Mazing : Infertile Couples and the Quest for
a Child
Margarete Sandelowski, Betty G. Harris, Diane Holditch-Davis
The overall purpose of ihe ongoing research prqect on which this report is based
is to explore the transition io parenthood of infertile couples who achieve parent-
hood through adoption or biotechnical means. Mazing, the process of negoiiat-
ing the paihs to parenthood, was found to be a key component of that transition
and the core variable that integrates the experiences of infutile couples ajier a
period of trying but failing to have a child of their own on their own. The the-
o v of mazing is grounded in information obtained from 40 couples who were
designaied for ihis siudy by means of theoreiical sampling. Techniques generic
to grounded theory research were employed; these included open-ended inter-
views, consiant comparison and subject ualidaiion. Mazing, a recursiue, iter-
ative and resource-intensive process, includes (a) the construction of a calculus
of pursuit, (b) six distinctive paiierns of pursuit, and (c) the refaming o j
desire.
* * * their own or waiting to adopt a child. Sampling decisions
I
nfertile couples’ quest for a child now involves more
options than ever before but not necessarily better
chances of achieving the goal of parenthood. New tech-
nologic developments such as in vitro fertilization and
the greater availability and acceptability of old solutions to
infertility such as artificial insemination and adoption offer
hope. Yet the promise of becoming a parent is undermined
by the relatively low success rates of some of these biotechni-
cal procedures and the increasing competition for a decreas-
ing supply of adoptable babies. Nevertheless, at least 50
percent of infertile couples who pursue parenthood will reach
their goals (Collins, Wrixon, Janes & Wilson, 1983; Kliger,
1984; Poston & Cullen, 1986).
Although infertile couples increasingly are taking alterna-
tive and controversial routes to parenthood, these routes have
yet to be fully explored for their impact on individual and
family well-being. Accordingly, the overall purpose of the
ongoing project on which this report is based is to explore
the transition to parenthood of infertile couples who have
achieved parenthood through adoption or through biotechni-
cal means including drugs, artificial insemination, in vitro
fertilization and corrective surgery. This paper addresses a
process within that transition.
220
Method
Techniques generic to grounded theory research were
employed to designate subjects for this study and for data
collection, analysis and verification. This methodologic ap-
proach is a recursive process, itself intended to uncover proc-
ess in the phenomenon under investigation. Theoretical
explanations are continually generated on the basis of incom-
ing data, and sampling, data collection and verification tech-
niques are continually subject to modification in order to
confirm or refute these explanations.
Theoretical sampling (Glaser & Strauss, 1967; Lincoln &
Guba, 1985) was employed to designate the subjects for this
study. Sampling began with couples who would be most
likely to illuminate infertile couples’ transition to parent-
hood-couples who had experienced difficulty conceiving or
carrying a child and who were currently expecting a child of
were subsequently guided by the need to find comparative
groups of subjects to explicate and validate heuristic theoreti-
cal lines or to saturate theoretical categories. These groups
included a variant group of infertile and expectant couples in
which one of the partners had undergone a sterilization rever-
sal, infertile couples who had already delivered or adopted
their children prior to entering the study and expectant cou-
ples with no histories of infertility. Sampling to complete the
theory presented in this paper ended at the point of “infor-
mational redundancy” (Lincoln & Guba, 1985, p. 202) or
when no new information was obtained from the subjects.
Forty couples provided the data on which this report is
based. They are profiled in Table 1. Because of the costs of
infertility and adoption services, the sample is fairly homoge-
neous in terms of socioeconomic class (middle income), race
(white) and age (primarily 30s). The childbearing couples
MARGARETE SANDELOWSKI, R.N., Ph.0.. Alpha Alpha, is Associate Pro-
fessor, and BETTY G. HARRIS, R.N.. Ph.D.. and DIANE HOLDITCH-
DAVIS, R.N., Ph.D., are both Assistant Professors at University of
North Carolina at Chapel Hill, School of Nursing. The authors thank Dr.
Phyllis N. Stern for her consultative support and Claudia Earle for the
design of the figure. This research is supported by Grant #NR01707,
from the National Center for Nursing Research. Correspondence t o
Professor Sandetowski. UNC-CH #7460 Carrington Hall. Chapel Hill, NC
27599.
I Accepted for publication June 16,1989.
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Mazing : Infertile Couples and the Quest for a Child

