Guide Making Babies the Hard Way: Living With Infertility and Treatment

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Making Babies the Hard Way: Living With Infertility and Treatment
Contents:


  1. Making Babies the Hard Way
  2. I.V.F. Coverage Is the Benefit Everyone Wants
  3. Making Babies the Hard Way by Caroline Gallup (ebook)
  4. Making Babies the Hard Way: Living With Infertility and Treatment
  5. Living With Infertility and Treatment

How far would you go to have a baby? Making Babies the Hard Way is a frank account of one couple's discovery that they cannot have children of their own, and their ensuing struggle through four years of fertility treatment. One in six couples worldwide seek assistance to conceive and 80 per cent of couples undergoing fertility treatment are currently unsuccessful. Writing with humour and honesty, Caroline Gallup describes the social, emotional, spiritual and physical impact of infertility on her and her husband, Bruce, including feelings of bereavement for the absent child, the unavoidable sense of inadequacy and the day-to-day difficulties of financial pressure.

As well as telling her own moving story, she also offers information and guidance for others who are infertile, or who are considering or undergoing treatment. This courageous and poignant book will be of interest to couples who cannot conceive and those who are undergoing treatment, as well as their families and friends. About 10 years ago Greil published a review and critique of the literature on the socio-psychological impact of infertility.

He found at the time that most scholars treated infertility as a medical condition with psychological consequences rather than as a socially constructed reality. This article examines research published since the last review. More studies now place infertility within larger social contexts and social scientific frameworks although clinical emphases persist. Methodological problems remain but important improvements are also evident.

We identify two vigorous research traditions in the social scientific study of infertility. One tradition uses primarily quantitative techniques to study clinic patients in order to improve service delivery and to assess the need for psychological counseling. The other tradition uses primarily qualitative research to capture the experiences of infertile people in a sociocultural context.

We conclude that more attention is now being paid to the ways in which the experience of infertility is shaped by social context. We call for continued progress in the development of a distinctly sociological approach to infertility and for the continued integration of the two research traditions identified here. Most medical sociologists agree that health and illness are best understood, not as objectively measurable states, but as socially constructed categories negotiated by professionals, sufferers and others in a sociocultural context.

Decisions as to what constitutes abnormality, how to define that abnormality and what steps, if any, should be taken to deal with its conditions are all made within a social context. How sufferers are seen by others and how they come to see themselves are both products of processes of social definition. One phenomenon that has become increasingly defined as a medical condition is infertility, usually defined in the biomedical context as the inability to conceive after 12 months of regular unprotected intercourse.

The medicalization of infertil ity began in earnest with the development of fertility drugs in the USA in the s but it has proceeded even more rapidly since the development of such assisted reproductive technologies ART as in vitro fertilization IVF and intra-cytoplasmic sperm injection. Thompson has recently described the complex ontological choreography involving precisely timed actions for example, injections of hormones, ejaculation of sperm and cryopreservation of gametes among an interrelated set of actors for example, physicians, nurses and patients to produce a baby in the modern ART clinic.

The social construction of health and illness is perhaps even more striking in the case of infertility than it is for other conditions. Firstly, no matter how medical practitioners may define infertility, couples do not define themselves as infertile or present themselves for treatment unless they embrace parenthood as a desired social role. Secondly, while the biomedical model treats medical conditions as a phenomenon affecting the individual, infertility is often seen, especially in developed countries, as a condition that affects a couple regardless of which partner may have a functional impairment.

Thus, defining oneself as infertile involves not simply negotiations between the individual and medical professionals but also negotiations within the couple and, possibly, the larger social networks. Thirdly, the presence of infertility is signaled, not by the presence of pathological symptoms, but by the absence of a desired state. It is, in the words of Koropatnick et al. Possible alternatives to treatment include self-definition as voluntarily childfree, adoption, fostering or changing partners.

