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INSTRUCTIONS: Number a sheet of paper from 1 to 70. Beside each number rate how important each statement is to you. Zero (0) means that the statement is not very important or is least descriptive of you. Five (5) means that the statement is very important or very descriptive of you. Use the numbers between 0 and 5 to show graduations between these extremes. If the statement doesn't seem to apply to your situation, place an X beside it. There are no right or wrong answers. Have your spouse take the evaluation separately. Then compare the two answer sheets and discuss where you agree and differ.

Children bring couples closer together.
Couples without children eventually become less stable and dissatisfied.
I want to see my spouse enjoying children.
I want a baby because it's important to my spouse.
I'm afraid our infertility may threaten our marriage.
My spouse wants a child.
Infertility makes me feel inadequate.
Sometimes I fear pregnancy.
Having a baby will demonstrate my virility/femininity.
I want a baby so my genes will be immortal.
I may someday regret not having done everything possible to have a baby.
I want to create a new life in my image.
Infertility makes me feel cheated.
I want my child to achieve some of the things I haven't been able to.
I want children so they can give me love and affection.
Without children I feel lonely.
Without children I'm bored.
Without children life is meaningless.
My infertility makes me feel powerless.
Sometimes I feel that I'm too self-centered.
I want a baby so I can quit my job.
I want children because then there will never be a dull moment in my life.
I sometimes wonder if we can afford a baby.
Having a family is what life is all about.
I want a baby because we live so far away from family and old friends.
I want a child who can help with my business/housework/hobby.
I feel that a woman's role should be mother and homemaker.
I feel that a man's role should be father and breadwinner.
I feel we are economically secure.
I've looked forward to having children all my life.
We frequently run out of money between paychecks.
Both of us have full-time jobs we enjoy.
Children will interfere with my career.
Children will interfere with my freedom to travel, be spontaneous, and live in the style I'm used to.
I'm not sure I want the responsibility of a child for the next twenty years.
There's never a "right" time for having a baby.
I'm not sure what to do with my life if I don't have a baby.
A child will not substantially affect our life-style.
I want a baby so I can show my spouse/father/mother/siblings that I can be a good parent.
I want a baby so my child will have a sibling.
I feel I'm breaking tradition by not having children.
People who can afford children should have children.
Infertility keeps me from fulfilling my religious beliefs.
I live in a community where everyone has children, a home, and a backyard.
I live in a city crowded with high-rise apartments.
I'll never really be perceived as an adult until I have children.
The family will treat us better when we give them grandchildren.
Having children will bring me respect and prestige.
I don't want the family name to end with me.
I can't face telling my family/friends about our infertility.
Having and wanting children is natural.
Not having and not wanting children is unnatural.
Women have a maternal instinct that needs to be filled.
Denying maternal instinct denies a woman's basic nature and function.
Sacrificing for children is noble and unselfish.
Deciding to remain childless is selfish and immature.
Having children is a stage necessary for adult development.
Good parents have a lot of children.
People with a lot of money have more children.
People who don't want children don't have anything to offer them.
Infertility is God's/nature's way of limiting the population.
My (our) parents want us to have children.
I like to take care of children—feed, diaper, bathe, clothe, etc.
I like to play with children.
I want children so I can give them love and affection.
I want a baby because I think I will make a good parent.
I sometimes wonder if I will make a good parent.
Children are stimulating, novel, and fun.
I look forward to sharing my knowledge and experience with children.
I like to direct and control children.

STATEMENTS:

1 - 6 pertain to couple's needs or considerations
7 - 20 pertain to internal needs (ego needs)
21 - 38 pertain to life-style needs
39 - 62 pertain to external pressures (needs of others)
63 - 70 pertain to parenting/nurturing needs

COUPLE'S NEEDS OR CONSIDERATIONS (Statements 1-6)

I find that most couples with fertility problems care for each other very much - perhaps too much. For example, Bryan W. said in a private interview, "I really don't care that much about having a baby. But I want one for Debbie's sake." When I interviewed Debbie, she said, "I'm afraid Bryan will divorce me and find a woman who can bear his children." In this case each misinterpreted the other's desires and was more concerned about the other's needs than his or her own. Their lack of communication and understanding added to their stress and hampered their choice of a mutually satisfying treatment program. When Bryan and Debbie began to share their feelings, they became happier and even more committed to finding a happy ending that was right for them. Comparing your test responses to your spouse's will help you see what is important to each of you instead of trying to outguess one another, as this couple had been doing.

