CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
EFFECTS OF NOVEL REPRODUCTIVE TECHNIQUES
ON MARITAL SATISFACTION,
SEX ROLE, AND SELF-ESTEEM
A thesis submitted in partial satisfaction of
the requirements for the degree of Master of Arts in
Psychology, Community-Clinical
by
Bonina Rosa Cohen
January, 1982
The Thesis of Bonina Rosa Cohen is approved:
Li.nda 1''1.dell, .l:'h. JJ.
Michele A. Wittig, Ph.D
California State University, Northridge
ii
ACKNOWLEDGEMENTS
The completion of my Master's Degree reflects a
very important growth process which has been inspired
by many important
individuals
for
whom
I
have
the
deepest gratitude and respect.
My parents, Edith and Aron, encouraged me to think
in terms
of unlimited capabilities and supported me
with security, self-worth and courage.
My brothers and
sisters, Lilita and Geoff, Sam and Maria, and Tuky and
Jerry
have
been
models
of
perserverance
and
determination.
I am also grateful to my close friends, who have
supported me through my struggles, inspired me to find
strength, and demonstrated their faith in me.
To Dr.
Roger Moss, who through my own teaching
efforts, has taught me the value of simplicity,
beauty
of
natural
style,
and
the
charisma
the
of
risk-taking.
My sincerest gratitude to Dr. Morton Friedman, Dr.
Phil
Ender,
Escobosa,
George
Speckart,
Patti
Ritzo,
Yolanda
and Kristin Marr who have provided me with
extended assistance and advice so that my research
iii
could be executed while maintaining my position in the
Department of Psychology at UCLA.
To
Dr.
Jaroslav
resources of his
Marik
who
made
available
clinic thereby enabling me
the
to have
access to such a unique population.
A very warm, special thank you is extended to Dr.
Neal
S.
Dickler
criticism,
and
throughout
the
who
offered
provided
fine
project.
His
insightful,
medical
emotional
frank
consultation
support
has
inspired recognition of my potential both personally
and professionally.
And last, but certainly not least, I
~vould
like to
mention the members of my thesis committee.
Dr.
Dee
Shepherd-Look
availabilty
and
my
appreciation
flexibility
allowing
me
I offer
for
her
to
complete
Dr.
Michele
this project in San Francisco.
Secondly,
I
would
like
to
thank
Wittig, who sparked my initial interest and provided me
with a very important and concrete beginning.
Finally,
I
extend
my
deepest
gratitude
to
my
chairperson, Dr. Linda Fidell, whose dynamic interest,
sensitive encouragement,
and
profound
expertise were
genuinely influential in both my personal and career
pathways.
iv
TABLE OF CONTENTS
ACKNOWLEDGEMENTS.
iii
ABSTRACT . . .
viii
INTRODUCTION.
1
METHOD. . . .
19
Subjects . . . . . . . . .
Assessment Measures . . .
Experimental Conditions
Procedure . . . . . . .
19
19
22
23
RESULTS . . . . . . . . . .
26
Demographics. . . . . . . . . . . . . . . . . . .
Univariate and Multivariate Analyses of Variance.
Effects on Self-Esteem. . . . . . . . . . . . . .
Effects on Marital and Sexual Satisfaction. . . .
Effects on Masculinity and Femininity (Sex-Role).
Other Analyses.
. . .
DISCUSSION . . . . . . .
26
27
32
32
40
51
53
Main Effects . . . . .
Interaction Effects . . .
AID-PREG vs. AID-NO PREG.
AIH-PREG vs. AIR-NO PREG.
PREG vs. NO PREG . . . . .
Further Analyses . . . . .
Open-Ended Responses . .
Summary and Conclusions
53
55
56
57
58
59
61
65
REFERENCES .
68
APPENDICES
A.
Letter of Introduction and Open-Ended
Questions . . . . . . . . . . . . .
v
73
LIST OF TABLES
Table
1
Anova Summary Table for Self-Esteem. . . . . .
33
2
Anova Summary Table for Self-Esteem (CYCLES
Variable Included)
. . . . . . . . . . .
34
3
Manova Summary Table for Marital Satisfaction
36
4
Tests of OUTCOM, WH, and AI by OUTCOM Interaction for the Consensus Subscale. . . . .
37
5
Comparison of Mean Responses from Normative
Samples and 74 Respondents on Marital
Satisfaction, Sexual Dissatisfaction
and Personal Attributes Questionnaire. .
41
6
Manova Summary Table for PAQ (WIVES only).
42
7
Anova Summary Table for MASC and FEM Subscales
of the PAQ (WIVES only) . . . . . . . . . . .
44
8
Manova Summary Table for PAQ (HUSBANDS only) .
45
9
Tests of Communal Subscale (HUSBANDS only) . .
47
10
Means for the Communal Subscale (HUSBANDS only) 48
11
Summary Table for the Communal Subscale Items
49
12
Anova Summary Table for ANXIETY. . . . . . . .
52
vi
LIST OF FIGURES
Figure
1
2
Combined effects of AID versus AIR
and OUTCOM on Cohesion. . . . . . .
39
Masculinity as an interaction effect
between AI and number of CYCLES . . .
50
vii
ABSTRACT
EFFECTS OF NOVEL REPRODUCTIVE TECHNIQUES
ON MARITAL SATISFACTION, SEX ROLE
AND SELF-ESTEEM
by
Bonina Rosa Cohen
Master of Arts in Psychology
The
purpose
what happens
of
this
thesis
is
to
investigate
to marital satisfaction in husband and
wife when a child is produced who is not genetically
linked to the father; to determine the effects, if any,
of the use of artificial insemination with donor sperm
(AID) versus husband sperm (AIR) on self-esteem of both
husbands
and
wives
and
on
masculinity and femininity;
their
self
reports
of
and to assess the outcome
of insemination (pregnancy or no pregnancy)
and its
interaction with the use of AID versus AIR on some of
these dependent measures.
Seventy-four couples from the Tyler Medical Clinic
in Los Angeles who had used either AID or AIR,
and
either had or had not achieved pregnancy responded to a
viii
questionnaire
which
assessed
sexual dissatisfaction,
marital
self-esteem,
masculinity and femininity.
satisfaction,
and
feelings
of
Analyses of variance and
multivariate analyses of variance
identified
several
effects, most of them weak.
The effects that were found suggest that infertile
couples
have
lower
overall
marital
consensus
(particularly among those who achieve pregnancy through
artificial
than
a
insemination)
normative
and higher marital cohesion
sample.
Cohesion was
particularly
high for those who had used AID and failed to achieve
pregnancy;
pregnancy
it was
lowest for
through AID.
those who had achieved
There was
also
a
small but
reliable difference in self-esteem and anxiety about
use of method among those who had used AID; they were
lower in self-esteem and higher in anxiety than users
of
AIH.
Men
who
agreed
to
use
AID
had
more
communion-like characteristics (as measured by the PAQ)
than
those
who
reported more
used AIH,
numerous
while
masculine
both men
and women
characteristics
if
they used AIR for 11 or more cycles of insemination.
Among women, lower femininity among housewives who
did not become pregnant, compared to employed women who
ix
did
become
sensitivity
pregnant,
may
point
to
of
group
to
the
this
the
special
outcome
of
insemination.
Higher self-esteem and masculinity among those who
tried
insemination
selection factors
artificial
verified
for
in
11
those who
insemination,
in
cycles
the
open-ended
or
more
suggest
persist with use
strain
responses
of
to
which
was
questions
concerning their experiences with the techniques.
X
of
EFFECTS OF NOVEL REPRODUCTIVE TECHNIQUES
ON MARITAL SATISFACTION, SEX-ROLE,
AND SELF-ESTEEM
Bonina Rosa Cohen
California State University, Northridge
INTRODUCTION
"Infertility is generally defined as the failure
to achieve a successful pregnancy (i.e., leading to a
live
birth)
following
a
year
relations without contraception.
means
that
a
pregnancy
has
secondary infertility refers
of
regular
sexual
Primary infertility
never
to
been
achieved;
situations
in which
there have previously been one or more living children.
Sterility
example,
is
defined
as
absolute
after a hysterectomy,
infertility--for
or for a male,
total
inability to produce sperm" (p. 138), as explained by
Mazor (1978).
Without contraception,
about 25% of all couples
who are sexually active will conceive in one month, 63%
in six months, and about 80% in one year.
1
An
2
additional five to ten percent will become pregnant in
the
second
percent
year.
of
conception
the
Finally,
couples
unless
they
the
have
a
remaining
low
to
10
probability
of
seek treatment.
It
5
is
this
particular group that is considered infertile (Behrman
1975).
Mazor
(1978)
further
distinguishes
between
definitive infertility, where a conclusive diagnosis is
reached about the reason for failure of conception and
indefinite fertility, where lingering doubts about "who
is responsible" for the couple's infertility may put
greater strains on the marriage.
The estimated percentage of infertility is about
10-15 percent of couples at childbearing age (Menning,
1977;
Moghissi,
1979).
The
Alabama-based
American
Fertility Society estimates that 3. 5 million American
couples have some fertility problem.
It is estimated
that 30%-50% of the time the difficulty involves the
male (Moghissi, 1979).
sperm count,
The problems are usually a low
sperm that exhibit
decreased motility,
sperm that are misshapen, or impotence.
Occasionally,
a previously vasectomized man reevaluates his decision.
Less common reasons include Rh or ABO incompatibility
with the mate,
or
severe hereditary defects
in the
male, such as Huntington's Chorea (Gilbert, 1976).
3
Other
widely
infertility
accepted
are
contributory
emotional
disturbed ovulation,
factors.
decreased
causes
Tubal
coital
of
spasm,
frequency,
and
impaired spermatogenesis have been linked to emotional
tension
impact
& Taymor,
(Bresnick
of
involuntary
acknowledged
Taymor,
(Berger,
1979;
and
1979).
infertility,
1977;
The
emotional
itself,
Bonnar,
1979;
has
been
Bresnick &
Rosenfeld & Mitchell,
1979).
In
turn, emotional tensions impede the normal functioning
of the reproductive system, producing a vicious cycle
of
infertility
(Bresnick
emotional
tension
infertility
& Taymor, 1979).
Several studies, primarily descriptive in nature,
have examined the psychological impact of involuntary
infertility.
large
portion
reproduction,
There
are
that
unobtainable,
presence
of
of
our
lives
parenthood,
many
determinants.
aware
Bresnick and Taymor (1979) connnent, " ... a
and
biological,
is
centered
raising
cultural,
of
a
and
around
family.
religious
When men and women become increasingly
reproduction
is
an
crisis
emotional
these
adverse
delayed
may
emotions
in
or
perhaps
develop.
one
or
The
both
partners may interfere negatively with areas of their
marriage and the quality of life of that individual"
(p. 154).