Infertility is best understood as a socially constructed process whereby individuals come to define their ability to have children as a problem, to define the nature of that problem and to construct an appropriate course of action. The study of infertility has much to contribute to the sociology of health and illness by providing researchers with an ideal vantage point from which to study such features of medicalized healthcare as the tension between the voice of medicine and the voice of the lifeworld Mishler , the gendered nature of health and healthcare and the interplay between structure and agency.

Because it involves an inability to achieve a desired social role, infertility is often associated with psychological distress. He noted that, while the descriptive literature on the psychological consequences of infertility presented infertility as a devastating experience, attempts to test the psychological consequences hypothesis had produced more equivocal results.

Studies that looked for psychopathology did not find significant differences between infertile individuals and others, while studies that employed measures of stress and self-esteem did find significant differences. He found support for the conclusion that infertility is a fundamentally different experience for women than for men. Most importantly, however, Greil argued that the psychological distress literature showed little regard for the social construction of infertility, treating infertility instead as a medical condition with psychological consequences.

Our goal here is to assess research published since the last review article to determine how it has changed, to discover new lines of research, to summarize generalizations about infertility experiences and to assess persistent limitations and progress in the methodological and theoretical dimensions of infertility research. We conclude that researchers are moving toward situating infertility in social contexts although the clinical focus of much earlier work persists.

We also find that, while many methodological problems remain, important attempts to redress these problems are evident. Throughout, we try to demonstrate the importance of making use of non-clinic-based samples if we are to progress in our understanding of the experience of infertility. We identify two distinct traditions of research in the study of the social and psychological consequences of infertility. One tradition is characterized by the quantitative analysis of patient populations — often focusing on patients being treated via ART — with the goals of improving service delivery and of assessing the need for psychological counseling procedures.

These clinically oriented studies typically make use of the quantitative analysis of standardized psychological assessment instruments. The other tradition is based on the qualitative analysis of infertile women and men — both in developed and developing societies — outside the clinic context. Those being studied may or may not be patients in biomedical contexts but the focus of this research is not so much on improving care as on understanding the experience of infertility and the social context that shapes it.

This second tradition has been more informed by developments in social scientific studies of illness experience, gender, the body and stigma. In the following review, we attempt to take a first step toward integrating these two research traditions. Because our emphasis here is on the experience of infertility and infertility treatment, we focus on studies published in the last 10 years that directly assess the responses to infertility of women, men, and couples.

We exclude studies that focus exclusively on the institution of reproductive technology and its cultural and societal context. These are the subjects of a recent review by Inhorn and Birenbaum-Carmeli We also exclude studies for which the primary focus is on the incidence and prevalence of infertility. Many methodological shortcomings in infertility research noted by Greil still persist.

Pasch and Christensen enumerated the following shortcomings in social-scientific research on infertility: small sample sizes, poor sampling methods, use of non-standardized measures, lack of adequate control groups and studies being conducted in infertility treatment centers with which the researcher is affiliated. Henning et al. Clinic-based studies of treatment seekers still prevail in research on the consequences of infertility Henning et al.

The focus on people receiving treatment makes it difficult to generalize to those who do not seek treatment Greil Clinic-based studies therefore provide no information about half of the infertile female population. Even in nations where access to infertility treatment is guaranteed by the state there are still many couples who do not seek treatment Boivin et al. Without studies of non-treatment seekers it is impossible to determine what factors differentiate those who seek treatment from those who do not or why those who would like to receive infertility treatment do not have access to it.

Even among treatment seekers, the emphasis has been on the most advanced treatments, limiting our ability to understand those who stop treatments after initial attempts. Without a non-clinic comparison group it is impossible to untangle the effects of infertility from the effects of infertility treatment on psychological outcomes. Since there have been some important studies using non-clinic based samples. King used the National Survey of Family Growth, a nationally representative sample that included infertility status data for women in the USA to assess whether treatment seekers and non-treatment seekers are more likely to meet the criteria for anxiety.

