[ad_1]
From the data analysis of the transcripts, three themes and 13 sub-themes were generated and are presented in Table 2. We present each theme below with subthemes, codes, and associated quotes.
Theme 1. Challenges encountered during fertility treatment
This was the first theme to be identified from the data. Within this theme, three sub-themes were identified. These subthemes describe specific ways fertility treatment posed a challenge to women. According to women, fertility treatment is emotionally distressing, physically painful, and financial constraining.
Emotional distressing
All women experienced emotional distress and suffered from anxiety, worry, depression, and loneliness. One woman described the fertility treatment experience as passing through the desert, where there is nothing to drink or eat, only scorching sun, meaning that the treatment journey is torturous and accompanied by psychological suffering.
“I feel like I am passing through dessert, in a dessert, there is no water and something to eat, only scorching sunny, which burns, that how I feel, my heart is breaking and I am in escorting pain” (participant 30–35 years old-no child).
Most women reported that they were anxious going through the treatment process and particularly about whether or not they will achieve pregnancy.
“This is my eighth year in treatment; I have tried all other methods such as surgery and hormonal therapy and failed. I am now trying ART; we are worried that if I do not conceive now, it may be our last chance to be biological parents of another child” (participant 8–42 years old-1 child).
“My husband and I were very hopeful at the beginning of the treatment, but the doctor explained that we have only a 50% chance of getting a baby; it is like a gabble. I am always worried and anxious about the treatment outcome” (participant 11–38 years old-1 child).
Most women talked about being worried and concerned about their current age because they were scared of reaching pre-menopausal without having their child and therefore needed help.
“I am worried that I am aging and will be a pre-menopausal woman soon; I heard that a woman’s fertility declines with age, so I came to the hospital to get help before it is too late” (participant 32–36 years old-1 child).
It has been ten years since we started trying to get pregnant, we are worried that we are getting old without a baby, and I came to this hospital to see if they can help me (participant 22–38 years old-no child).
Most women talked about the intense feeling of sorrow, disappointment, loss, and hopelessness following unsuccessful treatment.
“It is depressing; I have visited different hospitals and gynecologists and undergone surgery to remove a cyst on the left of my ovary. Now I am going through an IVF. I have spent much money seeking the solution, all in vain. Very disappointing” (participant 25–31 years old-no child).
“I was so disappointed last month after unsuccessful treatment. My husband and I spent a lot of energy and effort with no fruit. We went through a lot of pain and hurt; it was challenging for us because we started with a lot of hope but ended up with nothing.” (participant 4–35 years old-no child).
Most women reported profound sadness, frustration, despair, and anger during their menstruation, with some perceiving their periods as a loss of embryos, especially those undergoing ART. In addition, all women who had experienced miscarriages during infertility treatment reported feeling like they had lost a child and its relationship, leaving them in intense emotional pain.
“The doctor told me to wait for three weeks for embryo implantation to occur, then two weeks later, I got bleeding that how I lost my baby, to be honest, I was in shock and could not believe it, to say the least” (participant 32–36 years-1 child).
“Having a fertility issue is a problem on its own, and losing the baby, you have worked for hard for, you feeling like you are bleeding inside, I lost my IVF baby (embryo) at eight weeks” (participant 33–40 years old-1 child).
Most women interviewed described their infertility treatment experience as lonely and isolating because they lacked communication with their husbands and lost most of their friends.
“My husband does not want to talk about infertility or treatment; he keeps quiet or changes the topic when I try. I also lost most of my friends, and I had nobody to talk to except God” (participant 1–32 years old-no child).
“Going through fertility treatment is a painful and lonely experience it takes a lot from you, starting from husband, time, money, and friends, and many people do not have any idea how it feels like” (participant 7–34 years old-1 child).
Most women reported experiencing emptiness, defectiveness, incompleteness, unworthiness, and less of a woman.
“Treatment process hit hard; it leaves one feeling like the body is has a defect, incomplete and less of a human being leave alone a woman” (participant 19–32 years old-no child).
