The experience of infertility: a review of recent literature

Emoting infertility online: A qualitative analysis of men's forum posts

Relatively little research on infertility focuses exclusively or significantly on men's experiences, particularly in relation to emotional aspects. Evidence that does exist around male infertility suggests that it is a distressing experience for men, due to stigma, threats to masculinity and the perceived need to suppress emotions, and that men and women experience infertility differently. Using thematic analysis, this article examines the online emoting of men in relation to infertility via forum posts from a men-only infertility discussion board. It was noted that men 'talked' to each other about the emotional burdens of infertility, personal coping strategies and relationships with others. Three major themes were identified following in-depth analysis: 'the emotional rollercoaster', 'the tyranny of infertility' and 'infertility paranoia'. This article then offers insights into how men experience infertility emotionally, negotiate the emotional challenges involved (especially pertaining to diagnosis, treatment outcomes and their intimate relationships) and how they share (and find value in doing so) with other men the lived experience of infertility.

Cross-border-assisted reproduction: a qualitative account of UK travellers' experiences

Surveys on patients' experiences of cross-border fertility treatment have reported a range of positive and challenging features. However, the number of such studies is limited, and there is no detailed qualitative account of the experiences of UK patients who travel overseas for fertility treatment. The present study used a cross-sectional, qualitative design and in-depth interviews. Fifty-one participants (41 women and 10 men, representing 41 treatment 'cases') participated in semi-structured interviews. The experiences reported were broadly positive with a large proportion of participants (39 cases, 95%) citing a favourable overall experience with only two cases (5%) reporting a more negative experience. Thematic analysis revealed 6 major categories and 20 sub-categories, which described the positive and challenging aspects of cross-border fertility travel. The positive aspects were represented by the categories: 'access', 'control' and 'care and respect'. The more challenging aspects were categorized as 'logistics and coordination of care', 'uncertainty' and 'cultural dissonance'. The study confirms findings from others that despite some challenges, there is a relatively high level of patient satisfaction with cross-border treatment with participants able to extend the boundaries of their fertility-seeking trajectories and in some cases, regain a sense of control over their treatment.

Cross-cultural comparison of fertility specific quality of life in German, Hungarian and Jordanian couples attending a fertility center

BACKGROUND

Only a few studies have reported cross-cultural comparisons regarding psychosocial consequences of infertility. Differences between societies with different cultural backgrounds were revealed and seemed to be based on the importance of pronatalism. Our aim was to measure cross-cultural differences in fertility specific quality of life of infertile couples in Germany, Hungary and Jordan who attend a fertility center in a cross-sectional study.

METHODS

A cross-sectional study was conducted in one fertility clinic in Germany, in five fertility clinics in Hungary and in one fertility clinic in Jordan. Overall 750 couples (252 couples in Jordan, 246 couples in Germany and 252 couples in Hungary) attending the first medical infertility consultation were asked to fill out our questionnaire set. Fertility specific quality of life (FertiQoL) and sociodemographic differences were measured between couples from three countries.

RESULTS

Jordanian couples had the shortest relationship (5.8 ± 4.3 yrs.), though they reported the longest duration of child wish (4.2 ± 3.6 yrs.) and fertility treatments (3.0 ± 3.3 yrs.). The proportion of high education was considerably higher in Jordanian women and men (60 % and 66 %, respectively) compared to the other two samples. First, marked cross-country differences were obtained on Emotional, Mind/Body and Relational subscales of the FertiQoL, indicating that Jordanian couples reported poorer fertility-related quality of life than Germans and Hungarians (p < 0.001). After controlling for the sociodemographic and medical variables, a significant difference only in the Emotional domain was observed (p < 0.001).

CONCLUSIONS

The study revealed only a few cultural based differences in fertility specific quality of life between the couples of the three countries. Thus, infertility counselors should pay attention to psychosocial problems rooted in individual sociocultural aspects of the infertile couple regardless of cultural stereotypes. Further studies should identify sociocultural factors within different subgroups of infertile patients instead of focusing different societies as a whole because intra-cultural psychosocial differences in experiencing infertility seem to be more important for the individual patient than intercultural differences.

Cross-cultural comparison of fertility specific quality of life in German, Hungarian and Jordanian couples attending a fertility center

Background

Only a few studies have reported cross-cultural comparisons regarding psychosocial consequences of infertility. Differences between societies with different cultural backgrounds were revealed and seemed to be based on the importance of pronatalism. Our aim was to measure cross-cultural differences in fertility specific quality of life of infertile couples in Germany, Hungary and Jordan who attend a fertility center in a cross-sectional study.

Methods

A cross-sectional study was conducted in one fertility clinic in Germany, in five fertility clinics in Hungary and in one fertility clinic in Jordan. Overall 750 couples (252 couples in Jordan, 246 couples in Germany and 252 couples in Hungary) attending the first medical infertility consultation were asked to fill out our questionnaire set. Fertility specific quality of life (FertiQoL) and sociodemographic differences were measured between couples from three countries.