without histories of infertility had background characteristics
similar to those of the infertile couples. The sample is varied
in terms of fertility and parenthood status and type of diagno-
sis, treatment and adoption. Couples were recruited with the
assistance of nurse, physician and caseworker intermediaries
in private physician practices, infertility services, adoption
agencies, infertility and adoption support groups; through
advertising; and through subject and personal referrals.
These 40 couples are currently participating, or have com-
pleted their involvement, in the research project entitled “the
transition to parenthood of infertile couples, ” which began in
April of 1987. The current protocol for this project calls for
(a) couples to enter the study as soon as possible after learn-
ing that pregnancy has been achieved or approval to adopt
has been obtained; (b) childbearing couples to be interviewed
five times in the home-three times during the pregnancy,
once within a week of delivery and once when the infant has
been home for three months; and (c) adopting couples to be
interviewed every three to four months until placement and
then one week and three months after placement.
The process explicated in this paper was described by the
couples primarily in the first interview (and in one diary sub-
mitted by one of the wives), allowing theoretical closure
within the time and sampling group specified here. Sixteen
childbearing couples were first interviewed in the first trimes-
ter and four in the second trimester; 15 adopting couples
were interviewed initially within six months of having
obtained approval to adopt an infant; and one couple, five
weeks after they learned that a baby would be available
through private adoption. In addition, one adopting couple,
who had a child placed with them within only two months of
obtaining approval to adopt, was interviewed initially seven
days after placement of a child. Three infertile couples who
had already had their children and were not awaiting an
additional child were interviewed only once, one to two years
after their last child was born or placed.
Couples were interviewed together in their homes, each
interview lasting from one and one-half to three hours. These
audiotaped interviews were open-ended; couples were asked
to tell the story of their infertility and their impending or
achieved parenthood. The techniques of probing (Schatzman
& Strauss, 1973) and tracking (Daniels & Weingarten, 1983)
were employed to clarify information and to validate inter-
viewer interpretations of that information.
The research protocol was approved by either a Human
Rights Committee or designated agent at each recruitment
site. The subjects’ consent was obtained with an approved
consent form. Subject privacy was protected by assigning

~-
TABLE 1. Profile of Four Sarnpllna Flrst Research Contact (N = 40)
. - Groups of Couples at -
Factors Contributing Treatment Prior to Type of Adoption
to lnfertility/Sterilitya Target Pregnancy
Grc
- - PSb - - Groups Groups
- -
1
- - 2 - 3 - 1 2 -
- 3
SF snsc
- ISF sp sc
Impairment p steriliza- 3 0 0 FertilitylHormonal drugs 3 Locallprivate agency 8 0
tion (includes vasecto-
my and BTL)

Male factor (excludes 2 5 0 Drugs + AIH 3 Locallpublic agency 4 1

sterilization impair-
ment)

Endometriosis 1 4 2 Drugs + AID 2 Interstate agency 1 0

Ovulatorylhorrnonal d y s 11 7 2 IVF 7 Independent 1 0

f unct ionsC

Hysterectomy 0 3 1 Spontaneous pregnancy 1 International agency 3 0

Cervicallmucus dysfunc- 1 4 1
tion

Tube factor (includes sal- 6 3 0

pingectomy; excludes
impairments p BTL)

Other (includes DES com- 3 3 0

plex, infectionladhes-
ions, immunologic
factor)

No explanation 0 1 0

a Couples fall into more than one catego
b Group 1-InfertilelStenlelPregnant (n =76).
Group 2-InfertilelSterileiWaiting to Adopt (n = 17).
Group 3-InfertilelSterilelAlready Parents;
not expectinglwaiting for a child (n = 3).
Group 4-FertilelPregnant (n = 4).
Couples placed in this category i f they stated this
diagnosis or stated that one or more fertility/
hormonal drugs were taken.
One couple in this group had first child by IVF
and second child by spontaneous pregnancy.