4
Both sexual and psychological problems are thought
to
be
associated
Rosenfeld
and
with
infertility
Mitchell
(1979)
(Walker,
recognized
1976).
probable
injury to the self-esteem, self image, and sexuality of
the infertile couple.
Williams and Power (1977)
cite
feelings of worthlessness, body defectiveness, and loss
of
sexual
possible
secondary
complications of diagnosis of infertility.
The study
conducted
attractiveness
by
Pohlman
in
as
Williams
and
Power,
1977,
concluded that children may represent the achievement
of
adult
status
so
that
for
some
itself may not be considered a
independence.
It
has
also
people,
marriage
sufficient symbol of
been
noted
that
many
individuals experience unfulfilled gender roles due to
their inadequacy in conception (Berger, 1979; Rosenfeld
& Mitchell, 1979).
When role conflict was investigated
in infertile couples as compared to a
the
infertile
groups'
role
significantly more traditional.
control group,
conceptions
were
Furthermore, infertile
couples reported less role conflict and showed greater
occupational commitment
(Allison 1979) .
Platt et al.
(1972, 1973) report lowered self-esteem and depression
among their infertile couples.
Many
couples
who
have
earlier
developed
a
satisfactory sexual relationship may have difficulty in
5
their
sexual
combined
pleasure
stresses
and
of
performance
attempting
due
to
the
conception
and
fertility evaluation (Bresnick & Taymor, 1979; Bullock,
1974; Wiehe, 1976).
Similarly, Berger (1977) suggests
that marital problems may become more apparent during
the
infertility work-up.
Finally,
David
and
Price
(1980) sunnnarize a study done by d 'Elicio et al. who
assessed
couples
requesting
artificial
insemination
donor (AID) and found that learning of sterility per se
was
not
the
influential
factor
for
the
drop
in
sexuality but rather, it was the disappointment arising
out of the frustration of the desire to have children.
Most couples who were adversely affected re-established
successful erotic relations once they turned from the
problem of sterility to the problem of having children.
The recent
and rapid decline
in the number of
adoptable infants in the United States has accelerated
due to the legality of abortion.
Couples having chosen
adoption may experience a lengthy delay in obtaining a
child and they are not restored to fertility by this
method.
few
The infertile couple, therefore, is left with
alternatives
childlessness.
in
As
dealing
a
with
result,
their
there
involuntary
has
been
an
increasing trend toward the use of novel reproductive
techniques.
6
One of these techniques, artificial insemination,
is
an
answer
to
the
problem
of
male
Artificial insemination can be homologous
the
husband's
semen
is used,
infertility.
(AIR), when
or heterologous
(AID) ,
when donor semen is used.
AID pregnancy rates have ranged between 37%-84%
due
to
varied methods
(Broekhuizen,
et
of
al.,
recording
1980).
A
the
information
national
response
survey using 379 physicians who performed AID indicated
a mean pregnancy success rate of 57%; of these 61% of
the cases conceived within 6 months, while 80% achieved
pregnancy
Behrman
in
(1979)
one
year
reports
10%-13% for AIR couples.
David & Price,
using AID,
1980)
(Curie-Cohen,
an
overall
et
al.,
success
1979).
rate
of
Schoysman-Deboeck (cited in
reports
that
among 865
couples
at least one pregnancy was achieved in 80%
of them.
Despite widespread use of AID and AIR, very little
literature
(in both
the medical
and
social
science
fields) has been devoted to the psychological impact of
the use of novel reproductive techniques.
The research
that does exist has been limited to small samples and
descriptive statistics.
Goldenberg
and White
(1977)
observed that couples using AID had far lower divorce
rates than the general population.
Similarly, Leward,
7
Crawford,
and Symonds
(1978)
noted
marriages of couples seeking AID.
study on over 200
majority
unchanged;
In a questionnaire
of
(1979)
marital
concluded that 1) a
relationships
2) those who were successful
were
unsuccessful
with pregnancy
seemed
in pregnancy
reported improvements in their relationship;
who
the
Irish couples who had attended an
infertility clinic, Bonnar
great
stability of
3) those
commented
that
they felt happier since they directly confronted the
problem of infertility.
But cause and effect are difficult to determine.
It is unclear whether couples become more stable as a
result of using artificial
stable
couples
conception.
from
their
choose
Finally,
survey
insemination or
this
alternative
Ledward et al.
that
many
couples
(1979)
that only
mode
of
conclude
prefer AID
to
adoption since it satisfied the wife's biological need
for pregnancy.
On the other hand, Peyser (1979) hypothesized that
the AID
issu~
conception
infertility
for
causes
alone.
couples experiencing this mode of
them
more
Walker
emotional
(1978)
stress
observed
than
guilt
feelings and distress in both the husband and the wife
if they choose to use AID.
husband's sense of failure.
The wife seems to share her
This situation has been
8
reported to
bizzare
lead men to exhibit novel and sometimes
sexual
behavior.
research is more
techniques
of
directly
artificial
psychological
Although
related
the
insemination,
literature
incorporated to
to
past
review
further elaborate
medical
usage
and
the following
is
offered
and
the exploration of
both social and personal consequences of these couples.
Measures
of
the
outcome
of marriage
have
been
described by such words as "happiness", "satisfaction",
and
"adjustment",
all
of
which
have
been
used
interchangably and have contributed to the complexity
and
confusion
study,
of much of
marital
adjustment
this
is
literature.
used
variable and is measured with four
as
a
In this
dependent
subscales of the
Dyadic Adjustment Scale (Spanier 1976), plus a subscale
measuring
sexual
adjustment
Marital Satisfaction Scale.
from
Snyder's
(1979)
Spanier (1976) asserted that
scales developed prior to his own did not assess the
changing process; instead, they measured a position on
a
continuum
from
adjusted
to
maladjusted.
The
"process" as he defined it, consisted of those events,
circumstances,
back
and
and interactions which move the couple
forth
along
the
adjustment
continuum.
A
sexual dissatisfaction subscale was also administered
since
the
Dyadic
Adjustment
Scale
did
not
have
a
9
comprehensive subscale on sexual relations and because
the special problems of infertility and use of novel
reproductive techniques may have special importance in
this area.
The study of marital relationships has generated
huge
literature
in
the
social
sciences.
Synder's
(1979) review of the literature on marital assessment
demonstrated
that
sociodemographic
prior
and
to
1960,
a
broad
psychological
correlates
marital satisfaction had been examined.
research
effort
measures
of
involved
marital
the
of
of
Part of the
development
satisfaction
range
and
of
global
attempts
to
construct predictive measures of marital success.
Since
the
concentrated
effective
1960's,
on
characteristics
communication
resolution.
research
and
and
efforts
processes
successful
have
of
conflict
Another body of research since 1960 has
investigated personality and attitudinal predisposition
as determinants of interpersonal attraction and marital
compatibility.
Other research has focused extensively
on the adoption of traditional versus non-traditional
sex-role
orientations
definitions of sex-role.
and
the
effects
of
partner's
Only a few studies have been
conducted on the history of marital disruption and the
effects
on
the
marital
stability
of
succeeding
10
generations.
Finally,
research
since
1960 has
also
investigated the life cycle of the family as well as
specific areas of marital controversy such as finances,
sexual relationships,
and
childrearing.
numbering
and
and concerns regarding children
In
addition,
spacing
of
the
effects
children
on
of
marital
satisfaction has been given special attention.
The literature that has been created by all this
research
activity
is
frequently
conflicting
generalizations are difficult to assess.
and
Because this
specific study used as the independent variable whether
or
not
the
childbearing
couple
and
produced
rearing
a
child,
on marital
effects
of
adjustment were
thoroughly covered.
Previous research has, however, only investigated
situations where it was a voluntary decision to remain
childless.
That literature may be summarized as follows.
Earlier studies
different
(1953)
social
have
parenthood.
(1950-1970) on childbearing have very
implications.
discussed
Children,
the
Burgess
societal
especially
and
Wallin
glorification
in
the
early childhood, are culturally idealized.
period
of
of
"Husband or
wife can be made individually happier because of the
pleasure derived from a child, and yet may not be more
satisfied with the marriage, except that it has given
11
them a child"
(1957)
(p. 62 in Bernard,
interpretation
of
a
1972).
LesMasters'
retrospective
concluded that parenthood, not marriage,
romantic
complex
parenthood
and
discontinuities
in
our
not
culture;
the real
moreover,
marriage
and
is
study
that
conflicts
in
it
is
occasions
the
marital
relationship.
The 1970's marks
attitudes.
One
a
time of change in parenting
investigation
childless marriages were happier
children.
demonstrated
that
than marriages with
Similarly, Renne (1970) found that childless
couples reported higher marital satisfaction than those
with children, especially when the latter were actively
engaged in childbearing.
However,
Hoffman and Manis
(1978) looked at the transition to parenthood as a set
of apparent contradictions.
The first child seemed to
exaggerate the sex stereotypic role differences between
husband
and wife.
Yet
they
found
most couples
children as bringing them closer together,
saw
primarily
because of the resulting interdependence of functions
and sharing of common goals.
Despite
the
fact
that
having
the
limit of two
children is still the perceived norm by both parents
and non-parents for most American families (Housenecht
1977),
voluntary
childlessness
has
become
a
growing
12
option (Kearney 1979).
Kearney's (1979) review of the
literature
that
indicates
the
choice
to
remain
childless is affected by such variables as the degree
of success the couple is experiencing in employment or
career development,
in the marriage.
peer group support,
and stability
In a study between two similar groups
of couples differing on the decision of whether or not
to have children,
differences
Hoffman
existed
identification,
in
(1978)
marital
found
that no
adjustment,
and marital orientation.
real
sex-role
It has been
suggested in the literature that the childless couples,
although
they
do
not have generative concerns, were
nonetheless similar to couples who anticipate having a
family.
The positive drive for marriages to exist without
children
or
significant
with
only
change
in
two
the
or
three
societal
has
trend
marked
a
(Bernard
1972).
The differences between voluntary childlessness
versus
parenthood
however,
childless.
path,
the
this
seem
is
not
clearcut
true
for
and
the
unequivocal;
involuntary
These couples have agreed upon a parental
but have been discouraged or slowed down due to
discovery
of
a
medical
obstacle--infertility.
Moreover, these couples have proceeded to the next step
13
in order to become parents by using novel reproductive
techniques.
Thus,
one
insemination
there
would
adjustment.
is
would
predict
successful
be
no
that
and a
negative
if
artificial
child is produced,
effects
on
marital
This conclusion is based on research with
people who are voluntarily childless, but may not hold
for the involuntary childless (infertile) couples.