Results

Jordanian couples had the shortest relationship (5.8 ± 4.3 yrs.), though they reported the longest duration of child wish (4.2 ± 3.6 yrs.) and fertility treatments (3.0 ± 3.3 yrs.). The proportion of high education was considerably higher in Jordanian women and men (60 % and 66 %, respectively) compared to the other two samples. First, marked cross-country differences were obtained on Emotional, Mind/Body and Relational subscales of the FertiQoL, indicating that Jordanian couples reported poorer fertility-related quality of life than Germans and Hungarians (p < 0.001). After controlling for the sociodemographic and medical variables, a significant difference only in the Emotional domain was observed (p < 0.001).

Conclusions

The study revealed only a few cultural based differences in fertility specific quality of life between the couples of the three countries. Thus, infertility counselors should pay attention to psychosocial problems rooted in individual sociocultural aspects of the infertile couple regardless of cultural stereotypes. Further studies should identify sociocultural factors within different subgroups of infertile patients instead of focusing different societies as a whole because intra-cultural psychosocial differences in experiencing infertility seem to be more important for the individual patient than intercultural differences.

Does fertility-specific distress vary by race/ethnicity among a probability sample of women in the United States?

This study explored whether fertility-specific distress varied by race/ethnicity among a nationally representative sample of US women. Participants were 2363 White (n = 1266), Black (n = 569), Hispanic (n = 453), and Asian (n = 51) women who participated in the National Survey of Fertility Barriers. Participants were given the Fertility-Specific Distress Scale and assessed for strength of pregnancy intent, primary versus secondary infertility, and socioeconomic hardship. Black women reported lower levels of fertility-specific distress than White women, but these were fully mediated by the strength of pregnancy intentions. Primary versus secondary infertility and economic hardship were not associated with fertility-specific distress.

From Infertility to Successful Third-Party Reproduction: The Trajectory of Greek Women

The purpose of our phenomenological hermeneutic study was to explore the lived experiences of Greek infertile women who achieve a pregnancy through the use of sperm, oocyte, or embryo donation or surrogate motherhood. Semistructured interviews were conducted with 15 infertile women. Findings suggest that conceiving a child through assisted reproductive technologies (ART) is lived as a highly distressing experience, comprising long waiting periods for medical results, several failed attempts, and treatment options with uncertain outcomes. The analysis of women's accounts revealed a constitutive pattern, journeying between hope and despair, and three associated themes: (a) coping with uncertainty and treatment failures, (b) exploring options and decision making, and (c) being supported by spouse and professionals. Findings illuminate the specific meaning-based coping processes, decision-making patterns, and sources of support that help women who pursue treatment until they give birth to a child, to manage highly stressful situations and critical decisions.

Effects of a mindfulness-based intervention on fertility quality of life and pregnancy rates among women subjected to first in vitro fertilization treatment

Generally, undergoing an in vitro fertilization (IVF) treatment is an emotional and physical burden for the infertile woman, which may negatively influence the treatment outcome. We conducted a study to investigate the effectiveness of a mindfulness-based intervention (MBI) among women subjected to first IVF treatment at a fertility medical center in China. Among infertile women registered for their first IVF treatment, 58 completed the intervention, and 50 were assigned to a control group using a non-randomized controlled study. Standardized measures of mindfulness, self-compassion, emotion regulation difficulties, infertility-related coping strategies and fertility quality of life (FertiQoL) were endorsed pre- and post-MBI, and measure of pregnancy rates at the sixth months after the intervention. Both groups were shown to be equivalent at baseline. By the end of the intervention, women who attended the intervention revealed a significant increase in mindfulness, self-compassion, meaning-based coping strategies and all FertiQoL domains. Inversely, they presented a significant decrease in emotion regulation difficulties, active- and passive-avoidance coping strategies. Women in the control group did not present significant changes in any of the psychological measures. Moreover, there were statistically significant differences between participants in the pregnancy rates, the experiment group higher than the control group. Being fully aware of the present moment without the lens of judgment, seems to help women relate to their infertility and IVF treatment in new ways. This is beneficial for promoting their self-compassion, adaptive emotion regulation and infertility-related coping strategies, which, in turn, may influence the FertiQoL and pregnancy rates. The brief and nonpharmaceutical nature of this intervention makes it a promising candidate for women' use during first IVF treatment.

The Effectiveness of Emotionally Focused Couples Therapy on Sexual Satisfaction and Marital Adjustment of Infertile Couples with Marital Conflicts

BACKGROUND

The purpose of this investigation is to determine the efficacy of emotionally focused couples therapy (EFT-C) on enhancement of marital adjustment in infertile couples.

MATERIALS AND METHODS

This was a semi-experimental study with a pre- and post-test design. We selected 30 infertile couples (60 subjects) by purposive sampling. Couples were randomly assigned to two groups, sample and control. Each group consisted of 15 couples who had marital maladjustment and low sexual satisfaction. Couples answered the marital adjustment and sexual satisfaction questionnaires at baseline after which the sample group received 10 sessions of EFT-C.

RESULTS

Results of pre-test and post-test showed that EFT-C significantly impacted marital adjustment and sexual satisfaction.

CONCLUSION

EFT-C had a significant effect on enhancement of satisfaction, cohesion and affectional expression. This approach impacted physical and emotional sexual satisfaction of infertile couples.