Malin et al. Redshaw et al. Sundby et al. McQuillan et al. Greil, McQuillan, and their colleagues are now collecting data for the National Study of Fertility Barriers NSFB , a prospective panel study based on a random sample of US women with an oversample of minorities and women who have not completed their childbearing. Other studies have taken steps short of a population study to improve the generalizability of their findings.

Epstein et al. Jordan and Revenson conducted a meta-analysis of six studies using the Ways of Coping Checklist.

Introduction

Jordan and Ferguson found respondents, of whom As studies of infertility in developing societies have proliferated, ethnographic approaches have become more common. These studies inevitably raise questions of representativeness, but, unlike studies of infertility in developed countries, they have not been as frequently limited to studying people in western-style infertility centers.

These studies cannot really deal with causality in a definitive way, but that is not their primary purpose. The fact that there have now been qualitative community-based studies done in many different cultural settings means that we are beginning to develop a sense of the experience of infertility in developing countries. Cross-sectional analysis, still the most common design in studies of the social and psychological consequences of infertility, makes it impossible to sort out cause and effect.

There have been more longitudinal designs in recent years, but most employ a fairly narrow time frame. Several studies have assessed fluctuations in stress levels during a reproductive cycle for example, Edelmann and Connolly , Verhaak et al. Other studies have worked with a slightly longer time frame Anderson et al. Much can be learned from longitudinal studies with expanded time frames. The NSFB, now under way, involves re-interviews of a nationally representative sample of US women three years after the original interview. Another methodological question has to do less with designing studies than with conceptualizing infertile individuals.

As long as the study of infertility is limited to the study of clinic patients, conceptualizing who should be considered infertile seems straightforward. Once we move beyond treatment seekers we observe that the line between infertile and non-infertile people becomes blurred Greil and McQuillan forthcoming , and infertile individuals are seen to constitute a much more diverse group than was previously understood.

How are we to classify a woman who would be considered infertile according to the medical definition but who does not see herself as having tried to conceive and who does not consider herself to be infertile? This is an important question, because such individuals are quite common. Greil and McQuillan and Jacob et al. Studying infertility in developing countries reveals that western biomedical definitions of infertility exclude a large portion of women in developing societies who think of themselves as infertile Gerrits Sundby writes that in The Gambia and Zimbabwe infertility is experienced as anything that prevents women from realizing their reproductive ambitions.

Leonard b presents the narrative of Solkem, a Chadian woman who, because her husband left her and she no longer has regular intercourse, might not be classified as infertile according to the western biomedical definition but who is nonetheless preoccupied with the quest for conception. Recent contributions to the descriptive literature on infertile women for example, Becker , Clarke et al. Several characterizations of infertile women or couples have emerged from qualitative research. Ulrich and Weatherall suggest that women experience infertility as an unanticipated life-course disruption.

Martin-Matthews and Matthews focus on the sense among infertile women that time is slipping away and explore the interaction between familial and societal timetables, body timetables and treatment timetables see also Earle and Letherby Parry and Shinew report that leisure satisfaction is impaired by the process of seeking treatment and by feelings of social isolation.

Evidence suggests, however, that the characterization of infertile woman as totally immersed in the process of trying to become pregnant describes only treatment seekers Greil and Mc-Quillan and forthcoming , Jacob et al. The social-scientific literature on infertility is increasingly emphasizing the importance of the sociocultural context in shaping the lived experience of infertility.

Kirkman and Rosenthal argue that the degree of availability of reproductive technology plays a major role in shaping perceptions of and responses to infertility. Letherby suggests that ambivalence toward motherhood may have been more socially acceptable before the advent of assisted reproductive technologies ART.

In a qualitative study of infertile individuals in South Africa, Sewpaul shows how differing religious traditions can shape the experience of infertility. According to Sundby , while infertility is seen as a stigma in The Gambia, the existence of a strong fostering tradition means that 43 per cent of infertile couples have a foster child, a circumstance certain to have an impact on the experience of infertility. Feldman-Savelsberg argues that the experience of infertility is permeated by the political context in Cameroon, where infertile women feel that a weakening state cannot protect them as well from witches as it once did.

