The social and cultural basis of medicalisation is explored through an examination of infertility, a social condition that has recently been recast as a disease. Infertility illustrates a basic dilemma of medicalisation: the health care system reflects the same value system at work throughout society. Placing social problems within a biomedical framework does not provide a satisfactory solution for conditions that deviate from cultural norms because those norms are replicated in biomedical ideologies about the nature and treatment of disease. We examine three phases of this dilemma through an analysis of data collected in in-depth interviews with 43 American couples who were undergoing infertility treatment: 1) the disparity between initial expectations about ease and speed of treatment and its actual complexity, 2) the confrontation with medical definitions of abnormality, and 3) the cumulative effects of treatment, in which emotional exhaustion from infertility treatment vies with the continuing need to ‘fix’ the infertility and produce a pregnancy. We conclude that individuals' efforts to eradicate feelings of abnormality for their childlessness by lending medical legitimacy to their failure to conceive are undermined by entering a medical system in which concepts of disease and abnormality are implicit.