Temporal Trends in Fertility Rates: A Nationwide Registry Based Study from 1901 to 2014

Objective

Increasing age at first childbirth has been suggested to increase the risk for infertility. Our objective is to determine whether women above thirty years of age historically have been able to sustain fertility rates above replacement level.

Design

A descriptive nationwide Danish study using birth registries from 1901–2014.

Setting

Information on women’s age at childbirth was obtained by using records from primary, secondary and tertiary institutions.

Participants

Mothers to 8,024,969 live births.

Main outcome measures

Mothers were stratified according to age at childbirth to determine total and age specific fertility rates.

Results

Total fertility rate (TFR) decreased from 4.1 to 1.8 children per woman and age specific fertility also decreased from 1901 to 2014. Women aged 30–34, 35–39 or 40–44 years in the first decade of the 20th century had higher fertility rates than the corresponding five year younger age groups (25–29, 30–34 and 35–39, respectively) have had for the last 65 years. On average, women gave birth to two children after the age of 30 and one or more child after 35 years of age in the beginning of the 1900s. Furthermore, women more than 40 years of age accounted for 10% of TFR in 1901 compared with 4% in 2014 despite usage of assisted reproduction.

Conclusion

This nationwide study shows that women above 30 years of age historically have been able to sustain fertility rates above replacement level. This implies that other factors besides age are strong determinants of fertility in women above 30 years of age.

Cognitive emotional consequences of male infertility in their female partners: a qualitative content analysis

INTRODUCTION

Infertility, as a global phenomenon and one of the most important issues of reproductive health, affects women more often than men, even when the infertility is due to a male factor. The purpose of this study was to explore the cognitive emotional experiences of women faced with male infertility.

METHODS

This qualitative study was conducted in 2014-2015 in Mashhad, Iran. The perceptions and experiences of healthy women whose husbands were diagnosed with primary male factor infertility were investigated using a qualitative content analysis approach. Participants were selected through purposeful sampling, and data collection was conducted using in-depth semistructured interviews. Data were analyzed using conventional content analysis with MAXqda software. Study rigor was verified via criteria proposed by Lincoln and Guba.

RESULTS

One main theme emerged through analysis entitled "cognitive emotional reactions confronting infertility diagnosis" with sub-themes of cognitive emotional reactions when confronted with male infertility diagnosis with subthemes of disbelief and denial, fear and apprehension, suffering and emotional distress, disappointment, frustration, confusion, and joy.

CONCLUSION

The diagnosis of male infertility was associated with important emotional cognitive consequences for their female partners. Emotional support, providing new insights into how to treat the issue, and trying to shorten the process of diagnosis are necessary for these women. This kind of support could reduce the psychological effects of confrontation with the diagnosis of male infertility, including social insecurity for women.

The Effectiveness of Emotionally Focused Couples Therapy on Sexual Satisfaction and Marital Adjustment of Infertile Couples with Marital Conflicts

Background

The purpose of this investigation is to determine the efficacy of emotionally focused couples therapy (EFT-C) on enhancement of marital adjustment in infertile couples.

Materials and Methods

This was a semi-experimental study with a pre- and post-test design. We selected 30 infertile couples (60 subjects) by purposive sampling. Couples were randomly assigned to two groups, sample and control. Each group consisted of 15 couples who had marital maladjustment and low sexual satisfaction. Couples answered the marital adjustment and sexual satisfaction questionnaires at baseline after which the sample group received 10 sessions of EFT-C.

Results

Results of pre-test and post-test showed that EFT-C significantly impacted marital adjustment and sexual satisfaction.

Conclusion

EFT-C had a significant effect on enhancement of satisfaction, cohesion and affectional expression. This approach impacted physical and emotional sexual satisfaction of infertile couples.

The Experience of Chinese Couples Undergoing In Vitro Fertilization Treatment: Perception of the Treatment Process and Partner Support

Background

Couples undergoing In Vitro Fertilization (IVF) Treatment suffer as dyads from the stressful experience of the painful treatment and the fear that the IVF cycle will fail. They are likely to report that their marital relationship has become unstable due to the prolonged period of treatment.

Methods

This is a qualitative study that was conducted to explore the experiences that Chinese couples have had with IVF treatment, especially their perceptions of the process and the support between couples.

Results

The interviews revealed that couples suffered from the process, experiencing physical and emotional pain, struggling with the urgency and inflexibility of bearing a child, and experiencing disturbances in their daily routines and work. The participants described how they endured the hardships as a couple and how it affected their relationship. The couples felt that sharing feelings and supporting each other contribute to psychological well-being and improves the marital relationship. They also identified some unfavorable aspects in their partner relationship. They were ambivalent about receiving social support from friends and family members.

Conclusions

With the couples indicating that the support that they received from each other affected their experience during the treatment process, it is suggested that a supportive intervention that focuses on enhancing the partnership of the couples and dealing with their inflexibility on the issue of bearing a child might result in improvements in the psychological status and marital relationship of infertile couples undergoing IVF treatment.

Sexual behavior of infertile women: a qualitative study

BACKGROUND

Infertility makes an essential challenge to the sexual life of couples, especially infertile women. When pregnancy does not happen, infertile women think that sexual intercourse is not fruitful and sexual desire became reduce gradually. Infertile women progressively forget that their sexual relationship is also a response to their natural need.