One characteristic of the sociocultural context that influences infertility is pro-natalism Parry , Ulrich and Weatherall For example, Israel is an intensely pro-natalist society with state subsidies for IVF and surrogacy Birenbaum-Carmeli , Kahn Remennick studied a small Israeli sample and concluded that none of the women she spoke to even believed that there was such a thing as voluntary childlessness.

In developing societies especially, having children may be the key to women achieving adult status and gaining acceptance in the community Hollos Bhatti et al. In Cameroon infertility can be a source of poverty for women Feldman-Savelsberg The experience of infertility is shaped by patriarchy, but the degree of male dominance and the range of roles other than motherhood open to women vary from society to society. In Egypt women bear the burden of infertility even when they know there is a male cause Inhorn According to Nahar et al.

Jenkins reports a case in Costa Rica where a woman, Silvia, had to resign herself to childlessness because her husband refused to be tested. Several studies demonstrate that infertile women who experience rejection or pressure from husbands and family experience higher levels of distress Gulseren et al. Gerrits reports that the experience of infertility may be different in matrilineal societies.

While patriarchy may be less striking in developed societies, it is by no means irrelevant to the experience of infertility in them. In a qualitative study of males who are infertile and have discontinued IVF, Throsby and Gill discuss what they see as the influence of hegemonic masculine culture on spousal relations. Husbands feel that infertility threatens their masculinity; while wives are pitied, husbands are teased. Men respond, according to Throsby and Gill , by casting blame on their wives.

As the above comments suggest, salient differences exist between the experience of infertility in developed and developing societies.

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Making Babies the Hard Way

It may be justifiable to think in terms of two worlds of infertility. Developed and developing societies tend to differ in prevailing assumptions about childlessness. In developed societies voluntary childlessness is viewed as a more viable and legitimate option and women without children are often presumed to be voluntarily childfree.

Because motherhood is so tightly connected to marriage in many cultures, the presumption is that women are childless only if they are infertile. The stigma and distress of infertility, therefore, is likely to be greater in developing countries Dyer et al. Policymakers and scholars are often more concerned about overpopulation than infertility in developing countries Bos et al. From the point of view of national and international policy, overpopulation is the most important problem, but women in the Cameroon grasslands perceive infertility and population decline to be the chief threat Feldman-Savelsberg Studies of infertility in developing societies are often quite sensitive to issues of sociocultural context; studies of infertility in developed societies more often treat infertility as a medical, ethical or psychological issue and pay less attention to the sociocultural context Bos et al.

Another difference between infertility in developed and developing societies has to do with folk models for making sense of infertility. In developed societies, acceptance of the biomedical model is virtually hegemonic, while in other societies biomedical interpretations of infertility coexist and interact to a greater degree with traditional interpretations Dyer et al.

In both developed and developing societies, folk explanations of infertility may be intertwined with biomedical interpretations Kahn , Sewpaul , Yebei Alongside the descriptive literature is a more quantitatively oriented literature focused on testing hypotheses about psychosocial aspects of infertility.

Edelmann and Connolly found no evidence of psychopathology among British infertility patients and propose that differences between the findings of controlled research and findings based on clinical impressions stem from the fact that counselors see the most distressed patients. They may, however, be responding to past arguments rather than to contemporary accounts in that most of the descriptive literature — as well as most reports based on clinical impressions — asserts not that infertile patients are fundamentally different from others in their psychological functioning but that the experience of infertility is a source of psychological distress Greil Wischmann et al.

While infertile women are not necessarily more likely to exhibit psychopathology they are more likely to experience higher levels of distress than comparison groups Beutel et al. Infertile women have higher distress scores on the Patient Health Questionnaire than do other women in family practice clinics Jordan and Ferguson Women currently experiencing infertility problems display more depression and anxiety than counterparts who have eventually conceived naturally Oddens et al. Several studies Holter et al. Studies of men also report mixed results.

