Monday, October 13, 2008

Oxford Journal Study

Since I'm still at a point where I can't put into words how I'm feeling, here's a nice upbeat little study for you:

http://humrep.oxfordjournals.org/cgi/content/full/20/7/1944


Difficulty with acceptance of infertility
For many women, the point of acceptance of childlessness had not been reached, which hindered the decision-making process. ‘I am always going to have regrets that we can't have a child, but you have to accept what you have got rather than what you haven't. You have to make alternative plans and they don't include children’. However, for some, ‘many questions remain unanswered’, and ‘many issues unresolved’. Similar sentiments were voiced by others: ‘Facing up to the fact that you will never have your own child is very traumatic and in a sense we feel forced into the situation of being childless’, or: ‘I think it's still happening [acceptance], it's such a long process, I mean we stopped treatment in May of last year, and I still can't accept it’. Although the decision to end treatment had been made, these women were generally less positive, not only with their inability to accept biological childlessness, but of their decision. Those who went on to adopt or have less invasive treatment such as donor insemination were more likely to feel more positive about their future, and no longer viewed themselves as ‘childless’: ‘I must admit the adoption changed things for us dramatically. We had another focus and we were probably ready to move on earlier than those couples for whom adoption is not an option’. One woman was more cautious about adoption and viewed the process as socially less acceptable; ‘We were too old for adoption, and anyway, we were not prepared to take on a child who may well be psychologically damaged’.

Stress associated with IVF
A common response from women was related to the stress caused by IVF treatment, and the process of decision-making often exacerbated this. However, relief of the cyclical process of ‘treatment and stress’ was evident once the final decision to end treatment was made. One interviewee indicated that: ‘the IVF for me was an extremely traumatic experience and I just wanted it all to end’, and went on to clarify that it was her life that she wanted to end. Others reported similar feelings of depression: ‘The GP started me on antidepressants. I just wasn't coping with it all’, or: ‘In a way, I felt quite depressed, not in the clinical sense, but I felt so low, so down, in a way I had never felt before. That lasted for about two months and I decided then that I never wanted to feel like that again’.

Unrealistic expectations of treatment

Making the final decision to end treatment was influenced by unrealistic expectations of success and the inability to cope with treatment failure: ‘I suppose we were naïve in thinking that IVF would work first time’. Many women were initially hopeful, but eventually succumbed to despair after repeated unsuccessful cycles of IVF: ‘In the beginning there was so much hope, I mean it was something positive we could do, and now ... there's no purpose in life anymore, no relationship left. What's the point?’. Many felt that continuing treatment was their only means of suppressing feelings of negativity and pessimism. Respondents appeared to go through a period of critical self-reflection in arriving at the decision to end treatment: ‘We never thought we would still be here [having IVF] three years on, but in time your attitudes change and you are faced with dilemmas you never thought possible’.

Pressure from media and society
Prior to making the final decision to end treatment, many women had searched the Internet for information about the possibility of new treatment options: ‘I searched every web-site you could imagine. If anything, it made me feel better about my decision in that thousands of people were going through the same experience’. However, some felt that medical staff appeared uncomfortable when faced with the results of their own literature search: ‘You never seemed to approve of the information we downloaded from the Internet, but we had to explore all options before making the final decision, leaving nothing undone I suppose’. In essence, the media proved to be another source of pressure on couples who experienced a social obligation to try new technology in order to reproduce: ‘It's the whole extended family thing. It's almost like a fashion accessory—sorry to be so flippant, but you're not accepted in the same circles or the same way if you don't have kids’. One couple commented on the apparent effect of ‘monthly media headlines’ that created indecision with regards ending treatment by suggesting that significant breakthroughs were imminent: ‘You read about it [in the media] all the time, third time lucky for IVF couple or someone who gets pregnant after adopting a baby’.

Social and professional opportunity costs
Most women had spent the majority of their thirties going through investigations and treatment resulting in a sense of ‘missed opportunities’, which eventually influenced their decision to end treatment: ‘I was so drained throughout treatment and never felt sociable. We had a great social life before IVF and a part of me wanted that back so badly’. Many were unable or unwilling to share their concerns and anxieties with close family and friends, distancing themselves from potential support networks. One woman captured her own experience: ‘One of my closest friends said that I had changed since starting IVF when I called off lunch yet again. ... I didn't feel sociable, but deep down I missed the social interaction. I suppose I was afraid that someone would appear with a baby or to say that they were pregnant, and I just couldn't cope with that. I had to stop [treatment]’ Some women actually described feelings of relief at the end of treatment, with one woman explaining in detail how she could now move on with her life: ‘I wanted my life back, and I remember feeling great sadness at the thought of never being pregnant, more than that, never having a child, but also a huge relief that I wouldn't have to go through another IVF cycle and the disappointment and grief that it brings’ Being released from the incredible stressful cycle of events that surround IVF treatment was expressed by another respondent: ‘I'm still grieving for the child I never had, for my fertility, but I feel a sense of relief that I don't have to go through the emotional upheaval of another cycle and that we can now move on’. For many, infertility and assisted conception-related issues created a sense of ‘life on hold’.

Physical and emotional pressure exerted on the couples' relationship
Financial pressure and the need to balance the conflicting demands of IVF, with those of an everyday social and professional life, caused frequent conflict within the marital relationship. ‘We had spent over $22,080 on IVF; not that we grudged the money; I mean you can't put a price on a child, but it added to the stress of it all’. In addition, whether to have another cycle of treatment or not created further conflict: ‘We just couldn't agree on whether we should have another cycle of IVF. Neither of us would admit we had really had enough, as you don't want to be the one who admits defeat’ Many commented on physical and emotional pressure that IVF exerted on their marriage/relationship, often resulting in periods of depression: ‘He [her husband] would have carried on, but I couldn't have coped with another disappointment, the anger and especially the depression—I just couldn't do it anymore’. As time went by, repeated failure lead to despair and isolation: ‘The constant stress and disappointment was incredible. Looking back, I would have risked my marriage for it all [a child/children]’

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