OBJECTIVE

This qualitative study was conducted to explore the infertility consequences in the sexual behavior of infertile women.

MATERIALS AND METHODS

This was a qualitative content analysis study; and it was part of a widespread study, used a sequential mixed-method and conducted from August 2014 until February 2015. A purposeful sampling was used to recruit infertile women who had referred to Yazd Research and Clinical Center for Infertility. Data gathering techniques employed in this research included in-depth semi structured open face-to-face interviews and field notes. Credibility, transferability, confirm ability, and dependability were assessed for the rigor of the data collection.

RESULTS

Totally, 15 infertile women and 8 key informants were interviewed. Data analysis showed four themes about impact of infertility on female sexual behavior: 1/ Impact of infertility drugs on couple sexual behavior, 2/ Impact of assisted reproductive technologies on female sexual behavior, 3/ Timed intercourse during infertility and 4/ The psychological impact of infertility on sexual behavior.

CONCLUSION

Some of Iranian infertile women could cope with their problems, but some of them were very affected by infertility drugs and assisted reproductive technologies procedures. Psychosexual counseling before medical treatment could help them to have a better sexual life.

Evolution of psychology and counseling in infertility

Five key paradigm shifts are described to illustrate the evolution of psychology and counseling in infertility. The first paradigm shift was in the 1930s when psychosomatic concepts were introduced in obstetrics and gynecology as causal factors to explain why some couples could not conceive despite the absence of organic pathology. In the second shift, the nurse advocacy movement of the 1970s stimulated the investigation of the psychosocial consequences of infertility and promoted counseling to help couples grieve childlessness when medical treatments often could not help them conceive. The third shift occurred with the advent of IVF, which created a demand for mental health professionals in fertility clinics. Mental health professionals assessed the ability of couples to withstand the demands of this new high technology treatment as well as their suitability as potential parents. The fourth shift, in the 1990s, saw reproductive medicine embrace the principles of evidence-based medicine, which introduced a much more rigorous approach to medical practice (effectiveness and safety) that extended to psychosocial interventions. The most recent paradigm shift, in the new millennium, occurred with the realization that compliance with protracted fertility treatment depended on the adoption of an integrated approach to fertility care. An integrated approach could reduce treatment burden arising from multiple sources (i.e., patient, clinic, and treatment). This review describes these paradigm shifts and reflects on future clinical and research directions for mental health professionals.

[Relationships between psychological well-being, lifestyle factors and fertility]

INTRODUCTION

10 to 15% of the Hungarian fertile age population struggles with reproductivity problems. Previous researches have shown that psychological well-being and lifestyle factors play a pivotal role in overall health status, which is closely related to fertility.

AIM

The aim of the study was to examine fertility-related psychological and lifestyle factors in a Hungarian sample.

METHOD

194 women (115 infertile and 79 fertile) took part in the study. Standardized, validated questionnaires were used for the assessment of psychological factors and self-administered questions were used for exploring lifestyle factors.

RESULTS

The results show that infertile women are younger (33.98±4.89 vs. 36.43±5.81 years, p<0.005) and their psychological status is significantly worse compared to their fertile counterparts. The number of their depressive (BDI 14.00±12.21 vs. 7.79±9.17, p<0.005) and anxiety symptoms is higher (STAI-T 48.53±10.56 vs. 40.25±10.65, p<0.005) compared to fertile women. Findings related to lifestyle factors show that lower level of fluid consumption (1.71±0.67 vs. 1.95±0.68, p<0.05) and diet (31.30% vs. 18.42%, p<0.05) is significantly related to infertility. In this sample higher level of fluid consumption was associated with the fertile group (OR = 1.65, CI = 2.58-1.06), independently of body mass index and age.

CONCLUSIONS

The results confirm the findings of international researches showing that women struggling with infertility are in worse psychological condition than their fertile counterparts. The authors conclude that the findings demand further investigations and follow-up studies in order to more specifically determine the relationship between fluid consumption and fertility.

Views of Swedish commissioning parents relating to the exploitation discourse in using transnational surrogacy

Transnational surrogacy, when people travel abroad for reproduction with the help of a surrogate mother, is a heavily debated phenomenon. One of the most salient discourses on surrogacy is the one affirming that Westerners, in their quest for having a child, exploit poor women in countries such as India. As surrogacy within the Swedish health care system is not permitted, Swedish commissioning parents have used transnational surrogacy, and the majority has turned to India. This interview study aimed to explore how commissioning parents negotiate the present discourses on surrogacy. Findings from the study suggest that the commissioning parents' views on using surrogacy are influenced by competing discourses on surrogacy represented by media and surrogacy agencies. The use of this reproductive method resulted, then, in some ambiguity. Although commissioning parents defy the exploitation discourse by referring to what they have learnt about the surrogate mother's life situation and by pointing at the significant benefits for her, they still had a request for regulation of surrogacy in Sweden, to better protect all parties involved. This study, then, gives a complex view on surrogacy, where the commissioning parents simultaneously argue against the exploitation discourse but at the same time are uncertain if the surrogate mothers are well protected in the surrogacy arrangements. Their responses to the situation endorse the need for regulation both in Sweden and India.