“Why me? What is wrong with my body? Why can I not be like other women who get pregnant easily? What did I do and did not do right, so I have to suffer like this by taking these drugs to get a baby? I feel like my body has failed me, and I empty from within” (participant 23–24 years old-no-child).
“Sometimes, I doubt my femininity. I say I am a woman who is a woman if she cannot conceive and give birth like other women. I have to get pregnant with the help of fertility treatment, and even with this assistance, I still cannot” (participant 6–35 years old-no child).
Notably, two women interviewed talked about having suicidal thoughts while pursuing treatment, although none had attempted suicide.
“I was driving from the hospital after my appointment; then a thought came to my mind, you useless woman, you may try to get the best care for your inability to have a baby, but no matter what, you will never have a baby. You are better off dead than alive because you have no value to the society, family and husband” (participant 28–34 years old-no child).
To conclude, women experienced various forms of psychological distress while seeking fertility treatment ranging from anxiety, worry, depression, loneliness, disappointment, and suicidal thoughts.
Physical pain
Almost all women reported experiencing physical pain during their fertility treatment, resulting from daily injections, intrusive procedures, and side effects of medications. The recommended drugs for infertility treatment include the gonadotrophin-releasing hormone (GnRH) to prevent premature ovulation, follicle-stimulating hormone (FSH) to stimulate ovarian follicle growth, human chorionic gonadotrophin (HCG) to facilitate the final maturation of oocytes, and progesterone to support the changes in the endometrium. These drugs are either administered orally or through injections. Frequent blood tests and transvaginal ultrasounds are needed to monitor the ovarian response. Some women described the treatment process as the following:
“The ART process is tormenting and traumatizing in general. For example, progesterone shots are painful as they must be injected deep into the muscle because they are oil-based. In addition to that, I have to get frequent blood tests, my whole body is full of pinholes, but I have to bear it since I want to have my baby” (participant 22-38 years old-0 child).
“The treatment process is torturous and punishing, especially going to the hospital daily for those injections. I had to juggle between hospital and work. I would go home very tired.” “(participant 17-33 years old-1 child).
“Frequent scans are a little annoying; I wish if they a way they can reduce them; it could be better. Egg retrieval was the toughest and most painful procedure. After the procedure, I had severe vomiting and could not eat anything. Both sides of my ovaries were swollen and sore, making it difficult to sleep and walk” (participant 25–31 years old-no child).
Almost all women reported having physical discomfort from hormonal therapy, such as weight gain, breast tenderness, ovarian pain, abdominal discomfort, and bloating. Some women expressed concern about the long-term effects of using fertility drugs.
“I experience severe bloating and headache after taking those fertility drugs, which is very uncomfortable” (participant 9–28 years old-no child).
“Since I started using the fertility drugs one year ago, I have gained 5 kg and frequently experience severe breast and stomach pain” (participant 12–21 years old-no child).
“I am worried about continuing using these drugs because we can never be sure if they can cause other diseases like cancer. I might be harming my body; you never know” (participant 21–35 years old-2 children).
In summary, women reported physical pain due to multiple injections, invasive procedures, and hormonal drugs related side effects while undergoing fertility treatment.
Financial constraining
All women, irrespective of their education and occupation, described fertility treatment as an expensive adventure. According to the women, many could afford the treatment because they had taken bank loans or borrowed from friends, sold their properties, supported by their husbands, and paid for by National Health Insurance Fund (NHIF) Card.
“I had to apply for a loan to pay for my treatment; I cannot afford it. For example, when I visit the hospital for an appointment, I need to pay more than KSH 5,000 for doctor’s consultation and prescribed drugs” (participant 10–33 years old-1 child).
“Fertility treatment is expensive, especially when surgery is involved. Last month, we had to ask our family and friends for money to pay for my fibroid removal operation” (participant 5-32 years old-1 child).
“We have spent all our savings on treatments, and we are now thinking of selling our car to cater for treatment” (participant 14–26 years old-no child).
One woman whose husband was paying for her treatment stated that her husband had been urging her to stop treatment so that they could save that money for other things.
“I know it is not easy for my husband; he works two jobs so I can undergo treatment, and we have our biological child. He wants me to give up the treatment so that we save money to buy a house, but that is not me. I consider a house useless; I cannot compare it with a baby” (participant 4–35 years old-no child).
