A 33-month longitudinal study was conducted with 38 infertile couples making the transition to biological childlessness after unsuccessful fertility treatments. Changes in their levels of psychological distress; marital, sexual, and life satisfaction; and self-esteem were examined. Increased self-esteem and decreased sexual satisfaction were evident over time. Poorer adjustment was related to having none or few available options, little social support, poor emotional and physical health, and reliance on emotion-focused coping. Participants who adopted demonstrated better adjustment.