Volume 2 I , Number 4, Winter 1989 22 1


code numbers to interview data and pseudonyms to each
couple.
Constant comparison (Glaser & Straws, 1967; Lincoln &
Guba, 1985) was the principle technique of analysis used with
the interview data. This technique involves moving back and
forth among data sets, comparing elements of the data to dis-
cover the core category that integrates it and accounts for
much of its variation. Consensus was reached on the essential
storyline, categories and components and variations of cate-
gories in a schema outlined by Turner (1981) in weekly meet-
ings held by the three members of the research team. The two
co-investigators acted to check the analysis of the principal
investigator (Rennie, Phillips & Quartaro, 1988, p. 148).
Techniques appropriate to inquiry in the naturalist para-
digm were employed to ensure the rigor of this investigation
(Lincoln & Guba, 1985; Sandelowski, 1986). These in-
cluded prolonged contact with subjects; triangulation across
informants, interviewers and data collection techniques;
informant validation; and continuous review of decisions
relating to sampling and other elements of the research proto-
col. The informants and the three members of the research
team comprised the “panel of experts” (Stern, 1989). Cou-
ples who had completed the study were mailed a draft of this
research report to determine the “recognizability” (Lincoln
& Guba, 1985, p. 314) of their experience in the investiga-
tors’ reconstruction of it. A consultant in grounded theory
research contributed to the auditing of the evolving research
protocol. As an additional verification measure, the data col-
lected for this study were compared to data collected from
infertile women in a previous study (Sandelowski & Pollock,
1986); and to memoirs written by adopting couples published
since 1981 in OURS: The Magazine of Adoptive Families, a publi-
cation of a national adoption support group.
Results
In stark contrast to the fertile couples in the study who
moved directly from point A to point B, from trying to con-
ceive to achieving parenthood, infertile couples who wanted
to become parents were forced to enter a maze of alternative
paths to parenthood with no assurances that point B would
ever be reached. These infertile couples engaged in muzing, a
tortuous process of negotiating the paths to parenthood,
unknown and unimagined by couples who easily, unthink-
ingly and accidentally conceive and bear children. Infertile
couples in turn, as adoptive father Charles Bond observed,
“can’t imagine what it’s like for the blissfully fertile, the
obliviously fertile.” (All names used in reporting the data are
pseudonyms.)
The process of mazing, shown in Figure 1, is recursive,
iterative and capital-intensive, demanding vast expenditures
of time, physical and psychic energy and the financial
resources to drive it. Steve Morrison evoked the image of
Sisyphus, persistently thwarted in his labors to push a stone
up a mountain, when he described the “medical and emo-
tional journey” that he and his wife had taken to achieve
pregnancy. For him, the journey was like a stone whose
weight compounded itself as attempts were made to move
forward.
Infertile couples documented the fatigue involved in “try-
ing” and “having to try” to have a child. The amount of
effort expended in negotiating the maze and in managing its
dead ends-treatment and adoption failures and pregnancy
losses-was staggering. If the immediate goal of this labyrin-
---
999
1 1 1
Mazing : Infertile Couples and the Quest for a Child
R refraining desire
* to have/to get a baby
Figure 1. The theory of mazing.
thine process was to have a child, the ultimate goal was to exit
the maze with no regrets, an objective accounting for infertile
couples’ high tolerance for suffering and failure and low toler-
ance for the “should-haves” and “what-ifs” that threatened
to shadow their lives. Ellen Gorman recalled an infertile
friend telling her that she would “regret ...that I didn’t try
everything possible. I can deal with trying and failing easier
than not trying at all.’’
Couples typically began mazing in the state of in-
betweenness that defines infertility. Infertility is a relative
rather than an absolute condition, the ability to reproduce
varying in each partner with time and circumstance. When
reproductive dysfunctions were discovered, they were neither
necessary nor sufficient causes of infertility, and their cures
did not always lead to conception. When no dysfunctions
were discovered, infertility remained unexplained. With
reversal techniques, even the presumably absolute incapacity
to reproduce in voluntarily sterilized individuals became
potential capacity; sterility reversed to infertility. Accord-
ingly, infertile couples were in a tenuous state of being in-
between reproductive capacity and incapacity, between
assuming that a child could be conceived and successfully
borne at will to accepting that such an event could occur only
with medical assistance or might never happen at all. In per-
ceptional and medical terms-in terms of identity and diag-
nosis-infertile couples were neither absolutely capable nor
incapable of procreation.
Within a year or less of trying and failing to have a child of
their own on their own, couples typically sought medical
assistance and entered the maze of contemporary infertility
diagnosis and treatment protocols, or embarked on “doing
infertility. ” Doing infertility was initiated when couples
began to question their failure to conceive, and involved
enlisting medical assistance to look for “what was wrong’’
and to “make [pregnancy] happen.” Couples spent relatively
little or no time at all trying on their own to determine the
reasons for their infertility or seeking the means to reproduce
outside the medical realm. Even the Morrisons, who placed a
high premium on living self-reliant lives within a “natural ...
holistic” framework, started “doing infertility” after only
one year of trying on their own. Infertile couples typically felt
the need to seek medical help after no more than one year of
trying to conceive, but there was also the feeling, especially
IMAGE: Journal of Nuning Scholanhip
Mazing : Infertile Couples and the Quest for a Child
among women with medical knowledge, that trying for one
year before getting help was wasting time. Kristin Danvers
knew a woman who insisted her doctor put her on Clomid
after only two months of trying to conceive.
“Doing adoption,” typically embarked on only after some
attempts at doing infertility had failed, involved pursuing one
of the many adoption routes to a child including adoption
though local private or public agencies, interstate and foreign
adoption and private adoption. Couples such as the Danvers,