Throughout
relationships
much
have
of
been
the
literature,
virtually
sexual
ignored.
It
was
previously mentioned that infertility may also impact
sexual relationships,
however;
it is
unknown whether
the use of AID and AIH affects sexual relations.
Orden
and Bradburn (1968) noted that the absence of sex is a
powerful
dissatisfier,
while
the
presence
represents a less strong satisfier.
agreement concerning
sexual
of
sex
The phenomenon of
intimacy was
reported by
Levinger (1966) as a predictor in marital satisfaction.
In a more
recent
study,
Burgess,
Locke,
and
Thomas
(1971) indicated that discrepancies between actual and
desired frequency, as well as interspousal agreement on
desired
frequency
have
been
found
to
be
powerful
predictors of marital satisfaction in both longitudinal
and cross-sectional studies.
14
The relationship between personality variables and
the choice to use AID vs AIH may have some correlation.
Moreover, what happens in a crisis situation when the
life cycle is interrupted by the inability to progress
in the marriage to a parental role is significant.
The
areas of sex-role and self-esteem have been extensively
investigated separately as well as in conjunction with
one
another.
It
is
pertinent
discuss
to
their
relationship to one another as appropriate to a study
of the impact of using novel reproductive techniques to
overcome infertility.
Wylie's
(1979)
comment
from
a
very
thorough
literature review on self=concept points out the sex
and
self-concept
relationship
that
has
repeatedly
appeared in psychoanalytic and personality theories, in
sociological and anthropological writings, and in the
recent research of women's
.summarizes
the
psychology.
emphasis
theorists
She further
have
put
on
biological factors as sources of self-regard in males
and
females--the
capacity
or
possession
incapacity
to
or
lack
bear
of
penis,
children,
the
the
bisexuality of each sex, and the respective roles of
men and women in sexual intercourse.
The assumption
that it is not merely a body, but rather a body subject
to taboos, to laws and to certain values imposed by the
15
individual elucidates the relationship between gender
role
and
self-esteem.
most
theorists
unfavorably
have
with
Wylie
(1979)
suggested
males
on
also noted that
that
females
compare
self
regard.
over-all
Generally, reasons for this relationship were explained
by women's substandard place in social order.
Although it is evident that couples may experience
loss
of self-esteem due
to
infertility,
it
is
still
uncertain whether this applies to the use of AID vs.
AIR.
On the other hand, couples may view infertility
as an accident by nature,
may
not
be
affected
such that their self-esteem
since
they
had
no
choice.
Furthermore, AID or AIR may have been their only choice
in pursuing their parental path.
The use of novel reproductive techniques may have
an
impact
on
masculinity
in men
and
femininity
females because of the discovery of infertility.
medical
literature
has
shown problems
in
this
in
Past
area.
Psychological research in this area has been vast and
conflicting.
It was
frequently
wish to have children enhances
speculated
that
the
"femininity" in women
(Fortney, 1971; Hoffman, 1974; Pohlman, 1969 in Gerson,
1980).
However, Gerson (1980) argues that this finding
was not significant in her study.
16
Helmreich et al.
1978)
offered
(1974 in
evidence
with
relationships and self-esteem.
used
to
Spence
and Helmreich
regard
to
sex
role
A criterion measure was
measure
masculinity-femininity.
The
between
the
and
correlation
masculinity
scale
self-esteem was higher than the correlation between the
femininity scale and self-esteem.
Their finding also
indicated that masculinity in males and femininity in
females
social
was
related
competence.
to
The
feelings
of
self-esteem
and
study classified individuals
into four groups (labeled: 1) Androgynous; high on both
masculinity (M)
and femininity (F);
2) Masculine;
the
"conventional male", high on M, low on F; 3) Feminine;
the
"conventional
female",
high on F,
Undifferentiated; low on both M and F.
low on M;
4)
When .compared
on self-esteem scores for both sexes, each of the four
groups had categorical differences.
individuals
"feminine",
had
the
were
in
self-esteem,
"masculine" was next,
correlation.
highest
characteristics,
classification
"feminine" women.
and
lowest
"feminine"
"Undifferentiated"
while
second
"androgynous"
In terms of cross-sex
women
with
reported
higher
a
"masculine"
self-esteem
than
The comparison of "feminine" males
females
on
self-esteem
(cross-sexed)
males versus "traditional" females was such that they
p '
17
were similar in self-esteem.
also
partially
replicated
These relationships were
by
Bem
(1977)
(1975 in Spence and Helmreich, 1978).
(in press)
syndrome
and Wetter
Moreover, Fidell
reported from her study on the housewife
that
dissatisfied
housewives
differed
from
employed women mainly in self-esteem, whereas satisfied
housewives differed from the other two groups in their
self attribution of lower masculinity.
Further
research
explored
the
life-span
perspective in the study of sex role self-concept and
sex
role
attitudes.
Abrahams,
evidence
for
sex
role
attitude
reflecting
et
al.
self-concept
fluctuating
specific life situations.
(1978)
and
found
sex
role
attributions
from
It was possible for them to
identify life stages (i.e., cohabitation, marriage, the
anticipation
of
a
first
called for more or less
feminine
behaviors.
required by
child,
and parenthood)
stereotypically masculine or
Moreover,
behavior
these situations were
than for men.
that
greater
changes
for
women
Specifically, their results showed that
marriage brought about a salience of feminine traits in
both sexes, such that males became more androgynous and
females
the
became less
parent
androgynous
situation,
both
(more feminine) .
males
and
females
In
were
18
furthest
from
the
androgynous
range;
each
had
more
stereotypic attributes for their own sex.
In
(1965)
summary,
and
the
(Spence, et al.,
the
Self-Esteem
Personal
Scale
Attributes
by Rosenberg
Questionnaire
1975) were administered to explicate
the process by which a life event such as using AID or
AIH would influence or modify self-esteem and sex role
attitudes.
The current study continues the investigation of
the
social
and
personal
consequences
of
the use of
artificial insemination (both AID and AIH) by infertile
couples.
We
propose
to
examine
the
effects
artificial insemination on marital adjustment,
relationship,
personal
self-esteem,
and
(feelings of masculinity and femininity).
the data base that was available,
sex
of
sexual
role
Because of
it was possible to
compare the effects of AIH versus AID,
the effects of
outcome of the insemination (whether or not a child was
produced),
and lastly, potential differential effects
on husbands and wives.
METHOD
Subjects
The sample was drawn from the patient lists at the
Tyler Medical Clinic in Westwood, California.
A total
of 180 couples were contacted by telephone and sent a
questionnaire packet explaining
research
study
evaluating
was
their
being
done
experience
reproductive technique.
that
for
in
a
socio-medical
the
purpose
using
a
of
novel
Seventy-four couples responded
to the questionnaire for a completion rate of 41%.
No
attempt was made to match couples or to control for
sociodemographic variables.
Assessment Measures
The
questionnaire
packet;
a
letter,
a
set
of
questions assessing demographic characteristics, a set
of open-ended
questions
regarding
their
experiences
with infertility and artificial insemination (refer to
Appendix
A),
and
the
following
four
standardized
scales.
1) Self-Esteem Scale (Rosenberg, 1965).
The scale
was designed to measure attitudes toward self along a
favorable-to-unfavorable dimension.
This version used
in the thesis is composed of 10 items, each measured on
19
20
four
points
ranging
"strongly disagree".
in
measuring
between
"strongly
agree"
and
The scale is brief and thorough
the
self-acceptance
factor
of self-esteem and has high reliability (r=.85), for a
short scale.
The validity has ranged between .56 and
.83 for similar measures and clinical assessment.
2)
Personal
Attributes
Questionnaire
(Spence,
Helmreich, and Stapp, 1975) measures self attributions
of items reflecting masculinity and femininity.
version
is
composed
of
41
bipolar
items
This
describing
personal characteristics, on each of which respondents
rate
themselves
on
a
five-point
scale.
Question 41
(masculinity versus femininity) was added for a direct
self-evaluation of these characteristics.
have
been
factor
Masculinity
(M)
analyzed
into
six
The 40 items
subscales.
The
scale consists of items that specify
traits judged to be more characteristic of males than
females, and socially desirable to some degree in both
sexes
(e.g.,
Femininity
"very passive"
(F)
to
scale consists
"very
active").
The
of items judged to be
both more characteristic of females
than males,
and
socially desirable to some degree in both sexes (e.g.,
"not
at
all
kind"
Masculinity-Femininity
to
(M-F)
"very
kind").
subscale
contains
The
items
21
stereotypically differentiating the
different
sexes
social desirability ratings
for
(e.g., "very home oriented" to "worldly").
to
the
above-mentioned
desirable
and having
the
sexes
In addition
subscales,
three
socially undesirable ("negative") subscales were also
included.
The M- scale assesses self attribution on
traits which are generally considered masculine,
socially
undesirable
(e.g.,
scale,
communion-like
but
aggressive).
characteristics
"subordinates oneself" to "never subordinates oneself")
and FVA- verbal
passive aggressive qualities
(e.g.,
"doesn't nag" to "nags a lot"), are composed of traits
considered to be socially undesirable.
3) Dyadic Adjustment Scale (Spanier,
32
i tern
scale
is
Four
satisfaction.
designed
to
empirically
analytically derived components
were used as subscales:
(COH),
consensus
The
(EXPRESS).
(CON),
1976);
examine
verified
marital
and factor
of dyadic adjustment
satisfaction (SAT),
and
this
affectional
"satisfaction"
subscale
cohesion
expression
consists
of
items such as: a) "how often do you or your mate leave
the house after a fight?"; b) "do you confide in your
mate?".
regarding
The
"cohesion"
the
subscale
occurrence
of
consists
of
events
such
items
as
22
a) "exchanging
together".
stimulating
be
and
b) "laughing
The "consensus" subscale refers to extent
of agreement on:
to
ideas"
a) "aims, goals,
important",
together".
and
and things believed
b) "amount
of
time
spent
Finally, "affectional expression" subscale
contains items concerning agreement about a) "being too
tired
for
sex",
and
b) "not
reliabilities
were
entire scale,
. 94 for satisfaction,
. 90 for consensus,
stated
as
showing
follows:
love".
The
.96
the
for
. 86 for cohesion,
. 73 for affectional expression
and
(components of the scale).
The validity was stated at
.86.
4)
Marital
Dissatisfaction
Satisfaction
Subscale
(Sex;
Inventory--Sexual
Snyder,
1979).
Items
assess dissatisfaction with the frequency and quality
of
intercourse
and
other
sexual
activity.
The
reliability was reported at .89.
