Trying for a second chance: Iranian infertile couples’ experiences after failed ART

Introduction: Despite significant advances, only 35% infertile couples conceive after ART. If IVF is unsuccessful, couples will need to decide whether to proceed again with assisted conception. The aim of this study was to explore Iranian infertile couples’ experiences after failed ART to continue treatment. Methods: In this qualitative study participants were selected using purposeful sampling method. Data were collected using 29 semi-structured face-to-face in-depth interviews at a regional Infertility Center from April 2016 to June 2017. All interviews were recorded, transcribed verbatim, and analyzed with conventional content analysis method using MAXQDA software. Results: Our findings suggest that couples’ decisions to continue treatment after unsuccessful ART is shaped by their social, emotional and financial circumstances. We have constructed two themes to describe their experiences: support to continue and trying for a second chance. Conclusion: Our findings suggest that good marital and family support networks can support infertile couples during this period of decision making. Considering the depression and anxiety caused by failed ARTs, which itself could affect the success rate of any further ARTs, the clinical team should effectively assess psychological readiness of couples who decide to continue with another ART after unsuccessful treatment

The effect of the collaborative infertility counseling model on coping strategies in infertile women undergoing in vitro fertilization: A randomized controlled trial

Objectives: Infertility is a stressful condition influencing interpersonal and social relationships among infertile couples. Various strategies have been suggested for coping with infertility. This study examined the effect of the collaborative infertility counseling model on coping strategies in infertile women undergoing in vitro fertilization (IVF) in an urban area of Iran. Materials and Methods: This clinical controlled trial was conducted on 60 women with primary infertility selected from Milad Infertility Center in Mashhad, Iran. They were randomly allocated to the intervention and control groups with 29 and 31 samples in each group. The intervention group received individual counseling based on the collaborative reproductive healthcare model. The counseling was provided with the collaboration of a midwife, a gynecologist and a clinical psychologist in 5 sessions during a 2-month period. The control group received only routine care. The fertility problem inventory (FPI) and general health questionnaire were used to measure perceived fertility-related stress and general health, respectively. Moreover, the ways of coping-revised questionnaire was used to collect data regarding the women’s coping strategies at the beginning of the study and at the day of the embryo transfer. The student t test, Fisher exact test, Mann-Whitney U test and analysis of variance (ANOVA) were used for data analysis. Results: A statistically significant difference was reported between the two groups in terms of problem-focused coping strategies (P = 0.037). However, no statistically significant difference was reported between the groups with regard to emotion-focused coping strategies (P = 0.947). There were statistically significant differences between the 2 groups in the mean scores of seeking social support (P = 0.022) and planful problem-solving strategies (P = 0.045) as the subscales of problem-focused coping strategies. Conclusion: The collaborative reproductive healthcare model promoted the use of problem-focused coping strategies. Therefore, the use of collaborative counseling approaches by healthcare professionals is suggested for assisting infertile women to cope with infertility. © 2018 The Author (s)

Infertile couples' perceived needs after unsuccessful fertility treatment: A qualitative study

Introduction: Infertility is a major medical issue. Investigations and treatment of infertility are the beginning of a complex, time-consuming and stressful process for couples that may fail well. The present study explored the needs of infertile couples following treatment failure with Assisted Reproductive Technologies (ARTs). Methods: A descriptive qualitative study was conducted in an Iranian infertility center, in the Northeast of the country between April 2016 and June 2017. The researchers recruited 29 individuals including 9 couples, 9 women and two men with primary infertility through purposive sampling. The data were collected using semi-structured interviews and analyzed iteratively, using conventional content analysis with MAXQDA software. Results: The main concepts obtained from the data were classified into one theme titled: ""The need for support"" and four main categories along with their subcategories, and included the need for psychological support, the need for more useful information, the need for social support and the need to access to supplementary services. Conclusion: The findings show that following treatment failure, the infertile patients’ expressed needs and preferences were not met. Identifying and meeting their needs may help the infertile couples to deal with ARTs failure and to reach a decision about future treatment

Iranian infertile couples' strategies to manage social interactions after unsuccessful treatments with assisted reproductive technologies

Many infertile couples feel vulnerable after failed treatment cycles and find insensitive remarks or inappropriate support distressing. They fear that the stress of failed treatment cycles may affect their marriage and lead to marriage breakdown. This study explored the strategies a sample of infertile couples used to manage social interactions after unsuccessful treatment with assisted reproductive technologies. A descriptive qualitative study was conducted with 34 participants including nine infertile couples, nine infertile women and two infertile men with primary infertility, two relatives, and three fertility clinic staff. The participants were selected through purposive sampling at an infertility centre in Iran, between 2016 and 2017. Data were collected using semi-structured face-to-face interviews and analysed by qualitative content analysis approach. Participants found some social interactions after failed assisted reproductive treatment cycles to be distressing and painful. They described tolerating painful emotions which cause them sadness and sorrow as well as feeling embarrassed. As a result, they found they needed to maintain their adopting concealment strategies with their families through not permitting speculation, selective disclosure, not giving details and hiding the truth. This study showed that social interactions following failed assisted reproductive cycles can be upsetting for infertile couples. Couples use different strategies to manage potentially distressing social interactions. Healthcare providers and psychologists may provide a space for safe social interactions in order to help couples to use appropriate strategies in these circumstances

