The Associations between Thoughts on Fertility Problems Death anxiety and Aspects of Parenthood

The decision to become a parent has long-term implications. While most people state that they would like to become parents at some point in their lives, recent years have seen an increase in the number of couples who experience infertility and have difficulties in realizing this wish. To date, studies have mainly addressed the direct and conscious consequences of coping with this stressful situation, and have not focused on the more implicit consequences, which include death-related thoughts and anxiety related to lack of continuity.

The current series of studies, based on Terror Management Theory (Greenberg et al., 1986), examined the association between awareness of infertility and awareness of mortality, as well as the implications of infertility awareness on aspects relating to parenthood: postponing the age of parenthood and factors related to the decision to become a parent. Four experiments were conducted among single men and women aged 20-35: Study 1 included 162 women, and examined whether infertility salience (vs. mortality salience or a control group where thoughts of another aversive subject were made salient) increases death-thought accessibility; Study 2 consisted of 89 women, and examined whether infertility salience (vs. a control group) increases biological symbolic immortality; Study 3 included 186 women, and examined whether infertility salience (vs. a control group) affects different decisions relating to parenthood, such as the desire to become a parent, the age at which to become a parent and the desired number of children; Study 4 consisted of 230 women and 164 men, and examined whether infertility salience (vs. a control group) leads to attributing less importance of various factors in the decision to become a parent, and whether sex differences exist. Additionally, two moderating variables were examined: motivation for parenting and sense of mastery. In all studies, the participants completed self-report questionnaires. In study 1 questionnaires were administered both by pen-and-paper and electronically. In studies 2-4 questionnaires were administered electronically only. Duration of completion of the entire questionnaire, as well as completion of individual scales, were monitored in the electronic version. In each of the studies a questionnaire manipulating infertility salience was administered, as was a control questionnaire (thought of dental treatment), a distraction task (crossword puzzle) and a demographic questionnaire. Additionally, in Study 1, a mortality salience manipulation and a scale assessing accessibility of death-related thoughts were administered. In study 2, questionnaires assessing biological symbolic immortality and motivation for parenting were also administered. In study 3 several questions relating to the transition to parenthood were added: satisfaction from life without children, the importance of having children, future plans to have children, desired number of children and age of transition to parenthood. Study 4 also included a scale assessing factors related to the decision to become a parent. Finally, sense of mastery scale was administered in studies 3 and 4.

The findings of study 1 suggest that, similar to mortality salience, infertility salience increased the accessibility of death-related thoughts among childless women. In other words, infertility appears to be associated with death-related thoughts. In studies 2 and 3, infertility salience was not associated with reports of higher biological symbolic immortality or a greater desire to become a parent, the desire to become a parent at an earlier age or have more children. Yet, when the moderating role of sense of mastery was examined, the findings indicate that among participants with higher levels of mastery, those in the experimental group reported wanting fewer children than those in the control group. In study 4, no significant differences were found between the experimental and control groups in factors related to the decision to become a parent. Sex, age, family status, level of religiosity and having a first-degree relative experiencing infertility contributed significantly to explaining differences in factors related to the decision to become a parent, regardless of the study group. Additionally, the findings suggest that infertility salience has a different effect on men and women. Men who were exposed to infertility salience attributed less importance to factors related to the decision to become a parent compared to women exposed to the same condition, whereas no sex differences were observed in the control group. Moreover, men exposed to infertility salience attributed less importance to factors related to the decision to become a parent than men in the control group, whereas no such differences were observed among women.

Furthermore, the study highlights the importance of being in an intimate relationship as a protective factor against infertility salience: participants in relationships who were exposed to infertility salience attributed less importance to factors related to the decision to become a parent than participants who are not in relationships.

Additionally, we observed differences when combining sex, family status and study group: men who are not in relationships and were exposed to infertility salience attributed less importance to factors related to the decision to become a parent than women in relationships exposed to the same condition, who, in turn, attributed the highest importance to these factors among the comparison groups. Regarding the moderating role of sense of mastery, among participants in relationships with low levels of mastery - those exposed to infertility salience attributed more importance to these factors than the control group. Among those who are not in relationships, when mastery levels were low, the importance attributed to these factors among the experimental group was lower than in the control group. This indicates the importance of family status (with/without a partner) as a protective factor against infertility salience.

The findings of this study add new theoretical knowledge on the association between awareness of infertility and awareness of death, and the way in which infertility salience affects the factors related to the decision to become a parent. Moreover, the study findings highlight the different effect of infertility salience on men and women, and the protective roles of intimate relationships and sense of mastery against the anxiety induced by infertility salience.

Understanding the meaning of infertility salience and its protective factors has important practical implications for clinicians treating couples facing infertility. These findings can assist in the development of new therapeutic interventions for men and women who experience various hidden and not necessarily conscious facets of coping with infertility, for whom difficulty in conceiving is equated to death anxiety. Future studies are needed to broaden our understanding of the effects of infertility on other aspects of parenthood, among both men and women, and expand the knowledge on the protective roles of intimate relationships and sense of mastery, so that these may be used in therapeutic interventions for those experiencing infertility.