Experimental Conditions
"Artificial insemination,
insemination
with
involves mechanical
(female.
sperm
than
(AID)
insemination,
indicates
husband's,
introduction of donor's
"Artificial
involves mechanical
other
donor"
sperm to
husband"
introduction of mate's
and
(AIR)
sperm
to
23
female.
Equal numbers
sampled.
We
of AID
selected
90
and AIR
couples
couples
who
had
were
achieved
pregnancy (45 AID and 45 AIR) and 90 couples who, after
another
6
fertility
cycles of insemination,
had not
achieved pregnancy (45 AID and 45 AIR).
Thus,
three independent variables were available
for analysis: AID versus AIR, the results of artificial
insemination
OUTCOM,
(whether
and
wives
or
not
a
versus
child was
husbands
produced)
WH.
Only
questionnaires filled out and returned by both husband
and wife from the same marriage were analyzed.
respondents
fall
into
four
AID-unsuccessful,
AIR-unsuccessful) .
questionnaires
number
responded.
couples
group,
was
responded
groups
Thus,
(AID-successful,
AIR-successful,
Although
sent
In
to
the
(53%).
an
equal
each
group,
AID-successful
In
the
and
number
an
of
unequal
group,
24
AID-unsuccessful
15 couples participated (33%).
AIR-successful
consisted of 21 couples (47%), and AIR-unsuccessful had
the least respondents, 14 couples (31%).
Procedure
A birth list, obtained from the clinic, was used
to identify both successful AIR and AID couples.
The
list was not comprehensive since many couples did not
24
leave forwarding addresses, but the biasing factor this
may have introduced is unknown.
composed
of
AIR
conceived after
and
AID
The unsuccessful list,
couples
who
had
not
yet
six cycles of insemination, was also
derived from medical records.
Both lists were used as
the
a
populations
from
which
random
selection
of
couples were chosen with additional constraint that no
couple in the successful groups had more than one child
aged 3 or
under,
Forty-five
couples
or had
were
experienced
a
miscarriage.
chosen per group hence,
the
initial sample totaled 180 couples.
Couples were asked to respond only if they were
still married to the original mate with whom they had
sought
fact
insemination.
that
pregnancy
study,
Furthermore,
"unsuccessful"
during
the
couples
time
to
establish
had
not
immediately prior
the question--"did you have a
the
achieved
to
the
child with the
assistance of the clinic?"--was asked.
Approximately
six "unsuccessful" couples answered in the affirmative;
as
a
result,
they
were
changed
to
the
appropriate
classification (successful).
After the 180 couples were selected, each couple
was called to confirm their address and obtain consent
for participation in the study.
containing
two
sets
of
They received a packet
questionnaires,
one
for
the
25
husband and one for the wife.
with
the
assessment
nature of the
A letter was included
materials,
study,
its value
which
discussed
the
to both social and
medical research, a reminder that respondents' answers
were not to be discussed until their packets were sent
back,
and
confidentiality.
a
statement
regarding
ultimate
The questionnaires were coded by the
ordering of the first four questions of the first scale
in the packet
(PAQ),
such
that
each packet
had
a
different combination identifying the particular group.
Approximately two weeks later the initial contact was
followed by a phone call to confirm receipt of the
packet and to encourage the participants to return it.
Within two months, 74 couples returned their packets.
RESULTS
Demographics
Completed
responses
were
couples and 35 AIR couples.
obtained
from
39
AID
Among the 39 couples who
used AID, 9 of the husbands had a previous vasectomy, 6
had previous health-related infertility problems
that
were known at the time of marriage and the remaining 24
had
sterility
marriage.
problems
that
were
discovered
after
Forty-five of the couples who responded had
become pregnant (about 60%) and 29 had not (about 40%).
Over
75%
of
the
couples
using
artificial
insemination had annual incomes in excess of $20,000.
The
couples
were
backgrounds,
Je\'lish,
from
a
wide
predominantly
Protestant,
but including Mormons,
professed
no
religious
variety
Moslems,
affiliation.
of
religious
Catholic,
or
and many who
The
husbands
averaged 35 years of age and 16 years of education.
Twenty-four percent had blue collar jobs, 44% had white
collar jobs, and 32% were professional.
Wives averaged
32 years of age and 15 years of education.
percent
of
the wives
were
homemakers,
Forty-four
34% had what
might best be described as jobs, while the remaining
22% had careers.
Husbands and wives using AID were
26
27
neither older nor younger, on the average,
than those
using AID.
Among the 68 couples who responded to the question
asking
how
many
insemination
(cycles)
they
had
experienced, 38% had had them for 5 cycles or fewer,
29% had had between 5 and 10 cycles inseminated, and
32% had experienced 11 cycles or more of insemination.
Among those who eventually conceived, 83% did so within
the first 10 cycles of insemination,
after 11 or more cycles.
and 17% did so
Among those who experienced
11 or more cycles of insemination, however,
became pregnant.
only 32%
Both AID and AIR couples were equally
likely to continue with inseminations if pregnancy was
not achieved within the first 5 cycles.
Univariate and Multivariate Analyses of Variance
It
seems
likely
selection would
differences.
be
Only
in
that
the
couples
any
biasing
direction
of
who
still
were
to the same spouse responded and,
likely that
couples
in
sample
minimizing
further,
married
it seems
(or individuals) who were still
troubled by use of artificial insemination were less
likely to respond. *
Therefore, we report some
We also suspect, but do not know for sure, that there
were selective losses in respondents among those with
Asian American surnames.
28
marginally significant differences (p
more reliable ones (p
~.
~.08)
as well as
05 or less) in the hope that
the trends they show will generate future research.
Both
analyses
of
variance
and
analyses of variance were performed.
multi variate
Several 2 x 2 x 2
between subjects multivariate analyses of variance and
univariate analyses of variance were performed.
as
independent
variables
AID
versus
AIR
Using
(these
variables are referred to as AI), pregnancy versus no
pregnancy (OUTCOM), and wives versus husbands (WH), an
analyses of variance was performed on the self-esteem
measure and multivariate analysis of variance on the
five subscales of the marital adjustment inventory (the
four
subscales
sexual
of the Dyadic Adjustment Scale plus
adjustment);
and
multivariate
analyses
of
variance separately for husbands and wives on the seven
subscales of the sex role measure (Personal Attributes
Questionnaire).
Additional analyses were conducted, as
needed, to illuminate the findings.
The omnibus SPSS MANOVA program was used for the
analyses with the hierarchical (default) adjustment for
non-orthogonality.
Order of effects were: AI (AID and
AIR gets unique and shared variance), OUTCOM (PREG and
NO
PREG),
WH
(WIFE
and HUSBAND).
Total N=74,
was
29
reduced to 68 for the additional analyses
involving
number of inseminations since 6 couples did not respond
to this question.
Data
found
were
missing
on
the
dissatisfaction scale for 3 respondents.
from
the husbands 1
responses.
sexual
Two occurred
and one from the wives 1 pool of
Since the mean difference between the sexes
was not significantly different, the overall mean value
for both sexes (21.0) replaced the missing scores.
SPSS CONDESCRIPTIVE was run to check for skewness.
Several of the variables were significantly negatively
skewed:
CON
(consensus),
(expression),
(sexual
and SELEST
dissatisfaction)
SAT
(satisfaction),
(self-esteem) ; however,
was
positively
EXP
SEX
skewed.
Because the metric they were measured on was arbitrary,
it was decided to transform the variables so they were
no
longer
conformed
skewed.
to
The
positive
distributions
skewness
were
first
.
*
reflect1.on.
by
Skewness was eliminated by square root transformations.
Once
assumptions
skewness
were
was
corrected,
evaluated.
the
Although
following
there
were
unequal sample sizes in the eight cells ** , at least 15
Each score was subtracted from a number that was the
largest score +1.
**Couples not succeeding in pregnancy responded less than
couples achieving pregnancy.
30
cases per cell and 14 degrees of freedom were available
for each analysis, thus the test was considered robust
to
cover
violations
of multivariate normality which
might have occurred.
Next, a preliminary check for robustness was done
for each MANOVA analysis to assess the homogeneity of
the
variance-covariance
matrices.
5 DVs
composing
marital satisfaction subscales in each of the 8 cells
revealed the largest to smallest variance was in ratio
6.08:1.
Boxes
matrices
M
test
produced
for
F
homogeneity
(105,
18240)
=
of
dispersion
1.28,
p=0.038.
Although this value is significant due to large degrees
of freedom, the size of F itself is not large enough to
warrant concern.
Next
for husbands,
the
7 DVs
composing
the
sex
role inventory were checked on each of the 4 IV cells.
The
largest
AID-PREG
subscale.
to
and
The
smallest
AID-NO
PREG
test
matrices produced F
variance
for
(84,
groups
was
on
homogeneity
7926)
=
. 797,
1.63:1,
the
for
"gender"
of
covariance
p
1.. . 05 for
Boxes M, showing no statistically significant deviation
from
homogeneity
of
variance-covariance
matrices.
Finally, the same analysis was done on the former, only
31
this time husbands were excluded from the analysis.
The largest to smallest variance ratio was 2.08:1, for
AID-NO
PREG
and
subscale.
AIR
The
PREG
test
groups
on
the
"gender"
for
homogeneity
of
variance-covariance matrices indicated F (84, 7926) =
p L . 05
1. 36;
deviation.
extremely
for
Boxes
Again,
large
the
and
M,
showing
degrees
F
of
sufficiently
a
significant
freedom
were
small
that
robustness seemed assured.
Finally,
examined.
multicollinearity
and
singularity were
The determinants of the pooled within-cells
correlation matrix were . 30,
. 53, and . 31 for marital
satisfaction, sex-role (men only), and sex-role (women
only).
neither
They were sufficiently different from zero that
multicollinearity
nor
singularity
was
considered a problem.
Using Wilks' multivariate test of significance the
combined DVs had several identified effects, however,
most of them weak.
To assess the importance of the
DVs, univariate F values were inspected.
In addition,
the Roy-Bargman stepdown Fs were examined (see Tables 4
and 8) to further elucidate multivariate effects.
32
Effects on Self-Esteem
Analysis of variance on the self-esteem variable
revealed
no
significant
differences.
That
is,
self-esteem did not differ for husbands or wives, for
those using AID or AIR, for those who had or had not
achieved pregnancy, nor for any of the three two-way
interactions (AI by PREG, AI by WH, and PREG by WH) or
the one three-way interaction (AI by OUTCOM by HW) of
the analysis.
When
a
inseminations
added
to
This is demonstrated in Table 1.
variable
representing
(CYCLES)
the
a
analysis
the
number
couple had experienced was
of
variance
on
self-esteem,
however, differences in self-esteem were found.
husbands
and
wives,
of
regardless
of
whether
or
Both
not
pregnancy had been achieved, had lower self-esteem if
they
had
used
multivariate
AID
than
if
F (1, 121) = 3.94,
they
had
/
*
P'"-0.05.
used
This
AIH;
is
displayed in Table 2.
