Richard Frank, “What the Adoption Worker Should Know About Infertility,” 1956

In the course of this brief review of infertility and its treatment, Richard Frank, the Medical Director of Planned Parenthood in Chicago, mentioned the work of John Rock, who studied the question of whether or not adoption might be a “cure” for infertility.

The question frequently arises as to when a couple should consider undergoing an infertility investigation, and it is usually accepted that one year of married life without use of contraceptives should pass, before an infertility work-up should be started. Another question raised is how long a couple should remain under investigation or treatment? If a factor or factors are found that will make conception impossible, the couple should be so advised and the investigation terminated. There are definite limits to our therapeutic ability, and it must be clearly stated that the use of hormones to produce or increase sperm production is strictly experimental, and that no sound basis exists at this time for such treatment. The same pertains to any hormonal treatment of absence of ovulation. There is today no known hormone which will, in the human female, stimulate or produce ovulation. In our endeavor to find such agents, we conduct clinical research in the course of which patients are given hormones. They must understand, however, that such treatment is entirely experimental and should be used only after all conventional means of treatment have failed.

If all tests are within the range of normal, the period of observation should extend over six to twelve months. During this time the above-mentioned steps toward improving the various factors are taken. At the end of that period, it is usually advisable to have a conference with the couple, explaining the satisfactory outcome of the study, and pointing out to them that another six to twelve months should pass without the possible anxieties involved in monthly observations and tests. If at the end of that period, now a total of three years, no pregnancy has occurred, plans for adoption should be discussed.

The term “functional infertility” is frequently used in lieu of a better term for a childless couple who have undergone all infertility tests and the entire period of observation without bringing to light any organic or physiological pathology. And still no pregnancy occurs. It is in such couples especially, that we look for psychological reasons of the infertility. The field of the psychological influence on infertility is practically untouched. Even though almost everybody knows some couple who achieved a pregnancy after adopting a baby and tries to make the adoption responsible for the “relief of tension” which caused the pregnancy, the work of Rock and others put these experiences in the category of “chance.” There is no question that many an infertile couple has psychological difficulties; it can also hardly be denied that undergoing an infertility study over a prolonged period of time and wanting a child desperately, can scarcely prevent the average couple from becoming anxious. . . .

If infertility factors are presented as the basis of the adoption request, it seems logical that a strict yardstick must be applied to the evaluation of the results as they are presented to the agency. A detailed medical questionnaire should be returned by every applying couple. . . . Agencies would do well to have on their staff a consultant gynecologist, who is an interested expert in infertility. The adoption worker should have occasion to discuss the infertility picture of every applicant with this consultant. It seems furthermore feasible that every adoption agency should have on hand a referral list of gynecologists who are interested in infertility and willing to cooperate with the agency to obtain or to complement the necessary study, so that couples are not deprived of the possibility of natural parenthood because they have been unable on their own to find a competent infertility expert.

Source: Richard Frank, “What the Adoption Worker Should Know About Infertility” in Michael Schapiro, A Study of Adoption Practice, A Study of Adoption Practice, Volume II: Selected Scientific Papers Presented at the National Conference on Adoption, January, 1955 (New York: Child Welfare League of America, 1956), 117-118.
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