Thursday, August 18, 2011

Pre-Parenthood Perspectives of IVF Couples

Social science researchers (Fishel, A.K. et al) at Massachusetts General Hospital have completed an interesting study with couples who have given birth to a healthy baby following IVF treatment. Comparing these couples to what is known about couples who conceive without medical interventions, this study provides a unique lens into the pre-parenthood perspectives of couples who desperately want a healthy birth child.

Married couples who conceive without medical intervention have been studied for years. Generally, what is known about their transition to first-time parenthood is that (especially for couples who had not planned their pregnancy) there is a spike in divorce, a decline in marital satisfaction and the frequency of sex, increased depression in both men and women, a shift to a more traditional division of labor, and less time available for the couple after the baby is born. Generally these transition issues are less problematic for couples who had planned their first pregnancy and who had anticipated both their needs and their babies’ prior to the birth.

With the 16 couples interviewed in their last trimester for this study, the focus was on the impact of IVF on the couples’ expectations of parenting, on their work life, and on their marital relationship. Of course, we also must remember that, in addition to the disruption of IVF treatment, the shadow of months of infertility (and perhaps pregnancy loss) also may have taken a toll on self esteem, interpersonal relationships and the couple’s sexual relationship. These infertility issues, which I portray from the perspectives of several hundred women with infertility in my recent book When You’re Not Expecting, form a backdrop over which the additional tensions (and hopes) of IVF build and play out.

So what did the research find with this particular sample of IVF couples? First, we must keep in mind that they are a group not typical of all IVF couples. The 16 highly educated dual career couples interviewed were relatively young (average age of women was 34 and of men was 36). Most couples had conceived this pregnancy after only one IVF cycle and had experienced infertility for a relatively short period of time. Half of the men in the sample had an infertility problem, as compared with 30 percent in large studies. Yet, even as this small group may not be typical of IVF parents-to-be, the six themes that emerged from the interviews provide a unique window into how these couples are beginning to think about themselves as parents:
• A truncated view of the future. Few of the individuals said anything about what they imagined their lives to be like once the baby had arrived, nor did they have elaborated fantasies about the baby. It seemed as though they could not risk imagining they would really have a baby. Instead, they placed their focus on living from one medical appointment to another, very much as they had done during their IVF experience.
• Health fears. Almost all the couples talked about their fears about the baby’s health, and one quarter of them were concerned about the mother’s health. When a pregnancy has been medicalized via IVF, it is understandable that medical problems are a high priority for these couples.
• Gender of infertility factor. With the higher than usual percentage of these couples where the male factor contributed to the couple’s infertility, the men expressed guilt that their wives had to bear the brunt of IVF treatment.
• Multiple disruptions to work, particularly for women. Women, in particular, noted that IVF had required them to take time off for appointments, meaning that they needed job flexibility and a compassionate boss. Finding or remaining in a job where the health insurance covered infertility treatment was a factor for some women. More than half the women anticipated working less after the baby’s birth and already were aware of a loss of interest in their work.
• Unequivocal attitude toward parenting. The emphatic wish to become parents was accompanied by a lack of complaining about the pregnancy, the anticipated delivery and parenthood.
• Infertility as relationship strengthening. Almost half of the couples stated that the process of going through IVF had strengthened their relationship, though a small number said that their sexual relationship had been negatively impacted.

So what can we learn from this study, even as we recognize its small sample size that is not representative of IVF couples in general? The medicalization of their IVF experience seems to have focused couples on the present (rather than encouraging hopefulness and planning for new parenthood), and also has placed health issues in the forefront of the couples’ minds. The couples’ lack of ambivalence about the much-relished hope of parenthood has caused all of them to have a positive focus, which might benefit from some anticipation that less positive feelings like frustration, anxiety and exhaustion will probably accompany early parenting and should not be a cause for guilt. Yet, the emphasis on infertility as having been a source of growing strength in their relationship provides many IVF couples with a good foundation on which to build their new parenthood experience, hopefully reaching out to family and friends for the support all new parents need.

I have found in my counseling experience with infertile couples (whether their parenthood is achieved by good fortune, by reproductive technologies, by surrogacy or by adoption) that continuing counseling, although less frequently, is a good idea during the first year of new parenthood, as the joys and the challenges often have infertility as a poignant backdrop. Couples who understand the impact of infertility and medical treatment on their parenting experience often find that counseling enables them to sort out those complexities in creative ways. Issues such as rebounding from months of medicalized sex, deciding about birth control, discussing the timing of a subsequent pregnancy, or dealing with the urge to be over-protective can benefit from using a counselor as a sounding board.