This paper revives an issue dormant in recent psychoanalytic literature—that of psychogenic causes of infertility. Modern technology to overcome anatomic or physiological blocks to fertility has probably contributed to the assumption that the psychogenic issue is obsolete. However, a broader perspective on the vicissitudes of pregnancy and motherhood in women who have particular psychological problems warrants reconsideration of the rationale for psychoanalytic evaluation and treatment. Three case presentations illustrate similar psychological issues that may interfere with the ability or wish to conceive. A hitherto unreported commonality in these cases is conscious and unconscious guilt and hostility toward a defective or deceased male sibling.