Notably, all women who had experienced failed treatment, especially those paying the medical bill out of their pockets, reported feeling financial loss from treatment costs, transport costs, accommodation costs, time spent during treatment, and loss of jobs.
“What a loss. We sold our house to cater to the treatment cost; then, the treatment did not work. All the time and money we used for transport and accommodation to come to Nairobi is gone. It was a total loss” (participant 17–33 years old-1 child).
“I quit my job to concentrate on the infertility treatment because it was so exhausting, then after treatment what did I get a negative test, so heartbreaking” (participant 25–31 years old-no child).
Three women employees of the Kenya government talked about using their NHIF to pay for their fertility treatment. They still weighed that they could not have afforded the cost of treatment if not for the NHIF card.
“I can access the treatment without financial difficulty because I have an NHIF card; without it, I cannot afford it on my own” (participant 16–42 years old-no child).
“Fertility treatments are expensive, and most infertility treatments are not covered by medical insurance. It would not have been easy financially to access the treatment without this NHIF card” (participant 27–36 years old-1 child).
In summary, women reported that fertility treatments were expensive, and most experienced financial burdens during the treatment period. The study observed that some women funded their treatment, others were supported by their husbands, and others took loans or borrowed from friends and relatives. It was, therefore, essential to explore how fertility treatment affected women’s relations with their husbands, family members, and friends.
Theme 2. Impacts of fertility treatment on relationships
The impact of fertility treatment on relationships was the second theme identified from the data. Within this theme, three subthemes were identified. These subthemes describe specific ways fertility treatment impacted their relationships. According to women, fertility treatment has negatively affected their relationships with their husbands, family members, and friends.
Relationship with their husband
Most women indicated that undergoing fertility treatment has negatively impacted their relationship with their husbands. According to women, one of the most affected aspects of their life was their sexual life. Some women reported that their husbands had lost sexual interest in them.
“Since he (my husband) started the treatment, he lost interest in me sexually; he does not want anything to do with me” (participant 20–34 years old-no child).
“Honestly, I do not know what happened to him (my husband) when I started the treatment. He is no longer excited as he used to be sexually, always giving excuses; I feel tired. It is very frustrating. I feel like I am forcing him to do it” (participant 26–29 years old-no child).
Some women also indicated the process of infertility treatment had shifted sex from romantic and intimate to stressful events.
“Our intimate moment died after my husband started treatment; we only concentrate on the mechanical–biological aspect of it conceiving. I miss those days when we would have spontaneous sex without worrying about getting pregnant; that was pleasurable” (participant 24–33 years old-1 child).
“Since I started treatment, we have been scheduling sex during ovulation; my partner complains that he feels like a sperm donor” (participant 18–29 years old-1 child).
Some women reported that their husband’s attitude and behavior had changed after starting the fertility treatment ranging from verbally abusive, absenteeism, drug abuse, and not providing financially for their family.
“My partner no longer pays for anything in this house; when I ask, he says I do not have money; I use all of it on those stupid hospital bills. If you would have a child normally, I will not need to pay for it, so keep quiet. It hurts so deep” (participant 28–34 years old-no child).
“He (My Husband) started drinking excessively and became verbally abusive. He says I am useless, my work is to eat and misuse his money from one doctor to another, and I should go back to my father’s house if I cannot give him another baby” (participant 3–28 years-1 child).
“My husband became a work alcoholic; he started going to work very early in the morning, coming home late, and even working during the weekends. He does not want anything to do with the treatment process” (participant 13–44 years-1 child).
None of the women, however, mentioned physical abuse.
Only four women reported that the treatment process had positively contributed to their relationship with their husbands.
“During this treatment period, we have become more emotionally connected. We share our fertility treatment struggles. My husband understands me, and I understand him. He is more than my husband, my best friend, if I may say” (participant 31–28 years-1 child).
“I knew my husband cared for me but not to the extent he has shown me during this treatment period. He says kind words and is always there for me even if I feel like giving up. The treatment struggles have brought us together emotionally. We can comfortably share our difficult emotions without fear of being judged but with the attitude of being accommodated with understanding and love” (participant 33–40 years-1 child).