Effects on Marital and Sexual Satisfaction
A multivariate analysis of variance was performed
The variable representing number of inseminations itself was marginally significant (p ~ 0.08), indicating
that those with more numerous inseminations had higher
self-esteem. Perhaps their self-esteem was enhanced by
having tried for a child for so long or perhaps only
those with higher self-esteem to begin with can endure
the strain.
33
TABLE 1
Anova Summary Table
For Self-Esteem
Source
Sum of
Squares
AI
df
Mean
Square
F
2.12
1
2.12
2.63
.60
1
.60
.75
2.01
1
2.01
2.50
OUTCOM
.04
1
.04
.05
\VH
.003
1
.003
.004
.61
1
.61
.76
.04
1
.04
.05
RESIDUAL
112.78
140
TOTAL
118.24
147
OUTCOM
WH
AI
AI
*
*
OUTCOM
AI
*
*
WH
OUTCOM
*
WH
34
TABLE 2
Anova Summary Table for Self-Esteem
(CYCLES Variable Included)
Source
Sum of
Squares
df
Mean
Square
F
WH
1.58
1
1.58
1. 97
AI
3.16
1
3.16
3.94*
OUTCOM
.00
1
.00
.001
CYCLES
.40
1
.40
WH *AI
.002
1
.002
WH* OUTCOM
1.02
WH* CYCLES
1
1. 02
2.99
.002
1.27
.671
1
.671
.835
OUTCOM
.013
1
.013
.016
AI * CYCLES
.314
1
.314
.391
OUTCOM * CYCLES
.059
1
.055
.073
WH * AI * OUTCOM
.021
1
.021
.026
WH * AI * CYCLES
.003
1
.003
.004
WH* OUTCOM * CYCLES
.645
1
.645
.803
AI * OUTCOM * CYCLES
.009
1
.009
.011
AI
*
WH *AI * OUTCOM *
CYCLES
Residual
Total
1.33
1
97.18
121
108.65
136
* significant at p = .05
1. 33
.803
1. 66
35
on the four subscales of the Dyadic Adjustment Scale
plus
the Sexual Adjustment subscale
(SAT,
COR,
CON,
EXPRESS and SEX) with AID versus AIR, pregnancy versus
no pregnancy, and husbands versus wives as independent
variables.
This analysis examined any differences that
might have occurred in marital satisfaction due to use
of AID instead of AIR,
to
outcome
of
insemination
(whether or not a child was produced), and to husbands
rather than wives.
The analysis also investigates the
operation of these variables in combination, that is,
it examines, for instance, whether producing a child
had different effects on marital adjustment when AID
was used rather than AIR.
A significant multivariate
effect was found for the pregnant versus not pregnant
variables,
multivariate F(S, 136)=2.25,
p=O.OS,
(see
Table 3) which was primarily due to differences in the
consensus (CON) subscale (see Table 4).
been
unsuccessful
in
achieving
Those who had
pregnancy
through
artificial insemination had higher consensus than those
who had become pregnant.
A
second,
marginally
significant
difference
(multivariate F(S, 136=2.09, p=0.07) was found in the
AI by PREG interaction.
This difference indicates that
the effects of pregnancy were different in an AID than
36
TABLE 3
Manova Summary Table for Marital Satisfaction
Source of
Variation
Multivariate
AI
F
df
Significance
of F
.46
5/136
.81
OUT COM
2.25
5/136
.05 *
WH
2.14
5/136
.06+
2.09
5/136
.07+
.06
5/136
.99
.68
5/136
.63
.65
5/136
.66
AI
AI
*
OUTCOM
...t.
WH
"
OUTCOM
AI
*
*
WH
OUTCOM *WH
* significant at p =
.05
+None of the main effects or interactions achieved
statistical significance. However, these were very
close.
37
TABLE 4
Tests of OUTCOM, WH, and AI
by OUTCOM Interaction for the Consensus Sub scale
Univariate
IV
DV
OUT COM
con'
3.65+
sat'
.868
1/140
3.65+
1/140
1/140
.089
1/139
1/140
.899
1/138
1/140
1/137
l/140
1.04
5.38 *
1/140
.08
1/140
1.25
1/140
2.70
1/139
.18
1/140
.97
1/138
express' 2.16
1/140
4.58*
1/137
sex'
1.61
1/140
2.19
1/136
con'
.98
1/140
.98
1/140
sat'
.44
1/140
.005
1/139
express'
sex'
con'
sat'
coh
AI by
OUT COM
Step down
df
coh
WH
df
F
F
2.49
.191
1.24
.087
1/136
J~
6.21 *
1/140
5.8"
1/138
express'
.04
1/140
1.28
1/137
sex'
.24
l/140
2.23
1/136
coh
'These variables were transformed.
*significant at p L . OS
+significant at p L.. . 06
38
those in an AIR couple.
on the cohesiveness
The difference was primarily
(COR)
subscale where the couples
who had not achieved pregnancy by AID had the highest
cohesiveness.
Next in cohesiveness were those who had
achieved pregnancy through AIR.
Somewhat lower were
couples who had not achieved pregnancy through AIR, and
lowest
in
cohesiveness
pregnant using AID.
where
those
who
had
become
A further analysis revealed that
the couples who had lower cohesion still shared outside
interests,
were having
and had discussions,
but
less
frequently
stimulating exchange of ideas,
together, or working together on a project.
laughing
Note that
this difference is not due to the presence or absence
of a child, per se, because the effect depended on how
the child had been produced.
The
results
of
this
analysis are shown in Figure 1.
Table 5 compares
respondents
to
those
the average responses
of
large,
normative
of
the
samples.
Larger numbers on the marital satisfaction measures are
indicative of greater satisfaction while larger numbers
on the sexual dissatisfaction scale indicate greater
dissatisfaction.
In general, our respondents averaged
close to the values of the normative samples except on
the Consensus subscale of the Dyadic Adjustment Scale,
where they were considerably and significantly lower.
39
AID
a)
AIR
Cohesion
5
5
AID
AIR
5
AID
AIR
AID
AIR
Cohesion Subscale Items
b) Exchange ideas
Figure 1.
c) Laugh together
d) Work on project
Combined effects of AID versus AIR and outcome(pregnancy=unlined bars; no pregnancy=
lined bars) on a) marital cohesion, b) exchanging ideas, c) laughing together, and
d) working together on a project: (Combined
effects of AID versus AIR and OUTCOM on Cohesion)
40
But while marital consensus may be adversely affected
by
reproductive
sexual
difficulties,
satisfaction
these respondents.
are
both
marital
cohesion
slightly
higher
and
among
This is shown in Table 5.
Effects on Masculinity and Femininity (Sex Role)
In order to compare the effects of AI and OUTCOM
on sex role, separate multivariate analyses of variance
were run for husbands and for wives using the seven
subscales
from
the
variables (DVs).
analyzed
sex
role
measure
as
dependent
Responses of husbands and wives were
separately
because
they
differed
between
themselves in predicted directions (e.g., husbands were
more
masculine
and
wives .more
analyses are designed to
role which may
result
feminine).
These
identify differences in sex
from use
of AID versus
AIR,
or the combination of AI and OUTCOM.
For
wives,
no
significant
observed in sex role as
their
interaction
inseminations
variables
over),
(see
(CYCLES)
a
function of AI,
Table
was
differences
6).
added
When
to
the
were
PREG,
or
number
of
independent
(fewer than 10 cycles versus 11 cycles and
there was
a
tendency
for
both AI
by CYCLES
interaction and the OUTCOM by CYCLES interaction
41
TABLE 5
Comparison of Mean Responses from Normative Samples
and 74 Respondents on Marital Satisfaction,
Sexual Dissatisfaction, and the
Personal Attributes Questionnaire
Normative Sample
74 Respondents
Total Men Women
Total Men
Consensus
57.9
49.2* 49.0 49.5
Satisfaction
40.5
41.2
Women
D~adic Adjustment 1
41.7 40.8
..t.
Cohesion
Affectional Expression
Sexual
16.4" 16.3 16.6
13.4
n·1ssa t'1s f act1on
· 2
9.0
10.0 8.4
relatively
satisfied
8.9
8.6
9.1
7.6
8.1
7.1
PAQ
Masculine
22.3 20.4
22.4 19.6
Feminine
22.1 24.5
21.6 24.3
Masculinity-Feminity
10.6 13.2
16.1 12.4
Negative Masculine
13.7 12.0
12.7 10.4
Communion-like
6.4
7.1
5.8
6.6
Verbal Aggressive
5.6
6.5
5.4
6.0
*D1fferent
.
from the normative sample at p ~0. 01
1Larger numbers indicate greater satisfaction.
2Larger numbers indicate greater dissatisfaction.
42
TABLE 6
Manova Summary Table for PAQ (WIVES only)
Source of
Variation
Multivariate
df
F
Significance
of F
AI
.76
7/64
.62
OUTCOM
.44
7/64
.87
1. 08
7/64
.39
AI
*
OUTCOM
43
F(l,60)=3.52) and F(l,60)=3.64, respectively
significant
(p~0.06).
masculinity
(not
affected
(see
In
the
Table
both
cases
femininity)
7).
to become
it
subscale
Inspection
of
was
the
that
was
the
means
revealed higher scores on masculinity for the women who
had experienced 11 or more cycles of insemination using
AIR.
There were also higher masculinity
those
who
had
achieved
pregnancy using
scores
11
for
or more
cycles of inseminations.
In a separate analysis for wives, differences in
their femininity scores were related to a combination
of OUTCOM
(whether or not
their occupation
(EMPLOY),
(see
Highest
Table
7).
they became pregnant)
F(2,
66)
femininity
and
= 4.87, p-'0.05
was
found
among
housewives who became pregnant, while lowest femininity
was found in housewives who did not achieve pregnancy.
For the husbands, no differences in sex role were
seen associated with the OUTCOM variable or with the AI
by PREG interaction.
In other words, sex role did not
differ for the men if pregnancy was or was not achieved
or if it was or was not achieved using either AID or
AIR.
(See Table 8)
the communal
However, a difference was found on
subscale of the sex role measure
function of AID versus AIR
(F (1,70)=4.96,
as
a
p<:0.03).
