfer, and artificial insemination by the man trying to conceive or a donor. Adoption occurs when the couple takes legal custody of a child to whom they usually have no genetic link, a surrogate mother relies on a woman who is not part of the couple to carry the pregnancy to term, deliver the child and then give it to the couple to adopt. The baby can be conceived using sperm from a donor, an egg from the surrogate mother or another donor, or even with the sperm and egg of one or moreboth members of the couple. In vitro fertilization occurs when eggs are removed from a woman's ovaries and fertilized by sperm in a laboratory test tube, then implanted directly into the woman's uterus. Intrafallopian gamete transfer occurs when a doctor inserts a sperm and egg directly into a woman's fallopian tube. Intrafallopian zygote transfer occurs when an egg is fertilized in a laboratory dish and then inserted directly into the fallopian tube. Artificial insemination occurs when sperm from a donor or partner is placed directly into the vagina or uterus when the woman is thought to be ovulating. (Herdt & Petit, 2014) While all of these options have a chance of success, they come at a heavy financial and emotional cost and run the risk of not being successful. Many couples report that the cost of infertility treatments has caused financial problems. (Onat & Beji, 2012) Infertility treatments and options have a physical and psychological effect on both women and men. Women report experiencing negative changes in their body during treatment such as headaches or pain where the injections occur. (Onat & Beji, 2012) A study conducted in Greece showed that women undergoing infertility treatments experienced high levels of anxiety. (Lykeridou et al., 2009) It has been shown that both members of the couple feel more depressed and also stressed. When a couple is stressed due to treatment, this could actually become counterproductive and create an even greater challenge to getting pregnant. A person in a depressed state is believed to experience higher levels of prolactin, thyroid dysfunction, and a change in the immune system that could affect fertility. In depressed women, the hormone that regulates ovulation is thought to function abnormally when they are depressed. These psychological symptoms lead many people to stop treatment. (Deka & Sarma, 2010) It has been shown that some drugs used in treatment can cause psychological side effects. For example, a drug normally prescribed to improve ovulation is suspected of causing anxiety, sleep disturbances, mood swings and irritability. Some other drugs are believed to cause depression, irritability, difficulty thinking, and even mania in some patients. (“The Psychological”, 2009) Sexual life is also believed to be affected by these drugs and patients begin to see themselves as “fertilization machines”. (Onat & Beji, 2012) Both the person being treated and the doctors themselves find it very difficult to understand which symptoms come from the stress of the treatment and which instead come from the drugs. Infertility treatments can not only cause new psychological problems, but they can also make existing conditions worse. ("The Psychological", 2009). Patients experience these psychological symptoms very intensely during treatment. (Onat & Beji, 2012) One woman is quoted as saying, “Menstruation during treatment was a period of mourning. I felt really sad and disappointed. It's a terrible frustration. It takes away all your physical and psychological strength." (Onat & Beji, 2012) Women appear to experience greater stress than men during both diagnosis and treatment of infertility. (Deka & Sarma, 2010) For this reason, women in treatment are advised to seek psychological support. (Lykeridou et al., 2009) Couples are offered many different treatment options that all provide their own negative and positive outcomes. Many couples attempt to adopt children but encounter increasing dissatisfaction due to the exhausting natureof the selection procedure, concern about the laws and high costs and about the limited number of children available for adoption, as the waiting list is very long. Doctors suggest that couples who want to adopt should deal with the pain of the inability to have genetic children and the bitterness they feel towards their spouse over infertility. It has been shown that when the adopted child reaches puberty, these feelings can resurface in the parents, leaving the father threatened by his child's ability to procreate and the mother envious if her daughter is capable of having genetic children. (Waltzer, 1982) Another option offered to couples wishing to have children is artificial insemination, either by the husband or by a donor. Many parents prefer this method of creating children so that the mother can carry her child and experience childbirth, there is a genetic bond between parents and children, it gives parents the ability to bond with the child before it is even born. Donor insemination is also a way to address social pressures related to infertility, as most people, except the couple, are unaware that the father is unable to give birth to their children. (Daniels, 1994) On the other hand, the husband in the relationship may feel that "the growing abdomen...may be a reminder...of his 'inability' and of a rival father." Some women gain their spouse's approval through emotional blackmail, which can lead to complications. (Waltzer, 1982) It has been shown that many people who become parents through donor insemination tend not to tell their conceived children anything and never know that they are not genetically related to both parents because the parents fear that the child will not will be able to bond with the non-genetic parent. It has been shown that keeping this secret can have a negative effect on the family. Many children have reported that they suspect something is wrong in their childhood and if the child ever discovers that he or she is not genetically related to a parent, he or she becomes very curious about his or her genetics and wants to know more about his or her biological parent. (Golombok, Murray, Brinsden, & Abdalla, 1999) Opinions vary on whether or not parents revealing their child's true genetic makeup has negative or positive effects on the child. Surrogacy is an option that some couples choose so that they can maintain a genetic heritage. relationship with your child or avoid the adoption process. It has been shown that the absence of a pregnancy could change the parents' experience of bonding with the child before birth, and that if another person besides the couple was involved in the birth of a child, this could lead to parenting difficulties. and also psychological problems for the child. (Golombok, MacCallum, Murray, Lycett, & Jadua, 2006) Surrogacy is not widely accepted socially and is in fact quite controversial. Some couples may view surrogacy as an “unwelcome but necessary reproductive option.” (Ciccarelli & Beckman, 2005) Couples may experience disapproval from family, friends, and more, which may also affect how they bond with the child. (Golombok et al., 2006) On the other hand it has been shown that women who are able to withstand the stress resulting from a surrogacy arrangement are highly tolerant of stressful parenting situations and that the desire to have a child surpasses the need for a genetic link or the experience of pregnancy. (Golombok et al., 2006) Women and couples who choose to resort to IVF increasingly experience negative effects as,” 2009)