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

How Individuals Use Metaphors to Negotiate Fertility Treatment Decision-Making with Their Romantic Partners

Fertility problems, or the inability to conceive or carry a pregnancy to term for a period of over 12 months while engaging in unprotected sex, affects 12% of women and 9% of men of childbearing age. To answer calls for more research about individuals' fertility decision-making (DM) with their partners, we conducted in-depth, semi-structured interviews with 53 individuals who have experienced fertility decision-making with a romantic partner at some point in their lives. Our findings indicate at least three primary ways individuals and their partners navigated their decision-making communication in their infertility "journeys:" (1) the Driver-Navigator, (2) Driver-Passenger, and (3) Driver-Backseat Driver approaches. All decision-making communication approaches were viewed by individuals as collaborative (i.e. shared), but varied in degrees of "togetherness" (high, moderate, low) in how they communicated with each other about treatment decisions. Implications include helping couples and their clinicians to be aware of their DM approach(es) and offering alternative DM approaches based on understanding how and why certain approaches may (not) be effective in addressing goals, needs, and identities.

Personal Growth and Life Satisfaction during Fertility Treatment-A Comparison between Arab and Jewish Women

Coping with difficulty conceiving and the ensuing fertility treatments is a stressful experience that impacts many aspects of women's lives. On the basis of Lazarus and Folkman's model of stress and coping and Schaefer and Moos's model of personal growth, and in view of the sparse literature on cultural aspects of infertility and personal growth, this study examined the relationship between stress on the one hand and personal growth and life satisfaction on the other among Arab and Jewish Israeli women. Furthermore, it investigated the moderating role played by perceived stigma, coping flexibility, cultural orientation (individualism and collectivism), and ethnicity. Two hundred five Arab and Jewish Israeli women undergoing fertility treatment completed self-report questionnaires. The results show that Arab women reported higher levels of personal growth and individualism than Jewish women. In the whole sample, a linear negative relationship was found between stress and life satisfaction, and a curvilinear relationship was found between stress and personal growth. In addition, perceived stigma, collectivism, individualism, and coping flexibility were found to moderate the association between perceived stress and personal growth. The findings provide further understanding of personal growth in the context of infertility, showing that personal resources and perceptions are more important than cultural differences in this regard.

Persevering in Fertility Treatments Despite Failures: Unrealistic Optimism and the Reality of a Pronatalist Culture

BACKGROUND

Fertility treatment discontinuation is difficult as it entails accepting childlessness. In most countries, financial limitations provide sufficient justification to terminate treatment. In Israel, unlimited funding enables women to undergo multiple treatment cycles, even when the odds of success are poor, thus providing a context for studying the psychological mechanisms involved when financial constraints are set aside. The study aimed to investigate the contribution of unrealistic optimism to Israeli women's willingness to continue fertility treatments even after repeated failures and to their psychological adjustment, comparing age groups.

METHODS

A longitudinal study of 100 women (ages 31-45) undergoing in vitro fertilization (IVF) treatment (1-22 previous cycles), who filled in questionnaires assessing their estimates of treatment success (theirs/for same-age patient), estimates received from the physician, intentions to continue treatment, and psychological adjustment. Follow-up was conducted 17(± 4) months later, by phone (n = 71) and/or medical records (n = 90).

RESULTS

Most women (57%) reported that they will continue as long as needed till they have a child, 13% did not know, and 25% mentioned a specific plan; 5 did not reply. Women's estimates of treatment success showed vast unrealistic optimism, which was unrelated to their age, history of unsuccessful treatment cycles, or intentions for treatment continuation, yet was related to better psychological adjustment. At follow-up, almost all women who did not conceive were found to have continued treatments.

CONCLUSIONS

Unrealistic optimism helps women maintain hope and well-being along the demanding journey to (biological) parenthood, where childlessness is highly stigmatized, and contributes to perseverance in treatment, regardless of objective factors.

Motherhood and assisted reproduction in a religious context: Genes, stigma and supports in Utah, United States

Six percent of cisgender (i.e. not transgender) women aged 15-44 are considered infertile in the United States, and 12% are unable to carry a pregnancy to term. For those who yearn to create a family despite these circumstances, assisted reproductive technology (ART) is an often-utilised resource. Though faith-based institutions have been referenced as a source of support for involuntarily childless adults, it is unclear how religious doctrine, especially that which prizes 'traditional' gender roles and genetic parenthood, may be a catalyst for distress. More research is needed to understand how the socio-cultural environment affects those who are unable to conceive without assistance. Therefore, the purpose of this research study was to understand the lived experiences of women who have utilised assisted reproduction in a particularly pronatalist, religious cultural context in the United States. From March to September 2017, in-depth interviews were conducted with 10 cisgender women who had utilised ART. Data analysis was conducted in NVivo 10 and consisted of line-by-line analysis, identifying themes, coding categories and developing matrices to uncover relationships between themes and categories. The quest for motherhood was truly a journey for the study participants who experienced rumination and self-blame due to their inability to become pregnant. This was rooted in their socio-cultural context. Thus, the study findings suggest that culture and stigma are linked with women's distress regarding their inability to become pregnant and results in distancing from other women. Genetic parenthood was prized initially, but this desire decreased over time. While past research suggests that infertility strains relationships, our study found that the turmoil of infertility and assisted reproduction actually strengthened couple relationships. Counselling was described as particularly helpful, but it is needed throughout the assisted reproduction process. The inclusion of religion and spirituality, for those who identify as such, in counselling would be beneficial.