According to women, fertility treatment had given some couples hopes of having their biological child, and this hope rejuvenated their marriage.
“After many years of trying various kinds of treatment such as fertility treatment and numerous surgeries, we were on the verge of giving up. Our doctor mentioned ARTs, indicating it is the best treatment for us; we feel hopeful again of being given another chance to become parents. We are delighted and grateful it is a matter of time now.” (participant 27–36 years-1 child).
“Pursuing treatment and following doctors’ orders make my husband and I feel hopeful that one day we will able to have a baby of our own” (participant 29–32 years old-no child).
Relationship with their family
Most women felt that infertility treatments negatively impacted their family members’ relationships. According to women, one of the severely affected relationships was the women’s relationship with their in-laws. Some women reported that due to treatment, financial and time constraints were unable to attend to family needs and functions.
“My mother-in-law is unhappy with me because we do not support her financially like before. We do not have money. All of it goes to fertility treatment. She thinks I am the one preventing her son from sending her money. Our relationship with her has become strenuous” (participant 2–29 years old-1 child).
“I can no longer attend family gatherings because most of the time I spend between hospital and workplace. I am always tired and feel sick due to fertility medications. Nobody in my Husband understands why I have suddenly changed apart from my husband. I hope this situation will not last for a long time. I wish our relationship with my in-laws would return as it used to be” (participant 8–42 years old-1 child).
Most women whose in-laws knew they were undergoing treatment reported feeling pressured to get pregnant. This pressure resulted from repeated intrusive questions such as what did the doctor say? Is everything okay now? And how is the treatment going? Which often inflicted emotional pain and forced these women to stay away from family gathering functions and not pick up in-law’s phone calls.
“I do not pick up my husband’s relatives’ phone calls; they want to know everything about the treatment and just because they once helped us pay the medical bill. They start with those questions. Is everything okay now? What did the doctor say was wrong? When do we expect the visitor (baby), or when are we coming to drink porridge? (customary, when a child is born, other women go to see the new baby, and the host offers them wheat porridge). Those questions hurt so much; they are too personal to be discussed with anyone” (participant 15–28 years old-no child).
“My Husband’s family always offers us advice, such as which hospital to go to, new drugs or positions to try, even which church to go to for payers. It is very irritating and upsetting because they think we have not done anything and others think we need to do more. I try to keep off from them” (participant 19–32 years old-no child).
Most women choose not to disclose their pursuit of fertility treatment to their families because of perceived pressure that would result from constant questions such as whether there is there still hope. Significantly, most women feared their children would be stigmatized if they happened to conceive as they would not be regarded as normal.
“We do not disclose any information about our treatment journey; otherwise, we will answer all families’ questions about how the treatment is going, which can be very annoying. We also do not want our children to be stigmatized in the family and society” (participant 17–33 years old- 1 child).
“We do not share any information regarding our infertility treatment journey; we want it to remain a private affair. Also, if we get children, hopefully, we want them to be regarded as normal children rather than test tube babies” (participant 4–35 years old- no child).
Only two women reported that their relationship with their in-laws remained the same after starting fertility treatment.
“My relationship with my in-laws is the same as before starting the treatment; they do not know we are pursuing fertility treatment, but they can see something is wrong. The in-laws frequently visit us in our home; we feel supported and loved” (participant 10–33 years old- no child).
“Our relationship with our in-laws has remained almost the same even after starting the treatment. My husband’s family has supported us financially, emotionally, and spiritually during our treatment journey. They are our source of strength. We feel truly blessed!” (participant 5–32 years old- 1 child).
Relationship with their friends
Most women indicated that infertility treatments had negatively impacted their relationships with their friends. According to women, their friends suddenly lost interest in them and started treating them differently immediately after learning about their fertility treatment. This reaction left the women feeling disappointed.
“I am very disappointed with my best friend. Since I told her that I was facing some problems while seeking infertility treatment, she started treating me differently and lost interest in me. She stopped calling or texting me, visiting my home, and stopped inviting me to her children’s birthdays” (participant 1–32 years-no child).
