Women's Experience of Infertility: A Multi-systemic Perspective

Abstract This article describes a study that used a multi-system perspective to document the self-reported experience of women struggling with infertility and its treatment. A sub-sample of 56 participants from a parent study that examined posttraumatic growth in the context of infertility was used based on their answers to a single open-ended question about their infertility experience, which was included in the original questionnaire. Inclusion criteria were self-identified failure to achieve a pregnancy or carry it to term after at least one year of trying in the six years prior to the study and absence of a recent crisis unrelated to the infertility. Responses were content analyzed independently by a team of three researchers. The analysis yielded agreed upon 85 codes clustered in six themes: Challenges, perception of the experience, reactions, support, coping strategies and posttraumatic growth. The main overall finding points to the sense of being "trapped" in a web of multi-faceted, environmental and internal relationships between diverse systems involved in the infertility treatment. Implications for practice are identified and directions for future research suggested. Key words: Women and infertility; infertility and psychosocial experience; single question Introduction And God blessed them, and God said unto them, be fruitful, and multiply, and replenish the earth and subdue it. Genesis 1:28 (1) The social demand for reproduction exists in all cultures. This study used a multi-system perspective to investigate the lived experience of women who are unable to meet this expectation due to infertility-related issues. Infertility is defined as the failure to achieve a successful pregnancy after 12 or more months of regular unprotected intercourse (ASRM, 2008). It is estimated that infertility affects about 80 million people worldwide (Nachtigall, 2006). While generally one in ten couples experiences primary or secondary infertility, its rates vary by socio-cultural contexts from less than 5% to more than 30% in developing countries (Vayena, Rowe, Griffin, Van Look & Turman, 2002). In the US, 2.1 million married women (7.4%) between the ages of 15-44 are reported to be infertile and 7.3 million women (11.8% of women ages 15-44) as well as approximately 3.3 - 4.7 million men (7.5% of those sexually active) have used infertility services (Anderson, Farr, Jamieson, Warner & Macaluso, 2009; CDC, 2002). Projections for up to the year 2025 suggest that these numbers are anticipated to increase (Stephen, & Chandra, 1998). The use of infertility services in the US often requires navigating complex medical and financial systems. For instance, medical treatment for infertility typically occurs at a hospital or community-based fertility treatment center staffed with numerous personnel including insurance and payment coordinators, schedulers, lab personnel, nurses, doctors and mental health professionals as well as secretarial and support staff. In addition, there is the necessary negotiating with health insurance carriers, which may require completing and submitting a plethora of documentation as well as following up with telephone calls and/or e-mails for approval of procedures and reimbursement of expenses. Those who utilize third party reproduction (e.g. sperm, egg or embryo donation) have the added tasks of coordinating with a cryobank or agency. These medical and financial systems join the existing systems of family, friends, career, religion, and community of those struggling with infertility. The combination of input from these complex environmental contexts affects and is affected by the physical and emotional challenges caused by the infertility experience itself, and is experienced within each individual's unique coping style. Cross-culturally, infertility is recognized as a stressor event with the potential to cause havoc in the lives of individuals, couples and families (Burns & Covington, 2006; Shapiro, Shapiro & Paret, 2001). …