Social and psychological consequences of infertility and assisted reproduction - what are the research priorities?

The lifetime prevalence of infertility in representative population-based studies from industrialised countries is 17-28%, and on average, 56% of individuals affected seek medical advice. Infertility, as well as being a medical condition, has a social dimension; it is a poorly-controlled, chronic stressor with severe long-lasting negative social and psychological consequences. Although infertility can lead to severe strain in a couples' relationship, it can also have a potentially positive effect. Appraisal-oriented coping strategies including emotional coping are associated with reduced stress in infertility. Long-term studies of involuntary childless women following unsuccessful treatment show that although most adjust well psychologically, their childlessness is a major theme of their lives. Most studies are based on cross-sectional studies among couples seeking fertility treatment and focus on individual characteristics, for example, stress level, anxiety and symptoms of depression. There is a lack of studies investigating the impact of infertility and its treatment on social relations and of studies which have used the couple as the unit of analysis. More large-scale, long-term prospective cohort studies which address the social as well as psychological consequences of infertility are needed.