Disclosure strategies, social support, and quality of life in infertile women

STUDY QUESTION

Do the strategies women use to disclose information about their infertility to social network members impact the quality of the support they receive and their quality of life?

SUMMARY ANSWER

The data showed that women who disclosed infertility-related information in direct ways, rather than in indirect ways (e.g. by incremental disclosures or through third parties), to social network members perceived higher quality support and reported greater quality of life related to their infertility experience.

WHAT IS KNOWN ALREADY

Social support has been shown to buffer stress associated with various health issues including infertility. The way people disclose information about stressors has been associated with the quality of the support they receive. Disclosing information in a way that most effectively elicits support is beneficial because women with infertility who have lower levels of stress are more likely to seek and remain in treatment.

STUDY DESIGN, SIZE, DURATION

This cross-sectional study of 301 infertile women was conducted in the USA.

PARTICIPANTS/MATERIALS, SETTING, METHODS

To determine the variation in length of infertility and treatment decisions, we conducted an online survey of 301 American women coping with infertility. We investigated the strategies women used to disclose infertility-related information with social network members, their perceptions of support from friends and family, and their quality of life both in general (overall quality of life) and related to the experience of infertility (fertility quality of life).

MAIN RESULTS AND THE ROLE OF CHANCE

Direct disclosure of experiences related to infertility was positively and significantly associated with the perceived quality of social support received (P < 0.01). Strategies of disclosure that use entrapment or indirect media were negatively associated with fertility quality of life (P < 0.001). Directly (P < 0.01) and incremental disclosures (P < 0.01) were positively associated with overall quality of life, while the use of humor was negatively associated with overall quality of life (P < 0.01). Perceived support quality also mediated the influence of direct disclosures on women's fertility quality of life (95% CI: 0.18, 1.05) and overall quality of life (95% CI: 0.10, 0.30). This effect is particularly noteworthy for the model predicting fertility quality of life, which exhibited a non-significant main effect with direct disclosures. The non-significant main effect combined with the significant indirect effect suggests that perceived support quality fully mediates the association between direct disclosures and fertility quality of life.

LIMITATIONS, REASONS FOR CAUTION

The cross-sectional nature of our convenient sample did not allow us to test cause and effect. It is equally plausible that women who perceive support are more likely to disclose. Longitudinal data are necessary to test the cyclic nature of these variables and confirm directionality.

WIDER IMPLICATIONS OF THE FINDINGS

When women make the decision to reveal information about their infertility, direct disclosure (i.e. face-to-face, clearly, verbally and with the opportunity for an immediate response) was the only strategy that significantly corresponded with perceived support quality and was one of only two strategies that were positively associated with quality of life. To the extent that social support reduces stress, and lower stress increases the chance that people seek and stay in treatment, infertility clinics and therapists can use this information as a low-cost strategy for supporting infertile women. Scholars and practitioners can also instruct women coping with infertility about how to most effectively engage in seeking effective support.

STUDY FUNDING/COMPETING INTERESTS

No external funding was either sought or obtained for this study and no competing interests are declared.

Sex and the menopausal woman: A critical review and analysis

Medical discourse has positioned the menopausal transition as a time of sexual atrophy and loss of femininity, with hormonal replacement as the solution. In contrast, feminist critics have argued that women’s experience of sexual embodiment during menopause is culturally and relationally mediated, tied to discursive constructions of aging and sexuality, which are negotiated by women. The aim of this article is to present a critical examination of women’s experiences of sexuality during and after the menopausal transition, drawing on previous research in this field, as well as qualitative research we have conducted with women at midlife, and women who have experienced premature menopause as a consequence of cancer treatment. We aim to challenge myths and misconceptions about the inevitability of sexual decline at menopause, as well as normalise the embodied changes that some women experience – whether menopause is premature, or occurs at midlife. We argue that sexual difficulties or disinterest reported by women during and after menopause are more strongly associated with psycho-social factors than hormonal status, in particular psychological well-being, relationship context and a woman’s negotiation of cultural constructions of sex, aging and femininity. However, sexuality can continue to be a positive experience for women throughout adult life and into old age, with many menopausal women reporting increased sexual desire and response. This undermines the biomedical construction of menopause as a time of inevitable sexual atrophy and decay.

An Analysis of the Concept of Partnership in the Couples Undergoing Infertility Treatment

The elements of a partnership in the couples undergoing infertility treatment are not well understood. This article aims to fill the gap by using Rodger's evolutionary method of concept analysis. The attributes of the concept partnership that were identified are a process of joint hardship, sharing, intracouple communication, and mutual support. The antecedents are love and attraction for each other, agreement, and interpersonal skills. The consequences are marital benefit, improvement in psychological status, and quality of life. A middle-range model for partnership in relationship to infertile couples is proposed. The understanding of the phenomenon of partnership will enable the researchers to develop interventions, identify the appropriate assessment instruments, and to determine directions for future research on effort to support infertile couples through their hardship.