The first six statements are designed to help you discover if you want a baby because you think your spouse wants one and/or because you think the success of your marriage depends upon having a baby. Believing that your marriage cannot survive without children is not unusual for an infertile couple. Shelley was so scared that she told me, "I will do anything to get pregnant—no questions asked." Shelley answered "5" to all six of these questions. She was absolutely shocked, however, when Michael's answers indicated he wanted a baby for her, but that he did not feel their childlessness threatened their marriage. Shelley told me later, "This information helped us face and resolve some very basic communication problems."

Marriages actually do survive without children. In fact, population statistics indicate that marriages sometimes become less stable when children are introduced The highest incidence of divorce occurs soon after the birth of the first child. I don't state this to frighten you, but to offer you some perspective. Children may add stress to a relationship because of their demands and impact on the couplets life-style. Moreover, the birth of a child will not stabilize an already rocky relationship.

As with Michael and Shelley, the foundation of your marriage may be stronger than you think. Knowing this will help you cope with your treatment and with your fertility in less emotional and distressing terms. If you both can focus your energy on developing and implementing a fertility treatment plan instead of preserving a marriage that is not in jeopardy, your energy will be better directed.

INTERNAL NEEDS (Ego Needs) (Statements 7-20)

Some women truly feel incomplete because of their fertility problem. Nor is it uncommon for infertile men to feel less virile.

These reactions seem to be more common among men and women from a traditional background where male and female roles are strictly defined: where the man sees himself as husband, father, and provider and the woman sees herself as wife, mother, and nurturer. Infertility obviously prevents these couples from fulfilling the primary roles they have defined for their lives.

Statements 7 through 20 will help you identify why you want or need a baby. Your answers will tell you, for example, if you want a baby so you can perpetuate your genes, so you can prove that you are virile or feminine, so you can bring meaning to your life, and/or so you can regain power over your body and destiny once more. Your motives are very important in choosing the "right" happy ending.

As you evaluate your answers to this section, you may wish to examine some of your other answers to determine (I) whether your life-style needs fit the traditional role, (2) whether you may be responding to external pressures (the needs of others) more than to your own, and (3) whether you have strong parenting and nurturing needs. I find that people who see life without children as purposeless usually believe that they are responding to internal needs and personal goals. In actual fact, they may be placing a higher value on their family's and society's expectations than they are on their own needs. This was the situation in Debbie's case. Debbie told me that her mother had frequently said to her, "Something's wrong with you if you don't want your own children." (See "External Pressures" below.) If you understand the source of your motives, you will better understand the source of your discomfort and stress.

If you truly feel powerless and that life is meaningless, you may need professional counseling to help you avoid episodes of anxiety and depression. Shelley told me, "I'm certain that Michael and I are still married today because of the help we received through our RESOLVE support group."

Many of the answers in this section will help you decide which happy ending is best for you. Armed with this knowledge, you can design a plan with your physician that will best meet your needs.

LIFESTYLE NEEDS (Statements 21-38)

Our society tends to praise and value the traditional family and frown on a childfree life-style. In reality, however, life-style needs are as valid a concern as any basic biological need.

For some the arrival of a baby makes life complete. For others the rewards of parenting will never be as satisfying as the lives they led before having a baby: lives of spontaneity, of freedom, of personal control. However, few couples with fertility problems pause to ask themselves if they really want a baby or a pregnancy.

A baby changes your life as much as or more than marriage itself. Baby will interrupt your sleep, your schedule, your private time, and your lovemaking. For most infertile couples the prospect of altering their lives to include a baby is a joyful goal. Planning will help smooth out the uncertainties during fertility treatment and after the new arrival.

Statements 21 through 38 will help you decide if you are ready to bring a baby into your life—to settle down into a different life-style—and if you are financially able to support a new family member. By comparing your answers, you'll discover whether both of you share the same life-style needs.

