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Learn More. Assisted reproductive technologies ARTs are complicated and stressful techniques and the social and cultural norms are major obstacles against their use. The aim of this study was to understand and describe the experience of women who have used assisted reproductive technologies for their current pregnancy. This qualitative study was conducted based on a content analysis approach. Women were selected purposefully and with maximum variation. Interviews were performed after a positive test of pregnancy and women were introduced to researchers in their first visit of pregnancy in the prenatal clinic.
Interviews were recorded, transcribed verbatim and analyzed concurrently. Semi-structured interviews were coded, categorized and the themes were also identified. Four main themes were uncovered which included struggle to achieve pregnancy, fear and uncertainty, escape from stigma and the pursuit to achieve husband satisfaction. It is essential for these women to be counseled and prepared by their health care providers after the use of ARTs. The desire to have children is very powerful and widespread, but unfortunately the ability to reproduce does not come as easily for all people 1.
According to the World Health Organization WHO Demographic and Health Surveyone out of every four couples in developing countries are willing to parent and this has not changed ificantly over the last decade 2.
Although many people accept their infertility problems, there are new assisted reproductive technologies ARTs which can overcome infertility in most of the cases 15. Assisted reproductive cycles usually consist of using self-injected ovulation stimulation drugs for 9 to 12 days, oocyte retrieval with transvaginal ultrasound, fertilization of oocyte in laboratory by use of sperm from husband or donor, and transfer of the embryo into the uterus. Couples must wait for 2 or 3 weeks to know whether the embryo has been implanted and pregnancy has occurred 9. Women are typically transferred from the infertility services division to the department of obstetrics and gynecology 6—8 weeks after a successful IVF.
Many women report that they feel as though they have lost their sense of control after an embryo implantation during the 2 week wait to receive the of a pregnancy test. The women felt that the treatment team had abandoned them. They wished to have a relationship with a member of the treatment team during those 2 weeks to aid them through the difficult ordeal Depressive disorders are common among patients who are undergoing new cycles of assisted reproduction and sometimes the psychological stress can cause treatment discontinuation 8 Couples often sacrifice everything they have for a treatment due to its burdensome expense and low rate of success 12 Moreover, support at all stages of treatment, particularly, before and during pregnancy is critical Psychological support for women undergoing ARTs has been taken into to some degree in recent years 15 ; however, less is known about support before pregnancy testing.
It is known that having children is considered a religious duty and also le to a higher social status, prestige, security in marriage, and care in old age. Children are considered as an important source of economic, social, and psychological support in Iran Although Iran is a country with rapid legalization and coverage of ARTs, the social and cultural norms are major obstacles against their use A qualitative method with content analysis approach was used to describe the experiences of Iranian women The data were collected through semi-structured interviews at Avicenna Infertility Clinic which is one of the referral clinics in Tehran, Iran.
Interviews were conducted over a 6-month period of time from August to February Participants consisted of 12 women. Interviews were coordinated with people who were willing to participate in the study to provide convenient time to conduct the interviews. Ethnicity, cause of female related infertility, infertility duration and of treatment attempts were some of the criteria for purposive sampling.
The inclusion criteria were female related primary infertility, experience of ARTs for current pregnancy and being fluent in Persian language. Participants were met after a positive test of pregnancy and in their first visit in the prenatal clinic. At the time of the interview, all of these women were in the first trimester of pregnancy. Women who had a history of recurrent pregnancy loss, pregnancy or miscarriage, as well as those who were candidates for egg donation were excluded from the study.
Participants were selected to be interviewed based on their medical records and with the help of the medical team. Other reasons for non-participation in the study were lack of time and interest. Additionally, pregnant women were chosen because they were the only women referred to the clinic immediately after a pregnancy test and other patients of Avicenna Infertility Clinic were not accessible in a timely fashion.
Face to face interviews with 12 women were conducted in a quiet and private room for 30 to 60 min. The semi-structured qualitative interviews were conducted in the Persian language. The semi-structured interview is similar to a purposeful and guided conversation The interviews were conducted in two steps with five participants. The saturation point was achieved after 17 interviews in which no new themes or issues came up from the interviews. The demographic data collected from women were age, ethnicity, educational level, employment status, cause of infertility, duration of marriage and infertility and the of treatment attempts.
Interview questions for assessing the experiences of infertile women seeking assisted pregnancy in Iran. Data were analyzed with content analysis approach and based on Graneheim and Landman strategies Their suggested steps used in the present study are:. Collecting the texts which were related to waiting for an assisted pregnancy and putting them in one text.
Sorting the codes to and sub based on similarities and differences. Credibility was attained by choosing participants with various experiences different age, educational level, ethnicity, duration of infertility and of treatment attempts and agreement among co-researchers, experts, and participants.
For the purpose of assuring credibility of the subsequent analysis, three experts, the first with qualitative research and reproductive health expertise, the second with nursing and qualitative research expertise, and the third with reproductive biotechnology expertise contributed to the present study. The interpretation of data was reviewed and approved by this team.
Prolonged engagement was maintained by the main researcher in the research field in order to build rapport and to gather in-depth data. The responses of women were returned to them to verify and to add anything else of necessity. This study was conducted following the approval of the ethics committee of the Tehran University of Medical Sciences and the Ethics Committee of the Avicenna Research Institute.
The research objectives were explained to the participants before beginning the interviews and women participated freely in the research. Written consent was obtained from participations in this study. The age range of the participants was between 24 and 36 years old and the gestational age was between 5—12 weeks. Six participants had an academic degree, five had secondary education, and one had incomplete secondary education. The duration of infertility treatments ranged from 6 months to 15 years and the of ART cycles varied between 0 to 5 cycles.
Common themes from analysis of interviews were a struggle to achieve pregnancy, b fear and uncertainty, c pursuit of husband satisfaction, and d fear of stigma. Some texts dealt with the experiences that displayed a degree of overlap and certain issues were common to two or more of the themes Difficulty in finding drugs, suffering pain and physical discomfort, long distance to the fertility clinic and financial problems were some of the difficulties that these patients struggled with in the pursuit to have a baby.
We leave out many things in our life. Sometimes, finding the drugs was difficult. Most of participants came from other cities. Treatment was painful and exhausting but these women were very determined. Fortunately, they could bear the hardships since they felt the experience was worthwhile. I said to myself whether the test result becomes positive or negative I will not undergo IVF anymore.
Their efforts for pregnancy were admirable. We repeatedly went from one doctor to another and from one city to another. Others said why you bother yourself in this way. Most of the interviewees had experienced distress and uncertainty because they did not know what will happen to them at the end of their efforts. They had busy minds about this issue.
Will I be among those very low of women or not? Waiting for the test result was so difficult for these women. I wished a machine could explain the situation for me. At least then I would not be so confused. How should I know that I will become pregnant or not? Will this struggle result in pregnancy or not? They thought that ICSI was their last resort and it made them concerned. What could I do if I do not get pregnant? These weeks passed only with fear. What if I do not get pregnant with microinjection also? Thinking to the last hope is common in women who have experienced multiple failures.
She said you have used ICSI four times and if you do not get pregnant this time put pregnancy out of your mind. You should use egg donation for your next cycles. These women were trying to achieve husband satisfaction with this difficult treatment. He was really sad about not being able to have at all. I am also sad about that she burst into tears. What could I do if he becomes disappointed? Although female cause of infertility is not so prominent, sometimes for example in mild polycystic ovary syndrome PCOSthey accepted treatment only because of their husband.
They felt guilty because of infertility problems and its consequences such as financial problems. At least for this reason I wanted to make my husband happy.Seeking fertile woman
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