Specifically, men who had agreed to use AID reported
44
TABLE 7
Anova Summary Table for MASC and FEM
Subscales of the PAQ (WIVES only)
Sum of
squares
df
Mean
square
AI
22.31
1
22.31
1. 35
OU.TCOM
28.60
1
28.60
1. 72
CYCLES
36.20
1
36.20
2.18
DV
Source
MASC
AI
*
OUTCOM
AI
*
CYCLES
60.31
1
60.31
3.64+
*
58.37
1
58.37
3.52+
1.63
1
1.63
.098
994.63
60
16.58
1180.51
67
17.67
EMPLOY
21.48
2
10.74
OUTCOM
.01
1
214.88
2
107.44
Residual
1347.70
61
22.09
Total
1584.98
66
24.01
OUTCOM
AI
.008
CYCLES
* OUTCOM
CYCLES
*
Residual
Total
FEM
F
EMPLOY
*
OUTCOM
+significant at p .( . 07
*significant at p < .06
1
.008
.011
.00
.49
.00
4.86*
'
'
45
TABLE 8
Manova Summary Table for PAQ
(HUSBANDS only)
Source of
Variation
Multivariate
df
F
AI
1.50
7/64
OUT COM
1.82
7/64
.37
7/64
AI
*
OUTCOM
".
46
themselves
subscale
higher
(more
gullible)
than
on
the
variables
of
spineless,
subordinant,
those
had
who
used
the
cmmnunal
servile,
AIH.
and
Although
multivariate F was not significant, univariate F for
the communal subscale was significant even when the DV
was entered in last place, indicating the stability of
the difference for this DV.
be noted, however,
(See Table 9)
that the average response to these
items for the AID group was
self
attribution
It should
on
these
a
"medium" or "average"
items,
while
the
average
response for AIH group was a "less than average" self
attribution to
these items.
(See Table 10)
Men who
had agreed to use AID considered themselves average in
communality while those who had used AIH thought they
were less than average on it.
were
found
for
specific
No significant results
communal
subscale
items
as
shown in Table 11.
When number of inseminations (CYCLES) was added to
the previous analysis,
other differences emerged,
and
the pattern was, in part, the same as for the wives in
that a significant interaction was found between CYCLES
and AI (F(l,61)=4.85,
p~0.03).
Specifically, husbands
attributed higher masculinity scores to themselves when
11
or
more
procedure.
Figure 2.
cycles
These
were
results
inseminated
are
by
graphically
the
seen
AIH
in
47
TABLE 9
Tests of the Communal Subscale
(HUSBANDS only)
IV
DV
Univariate
df
F
Step down
df
F
AI
masc
fem
bmasc
va
c
mf
gender
.064
.00
1.07
.151
4. 96**
.031
1.11
l/70
1/70
1/70
l/70
l/70
l/70
l/70
.064
.001
1.13
.826
7.24**
.049
1.13
1/70
1/69
1/68
1/67
1/66
1/65
1/64
OUTCOM
masc
fem
bmasc
va
c
mf
gender
.074
1.07
1. 78
1.95
.66
2.33
.181
1/70
l/70
l/70
1/70
l/70
1/70
1/70
.074
.983
3.12
.347
.289
7.62**
.060
1/70
1/69
1/68
1/67
1/66
1/65
1/64
masc
fem
bmasc
va
c
mf
gender
.920
.402
.020
.777
1.57
.203
.120
1/70
1/70
1/70
l/70
1/70
1/70
1/70
.920
.20
.590
.939
.550
.016
.039
1/70
1/69
1/68
1/67
1/66
1/65
1/64
AI *
OUTCOM
**p
.03
48
TABLE 10
Means for the Communal Subscale
(HUSBANDS only)
AID
(n)
AIH
(n)
Combined (n)
spineless
1. 31 (39)
. 94 (35)
1.14
(74)
subordinate
1.82 (39)
1. 71 (35)
1. 77
(74)
servile
1. 79 (39)
1.43 (35)
1.62
(74)
gullible
1. 31 (39)
1.14 (35)
1.23
(74)
49
TABLE 11
Summary Table for the Communal Subscale Items
(HUSBANDS only)
Variate
spineless
subordinate
servile
gullible
Hypothesis
Sum of Squares
Error
Sum of
Squares
F
Significance of
F
2.46
70.19
2.51
.12
.21
62.87
.23
.63
2.48
56.93
3.13
.08
.50
60.59
.60
.44
50
Masculinity
27
26
10+ CYCLES
25
24
23
22
21
1-9 CYCLES
20
AID
Figure 2.
AIH
Masculinity as an interaction
effect between AI and number
of CYCLES
51
Other Analyses
Numerous
additional
other variables
analyses
were
performed
from the questionnaire.
on
Couples who
had achieved pregnancy using artificial insemination,
either AID or AIH,
were asked how anxious
they were
about having a child by artificial insemination and how
concerned they were about the physical appearance of
the
child.
Both
husbands
and
wives
reported
more
anxiety about the use of AID than AIH (F(l, 78)=18.52,
p
0.05)
appearance
but
of
were
not
the
child.
more
This
concerned
is
about
demonstrated
the
in
Table 12.
We had also believed that the effect of AID might
be
different
for
couples
who
needed
insemination
because of a previous male vasectomy or health problem
known at the time of marriage versus those who found
out about their infertility problem after marriage, but
none
of
the
dependent
related to this variable.
variables
investigated
was
52
TABLE 12
Anova Summary Table for ANXIETY
Sum of
Squares
df
Mean
Square
AI
18.52
1
18.52
4.10*
~VH
4.38
1
4.38
.97
AI *WH
1. 91
1
1. 91
.42
Residual
352.05
78
4.51
Total
376.44
81
4.65
Source
*significant
at p
=
.05
F
DISCUSSION
It is essential to recognize that this study does
not
test
the
effects
of
infertility,
but
rather,
examines the impact of the use of novel reproductive
techniques
among
couples
with
fertility
problems.
Whatever assault on marital satisfaction, sex role and
self-esteem that
the infertility experience produces,
it had previously occurred to all our respondents.
a
further
research
cause
limitation
does
and
not
of
permit
effect.
the
results,
unambiguous
Although
As
retrospective
attribution
relationships
can
of
be
identified, there are frequent alternative explanations
which
require
longitudinal
prospective
study
for
further discrimination.
Main Effects
Few main effects were found
that
were
directly
related to the use of AID rather than AIR.
While some
differences
they
occurred
were
in
noted
between
conjunction
with
the
two,
other
only
conditions
(described under "Interaction Effects").
Self-esteem remained unaffected.
It may be that
social values allow for maintainance of self-esteem by
53
54
attributing the problem to a biological variable, such
as involuntary infertility, over which AID couples have
no control.
The overall finding for pregnancy (PREG/NO
PREG) itself was paradoxical.
As a simple main effect,
inability
not
to
self-esteem,
conceive
or
any
measures.
The
although
husbands
identity
in
did
of
third
the
main
differed
predicted
impact
marital
effect
from
role,
satisfaction
indicated
wives
directions
masculine, women more feminine),
sex
(i.e.,
in
that
gender
men
more
the effects of novel
reproductive techniques on the two were similar.
In
the
past,
physicians
insemination have
had
impact
reproductive
couples.
of
novel
The
results
employing
legitimate
of
this
artificial
concerns
about
the
techniques
upon
AID
study
indicate
that
physicians involved in this field need not be concerned
about the psychological effects of AID; no significant
differences between the two groups
were demonstrated.
response
rate
(AID versus
AIH)
However, it is to be noted that the
between
the
successful groups was different.
unsuccessful
versus
55
Interaction Effects
AID vs AIR
As previously mentioned in the discussion of "Main
Effects",
there
were
no
significant
differences
self-esteem between AIH and AID couples.
the
marginally
significant
independent
in
However, when
variable
of
CYCLES was taken into account, the above results were
inexplicably altered.
Although both groups had higher
self-esteem with more numerous
cycles,
the degree of
change was less for AID couples than for AIR couples.
Consequently, with increasing number of CYCLES, the AID
couples had lower self-esteem than AIR couples,
even
though their overall self-esteem was increased.
Men
who
agree
to
use
AID
display
communion-like characteristics than AIR men.
al.
(1979)
present
results
demonstrated that sexes
agentic
agentic
and
stronger
as
the
females than males.
have
Spence et
consistently
differ in relative degree of
characteristics.
characteristics
principle",
communion
comunal
which
more
in
(agency)
males
"female
They
as
than
principle",
defined
the
"male
females,
stronger
and
in
Hence, AID males may be altering
their masculine agency with some degree of communion, a
behavior change required for
a husband consenting to
56
donor insemination.
The other explanation involves the
initial selection factor in which only men who are more
communal consent to this treatment in the first place.
AID-PREG vs AID-NO PREG
Cohesiveness
was
higher
for
all
groups
participating in artificial insemination than for those
who did not (norm scores were taken from the Dyadic
Adjustment Scale, Spanier 1976).
Among the groups in
this study, cohesiveness was an interaction effect that
appeared highest
among couples who had not achieved
pregnancy using AID, while lowest cohesion was found
among couples who had conceived using AID.
The decision to use AID is extremely difficult to
make, and the process of reaching this decision could
have initially brought couples closer together.
the
couples
finally
conceive,
however,
When
they
may
experience lowered cohesion due to the use of AID.
The
reality of producing a child with someone else's sperm
may in fact be more divisive than the reality that both
spouses are infertile.
It is to be noted that only
from lack of success in AID does the wife learn of her
probable infertility.
Perhaps couples withstanding AID
and not conceiving have higher cohesion because both
57
the wife and husband, experiencing the same biological
problem (infertility) must share in the helplessness of
being involuntarily childless,
alternate
method
of
having
in the
pursuit
children,
and
of
in
an
the
possibility of not having children at all.
No other differences in marital satisfaction were
observed.
Satisfaction,
affectional
expression,
and
sexual dissatisfaction were unaffected.
AIR-PREG vs AIR-NO PREG
Both men and women report higher masculinity if
AIR is used and the number of inseminations is 11 or
more,
regardless
These results
of
show
the
that
outcome
the
(PREG vs NO PREG).
attempt
to
conceive
by
using AIR for a long duration brings about a salience
of masculinity
for
both
sexes,
females
become
more
androgynous and males become more stereo typic.
It is
possible that masculinity increases in husbands upon
discovering
problems
Similarly,
that
their wives
contributing
wives'
androgeny when the
to
sex-role
option
the
may
also
couple's
attitude
of
have
becoming
medical
infertility.
adjusts
a
toward
parent
completing a feminine role does not seem viable.
and
The
other probability may involve a selection factor, males
58
who are initially more masculine and females who
initially
more
androgynous
may
comprise
the
are
only
couples that persist with AIR for this length of time.
PREG vs NO PREG
Women reported higher masculinity if they become
pregnant
after more
than 11 cycles of insemination,
while men were unaffected.
support
for
evidence
These findings may provide
suggesting
that
gender-role
attitudes reflect specific life situations (Abrahams et
al. 1978).