Liminal reproductive experiences after therapies for hematological malignancy

In this article, we discuss the psychosocial health of young women related to fertility, pregnancy, and motherhood after therapies for hematological malignancies. We utilized a hermeneutical phenomenological approach to conduct in-depth interviews with 12 women who had previously received treatment for a hematological malignancy and had experienced uncertainty surrounding their ability to start or extend their biological family. Our presented findings are interpretations of the women's own words as they articulated how they inhabited a liminal space. We concluded that although fertility and motherhood possibly might not be immediate concerns when they received a diagnosis of hematological malignancy, young women could subsequently experience ongoing issues and concerns related to reproductive uncertainty and motherhood capabilities, which have the potential to affect emotionally and psychosocially on their lives. These issues might possibly require longer-term support, counseling, and informational resources. We also discuss the strengths, limitations, and implications of the study.

The Social Consequences of Infertility among Iranian Women: A Qualitative Study

BACKGROUND

Infertility may prevent couples to achieve the desired social roles and lead to some social and psychological problems. This study aimed to explain the social consequences of infertility in Iranian women seeking treatment.

MATERIALS AND METHODS

A qualitative content analysis was conducted based on 32 semi-structured interviews with 25 women affected by primary and secondary infertility with no surviving children. The participants were purposefully selected with maximum variability from a fertility health research center in Tehran, Iran, from January to October 2012. Data were collected using semi-structured interviews and analyzed using the conventional content analysis method.

RESULTS

Our findings indicate that the consequences of infertility are divided into five main categories: 1. violence including psychological violence and domestic physical violence, 2. marital instability or uncertainty, 3. social isolation including avoiding certain people or certain social events and self-imposed isolation from family and friends, 4. social exclusion and partial deprivation including being disregarded by family members and relatives and reducing social interactions with the infertile woman and 5. social alienation.

CONCLUSION

This study reveals that Iranian women with fertility issues seeking treatment face several social problems that could have devastating effects on the quality of their lives. It is, therefore, recommended that, in Iran, infertility is only considered as a biomedical issue of a couple and pay further attention to its sociocultural dimensions and consequences.

Experiences of Infertility in British and Pakistani Women: A Cross-Cultural Qualitative Analysis

The psychosocial impact of infertility is affected by cultural factors. In this cross-cultural qualitative study we explored the experience of infertility among six women living in Pakistan and eight living in the UK. Although infertile women in the UK and Pakistan had many shared experiences related to their own desires for motherhood and the hopes of others, they also faced unique psychosocial challenges shaped by cultural context. Based on our findings, we suggest a need for further resources and networks to support women, particularly women living in cultures that allow women few fulfilling social roles other than motherhood.

First childbirth and motherhood at post natural fertile age: a persistent and intergenerational experience of personal and social anomaly?

This study was aimed at understanding long-term psychosocial implications of first childbirth at post natural fertile age following assisted reproductive treatment. Twenty women, whose average age at childbirth was 45, participated. Findings show that the sense of anomaly experienced prior to pregnancy and childbirth related to infertility and advanced age continued during treatment, pregnancy, and motherhood. Participants associated their advanced age as cause for what they perceived as a similar sense of anomaly experienced by their children. The issue of a continuing and intergenerational sense of anomaly should be addressed when counseling women considering fertility treatment at advanced age.

Infertility Specific Quality of Life and Gender Role Attitudes in German and Hungarian Involuntary Childless Couples

Introduction: As gender role attitudes and the evaluation of parenthood and childlessness have subtle variations in each society, cross-country studies focusing on infertility are needed to draw a complex picture in the psychosocial context of infertility. This study investigates similarities and differences between German and Hungarian infertile couples regarding infertility specific quality of life and personal gender role attitudes. Methods: A cross-sectional study was conducted with data of 540 participants (270 couples) attending the first fertility consultation in one fertility clinic in Germany and in five fertility clinics in Hungary. Data were collected between February 2012 and March 2013. Two psychological questionnaires were applied: The FertiQoL to measure infertility specific quality of life and the PAQ to measure gender role attitudes like "instrumental" acting (as a traditional "masculine" attitude) and "expressive" communicating (as a traditional "femine" attitude) and their combinations "combined" attitude (as both "instrumental" and "expressive") and "neutral" attitude (neither "instrumental" nor "expressive"). Results: German couples seeking assisted reproduction treatment are older aged and have longer lasting relationships than Hungarian couples. Hungarian couples scored higher on all quality of life scales than did German couples. In the Hungarian group, "combined" attitudes (use of both "expressive" and "instrumental" attitudes) is associated with higher levels of quality of life compared with other gender role attitudes. In the German group, individuals with "combined" attitudes seem to show better quality of life than those in "expressive" and "neutral" clusters. Conclusions: The strategy of using combined "expressive" and "instrumental" attitudes proved to act as a buffer against infertility-related stress for both members of the couple in two European countries and can therefore be recommended as helpful in counselling the infertile couple.

