The cost of coping with infertility: Extending theory on stressor appraisal

Despite research on the workplace challenges of pregnancy, there has been notable inattention toward those struggling to become pregnant-women experiencing infertility (one of the most stressful and life-altering experiences women endure that affects around 13% of women of childbearing age). From the perspective of transactional stress theory, a coping response that addresses the cause of infertility (assisted reproductive technology treatment, ART) should reduce anxiety. However, for millions of working women coping with infertility via treatment, their anxiety persists, with consequences for occupational prestige and income. This divergence between scholarly consensus on coping and the lived experience reflects a puzzle with theoretical, practical, and societal implications. To reconcile this, we explain that the consensus is misaligned with the fundamental tenets of transactional stress theory. We posit that the cost of treatment creates a context whereby its efficacy for coping is hindered-a phenomenon called financial toxicity. We hypothesize that insurance may detoxify infertility treatment and reduce anxiety as predicted. Across two studies (an Australian longitudinal panel data set [N = 2,728] and a cross-sectional U.S. survey [N = 192]), we triangulate tests of our hypotheses and find support for our arguments. We discuss implications for transactional stress theory and illustrate how scholars can expand their conceptualization of coping to consider its potential toxicity. We further call attention to the critical societal and public policy implications of our findings, and we provide a roadmap with clear and actionable solutions. (PsycInfo Database Record (c) 2026 APA, all rights reserved).