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In her presentation to the American Academy of Psychoanalysis Jennifer Downey (1991) explored why in her many years of practice and doing research on the mental health effects of infertility on women, she had not had the opportunity to treat psychoanalytically any infertility patients. This appeared all the more unusual in light of the enormous stress and suffering these women experience and the readiness of many gynecologists to refer them for psychological help.
As a therapist who has specialized for almost 10 years in the area of reproductive loss, I can report similar observations. In my clinical sample of 20 cases of women presenting with psychological problems following pregnancy loss (Leon, 1990), six women left treatment during the consultation or soon after therapy began. Of these six, five were coping with infertility before or after their pregnancy loss. Most importantly, these five were the only infertile women in my sample. There would appear to be something about the experience of infertility that interferes not only with undertaking psychoanalytic, uncovering therapy or analysis, but even a more limited, short-term, psychoanalytically informed treatment. This approach appears to be effective for women coping with a discrete pregnancy loss such as miscarriage, stillborn, or neonatal death (Leon, 1987, 1990). Dr. Downey's observation that the all-consuming involvement in medical treatment for infertility leaves little energy for psychic investigation seems accurate. Even when medical treatments are ended and emotional pains endure, however, psychoanalytic psychotherapy is rarely chosen as an option.
This article considers why reproductive loss may remain so elusive among psychoanalytic investigators. It is most definitely not because these losses are uncommon. If we combine all reproductive losses—pregnancy and newborn loss, pregnancy