Baluch et al. Folkvord et al. On the other hand, Monga et al. On the basis of a longitudinal study in Denmark, Peronace et al. Much research on both fertility-specific distress and general distress has focused on gender differences in levels of distress. Literature reviews Abbey , Eugster and Vingerhoets , Henning et al. Edelmann and Connolly suggest that this finding may simply reflect the tendency for women generally to be more distressed than men.

Despite this caution, most recent studies confirm earlier research that concludes that infertility is more distressing for women than it is for men Anderson et al. Additionally, White and McQuillan found that relinquishing a strong intention to have a child is associated with elevated distress for women but not for men. Pasch and Christensen write that women invest more in having children and are more treatment-oriented than men.

Women experience higher levels of stigma than men Slade et al. On the other hand, Dyer et al. It is also important to explore qualitative differences in the ways that men and women are affected by infertility. Beutel et al. Hjelmstedt et al. Most researchers who have investigated the relationship between infertility diagnosis and distress have reached the conclusion that the diagnosis does not exercise an influence over distress levels Edelmann and Connolly , Hjelmstedt et al.

No studies have established the extent to which distress among infertile individuals may reflect infertility treatment rather than infertility itself. Based on a national probability sample of women in the USA, King concludes that the effects of sub-fecundity on general anxiety disorder are not moderated by treatment. Some studies show that the length of treatment is not related to the level of stress Anderson et al.

I.V.F. Coverage Is the Benefit Everyone Wants

One unanswered question is whether changes in distress over time are a response to treatment or whether they are a result of the duration of infertility. Studies of IVF women and men Ardenti et al.

Making Babies the Hard Way Living With Infertility and Treatment

Studies of IVF women have also provided evidence that it is the outcome of the treatment rather than its duration that gives rise to increased levels of distress Lok et al. Most women eventually adjusted to unsuccessful treatment but a significant minority showed signs of emotional problems Beutel et al. The sizable literature on the relationship between distress and coping strategies among infertile individuals for example, Benyamini et al. According to Gibson and Myers , social coping resources, growth-fostering relationships, partner support and family support all contribute to lessened infertility stress among women.

Hansell et al. Brothers and Maddux report that women who perceive a strong link between their future happiness and becoming a parent exhibit higher levels of psychological distress. The focus on gender differences is also evident in studies of coping strategies Dhillon et al. A meta-analysis of six studies using the Ways of Coping Checklist led Jordan and Revenson to conclude that women display higher levels of seeking social support, escape or avoidance, plan-oriented problem-solving and positive reappraisal. A fascinating discovery comes from Pasch et al.

While infertility may lead to stress and communication problems between marital partners, Greil a , claims that couples nonetheless report that they feel that infertility has brought them closer together. A literature review by Pasch and Christensen finds that infertility does not typically lead to relationship or sexual problems see also Daniluk , Hjelmstedt et al. Webb and Daniluk state that when men reported actually beginning to deal with their infertility they started talking to their partners, which ultimately resulted in a sense of infertility as a shared experience and in turn strengthened relationships.

There are, however, some who claim that infertility does have a deleterious impact on marital relationships Wirtberg et al. According to Sundby , in The Gambia, where marital stability is already an issue, infertility is seen as a major threat to marital stability. These studies suggest that the impact of infertility on marital relationships depends on the sociocultural context. This implies that infertility will have a greater impact on relationships in the developing world.

Evidence for this claim comes from research showing that infertility is more strongly associated with psychopathology in Nigeria, a polygamous society Aghanwa et al. Researchers are conducting more systematic studies of the use and effectiveness of psychological interventions than was the case in the past Domar et al. A literature review of studies of the effectiveness of psychosocial interventions concludes that the evidence does not yet support the conclusion that counseling is beneficial Boivin More infertility patients express a need for counseling than actually seek it Boivin et al.