“My friends lost interest in me and did not want to be associated with me after news spread that I had been spotted attending a fertility clinic in a nearby hospital. I feel hurt, sad, and deeply disappointed” (participant 9–28 years-no child).
Some women reported that they had lost a lot of friends during their infertility treatment journey. Some reasons for this loss were not getting financial support and lack of engagement with friends due to treatment constraints such as time and money.
“When I reached out to my friends for financial assistance to pay for my fertility test and treatment, they all disappeared, is when one is in problems knows their true friends. I am afraid to say I have no true friend now” (participant 2–29 years-1child).
“I have lost a lot of friends during this treatment period. One reason is I do not engage with them as I used to. I am always tired and feeling sick due to fertility treatment. I take breaks and rest more often than before. The second reason is that I do not have the money to visit new places or buy new stuff. I use that money to pay for the hospital bill and buy drugs. To treat infertility is an expensive affair in this country” (participant 12–21 years-no child).
One woman refused to talk about how fertility treatment has affected her relationship with friends. While looking down, she said:
“There are no friends in this world. I do not like talking about friends. I find no value in discussing having friends and speaking of people who will discourage you from seeking fertility treatment. God is the only true friend” (participant 26–29 years-no child).
Some women reported how asking intrusive questions about fertility treatment had impacted their relationship with their friends, particularly those who had helped raise money to pay the medical bills, which most participants did not appreciate.
“Friends ask many questions such as how is the treatment? And what do the doctors say about your progress? They repeatedly ask because they feel they have the right to ask questions and get answers. After all, they contributed to the hospital bills. It is tiring and frustrating to answer these types of questions” (participant 30–35 years-no child).
“I dislike speaking or answering questions about my infertility treatment struggle. So I keep off from friends who like asking such questions” (participant 20–34 years-no child).
Throughout fertility treatment, women face numerous challenges, including emotional distress, physical pain, and financial constraining. Women considered fertility treatment torturous and punishing, and oocyte retrieval was the most challenging procedure than injections, tests, and embryo transfer. The menstruation period was characterized by profound sadness, despair, and anger, especially for those women undergoing ARTs. Those women who had experienced a miscarriage during the treatment reported intense emotional pain from the perceived loss of a child and its relationship. Moreover, fertility treatment made women endure the negative impact of the relationship with their husbands, family, and friends. Therefore, it was essential to explore how these women coped with all these fertility treatment challenges.
Theme 3. Coping with fertility treatment
From the data, there were six ways women tried to cope with the fertility treatment burden ranging from religious practices and personal faith, giving in to feelings, shifting focus, taking a break, staying with their relatives’ children, and receiving support from others.
Religious practices and personal faith
All women reported relying on their faith or religious practices to cope with fertility treatment challenges. The women described how reading the Bible, praying, and believing in God have been their source of strength as they pursued fertility treatment.
“If not for prayers and reading the word of God, I do not know how I could have managed to overcome the treatment burden. It is not easy, but my husband and I are coping well with the process through God’s grace” (participant 3–28 years old-1 child).
“I do not get very stressed by fertility treatment outcome because I believe Allah will give a child at His own time” (participant 13–44 years old-1 child).
“Knowing that in the Bible, Sarah, Hannah, and Elizabeth struggled with infertility, God answered their prayers. I get encouraged to continue with treatment. Knowing that the same God responded to their payers is the same God who will answer my prayers one day. When I remember that God is not a man and that He should lie, I stop worrying and wait on Him patiently” (participant 6–35 years old- no child).
Giving into feelings
Most women reported coping with fertility treatment challenges by crying, especially during menses.
“During my periods, I cannot hold my feelings, I cry and cry, but it makes me feel better equipped to deal with negative treatment outcomes. Although it is very frustrating” (participant 8–42 years old- 1 child).
“I cry almost every night because of fertility treatment emotional challenges. I think I cannot hold my feelings for long. After crying, I feel relieved and much better” (participant 21–35 years old- 2 children).
Some women said that they neglect doing their daily activities such as house cleaning, work, or even sleeping the whole day.