the Sargents and the Iversons spent relatively little or no time
at all doing infertility before pursuing adoption. After one
year of trying to have a child. Kristin Danvers was diagnosed
with endometrial cancer and had to undergo a hysterectomy.
The Sargents had not attempted to have a child at all when
Cheryl had a hysterectomy for severe endometriosis. Within
five months of medical testing, the Iversons knew that Quin-
ton had a congenital anomaly that had left him sterile. These
three couples were spared the exigencies of doing infertility
(although not the traumas engendered by cancer, surgery and
sterility) that characterized the typical journey to parenthood
of infertile couples. As Cynthia Ingram, who knew before her
marriage to Sam that her tubes were blocked, explained it,
there was no “wondering” for them about what was imped-
ing conception. Moreover, circumstances such as absent vasa
and hysterectomy removed any uncertainty about whether or
not conception would ever occur. These couples were in an
absolute state (sterile) rather than in an in-between state
(infertile) of fertility and were quickly forced to consider
doing adoption or never entering the maze at all and remain-
ing childless.
Once in the maze, couples were confronted with a variety
of paradoxical and frustrating situations. Couples doing
infertility were confronted with being infertile without defini-
tive cause, with presumed causes of their infertility for which
treatments were unavailable or ineffective and with treat-
ments suggested in the absence of any established causes.
Similarly, couples doing adoption were confronted with avail-
able babies whom they could not get, bureaucratic policies
and decisions that they could not fathom and varying criteria
for acceptance as adopters that they could not rationalize.
Calculus of pursuit
Accordingly, couples engaged in as rational an accounting
process as they could and weighed the options known and
accessible to them and then constructed their own calculus of
pursuit. As shown in Figure 1, couples constructed a matrix
of resources, of venture capital including time, money and
physical and psychic energy and then, for each option, deter-
mined whether or not to pursue it at a given time. Couples
calculated the amount of each of these four categories of
resources available to them including what they could borrow
at the time of decision making. For example, they considered
the time available to them to pursue options such as adoption
and in vitro fertilization (IVF), given their ages and the age
limits of these ventures, and the loans they could secure to do
IVF. Couples determined the level of resources that any par-
ticular medical or adoption protocol required for an acceptable
probability of success. For example, couples considering IVF
perceived the 20 percent chance of succeeding with this pro-
cedure alternatively as improving or declining with each try
and therefore alternatively worth or not worth the high cost of
repeated attempts. The Bostwicks calculated that the 5 per-
cent chance they were given of conception after tubal surgery
was not worth the capital investments that the procedure
Volume 2 1, Number 4, Winter 1989
required and decided to put their resources into two IVF
attempts.
Couples also determined the level of resources they were
willing to invest in pursuit of uncertain options. For example,
couples who perceived the 20 percent chance to have a child
by IVF as good odds, or “better than no chance” to conceive
at all, were willing to undergo the emotional and bodily trau-
mas of this procedure. The Kosters, who were waiting to
adopt a second child, decided that they were unwilling to do
infertility any longer because they perceived it as unduly risk-
ing emotional health and marital stability. The Langstons
were unwilling even to consider donor insemination because
of Kurt’s feelings that Belinda’s child would belong to
another man.
Finally, couples determined the amount of regret they would
experience if they did not pursue a particular option at all or
any longer. Couples tried to “clear the slate” and “go the
gamut” in their efforts to avoid “if-onlys.” Already regret-
ting or, at the very least, reviewing fertility choices made
in the past (e.g., delaying childbearing, elective pregnancy
terminations, elective sterilizations), infertile couples antici-
pated regret in their cost accounting of the benefits and liabil-
ities of pursuing any one path to parenthood. Before deciding
to adopt their second child, Gail Koster went back on Clomid
for six months to be certain that she had not “dropped”
doing infertility “too abruptly. ’ ’ After this trial period, and
because they were so pleased with their first adopted child,
the Kosters anticipated no regrets about stopping the pursuit
of pregnancy.
Each couple’s calculus of pursuit allowed them to deter-
mine what part of the parenthood maze they would enter at
any one time. When a conception occurred, or when they
made an agency’s adoption list, they had the exit point in
sight, the “light at the end of the tunnel.” When a failure
was incurred, couples repeated the process and constructed a
new calculus of pursuit. Couples determined whether doing
infertility or doing adoption was the ‘‘surer thing,” the path
more likely to get them out of the maze.
Patterns of pursuit
Couples exhibited six patterns of pursuit of parenthood
that reflected the calculations that they had made. The sequen-
tial tracking pattern was exhibited by couples who elected to
“exhaust one route before we start another” such as trying
one or a variety of treatment options in tandem for a limited
number of cycles before selecting one of the many adoption
tracks available. Couples did not necessarily choose freely this
pattern of pursuit. For example, the Dussaults wanted to pur-
sue simultaneously several foreign adoption tracks to save
time, but the adoption agencies would not allow this.
A second pattern of pursuit and a variant of sequential
tracking was backtrucking, in which couples restarted the medi-
cal regimen with a new physician or returned to a previously
attempted treatment or adoption option. The Danvers
returned to and were accepted by an adoption agency that
had previously discouraged their application.
A third pattern of pursuit, exhibited by couples only while
doing infertility, was getting stuck. Seeing, believing or being
encouraged by their physicians that persistence paid off, those
couples who got stuck in a treatment groove attempted the
same regimen over and over and over again. Charlene Shaw
had roughly 200 injections of various hormonal preparations
before achieving conception. The Everetts mentioned a
223