For example, they found that the transition
from marriage
to
masculine
feminine
and
expectancy
(pregnancy)
gender
traits.
raised
In
both
addition,
behavior changes generally were greater in magnitude in
women than men.
In
a
femininity
separate
was
found
analysis
in
for
pregnant
wives,
highest
housewives,
while
lowest femininity was found in housewives who could not
conceive.
Involuntary
childlessness
is
probably
greater assault on femininity among those who
have
an
alternative
source
of
a
do not
gratification
and
identification.
Among both groups
(AID and AIR) NO PREG couples
showed higher consensus however no difference was found
,, .
59
in cohesion, affectional expression, satisfaction,
sexual
dissatisfaction
scale.
The particular affected areas of consensus were
sharing ideas,
of
laughing,
the
marital
and
satisfaction
and doing projects together.
Perhaps the NO PREG couples have more
time
to
spend
together, whereas couples who conceive must spend more
time with their child.
This finding is
supported by
previous research that has indicated childless couples
reporting higher marital satisfaction than couples with
children (Bernard, 1972).
Further Analyses
CYCLES
emerged
as
an
important
variable,
increasing number of cycles was associated with higher
self-esteem.
It may be
that
only
people higher in
self-esteem and masculinity can endure the trials of a
lengthy process.
attempts
at
It should be noted that the number of
conception
(CYCLES),
and
therefore
the
duration of treatment, was up to the discretion of the
couples.
More
determination
coincide with
on
cycles
the
indicate
part of the couple,
greater
extended treatment.
may
financial
ability
greater
or it may
to
pay
for
It is also conceivable that only
androgynous women chose to continue with the treatment.
60
AID couples were more anxious about the use of AID
than AIH couples.
is
still
in
its
ramifications.
with
moral,
Because this progressive technique
infancy,
it
has
many
unknown
The couple using AID is left to contend
ethical,
and
legal
undetermined.
There was no
the
regarding
groups
characteristics,
issues
remain
difference found between
concern
therefore
that
it
further research be devoted
about
seems
to
physical
necessary
identify
the
that
anxiety
that AID couples seem to be experiencing.
Housewives were less masculine than either job or
career
women,
findings
Fidell
were
regardless
of
supported by
(in press).
CYCLES
or
PREG.
both Allison
These
(1979)
and
It would seem that housewives not
achieving pregnancy would have a particularly difficult
time
since
their
sex
role
is
more
traditionally
oriented and has prepared them for parenting.
We had also believed that the effect of AID might
be
different
for
couples
who
needed
insemination
because of a previous male vasectomy or health problem
known
at
the
time
of
marriage,
but
none
of
the
variables investigated was related to this knowledge.
61
Open-ended Responses
AID couples (regardless of PREG/NO PREG) generally
discussed their exhaustion of all other childbearing
alternatives and perceived AID to be the next logical
step.
By contrast, AIR couples seemed strongly opposed
to AID.
AID-PREG
This group preferred this procedure over adoption,
indicating that adoption took too
specifically were
pleased
to
long,
while wives
have had a
experience biological reproduction.
chance
to
Furthermore, they
experienced the strains relating both to infertility
and the usage of novel reproductive techniques.
The
majority of the couples expressed relief that their
infertility problem was finally resolved.
Counseling
for this particular group did not seem necessary during
the
time of insemination;
however,
some appreciated
having obtained counseling following their diagnosis of
an
infertility
consistently
sharing
a
problem.
reported
common
After
experiencing
goal,
feeling
using
AID,
the
closeness
good
about
they
of
their
marriage and offspring, forgetting about the procedure,
and electing to keep their AID experience confidential.
62
Finally, they all spoke of the personal tragedy of the
infertility experience, admitting that it led to the
avoidance of other couples who had children and to such
feelings as bitterness, dispondence, and depression.
AID-NO PREG
Couples who did not achieve pregnancy through AID
communicated
Generally,
a
both
much
spouses
more
from
negative
this
experience.
group
expressed
frustration and depression with their situation, noted
that the spontaneity of their sexual relationship had
changed,
emphasized
that
they felt
no blame
toward
their spouse, complained about feeling 'led on' by the
clinic,
engaged
and either had experienced or were presently
in
counseling.
Husbands
commonly
reported
accepting the situation, although they felt concerned
about their wives.
Finally, out of 15 couples, 4 had
already adopted a child, 7 had tried or were going to
try for adoption, and 4 had ceased trying for a child
altogether.
This
group was noted to have the most
omissions in their responses to the questionnaire:
Couples from AIR (regardless of PREG/NO PREG) felt
the strain of having to shuffle their lives in order to
63
attend
appointments.
Many
couples
emphasized
their
usage of AIH as opposed to AID.
AIH-PREG
those
Among
AIH,
many
saw
strengthened
received
had
their
and
from
Generally,
who
achieved
marriage
appreciated
their
couples
pregnancy
spouse
as
the
and
commented
having
support
from
that
through
they
the
they
been
had
Clinic.
had
good
communication and did not feel a need for counseling.
However,
while receiving insemination treatment,
reported sexual deterioration and felt
by
the demands
of
the procedure.
they
inconvenienced
Husbands expressed
feelings of sorrow for their wives, and wives reported
that their husbands felt frustrated.
AIH-NO PREG
Those who were unsuccessful through AIH wrote that
they were grateful for artificial insemination because
it took the pressure off sex, although they reported an
overall
lowered
sex
drive.
They
overall positive attitude about
also
retained
their marriage.
husbands discussed the humiliation of having
sex
an
The
'on
schedule' and the frustration of repeated trys with the
64
Clinic,
while
both
partners
reported
disappointment
with the treatment.
Husbands vs Wives
Generally, both partners were touchingly concerned
about each other, being more concerned about how the
experience
affected
themselves.
This
their
was
spouse
particularly
rather
than
apparent
for
husbands.
NO PREG
Both
treatment
groups
unsuccessful in achieving
pregnancy expressed extreme frustration and depression
more
markedly
so
for
wives
than
husbands.
These
individuals frequently directed their anger toward the
Clinic
since
Moreover,
the
most
method
had
complained
not
about
attempts, hence costly medical bills.
been
successful.
their
lengthy
The majority of
the couples continued to pursue alternative plans.
65
Summary and Conclusions
There seems to be little in these results to deter
a
concerned physician from the use of AID.
several
effects
were
found,
most
were
Although
weak.
The
effects that were found suggest that infertile couples
have lower overall consensus (particularly among those
who had become pregnant through artificial insmination)
and higher marital cohesion than a normative
sample.
Cohesion was particularly high for those who had tried
AID and failed to achieve pregnancy.
There was also a
small
self-esteem
but
reliable
difference
anxiety among users of AID;
in
they were
lower
on
former and higher on the latter than users of AIR.
who
agreed
to
use
of
AID
had
more
and
the
Men
communion-like
characteristics than those who used AIR, while both men
and
women
reported
characteristics
in
more
personality
numerous
masculine
if they used AIR for
more than 11 cycles of insemination.
Among women,
lowered femininity among housewives
who did not become pregnant, compared to employed women
who
did
become
sensitivity
insemination.
of
pregnant
this
may
group
point
to
to
the
the
special
outcome
of
66
Along
with
the
decision
to
employ
AID,
the
physician must also consider number of inseminations.
The higher
self-esteem of those who used artificial
insemination
for
11
cycles
or
more
and
the
higher
masculinity among women who became pregnant after 11
cycles
or
more
of
insemination
both
suggest
some
selection factors in terms of who agrees to the use of
these procedures and the length of treatment.
Past
literature
assessment
of
stability,
as
has
parenting
well
as
recommended
capabilities
discussion
of
preliminary
and
marriage
psychological,
ethical, and legal issues pertaining to infertility and
the use of AID (Berger,
needing
complicated
1977).
logistical
insemination may require rest
Also
couples
(Behrman,
1979;
should
Furthermore, patients
be
arrangements
cycles
advised
Cramer et al.,
of
for
(Corson,
1980).
success
rates
1979) and informed of
possible financial burdens due to prolonged treatment
(Dixon
and
Buttram,
1976).
A
thorough
preliminary
interview and periodic intervention program combining
all
these recommendations will minimize the couple's
psychological
trauma
and
will
realistically the couple's expectations.
clarify
more
67
We suspect that only marriages that are reasonably
stable to begin with can withstand the decision to use
AID
and
that,
within
that
group,
only
those
with
extraordinary coping mechanism can endure the strain of
protracted
use
of
AID.
Furthermore,
it
seems
worthwhile to encourage psychological support so that
the strain can be minimized.
For all, however, there
must be a point of diminishing return beyond which even
the
hardy
suffer.
This
study has been limited to
couples who wished to respond to this study and had
children
3
years
of
age
and
younger.
Future
investigation of the couples in this study may reveal
more information about marital satisfaction with regard
to the unfolding family life cycle.
REFERENCES
Abrahams, B., Feldman, S.S. Nash, S.C. Sex role
self-concept and sex role attitudes: Enduring personality characteristics or
adaptations to changing life situations.
Developmental Psych. 1978, 14, 393-400.
Allison, Janet R. Roles and role conflict of
women in infertile couples. Psychology of
Women Quarterly, 1979, 4(1) 97-113.
Behrman, S. and Kistner, R. Progress in Intertility, Second Edition. Boston, Little, &
Brown, 1975.
Behrman, S.J. Artificial insemination.
Obs. and Gynacol. 1979, 22, 245.
Clin.
Bem, S.L. On the utility of alternate procedures
for assessing psychological androgyny.
Journal of Consulting and Clinical Psychology,
1977, 45, 196-205.
Bernard, J. The Future of Marriage. New York: World
Publishing Company, 1972.
Berger, David. The role of the psychiatrist in a
reproductive biology clinic. Fert. Steril.
1977, 28, 141-145.
Bonnar, J. The infertile couple: the current scene.
Irish J. of Med., 1979, 148(51) 3-5.
Bresnick, E. and Taymor, L. M. The role of counseling in infertility. Fert. Steril., 1979, 32,
154-156.
Broekhuizen, F. F., Haning, Jr., R.V., and
Shapiro, S. S. Laparospic findings in twenty~
five failures of artificial insemination.
Fert. Steril., 1980, 34, 351-354
Burgess, E.W., and Wallin, P. Engagement and
Marriage. Philadelphia, Pa: J.B. Lippicott,
1953.
68
69
Corson, S.: Factors affecting donor artificial
insemination
success rates. Fert. Steril.,
1980, 33, 415.
Cramer, D.W., Walker, A.M., and Schiff, I.
Statistical methods in evaluating the outcome
of infertility thereapy. Fert. Steril. 1979,
32, 80-86.