“When I get stressed about the treatment process, I do not do anything, even taking a shower or eating. I sleep for several days, and somehow, I regain my strength. Fertility treatment is a tough journey to be in” (participant 7–34 years old–1 child).
“I lost my business because I could not open it consistently because of the physical and emotional turmoil I was experiencing during the treatment process” (participant 18–29 years old-1 child). (participant 22–38 years old- no child).
Other women reported indulging themselves by buying new outfits and bags or going for dinner.
“When I feel depressed or sad during the treatment, I take myself out for dinner. It makes me feel special and like I am giving myself the attention I need” (participant 16–42 years old- no child).
“I buy new outfits and bags when I feel overwhelmed by the fertility treatment process. At least it makes me take my attention away from the treatment, even if it is for a while.” (participant 23–24 years old- no child).
Shifting focus
Some women reported coping with fertility treatment challenges by emotionally distancing themselves from the infertility treatment struggles. This distancing was done by keeping themselves busy with their career-related activities or getting involved in community services, which kept them busy, so they momentarily forgot about their fertility treatment problems.
“When I was started with infertility treatment, I decided to pursue higher education; I have done bachelor’s degree, last year I graduated with master’s degree. School work has kept me busy, making me forget temporarily about my treatment problems” (participant 16–42 years old-no child).
“Since I started the treatment process, I became more involved in voluntary work at church; it makes me useful and feels like I am giving back to society. Also, it takes my mind off fertility treatment-related challenges” (participant 28–34 years old-no child).
Taking a break
Some women reported that they coped with fertility treatment challenges by temporarily taking a break from treatments because treatments were emotionally, physically, and financially overwhelming.
“Last year, my husband and I decided to finish doing the infertility tests that the doctor ordered, then take a break for some months to rest as we look for money to do laparoscopy” (participant 32–36 years old-1 child).
“My husband and I just resumed fertility treatment last month. We had taken a break for two years because the treatment was emotionally challenging. We now feel ready to continue with treatment” (participant 29–32 years old-no child).
Staying with their relative’s children
Most of the women reported staying with their relative’s children. According to women, reasons for staying with the relative children, especially during the treatment process, included children giving them company, helping them with home chores, and creating a feeling of a complete family.
“I stay with two of my nieces, age 8 and 10 years. Those girls give me company as fertility treatment is a very isolating process. When I am not feeling so well, and my husband is not in the house, I can ask them to do simple chores like going to the shop to buy something.” “(participant 1–32 years old-no child).
“I would love to have twins, baby boys. Having my nephews in my house during treatment creates a complete family feeling because I care for them as their biological mother. I am a mother of two twin boys in waiting.” “(participant 15–28 years old-no child).
Interestingly, none of the women had adopted a child; when asked why most of them said they were not ready yet.
“Adopting a child is a critical decision a couple has to make. My husband and I are not yet ready for that now. If that time comes and we feel ready. We will be open to that option also. For now, we are pursuing the treatment” (participant 14–26 years old-no child).
“For a couple to adopt a child, they need to be prepared, more importantly psychologically, so that the child can grow in a loving and caring environment. We feel we are not ready yet but are open to it in the future. We are concentrating our efforts and time on seeking medical assistance” (participant 29–32 years old-no child).
Receiving support from others
Only a few women reported receiving financial, emotional, and spiritual support from their husbands, families, and friends while seeking fertility treatment.
“During the hospital appointment, my husband always accompanies me; he is my great source of support” (participant 33–40 years old-1 child).
“My mother is very supportive; she advises me a lot, encourages me to try new types of treatments, and prays for me” (participant 27–36 years old-1child).
“My friend, may God bless her, she has been supporting me all through my treatment journey, she has been helping me with my work assignment; she is such a good friend, caring, understanding, supportive and encouraging” (participant 11–38 years-1 child).
“My friends are always there for me. When I cry, they cry with me. They understand me even if they do not have fertility problems. They accompany me in my appointments and are the best friends one can ever need. I feel truly blessed to be my friend” (participant 5–32 years old-1 child).
[ad_2]
Source link