Exploring fertility-related quality of life of infertile women experiencing in vitro fertilization treatment failure and role of childbearing beliefs in women's well-being in traditional family systems

Abstract

BACKGROUND: The experience of infertility treatment, especially in vitro fertilization, were frequently described as an emotional roller coaster, with stress, anxiety and depression as common reactions over the course, and emotional burden and psychological distress as common side-effects of treatment discontinuation after cycle failures. Not only has the treatment experience create on marital tension, under the cultural stigma of attributing responsibility of infertility to the women, treatment failures will potentially creating emotional pain and suffering for the infertile women. Currently, few studies explored the impact of infertility treatments in women in Asian cultures, which place much importance on the continuation of patriarchal lineage, on infertile women. Little is known about their fertility-related quality of life (FertiQoL), the role of cultural beliefs in affecting their well-being, and effects on her well-being when treatment fails. This studies investigated the fertility-related quality of life in Chinese infertile women after unsuccessful treatment, and the role of cultural beliefs in childbearing in affect the women’s well-being as well as couple relationship. METHODS: A cross-sectional survey was conducted with 198 infertile women who experienced IVF treatment failure. They were recruited through individual invitation at a university-affiliated assisted reproduction clinic, and completed questionnaire about their fertility-related quality of life (FertiQoL), beliefs in childbearing, couple relationships, treatment history, and demographic characteristics. RESULTS: On average, participants were aged 37.0 (SD=3.5), married for 7.4 years (SD=3.7), and being diagnosed of subfertility for 4.1 years (SD=2.45). Majority received tertiary education and had a full-time job. The mean scores of total fertility-related quality of life (Total FertiQoL) (t = 8.10 and 8.36, p < .01) and quality of life across the emotional, mind-body, relational and social domain (Core FertiQoL) (t = 8.10 and 8.36, p < .01) were found to be better than that from a Western sample. Nonetheless, their quality of life associated with infertility treatment (Treatment FertiQoL) showed no difference from their Western counterparts (t = 1.41, n.s.). Total and Core FertiQoL were found to be negatively associated with the women’s identification with Chinese cultural beliefs about childbearing such as “It’s the Wife responsibility to childbearing’ (b= -3.384, p <.001), “No children is the biggest issue” (b= -2.97, p <.05). For Treatment FertiQoL, identification with the “It’s the daughter in-law’s responsibility continue lineage” belief significantly predicts poorer outcomes (b= -3.356, p <.01). IMPLICATIONS: This study sheds light on the quality of life of Chinese infertile women after unsuccessful IVF treatment. Identification with Chinese beliefs of childbearing, which emphasizes the patrilineal culture, was associated with worse well-being. The study underline the importance of cultural sensitivity in addressing fertility-related issues in order to better facilitate psychosocial support at the clinic, as well as to empower these women to express their personal values and cultural beliefs throughout the course of infertility treatment. This study was generously funded by the University Grant Council – General Research Fund HKU740613.