Bryan and Debbie got into quite a tangle when he said he wanted to continue their sailing, skiing, and traveling while she wanted to save so she could quit work and stay home with the baby: "We'd always had trouble managing our money. And if I quit, we would have to have a nest egg. After we talked about it, we decided to set aside a percentage of our income. Actually, Bryan gave up buying the sailboat he wanted and we joined a sailing club so we can rent a boat anytime we want."

Kathy's answers indicated that she wasn't ready to give up her amateur running status. "When Steven and I talked about how important my physical, competitive, and social needs were to me, he stopped bugging me about quitting. Once I was relieved of my guilt, I could proceed with an aggressive treatment program—one that eventually resulted in my pregnancy."

Compare your answers with your spouse's. Explore how your fertility treatment will affect your life-style. How will it affect your career? Your finances? Your travel? Are you willing to adjust these aspects of your life for a prolonged period of treatment? And if your fertility treatment is successful, how will the baby fit into your life?

EXTERNAL PRESSURES (The Needs of Others) (Statements 39-62)

I find that infertile couples (as well as those who decide to remain childless) often feel that full adulthood cannot be achieved without bearing children, and that remaining childless is a sign of immaturity, selfishness, failure, and instability.

Steven's answers revealed some startling facts. Coming from a large traditional family, Steven felt that he would not truly be a man until he fathered children. Steven's dad was a very devoted family man and Steven had many fond memories of their weekends working and playing together. Steven couldn't imagine life without sons and daughters to help fill his non-working hours. Kathy was shocked with Steven's answers: "All along I thought that Steven's 'poor' sexual performance was because he didn't really want children. When I discovered that it had to do with his self-image and not his desire for children, it shed a whole new light on our problem. One we could deal with."

Your family may exert a number of pressures on you to have a baby. Your parents may want to become grandparents. Or they may want you to continue the family lineage and name. If you seem to be overly concerned about what your family thinks and/or how to relate to them, you will be especially interested in reading chapter 20, Awaiting Your Miracle Baby. And you may wish to show your family "A Letter to Family and Friends".

Not having a baby makes you different much as being single, being unemployed, or being handicapped makes you different. "Different" people must cut their own paths, define their own roles, and even defend their individuality to family, friends, and co-workers. It' s little wonder that couples having fertility problems often seem driven to conquer their infertility their "difference."

Richard and Margaret found it more and more difficult to relate to their close friends, all of whom had children. "I don't have anything in common with them," Margaret told me. "I want to talk about my most recent business trip and my girlfriend wants to talk about Andrew's preschool." Their answers to the test showed a strong need to belong to fit into the community.

Compare how you and your spouse answer these statements. See how influenced you are by what others think. If you find you are more concerned with fulfilling the needs of your parents and society than with identifying your own needs, you may want to get your priorities in order.

When my patients begin to discuss how these social pressures control their emotions and actions, their decisions often turn completely around. Michael and Shelley, for example, discussed why going home for Christmas was the last thing Shelley wanted to do. "Holding my sister's new baby would be too much for me," Shelley said. "After talking it over, we gave ourselves permission to vacation in Hawaii instead."

Once my patients realize why outsiders have such an influence on their lives, they can handle comments from relatives, friends, and co-workers with a more positive view. And they remain true to their own convictions instead of bowing to external pressures.

PARENTING AND NUTURING NEEDS (Statements 63-70)

This section of the test will help you explore how you feel about children. Do you want to care for them, play with them, discipline them, and teach them—for the next twenty years? For some this sounds like an awesome task; for others it sounds like a dream come true.

Not everyone enjoys diaper changing and 2:00 A.M. feedings. So if you are still ambivalent about having a baby or have doubts about your ability to care for a tiny tot, count yourself as part of the human race.

If like Margaret and Richard your answers show that you like to play with children, that you like to feed, diaper, and bathe children, and that you believe you'll make a good parent, I wouldn't worry too much about your motives for having children. These statements should confirm what you already know that you want to love and care for a child and, perhaps most of all, you want to have fun with a family of your own.

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