Guerra et al. Many couples now use the internet for information and support Kahlor and Mackert , Porter and Bhattacharya , Rawal and Haddad Wingert et al. Cousineau et al. Although most researchers have rejected the notion that psychopathology is an important causal factor in infertility Brkovich and Fischer , there is support for the cyclical argument van Balen that infertility produces stress, and that stress in turn inhibits fertility Henning et al.

In a literature review on psychological distress and infertility, Wischmann argues that stress and anxiety are likely to be contributing causes but are rarely the sole cause of infertility and asserts that methodological improvements are necessary before definitive statements about the causal roles of stress and anxiety can be made. In another literature review, Eugster and Vingerhoets cite some evidence that psychological factors may influence IVF success rates.

This is supported by research by a number of researchers Boivin and Schmidt , Boivin et al. Strauss et al. There is evidence that stress levels and coping strategies have an impact on sperm quality Pook and Krause , Pook et al. Alongside the literature on the experience of infertility exists another body of research that focuses on the experience of infertility treatment both in developed and developing societies. An important factor influencing the experience of infertility, even in developed societies, is access to care Beckman and Harvey Feinberg et al. In contrast to US women, Israeli women experience infertility in the context of state support of infertility treatment Kahn , Remennick This suggests that, as new treatments become available, patterns of usage and, indeed, the experience of infertility, may change as well.

For example, Miller observes that the intention to have children has risen faster among sub-fecund women than among fecund women and speculates that this trend may be a response to the increasing availability of ART.


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Although rates of seeking help for infertility are comparable in developed and less developed societies Boivin et al. Dyer et al. Lack of access to primary care appeared to be a major barrier. Sundby writes that the formal medical systems in both The Gambia and Zimbabwe are unable to meet the need for services. That infertility is a major concern is evident from the high proportion of hospital admissions, but the care women receive is often inappropriate Sundby et al.

Making Babies the Hard Way by Caroline Gallup (ebook)

Lack of coordination between care providers means that people may go through the same treatment several times. Affluent women in The Gambia, India and Egypt have access to sophisticated gynecological facilities and ART but the needs of poor and middle-class women are not met Sundby et al. A crucial difference between infertility treatment in developed and developing societies is the greater availability, acceptance and utilization of alternative care systems in developing societies Kielman , Okonofua et al.

Many clinic patients in both South Africa and Zimbabwe say that they went first to see a traditional healer Dyer et al. Nahar et al. Yebei reports that, even after they had immigrated to The Netherlands, Ghanaian women often had to seek alternative practitioners, such as herbalists and spiritual healers, because of the high cost of biomedical treatment.

The delivery of infertility treatment appears to be shaped in many ways by its sociocultural context. Treatment of infertility in India is shaped by the fact that adoption is not an option, given the Indian ideology of marriage and the family. Inhorn writes that Islam prohibits adoption because there are no blood ties to the father and no maternal bond.

In contrast, Jenkins describes the situation in Costa Rica, where adoption is a socially acceptable solution to the problem of infertility because unwed pregnancies are a problem and abortion is illegal. In countries influenced by Islam, religious leaders deem donor insemination unacceptable Folkvord et al. Handwerker posits that the ideological importance in China of having sons fuels the Chinese ART industry. Inhorn has been especially eloquent in discussing the interplay between cultural understandings and reproductive technology in Egypt.

Mitchell argues that increased marketing of reproductive technologies has led to couples seeking help earlier and may have resulted in unnecessary treatments. Because only about half of infertile individuals worldwide seek treatment, the question of what factors influence help-seeking is an intriguing one. On the basis of a study of a population-based sample of infertile women, White et al. Because this was a cross-sectional study, it remains unclear whether defining oneself as infertile is a prerequisite to seeking treatment or whether it is treatment that leads individuals to define themselves as infertile.

Bunting and Boivin found that women who were more concerned about being labeled infertile were less likely to seek treatment. Greil and McQuillan have found that infertile individuals with intent were more likely to seek treatment than infertile individuals without intent. It is apparent that not all US women who are infertile by the medical definition see themselves as infertile.