woman they knew who had tried IVF 11 times before she
achieved success. Nancy and Tony Sellers tried IVF 4 times
before they achieved a pregnancy, and would have continued
with this technique if it had failed again because they believed
their chances to succeed increased with every attempt. As
they explained it, the technology was steadily improving and
the doctors “get to know you more as an individual and your
body” every time IVF was tried. Moreover, Nancy tended to
locate the three IVF failures she had experienced in herself, a
factor that encouraged her to stay in the IVF groove. Even
though she knew that “the odds are against you” with IVF,
she wondered “what did I not do that was right that would
have made a difference?” She attributed the success of her
fourth IVF attempt to her having taken “better care of
myself. ” Similarly, Connie Cunningham was encouraged to
try IVF a third time because she was told that persistence
paid off and that she was a “good stimulator” (a reference
to the numbers of eggs she produced with hormonal in-
ducements).
Getting stuck in a treatment groove not only suggested a
belief in persistence and personal control over the treatment
but also an inability to accept infertility and a low tolerance
for anticipated regret. Marsha Underwood tried donor
insemination 15 times before achieving success. Having con-
ceived and borne a child in a previous marriage and not
accepting that she could not conceive another, she was willing
“to play the odds” and would have continued to play them
had she not achieved a pregnancy.
A fourth pattern of pursuit was paralleling, or the attempt to
pursue simultaneously and actively (rather than merely
“thinking about,” “talking about” or “looking into” an
option) multiple tracks. Generally exhibited by couples who
felt “in a panic” and “desperate,” paralleling was a means
to “maximize the options” while minimizing the time wasted
in pursuit. In extremis, in both having to resort to
“unusual,” “extraordinary” and “backup” means toward
parenthood and in feeling pushed to the wall, these couples
decided “not to close any doors,” “to keep the options
open,” “to keep our irons in the fire,” and, most signifi-
cantly, “to never give up.”
Couples exhibiting the paralleling pattern attempted to
navigate several paths at the same time, even pursuing addi-
tional paths as they opened up. The Edgertons, who had been
trying to conceive for five years, decided after an initial
period of doing infertility to “look into” adoption. They per-
sisted in doing infertility because they felt they were finally
making progress medically and had “something to shoot
for.” When that something did not work, they moved along
(in a sequential tracking pattern) to the next stages of doing
infertility. Increasingly, though, they experienced “desperate
feeling(s)” as they lost “excess years,” and decided to “pur-
sue both sides.” Their physicians gave them hope, but they
had nor as yet succeeded in becoming pregnant. They felt
compelled to get on an adoption waiting list, even though
they had reservations about adopting because they were “see-
ing time go by.” As Mona explained:
I’m having to decide now whether I’m going to go back and spend
money that is not covered by insurance to go any further when we
don’t have to. [We are] kind of af II crossro& again [emphasis is ours]
since i t hasn’t worked so far. It seems like I would be better off psycho-
logically if I’d been told that I can’t get pregnant. Then I’d just forget
that part and I could be all for the adoption with no reservations. But I
just haven’t got to that point yet.
2‘4
Mazing : Infertile Couples and the Quest for a Child
Now at the end of the period after Mona’s corrective surgery
when a pregnancy should have occurred, if it were going to
happen at all, the Edgertons would have to reconsider the
options. As Mona observed: “If I could just ...forget the
adoption and know I’d get pregnant, or forget the pregnancy
and go ahead and adopt.” Four months later, after a chance
to adopt fell through, Mona remembered that when they
received the call about that baby, she forgot about getting
pregnant, “forgot and didn’t even care...a nice feeling.”
After the adoption failure, they were back to doing infertility
(backtracking), undergoing repeated cycles of fertility drugs
and homologous inseminations (getting stuck), and they were
waiting for another call that a baby was available for them
to adopt.
Similarly, the Ingles maintained that you have to “seek all
your outlets and investigate anything that you hear about. ”
The Ingles illustrated the complete lack of closure to any new
option that might appear that was characteristic of paralleling
by remaining on an adoption agency waiting list while con-
tinuing to do infertility and staying open to any chance for a
