Abstract
This exploratory and descriptive qualitative case study examined how religious beliefs shaped decision-making and emotional experiences in a couple facing infertility who refused assisted reproductive technologies (ART), with particular attention to moral distress concerning embryo status and the psychosocial implications of treatment refusal. Psychological follow-up in the context of reproductive counseling involved a heterosexual couple and a potential gestational carrier. Data were obtained from semi-structured interviews and projective graphic techniques within the House-Tree-Person framework, emphasizing human figure and family drawings. Interpretive qualitative analysis was used to identify thematic categories and integrate narrative data with psychological assessment material. Three central processes emerged: moral distress anchored in the perceived moral status and anticipated fate of surplus embryos; value-based boundary-setting, in which embryo donation or disposal was considered morally unacceptable; and relational coping characterized by asymmetrical expressions of distress within the couple. Psychoeducation elicited repeated questions about embryo status, the number of embryos transferred, cryopreservation, and uterus transplantation, which functioned as markers of moral conflict. Projective material was interpreted as consistent with vulnerability, perceived impotence, and conflict between life projects and moral imperatives. In this case, religiosity operated not only as a coping resource but also as a decisive framework that constrained acceptable reproductive options. Clinicians should provide non-coercive, empathic, and value-sensitive counseling that supports informed refusal while addressing grief, identity disruption, and moral distress.