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Thus for Koh, the only solution to infertility was penitence: "I would pray at night and cry at night, 'I'm so sorry for what I've done; please don't punish me.'"

In the two years since, Koh has come to a different understanding of God's role in her infertility. "I've realized God doesn't punish people," she says now. But Koh's two interconnected struggles -- with infertility and with God -- are representative of the issues faced by many other deeply religious people for whom the physical reality of infertility often precipitates a spiritual crisis as well.

Also Today Don't call me Mrs. When the local Catholics couldn't face my surname, I went church shopping. By Donna Cornachio

Certainly infertility presents a crisis to any couple who wishes -- and expects -- to have children. But infertile couples who are committed to an orthodox religious ideology and who are part of a tightknit religious community may find that their faith presents additional problems in their quest for a pregnancy. They often face added pressure to have children, based on church doctrine. They may also have to grapple with rules that can inhibit certain fertility practices: Roman Catholics have prohibitions against in vitro fertilization; Jews have prohibitions against masturbation, which may be necessary for certain procedures.

Some may find solace in God and community, but for many, like Koh, God is seen as just another barrier standing in the way of a woman and her coveted pregnancy.

"The very religious patients or the ones brought up in the most religious homes have the hardest time with infertility," says Alice Domar, director of the Mind/Body Center for Women's Health at Boston's Beth Israel Deaconess Hospital. "Women who truly believe they are being punished for their sins, who believe in a punitive God, will be the worst off."

Domar and Barbara Nielsen, an Episcopal priest and a fellow at the center, are launching a study to document the correlation between a couple's religious commitment and their level of depression over infertility. Working with a Boston in vitro fertilization clinic, they will survey several hundred infertile women.

But they already have a strong hunch about what they will prove. Domar estimates that more than half of the hundreds of infertile patients she has counseled over the years said that their infertility evoked negative thoughts about God -- a situation Domar says she felt "completely unprepared to deal with."

Nielsen already has conducted a preliminary study, interviewing 12 infertile women. The results backed up the pair's hypothesis that deep religious faith exacerbates depression in infertile couples. She found that infertility made these patients question virtually everything they had previously believed -- making it the worst spiritual crisis of their lives.

"They feel as if they'd been robbed of their birthright," Nielsen says. And being part of a large religious community often failed to help: Religious women often face implicit and explicit expectations -- embodied in community standards and biblical commands -- that they will have large families. Community members' well-intentioned but ultimately insensitive comments to married couples -- "When are we going to hear some good news?" -- make the situation even worse.

Next page | "Be fruitful and multiply"