private adoption. Couples like the Ingles paid a high psychic
price for paralleling, spending several years of never letting
go of any path to parenthood, suffering many failures and
losses and investing a tremendous amount of energy just to
stay on track with every option being pursued. The burdens
ofjuggling too many options at the same time included mari-
tal tension, frustration and sometimes even deception when
adoption agency policy prohibited couples from simulta-
neously doing infertility and adoption.
A fifth pattern of pursuit was taking a break. Couples had a
variety of reasons for withdrawing from either pursuit of fer-
tility or parenthood for several months to years, including
breaks necessitated by moves to new locations, financial and
insurance constraints and the need to recover from failures
and losses. Taking a break had positive consequences. The
Danelins achieved a pregnancy while taking a break from
doing infertility. Taking a break also allowed couples to
recapitalize their waning financial, physical and psychic
reserves and to construct a new calculus of pursuit.
Alternatively, not taking a break had negative conse-
quences. Evelyn Everett moved directly from one IVF failure
to another without giving herself “time to grieve.” Similarly,
the Harrisons decided only ‘Lanhour after” being informed
that Donna could die having a child to go to an orientation
meeting for adopting couples. She recalled that her intensely
negative feelings about pursuing adoption at that time had
been a “reaction” to the stunning “blow” her doctor had
inflicted on her and recognized that it had not been “good
timing” on her part to think about adoption so soon after sus-
taining it.
A sixth pattern of pursuit, exhibited by couples doing
infertility, was drawing the line. Couples “drew the line,” or
stopped doing infertility at different points in time, depend-
ing on when they became “fed up” with, or were no longer
willing to invest in, medical solutions. The Carlsons decided
to stop doing infertility after only two years, Larue finding
the process of diagnosis and her one year on Clomid painful,
degrading and futile. Linda and Donald Lafferty spent two
years doing infertility before considering adoption. They
were frustrated by the fact that, before Linda’s tuboplasty,
she was given a 30 percent to 50 percent chance of conceiv-
ing, but she was given almost no chance after surgery. Linda
recalled thinking while she was being rolled into surgery,
IMAGE: Journal of Nursing Scholarhnip
Mazing : Infertile Couples and the Quest for a Child
“why am I doing this?” Having to undergo a second opera-
tion for an ovarian cyst, which she thought was a pregnancy,
Linda decided she “had had it” with medical efforts. Impor-
tantly, the Laffertys had reached a point where they no
longer anticipated regretting not doing infertility anymore.
In contrast, there were couples who took much longer to
draw the line. The Bonds spent seven years doing infertility;
going to different physicians, and trying Clomid, Pergonal,
Danazol, cauterizations, inseminations and varicocele repair
to treat the irregular ovulation, endometriosis and low sperm
count believed to be contributing to their inability to con-
ceive. Lenore observed that there is “a little male factor,
there’s a little female factor.. .(but) there’s no statement with
all this evaluation that we will never be able to conceive a
child.” The Bonds finally determined that it was “very
unlikely” they would conceive a child and decided to pursue
adoption.
Couples who eventually drew the line on doing infertility
still harbored a “faint hope,” “like waiting for publishers’
clearinghouse,” that pregnancy might occur, but they no
longer “actively,” “seriously” or “aggressively” tried to
make it happen. They had reached the “if it happens, it hap-
pens” stage. Couples who had not as yet drawn the line were
still doing infertility “at the eleventh hour.” Maureen Ingle,
admittedly “a puzzle case” to her physician and at a point in
doing infertility where “we’ve tried everything basically
other than in vitro,” vowed “to keep trying as long as I
can,” no matter what the odds. Even if her doctor told her
there was no way she could become pregnant, she could not
give up “100 percent.”
Maybe 98 percent; 2 percent will always nag me ...I can’t give up. Not
unless that doctor looks at me and says there’s no way under
God’s green earth that you are going to get pregnant. Sometimes they
have told people that and they still have gotten pregnant. I just can’t
give up.
Her only impediment to continuing to do infertility was
financial; she felt she could “deal with the physical anguish
for now.” Maureen’s tolerance for anguish was high, but it
was low for the regret she anticipated if she stopped trying.