Infertility Specific Quality of Life and Gender Role Attitudes in German and Hungarian Involuntary Childless Couples

Introduction: As gender role attitudes and the evaluation of parenthood and childlessness have subtle variations in each society, cross-country studies focusing on infertility are needed to draw a complex picture in the psychosocial context of infertility. This study investigates similarities and differences between German and Hungarian infertile couples regarding infertility specific quality of life and personal gender role attitudes. Methods: A cross-sectional study was conducted with data of 540 participants (270 couples) attending the first fertility consultation in one fertility clinic in Germany and in five fertility clinics in Hungary. Data were collected between February 2012 and March 2013. Two psychological questionnaires were applied: The FertiQoL to measure infertility specific quality of life and the PAQ to measure gender role attitudes like "instrumental" acting (as a traditional "masculine" attitude) and "expressive" communicating (as a traditional "femine" attitude) and their combinations "combined" attitude (as both "instrumental" and "expressive") and "neutral" attitude (neither "instrumental" nor "expressive"). Results: German couples seeking assisted reproduction treatment are older aged and have longer lasting relationships than Hungarian couples. Hungarian couples scored higher on all quality of life scales than did German couples. In the Hungarian group, "combined" attitudes (use of both "expressive" and "instrumental" attitudes) is associated with higher levels of quality of life compared with other gender role attitudes. In the German group, individuals with "combined" attitudes seem to show better quality of life than those in "expressive" and "neutral" clusters. Conclusions: The strategy of using combined "expressive" and "instrumental" attitudes proved to act as a buffer against infertility-related stress for both members of the couple in two European countries and can therefore be recommended as helpful in counselling the infertile couple.

Outcome of assisted reproductive technology (ART) and subsequent self-reported life satisfaction

OBJECTIVE

To compare life satisfaction between women with successful or unsuccessful outcome after assisted reproductive treatment (ART) by taking into account the time since the last ART.

DESIGN

Cohort study.

SETTING

Tertiary hospital.

PATIENTS

A total of 987 consecutive women who had undergone ART during 1996-2007 were invited and altogether 505 women participated in the study.

INTERVENTIONS

A postal enquiry with a life satisfaction scale.

MAIN OUTCOME MEASURE

Self-reported life satisfaction in respect to the time since the last ART.

RESULTS

In general, women who achieved a live birth after ART had a significantly higher life satisfaction than those who had unsuccessful ART, especially when compared in the first three years. The difference disappeared in the time period of 6-9 years after ART. The unsuccessfully treated women who had a child by some other means before or after the unsuccessful ART had comparable life satisfaction with successfully treated women even earlier.

CONCLUSIONS

Even if unsuccessful ART outcome is associated with subsequent lower level of life satisfaction, it does not seem to threaten the long-term wellbeing.

Expectations towards medical personnel – a study with infertility clinic patients

<b>Background</b><br /> Contacts with medical personnel are important for patients’ experiences. The role of physicians’ psychosocial competence was noted in Polish studies, but systematic analyses of infertile patients’ expectations have not been conducted. This study was designed to learn about patients’ views on relationships with medical personnel. It was assumed that: 1) staff involvement in infertility treatment would be reflected in expectations towards persons in different roles, 2) expectations might be related to patients’ gender, duration of infertility, and type of treatment, 3) expectations of couples would be related.<br /> <br /> <b>Participants and procedure</b><br /> Fifty-one married couples filled in a purposely designed questionnaire. Items related to information, attitudes and support were divided into three sections – expectations towards physicians, other medical personnel, psychologists – and were scored on a scale of 1 to 5 points.<br /> <br /> <b>Results</b><br /> No gender effect of duration of treatment, type of infertility or treatment method on expectations was found. Partners expected the same level of information from physicians and the same level of emotional support from psychologists. Other expectations were consistently higher in women. There was a clear division of expectations towards different groups of personnel – the expectation to make the best medical choices was assigned to physicians, while the expectation to provide a supportive relationship and coping skills was assigned to psychologists, but all were expected to respect patients’ privacy, choices and decisions.<br /> <br /> <b>Conclusions</b><br /> The findings indicate the division of expectations towards different groups of personnel, with the tendency of women to articulate their expectations more clearly and strongly, but towards the same aspects of staff functioning as men do.

Relationship between infertility-related stress and emotional distress and marital satisfaction

The aim of this study was to evaluate the predictive effects of infertility-related stress on psychological distress and marital satisfaction. Structural equation modeling was used to estimate a nonrecursive model hypothesizing the impact of infertility-related stress on both emotional distress and marital dissatisfaction, which were supposed to have a reciprocal influence on each other. The model was estimated using data from a sample of 150 infertile patients (78 males and 72 females). Findings confirmed the predictive effects of infertility-related stress on both emotional and marital distress. However, infertility-related stress was found to have more impact on emotional distress than on marital satisfaction.

Pseudocyesis, delusional pregnancy, and psychosis: The birth of a delusion

Both pseudocyesis and delusional pregnancy are said to be rare syndromes, but are reported frequently in developing countries. A distinction has been made between the two syndromes, but the line of demarcation is blurred. The aim of this paper is to review recent cases of pseudocyesis/delusional pregnancy in order to learn more about biopsychosocial antecedents. The recent world literature (2000-2014) on this subject (women only) was reviewed, making no distinction between pseudocyesis and delusional pregnancy. Eighty case histories were found, most of them originating in developing countries. Fifty patients had been given a diagnosis of psychosis, although criteria for making the diagnosis were not always clear. The psychological antecedents included ambivalence about pregnancy, relationship issues, and loss. Very frequently, pseudocyesis/delusional pregnancy occurred when a married couple was infertile and living in a pronatalist society. The infertility was attributed to the woman, which resulted in her experiencing substantial distress and discrimination. When antipsychotic medication was used to treat psychotic symptoms in these women, it led to high prolactin levels and apparent manifestations of pregnancy, such as amenorrhea and galactorrhea, thus reinforcing a false conviction of pregnancy. Developing the erroneous belief that one is pregnant is an understandable process, making the delusion of pregnancy a useful template against which to study the evolution of other, less explicable delusions.

