In vitro fertilization is the process where an egg is combined with sperm outside the body, i.e. in vitro (in glass). The assisted reproductive technology (ART) gave birth to in vitro fertilization which is commonly referred as IVF. It is the process of fertilization by extracting eggs, retrieving a sperm sample, and then manually combining an egg and sperm in a laboratory dish. The embryo(s) is then transferred to the uterus. The rate of infertile couples is rising rapidly worldwide and was reported that 60 to 80 million couples are affected by fertility issues with every fifth couple in Europe with issues while conceiving offspring. Couples going through this phase of infertility became guilty for not fulfilling the needs of their partners which eventually evoke mood deterioration. The level of anxiety and depression increased as the couple failed to conceive a child. In this context, the focus of present research study would be on analysing the psychological impact on couples that undergo IVF treatments. The researcher in this cross-sectional study will conduct literature review in order to create arguments in the research study. Researcher will also elaborate the research strategy, design and methods used for the collection of data so that readers can know about the research process. With the help of Gnatt Chart, the operational plan of the for research includes achievable tasks. The description of research methodologies will be made in the research project. In this context, the aim and objective of the present research
The aim of the research is study is “To assess the psychological effects on couples who undergo in vitro fertilization treatment.”
The summarised objectives underpinning aim of research is mentioned below:
1.To identify and comprehend the meaning of in vitro fertilisation.
2.To examine the impact of in vitro fertilisation on the psychology of couple who undergo treatment.
3.To identify measures or therapies used by health care professionals in order to transform or minimise the effects of psychological factors in couples.
BACKGROUND OF STUDY
The Assisted Reproductive Technology (ART) gave birth to in vitro fertilisation which is commonly referred as IVF (Gardner and Simón, 2017). It is the process of fertilisation by extracting eggs, retrieving a sperm sample, and then manually combining an egg and sperm in a laboratory dish. The embryo(s) is then transferred to the uterus. In vitro fertilisation is applied for the treatment of patients who have blocked or damaged fallopian tubes, or male factor infertility including reduced sperm count or sperm motility, ovulation disorders in women or premature ovarian failure or due to uterine fibroids, or due to removal of fallopian tubes, individuals with genetic disorder and unexplained infertility. It has been studied by researchers that couples show mixed feelings regarding in vitro fertilisation. Both men and women show identical behaviour and psychological distress. After knowing that they are not able to conceive a child makes them sad and eventually their depression increases. In many cases, domestic violence has been seen between couples which lead to separation.
Research questions are the fundamental core for research study. They determine the flow of research and helps researcher in conducting research analysis in effective and efficient manner.
In the present research, researcher must answer the following questions which are listed below:
- What is the meaning of in vitro fertilisation?
- What are their impacts on the psychology of couple who undergoes treatment?
- What measures or therapies used by health care professionals in order to transform or minimise the effects of psychological factors in couples?
Research process is a process which is followed by the researcher in order to accomplish the aim and objectives of the study (Hauser and et.al., 2016). It is essential for researcher to describe the research process in explicit and succinct manner so that readers can comprehend it thoroughly. The process to scope the purpose of research is described below:
- Identifying Research Problem:This is the first step in the present research process, here researcher identifies the problem and describein the research study efficiently. Identifying problem of research is very important and essential after identifying research problem; researcher could develop questions of research.
- Literature Review:This is the next step in the present research study, which is to conduct and review literature. The motive of conducting literature review is to enhance the level of education and knowledge of researcher about the subject matter.
- Clarifying Problem: Many times the initial problem identified in the first step of the process is too large or broad in scope. In this step, researcher clarifies problem and narrows scope of the study.
- Explicitly Defining Terms and Concepts:In the fourth step, researcher clearly defines terms and concepts associated with the research study (Levin and et.al., 2015). This is essential as it helps readers or users of research study in enhancing their understanding of comprehension.
- Defining Population:In the fifth step, researcher defines the population of study. In this step, researcher elaborates about the participant of study whom will be inquired for research. In present research, the participants will be couples who undergoing in vitro fertilisation.
- Collecting Data:Data collection is considered to be essential process. There are two sources from where data can be collected which are primary and secondary source. In the present research, the data will be acquired through semi-structured interview which will be conducted with couples (Ying and et.al., 2017). Relevant books and journals will be used in order to collect data from secondary source.
SIGNIFICANCE AND RATIONALE OF RESEARCH STUDY
In vitro fertilisation is a process through which baby is produced by combining man's sperm with woman's egg in a laboratory dish “in vitro”,which means outside the body. With an increase in technologies and up gradation in the field of medicine, new and enhanced methods of treatments have been germinating. From hair to heart, from kidney to lungs, for each critical and chronic condition, new and efficient medical and surgical treatments are now practised in different healthcare organisations (Bensdorp and et.al., 2016). Due to numerous benefits associated with in vitro fertilisation, couples prefer to undergo in vitro fertilisation. The first benefit of IVF is that anyone can have a baby. The process makes it possible for any person or couple to have a baby, regardless of family status or sexual orientation. Single women and men who've had a hard time conceiving have all used IVF as a way to obtain child. Though, there are number of issues associated with IVF. Men who have been identified with infertility issue prefers to not to express their feelings explicitly. They hide the information or keep it with themselves so that partner won't get hurt. This increases their psychological distress and they became infuriated day by day. Infertility can be perceived as stressful and straining conditions which affects the psychology of couples negatively. Infertility causes damage to relationship of couples and it can create negative and permanent affects on the relationship of couples (Ying and et.al., 2018). Couples who undergo in vitro fertilisation tends to show depressed and anxious behaviour. This research significant for other researchers, nurses, healthcare professionals as they could able to assess what are the major psychological impacts that couples may face before and after in vitro fertilisation. The research study can be beneficial for couples who are planning to have in vitro fertilisation. They will able to enhance their knowledge about the treatment and its negative and positive impacts on their psychology.