What if she gave up too soon?
Reframing Desire
At some point in their failed questing for a child, infertile
couples had to confront what they really wanted. They had to
distinguish between wanting to have and wanting to get a
baby, between wanting fertility and wanting parenthood,
distinctions that are at the most only theoretical for the
“obliviously” fertile. Both the medical and adoptive routes to
parenthood forced these couples to examine the differences
among wanting a child at all, wanting pregnancy, wanting a
healthy baby, wanting a baby, wanting a healthy child and
wanting any child to parent. The new conceptive techniques
as well as adoption create and accentuate the separation
between genetic, gestating and social parenthood.
The rejraming of desire was a refrain, a recurring task, in
infertile couples’ efforts to “come through and come out the
other end” of the maze. For those individuals who entered
their marriage with little or no desire for children, the re-
framing of desire-the process in which wants in relation to
fertility and parenthood are reconsidered, refined and altered
-began with resolving their ambivalence about becoming
parents. Cheryl and George Sargent were ambivalent about
Volume 2 1, Number 4, Winter 1989
having children of their own to the point of terminating a
pregnancy in the early years of their marriage. For Cheryl,
the hysterectomy she had to undergo because of severe endo-
metriosis “was almost like a relief because I had always felt a
lot of peer pressure to have my own children.” The hysterec-
tomy “simplified” her situation and the decision of whether
or not to have a child of her own. This couple, now waiting
to adopt, eventually came to the point where they wanted
a child because they felt something was missing from
their lives.
Once the desire for children was affirmed but unfulfilled,
the reframing of desire involved altering the desire to have a
baby naturally to having it with medical help. Elaine Morri-
son wanted to make pregnancy happen on her own but was
forced to consider unnatural alternatives. Elaine progressed
from wanting to have a baby naturally and failing to wanting
to have a baby with medical assistance and failing to being
unsure that adoption is “what I want.” The pregnancy she
finally achieved made it unnecessary for her to consider seri-
ously whether wanting to beget a baby was more powerful
than wanting to get one.
For those couples who succeeded fairly early in doing infer-
tility, no reframing of desire-from wanting to have a baby
to wanting to get a baby-was necessary. In contrast, those
couples who suffered repeated failures to have a child with
medical assistance were forced into a more intensive and
painful process of reconsideration, revaluing and introspec-
tion. Donna Harrison explained that couples in the situation
of having to consider adoption had to ask themselves the right
questions: “It’s not, Do you want to adopt? It’s, Do you
want children? You weigh the two things, Either have a child
that’s adopted or don’t have children.”
Asking the right questions, confronting self, revelation and
letting go were key components of the reframing of desire.
Evelyn Everett had always “placed a high premium on being
pregnant,” even though she had not wanted a child before
falling in love with Edwin. Because the “idea” of pregnancy
was so hard for her to give up, she experienced her first dis-
tancing from Edwin, who had no trouble with the idea of
their adopting a child. She recalled that her husband was
shocked that she might not be able to love an adopted child as
much as her own. Evelyn was forced to confront herself as she
appeared in her husband’s eyes. Grieving over the “tragedy”
of discovering that she would never have her own child, she
began to reframe her desire:
I t gelled in my mind that I wanted to be a parent rather than be preg-
nant. I did very much want to be pregnant, but if I couldn’t have that,
I wanted to be a parent.
Having focused for too long on what she wanted but could
not have, Evelyn gradually
came to terms with what I really wanted, which was difficult for me. I
fell in love with the idea [of adoption]. Thaf has become what I wanf.
[Emphasis is ours] ...I want the child more than I want to be pregnant
...It didn’t all of a sudden come to me in the middle of the night. Just
through a lot of introspection and trying to figure out and talking to a
therapist about what I really wanted.
Importantly, Evelyn experienced a revelation reading a story
written by the grandparents of an adopted child who had
observed that love was not contingent on relationship by
blood. She realized that there was no one she loved more than
her husband, who was also not her blood kin. She started
“thinking in a whole new portion of my brain about relation-
225