Curie-Cohen, M., Luttrell, L., Shapiro, S. Current
practice of artificial insemination by donor
in the United States. Engl. J. Med., 1979, 300,
585-590.
d'Elicio, G, et al.: Psycho-dynamic discussions with
couples. In David, G. and Price, W. S. Human
Artificial Insemination and Semen Preservat~on.
New York: Plenum Press, 1980, 407-411.
Dixon, E. and Buttram, V.C. Artificial insemination
using donor semen: A review of 171 cases.
Fert. Steril. 1976, 27(2), 130-134.
Fidell, L.S. Employment status, role dissatisfaction
and the housewife syndrome. (In press).
Gerson, M.J. The lure of motherhood. Ps~chology of
Womens Quarterly, 1980, ~(2), 207- 17.
Gilbert, S. Artificial insemination.
1976, 76, 259-261.
Am. J. of Med.,
Goldenberg, R. L. and White, R. Artificial insemination. J. Reprod. Med., 1977, 31, 149-153.
Hoffman, Susan Ronnie, Ed.D. Unpub. dissertation,
Boston University of Education, 1978, 39 (5-B)
2502
-Hoffman, L.W. and Manis, J.D. Influences of children
on marital interaction and parental satisfactions
and dissatisvactions; Child Influences on Marital
and Famil~ Interaction: A Life S~an Perspective,
Academic ress, Inc., 1978, 165- 13.
Housenecht, S.K. Reference group support for voluntary
childlessness: evidence for conformity. Journal
for Marriage and the Family, 1977, 39, 348-360.
70
Housenecht, S.K. Timing of the decision to remain
voluntarily cl1ildless: evidence for continuous
socialization. Pstchology of Womens Quarterly,
1979, 4 (1), 81-9 .
Kearney, H.R. Feminist challenges to the social
structure and sex roles. Pstchology of
Women's Quarterly, 1979, 4 1), 1 -29.
Ledward, R. S., Crawford, L., and Symonds, E. M.:
Social factors in patients for artificial
insemination by donor (AID). Assoc. Sci.,
1979, 11, 473-479.
LeMasters, E.E. Parenthood as a crisis. Journal of
Marriage and the Family, 1957, 19, 353.
Levinger, G. Interpersonal attraction and agreement:
a study of marriage partners. Journal of Personal
Social Psychology 1966, ~ (4), 369-372.
Mazor, M. D. The problem of infertility. In M. T.
Notman and C. C. Nadelson (Eds.), The Woman
Patient: Medical and Ps cholo ical Interfaces.
Menning, B.E. Infertilitt: A Guide for the Childless
Coutle. Englewood C iffs, New Jersey: PrenticeHal, Inc., 1977.
Moghissi, K. S.: Basic work-up and evaluation of
infertile couples. Clin. Obs. and Gynecol.,
1979, 22, 11-25.
Orden, S.R. and Bradburn, N.M. Dimensions of marriage
happiness. American Journal of Sociology, 1968,
73 (6), 715-731.
Peyser, M. R., et al. Luteal function in patients
seeking AID. Obs. Gynec., 1973, 42, 667.
Platt, J. J., Ficher, I., Silver, M. J.: Infertile
couples: personality traits and self-ideal
concept discrepancies. Fertil. Steril., 1973,
24, 972.
71
Renne, K.S. Correlates of dissatisfaction in marriage.
Journal of Marriage and the Family, 1970, 32 (3),
441-442.
-Rosenberg, M. Societ
Self-ima e.
Princeton-,~~e-w~r-----~~r-1rn-c-e~t-on--r.-n~1-v_e_r_s~1~t-y~~
Press, 1965.
Rosenfeld, D. L. and Mitchell, E.: Treating emotional
aspects of infertility: Counseling services in
an infertility clinic. Am. J. Obstet. Gynecol.,
1979, 135, 177-180.
Schoysman-Deboeck, M. M., et al.: Results of AID in
865 couples. In David, G. and Price, W. S.:
Human Artificial Insemination and Semen
Preservation. New York: Plenum Press, 1980,
231-247.
Spanier, G.B. Measuring dyadic adjustment: New scales
for assessing the quality of marriage and similar
dyads. Journal of Marriage and the Family, 1976,
38' 15-28.
Spence, J., Helmrich, R., and Stapp, J. The personal
attributes questionnaire: A measure of sex-role
astereotypes and masculinity-feminity.
JSAS Catalog of Selected Documents in Psychology,
1974, 4, 43.
Spence, J.T. and Helmreich, R.L. Masculinity and
Feminity - Their Psychological Dimensions,
Correlates and Antecedents. University of
Texas Press, Austin and London, 1978.
Spence, J.T., Helmreich, R.L., and Holahan, C.K.
Negative and Positive components of psychological
masculinity and femininity and their relationships to self-reports of neurotic and acting out
behaviors. Journal of Personalitt and Social
Psychology, 1979, 37 (10), 1673-1 82.
Snyder, D. Multidimensional assessment of marriage
scale. Journal Marriage and the Family, 1979,
41, 813-823.
Snyder, D. Marital Satisfaction Inventory.
Psychological Services, 1979.
Western
72
Walker, H.E.: Psychological aspects of infertility,
contraception, and sexual dysfunctions.
Int. J. Andr., 1978 (SI) 85-92
Williams, L. and Power, P. The emotional impact of
infertility in single women: some implications
for counseling. Journal of the Amer. Med.
Women's Assoc., 1977, 32, 327-333.
Wylie, Ruth C. The Self Conce~t, Revised Edition,
Volume 2. University of ebraska, Lincoln/
London, 1961, 1979.
APPENDIX A
Letter of Introduction
and Open-Ended Questions
73
THE TYLEF< MEDICAL CLINIC, iNC;
fJ21 WESTWOOD BOlJLO.VARO
LOS ANGELES. CALIFOHNII.. 90024
477-6765
272-1905
272.5673
Dear
Your previous invo]vemoomt tvith the 2'yler C.Zin.ic has pn>mpted us to
ask For your sincere cooperation 1'lith the follo:·cing study.
Physicians at the Tyler Clinic have bee:n treating infertile patients
for years, but almost no infonnation regazding the persona.( and social
consequences of this therapy is available. Because the clinic is interested
in the total ~cell being of the clients it serves, it is conducting rese;:rch
to cles.i.gn a study of the social ef.fects of netv reproductive techniques.
SJ:nce you tvere patients of the 'I'yler J.Jedical CJ.inic 1 t-1e ask for your
ass.ist<Once in fiLling out the enclosed questionna.ires. 'l'hel'e a.re h·-:o sets
of packets, one for each spouse. The sets of packets were chosen to assess
the effects, if any, of the medical procedur,es on your marriag-e and on yourseJ.ves, pc1.·sonally. Your responses ~·il.l !_J<2_t:_ be associated 1·1.ith you ar yo:n·
name .in any t·tay. We have no t-vay of knov1ing t-;ho fiLled out ar;d returned the
quest.i.onnaires, 'l'he responses wi-ll be used to guide the techniques at the
Ty.ler C.linic and elset·ihen?, insofar as it can bc determined as to ~;ho hGnefits
from the techniques and under 1-vhat conditions. Your candor in ansh'er ing the
questions is much appret;;:iated.
P.lease do not discuss your answers together unti.J. you hiJ.ve completed the
forms.
A seJ.f-addressed stamped envelope is provided for tlw return of the
materials. If you have further questions regarding this research, please
call Bon.ina Cohen at 825-1603 ;.·eek days betv1een 8··5.
Completing the questionnaires should take about 20 m.irwt:es for each of
liga.in, h'e ~·oul d 1 ike to remind you about the importance of your
participation and feedback-.
Your J:esponse lvill he a valuahle tool to under-.
standing and iwprov ing the process and func:t ionin~1 of the c.!.in ic.
you.
l·le sincere] y appreciate your spending this t: ime in helping us to under-stand the personal. and social consequences of novel reproriuct.ive procedures.
11.cere./ly,?2-\
/1.'fJoslav
/J/1 ·l~
v.
?·ku.ik,
./
L.'t
' {..-"
N.D.
(!
'f,.~Jvlt.C->t-r._) (~c:-;1.{-I'L-;
JJori.in<': Collen, N.Jl.
Y7(- . .;-'t:.
75
PLEASE CIRCLE:
Are you
HUSBAND
WIFE
PLEASE ANSWER THE FOLLOWING QUESTIONS.
(Use back of page if necessary)
1.
2.
3.
4.
5.
SA.
6.
7.
8.
9.
10.
How did you arrive at the decision to use artificial insemination?
How long did it take to arrive at the decision?
Did you have trouble agreeing with your spouse
to use this procedure? Please explain.
Did you seek or would you have liked to have had
personal or marital counseling during this period?
Please explain.
How did your spouse react to the difficulty in
conceiving a child?
Are you still married to the same spouse with whom
you originally sought insemination? YES
NO
How did you feel personally?
How would you describe the effects artificial insemination had on the marriage? Please discuss
the sequence of events that occured from the time
you sought insemination until now.
Did you have a child with the assistance of the
Tyler Medical Clinic? YES
NO
Have you pursued other means-fOr pregnancy?
ANOTHER INFERTILITY CLINIC
ADOPTION
NOT TRYING FOR PREG&~CY
REMARKS:
How many fertilit~ c~cles were you inseminated?
(Do not count ind1vi ual inseminations; count
montfi'S"in which you had at least one insemination.)
1-5 cycles
6-10 cycles ____
10 and over
IF YOU DID NOT HAVE A CHILD WITH THE CLINIC'S
ASSISTANCE, PLEASE DISREGARD QUESTIONS 11 - 14.
11.
12.
13.
14.
As the time the birth approached, on a scale of
1-7, how would you rate your anxiety over the
decision to have a child by this method?
(1 being not at all anxious and 7 being
extremel! anxious).
on a sea e of 1-7, how concerned were you over
the physical appearance of your child (1 being
not at all concerned and 7 being extremely
concerned)
What is the child's age?
What is the child's gender? Male
Female
76
15.
16.
17.
18.
19.
20.
21.
What is your occupation?
Circle the letter of the income group that best
describes your family income before taxes at the
time you requested artificial insemination.
Figure should include salaries, wages, dividends,
profits, pensions, and all other income.
a. less than $3,000
f. 15,000-19,999
b. 5,000-7,499
g. 20,000-24,999
c. 7,500-9,999
h. 25,000-29,999
d. 10,000-12,499
i. 30,000+
e. 12,500-14-999
j. N/A
What was the last year of school completed?
What is your highest degree?
What is your age?
What is your relig1ous affiliation?
Any additional comments? Use back side of page
if necessary.