Conversely, Gerrits notes that Macua women in Cameroon who sought both western and traditional treatment were not necessarily infertile by the biomedical definition. More recently, Daniluk has reported that, of the 65 infertile couples she interviewed, it was the woman who initiated treatment in all cases see also Webb and Daniluk , Throsby and Gill Although women are very treatment-oriented, they nonetheless find the experience of treatment highly stressful Peddie et al.

Yebei discovered that Ghanaian women in The Netherlands found infertility treatment unpleasant and emotionally draining. Husbands, too, find treatment stressful Schneider and Forthofer , but men who perceive healthcare professionals as supportive report lower levels of stress and anxiety Brucker and McKenry Several studies have shown that patients are intimidated by the language of biomedicine and by the technical aspects of infertility treatment, especially in situations where language barriers exist Becker et al.

The infertility treatment experience has been described as a situation that engulfs patients and dominates their daily routine Daniluk , Redshaw et al. Greil summarizes the experience of treatment of infertile women in terms of three paradoxes: i their sense of loss of control leads them to treatment where they lose even more control; ii their feelings of loss of bodily integrity leads them to treatment where the body is invaded; and iii their sense of loss of identity leads to treatment where they feel they are not treated as whole people. Still Greil insists that infertile women in the USA should not be seen as passive victims see also Letherby , Parry Riessman , and Todorova and Kotzeva make similar observations about women in southern India and Bulgaria, respectively.

Infertility patients want to receive patient-centered care Schmidt et al. Nonetheless, women expressed stoicism and saw the difficulties of treatment as the price they had to pay to have a child.

Making Babies the Hard Way: Living With Infertility and Treatment

Patients expressed satisfaction if they perceived that care was individualized, supportive and friendly. Sources of dissatisfaction were the slow progress of treatment and poor relationship with healthcare providers. Women display variability in which aspects of treatment they find most stressful Benyamini et al. The difficulties patients have in putting a stop to treatment have also been discussed Greil a , Sandelowski Olivius et al.

Although it is difficult to stop treatment, Verhaak et al. Women who have stopped IVF treatment often go through a period of self-reflection before coming to terms with their infertility Peddie et al.

Living With Infertility and Treatment

A study of Scandinavian women two years after unsuccessful IVF found that the women refocus on other concerns but still retain hope for a child Johansson and Berg Johansson and Berg describe women who, even after they discontinued treatment, do not relinquish hope, at least until they reach menopause. Small-sample studies of women who are not able to have biological children find that many restructure their definition of family to include adoption and childfree lifestyles Parry , Su and Chen , Ulrich and Weatherall Achieving pregnancy does not necessarily restore normalcy to the lives of infertile individuals.

Eugster and Vingerhoets report in a literature review that pregnancy for people undergoing IVF is more stressful than for people without fertility problems see also Bevilacqua et al. Letherby states that infertile women who have given birth through ART report feelings of anxiety and guilt as well as an obligation to be perfect mothers.

Conversely, Hjelmstedt et al. Parents say infertility has led them to have stronger feelings for children, to have greater tolerance for the difficulties of parenting and to be more grateful. Men felt infertility had made them emotionally closer to their children than they would otherwise have been. The few empirical studies that have been done on the acquisition of maternal identity among infertile women show that infertile mothers have lower self-evaluations and take longer to embrace the motherhood identity Gibson et al.

There is, however, no evidence of problematic maternal behavior, marital problems or psychological problems Repokari et al. Ulrich and Weatherall state that infertile women who eventually give birth discover that motherhood presented more challenges than they had expected. Eugster and Vingerhoets find no differences in parenting between parents who have conceived through IVF and other parents. Some researchers have addressed the long-term consequences of infertility. Wirtberg et al. They found that the women still had vivid memories of their time as infertility patients although all but three were able to develop a satisfying childfree life-style.