ships and what does this genetic tie mean?” Her “awaken-
ing” to the unimportance of blood ties led to her comfortably
replacing her desire for pregnancy with a desire for a child.
A consequence of the confrontation with self was a new
appraisal of personal values and prejudices. Adopting couples
typically felt good about the fact that they could look posi-
tively on adoption and about what they had discovered about
themselves and their partners while preparing their family
history and album for their homestudy. But confrontation
with the self alternatively included the discovery that the
desire to parent could not as yet or never include the desire
for just any child. F. U., in the Sandelowski and Pollock
study (1986), who adopted an American child, observed that
having to face adoption confronted her with her basic beliefs.
It upset her “that she said no to a [Korean] child out there
who needs a family,” while professing to want a child. In
addition, she was ambivalent about her ability to “handle
such a child.” B. I., also in that study, knew she was being
“harsh” and “inhuman” in her judgment of adoptees as
“bad seeds” and “rejects.” Yet she allowed that should she
not have a child of her own by the time she was 35, she might
have to reconsider adoption.
Discussion
The theory of mazing explicates the questing process that
infertile (and sterile) couples engage in to reach the desired
goal of parenthood, a deliberative process that helps couples
preserve mastery and make order out of ambiguity (Sande-
lowski, 1987) and chaos. Although infertile couples’ questing
may on the surface be viewed as “grasping at straws” or
“wandering” (Daly, 1988) in a maze of treatment and adop-
tion solutions, the theory of mazing reveals that infertile cou-
ples’ efforts to achieve parenthood are based on a rational, if
idiosyncratic, calculus, which nurses must understand if they
are to assist couples in such areas as limit setting, energy con-
servation and preservation of self.
Infertile couples have been described as “treatment-
addicted” (Greil & Porter, 1988) and “driven” (Olshansky,
1988) in their questing for a child. The infertile couples in the
present study were not so much treatment-addicted (deriving
no pleasure from any medical regimen per se), as they were
intolerant of regret. In addition, there are indications that the
tenacity of their pursuit may, in part, be attributable to
encouragement by physicians, nurses and others to keep try-
ing. Paterson and Chan (1987), for example, suggested that
infertile couples ought to be encouraged to keep trying IVF
since pregnancy rates in later cycles have been shown to be as
high as rates in the first cycle. Medical experts and critics of
advancements in conceptive technology, however, have
lamented the distorted “success” rates and pronatalist imper-
atives used to lure infertile couples to keep doing infertility
(Corea, 1985; Soules, 1985).
The couples described here have successfully exited the
maze and have either become parents or are currently in
waiting for a child. There are couples who quit the maze
childless, failing to achieve success with the options they have
chosen and/or rejecting options, notably adoption, that might
have led to parenthood. S.L. (Sandelowski, 1988) quit maz-
ing by drawing the line on doing infertility and rejecting
adoption and was even contemplating hysterectomy to put an
unequivocal end to any further pursuit. Significantly, mazing
describes the process of pursuit of parenthood, whether or not
it is achieved.
226
Mazing : Infertile Couples and the Quest for a Child
There is an important qualification to the theory presented
here. The theory of mazing explicates the process of pursuit
of parenthood engaged in by both infertile and sterile couples
who want a child and who choose to do infertility and/or
adoption in the public domain. Information concerning this
public pursuit of parenthood or seeking solutions from the
medical or legal systems necessarily excludes many individu-
a l s and couples unable but wanting to become parents who
choose to do nothing but wait for God to grant them a child,
who cannot afford infertility and adoption services, who are
reluctant to suffer the scrutiny of medical personnel and case-
workers, who attempt folk or other extramedical remedies for
infertility or who arrange intrafamily or other kinds of private
adoptions without engaging the medical or legal systems. Sig-
nificantly, the best current estimates of the use of infertility
services suggest that at least half and perhaps two thirds of
couples who are unable but wanting to become parents act in
private domains not readily accessible to investigation
(Hirsch & Mosher, 1987). Whether these individuals and
couples undergo a similar process is still unknown and is a
question for future research.
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