The relationship between body image and marital adjustment in infertile women

Introduction: Body image is one of the most important issues in women's mental health and due to its relationship with physical, cognitive and emotional aspects of women’s life; it can predict their healthy or unhealthy behaviors. According to some research reports, women’s negative or positive body image can affect their marital relationships. Considering the impact of infertility on both body image and marital adjustment and the lack of evidence regarding the relationship of these two variables in infertility, this study aimed to investigate the relationship of body image with marital adjustment in infertile women in 2010 in Mashhad. Methods: This correlational study was carried out on 130 infertile women referred to Montaserie Infertility Research Center in Mashhad who were selected through convenient sampling. Research tools were consisted of valid and reliable demographic questionnaire including personal and infertility-related information, modified Younesi Body Image Questionnaire and Spanier marital adjustment scale (DAS) which were completed by subjects. Data analysis was carried out by SPSS software (version 15/5) using t-tests, one way ANOVA, and Spearman and Pearson correlation test. Results: 93/1% of women reported positive body image and 76/9% had high marital adjustment. There was a direct correlation between the overall score of body image with marital adjustment (P<0/001). There was also a direct correlation between the scores of body image subscales including body in loneliness (P= 0/001), real body (P=0/014), public image of body (P=0/016), spouse image of body (P<0/001) and spouse family image of body (P<0/001) with marital adjustment. However, this relationship was not observed between the subscale of ideal body and marital adjustment. Conclusion: The presence of a direct correlation between body image and marital adjustment could guide developing educational or counseling programs particularly for infertile women who suffer from marital disputes. Keywords: Body image, Marital adjustment, Infertilit

Iranian infertile couples' strategies to manage social interactions after unsuccessful treatments with assisted reproductive technologies

Many infertile couples feel vulnerable after failed treatment cycles and find insensitive remarks or inappropriate support distressing. They fear that the stress of failed treatment cycles may affect their marriage and lead to marriage breakdown. This study explored the strategies a sample of infertile couples used to manage social interactions after unsuccessful treatment with assisted reproductive technologies. A descriptive qualitative study was conducted with 34 participants including nine infertile couples, nine infertile women and two infertile men with primary infertility, two relatives, and three fertility clinic staff. The participants were selected through purposive sampling at an infertility centre in Iran, between 2016 and 2017. Data were collected using semi-structured face-to-face interviews and analysed by qualitative content analysis approach. Participants found some social interactions after failed assisted reproductive treatment cycles to be distressing and painful. They described tolerating painful emotions which cause them sadness and sorrow as well as feeling embarrassed. As a result, they found they needed to maintain their adopting concealment strategies with their families through not permitting speculation, selective disclosure, not giving details and hiding the truth. This study showed that social interactions following failed assisted reproductive cycles can be upsetting for infertile couples. Couples use different strategies to manage potentially distressing social interactions. Healthcare providers and psychologists may provide a space for safe social interactions in order to help couples to use appropriate strategies in these circumstances

Body image and its relationship with sexual function and marital adjustment in infertile women

BACKGROUND: Body image is related to cognitive, emotional, and physical aspects of women's life. Therefore, it is expected to have an important role in women's sexual health and marital adjustment too. This issue seems to be salient in infertile women who suffer from psychological consequences of infertility. This study was conducted to investigate the relationship of body image with sexual function and marital adjustment in infertile women in 2011 in Mashhad, Iran. MATERIALS AND METHODS: This correlational study was performed on 130 infertile women who referred to Montaserieh Infertility Research Centre in Mashhad, Iran. Subjects were selected using convenient sampling method. To collect data, valid and reliable questionnaires including demographic and infertility-related data tool, modified Younesi Body Image Questionnaire, Rosen Female Sexual Function Index (FSFI), and Spanier Dyadic Adjustment Scale (DAS) were used. Data analysis was performed by SPSS software using Student's t-test, correlation, analysis of variance (ANOVA), and Tukey post-hoc test. RESULTS: The mean scores of body image, sexual function, and marital adjustment in women were 308.1 ± 45.8, 27.23 ± 3.80, and 113.8 ± 19.73, respectively. There was a direct correlation between overall body image and subscales of sexual function including sexual arousal (P = 0.003), sexual desire (P = 0.024), vaginal moisture (P = 0.001), orgasm (P < 0.001), sexual satisfaction (P < 0.001), and dyspareunia (P = 0.007). A direct correlation was also observed between overall body image and subscales of marital adjustment including agreement and consent (P < 0.001), satisfaction with life (P < 0.001), continuity of life (P = 0.007), and expressing emotions within the family environment (P < 0.001). CONCLUSIONS: Improved sexual function and marital adjustment in cases with higher body image provides evidence that one of the solutions to reduce sexual dysfunction and marital dispute in infertile women could be planning educational and counseling programs to improve women's body image

Pregnant mothers’ strategies for the management of pregnancy concerns

Background & Aim: Mothers during pregnancy face many concerns. Identifying mothers’ strategies to manage those concerns can help healthcare providers to promote their mental health. The aim of this study was to explore pregnant mothers’ strategies for the management of their concerns during pregnancy. Methods & Materials: This qualitative study was conducted in Gorgan city during 2014-2015. The study participants were 20 pregnant women and three of their husbands as well as three experienced midwives who were selected using purposive sampling and interviewed through semi-structured interview. Data were analyzed through conventional content analysis using the MAXQDA software. Results: Data analysis led to the emergence of five main categories including the utilization of purposive knowledge acquisition, reliance on the leverage of spirituality, thinking management and stress control, the effort to maintain and improve familial interactions and emotional preparation for pregnancy. Conclusion: The five strategies used by pregnant women to manage their concerns, were identified in this study. Midwives can play an important role in implementing these strategies and empowering pregnant women. © 2017, Tehran University of Medical Sciences (TUMS). All rights reserved