Complementary and alternative medicine use in infertility: cultural and religious influences in a multicultural Canadian setting

OBJECTIVES

To explore the use of complementary and alternative medicine (CAM) for infertility in a multicultural healthcare setting and to compare Western and non-Western infertility patients' reasons for using CAM and the meanings they attribute to CAM use.

DESIGN

Qualitative semi-structured interviews using thematic analysis.

SETTINGS/LOCATION

Two infertility clinics in Montreal, Quebec, Canada.

PARTICIPANTS

An ethnoculturally varied sample of 32 heterosexual infertile couples.

RESULTS

CAM used included lifestyle changes (e.g., changing diet, exercise), alternative medicine (e.g., acupuncture, herbal medicines), and religious methods (e.g., prayers, religious talismans). Patients expressed three attitudes toward CAM: desperate hope, casual optimism, and amused skepticism. PARTICIPANTS' CAM use was consistent with cultural traditions of health and fertility: Westerners relied primarily on biomedicine and used CAM mainly for relaxation, whereas non-Westerners' CAM use was often influenced by culture-specific knowledge of health, illness and fertility.

CONCLUSIONS

Understanding patients' CAM use may help clinicians provide culturally sensitive, patient-centered care.

Lost in transition: women experiencing infertility

This paper illustrates key findings from a qualitative doctoral research project exploring women's experience of infertility. Six women maintained treatment diaries, reflecting on their experiences prior to, during and beyond infertility treatment. The following key themes are identified: hopefulness, adaptation, transitioning and shifting focus. The data suggest that treatment, clinic experience and living a life 'on hold' act as turning points within the individual life course. It is at the intersection between treatment and outcome that difficulties negotiating the expected and anticipated life course become illuminated, revealing limited connectivity and transitioning through and beyond the treatment process. This is a critical focus area and one that sets the scene for effective future adaptation. The data suggest that the accessibility of supportive care moving through and beyond treatment is limited. This paper argues that the infertility clinic is a critical space and place and one where effective supportive care may enable effective transitioning beyond the experience of infertility as an unanticipated life course disruption.

Young women's construction of their post-cancer fertility

Younger women diagnosed with cancer often face compromised fertility as a result of their treatment. However, previous research has adopted a biomedical model of fertility and utilised hypothetico-deductive research methods which have not allowed for full exploration of women's subjectivity. This study explored younger women's construction of their fertility post-cancer, and their discussions of fertility with healthcare professionals, from a social constructionist epistemology. Semi-structured one-to-one interviews were conducted with eight women aged 18-26, across a variety of cancer types. Foucaultian Discourse Analysis identified three subject positions associated with fertility concerns: 'Inadequate woman: Accepting the motherhood mandate'; 'Adequate woman: Resisting the motherhood mandate'; and 'Survival of the fittest: Woman as genetically defective'. Implications of these subject positions included feelings of inadequacy, fear and devastation; feeling undesirable to romantic partners; and concern about passing on cancer-positive genes. In describing healthcare professional interactions, women adopted positions of 'Satisfied patient'; 'Passive recipient patient'; or 'Resisting the passive patient position'. Accounts of inadequate information provision were associated with anger and frustration, whereas feeling adequately informed was associated with satisfaction at making decisions about fertility preservation. These results suggest that fertility is of importance to young women cancer survivors, and that compromised fertility can negatively impact subjectivity.

Missing Motherhood: Jordanian Women's Experiences with Infertility

Aim, Background, and Introduction. Bearing and rearing children are an important part of life in nearly all cultures and are a central role for Jordanian Muslim women. Infertility can create anxiety, stress, and depression for couples who are infertile. Women frequently bear the emotional stigma of a couple’s infertility. There is a paucity of literature focusing on Jordanian Muslim women experiencing infertility and failed assistive reproductive technology. Therefore, this study explored these women’s lived experience. Methods. Qualitative data were collected through interviews with 30 Jordanian Muslim women who experienced failed assistive reproductive technology for infertility. Perceptions of experiences with failed treatment of infertility were documented and analyzed. Results. Major themes were identified: missing out on motherhood and living with infertility, experiencing marital stressors, feeling social pressure, experiencing depression and disappointment, having treatment associated difficulties, appreciating support from family and friends, using coping strategies, and fear of an unknown future. Discussion, Conclusion, and Implications for Clinical Practice. Being infertile significantly influences the physical, emotional, social, and spiritual health of Jordanian Muslim women as well as their quality of life. Perceived social support and personal coping strategies were used by study participants to mediate failed attempts to conceive. Designing and implementing culturally appropriate interventions for Muslim women globally who are experiencing infertility are essential.