The research project is significance for the academicians, PhD scholars, students of nursing and people in the field of medical and psychology. The present research project will help in contrasting on the psychological impact on couples who undergo in vitro fertilisation. This research will helps in delivering adequate knowledge and information about the in vitro fertilisation and its impact on the mentality and behaviour of couples who undergo the treatment. This can be beneficial for them as academicians and other researchers will be able to enhance the level of knowledge and education regarding the subject matter. In vitro fertilisation helps in addressing infertility issues. The traditional use of IVF is to provide assistance to both man and woman by addressing their infertility issues. Women, who possess missing, destroyed, or jammed fallopian tubes were some of the initial patients to carry out successful IVFs (Péloquin and et.al., 2018). The egg is fertilised outside the body of woman and then placed inside the uterus for a more likely implantation. In this context, the research project will benefits the women who desire to have IVF treatment in future by elaborating them few advantages associated with it.
Infertility can be perceived as stressful and straining conditions which affects the psychology of couples negatively. Infertility causes damage to relationship of couples and it can create negative and permanent affects on the relationship of couples. Researches states that women are more likely to be affected after knowing about infertility than men. The research project will helps in examining the psychological impact on couples who undergo in vitro fertilisation. This can be beneficial for healthcare professionals and medical professionals who are associated with in vitro fertilisation. They will be able to acquire adequate knowledge and information about the factors which effects their psychology drastically. From this research study, the various factors which impacts on the psychology on couples will be discussed thus helps in enhancing comprehension understanding of healthcare professionals, nurses and clinicians working in fertilisation clinics and hospitals.
Eventually, from this research study, researcher will be able to enhance his or her level of knowledge and understanding about the factors that affects the psychology of couples who undergo in vitro fertilisation. From this research study, researcher will be able to get familiar about the process of in vitro fertilisation. From literature review, researcher will be able to understand what were the reviews of senior researchers and authors regarding the subject matter and thus eventually will be able to enhance his or her level of knowledge and understanding.
A literature review is considered to be an essential and vital part of the research study. Here, researcher aims to explain the subject matter in more detailed and in explicit manner by critically reviewing the work of previous researchers. Researcher creates robust arguments in literature review by comparing and contrasting on the articles and previous researchers. IVF creates huge effects on the psychology of couples who undergo the surgery. In this literature review, the critique of relevant articles will be made by researcher.
Article 1: “Prevention of multiple pregnancies in couples with unexplained or mild male subfertility: randomised controlled trial of in vitro fertilisation with single embryo transfer or in vitro fertilization in the modified natural cycle compared with intrauterine insemination with controlled ovarian hyperstimulation.”
The research conducted by Bensdorp and et.al. (2015) was in order to compare the effectiveness of in vitro fertilisation with single embryo transfer or in a modified natural cycle with that of intrauterine insemination with controlled ovarian hyperstimulation in terms of a healthy child. Majority of the researchers in the study were gynaecologist and only A.J. Bensdrop and Tijon-Kon-Fat were PhD students. The article was about prevention of multiple pregnancies in couples with unexplained or mild male subfertility. Randomised controlled trial of in vitro fertilisation with single embryo transfer or in vitro fertilisation in modified natural cycle compared with intrauterine insemination with controlled ovarian hyperstimulation. 602 couples were randomly selected by the researcher. The main outcome of study classified into two, primary and secondary. In the primary outcome, healthy child resulting from singleton pregnancy conceived within 12 months after randomisation has been assessed. In the secondary outcome, live birth, clinical pregnancy, ongoing pregnancy, multiple pregnancy, time to pregnancy, complications of pregnancy, and neonatal morbidity and mortality has been derived. The strength identified of the article includes the robust research and explicit interpretation of the data which focuses on the core research problems. The weaknesses identified the inadequate use of literature in the research study. This article support the study by providing explicit understanding about in vitro fertilisation.
Article 2: “The experience of Chinese couples undergoing in vitro fertilization treatment: perception of the treatment process and partner support.”
Ying, Wu and Loke, (2015) discussed the effects of psychological interventions on the psychological health, pregnancy rates and marital function of infertile couples undergoing in vitro fertilisation. The authors were professors at School of Nursing, The Hong Kong Polytechnic University and Zhejiang Chinese Medical University Hangzhou China. The motive of article is to investigate the impacts of psychological interventions on the mental health, marital functions and pregnancy rates of infertile couples who undergone in vitro fertilisation. Authors conducted randomised control trial on 20 participants. Positive results were identified due to intervening harm therapy, psychotherapy and cognitive behavioural therapy in reducing anxiety levels, etc. in infertile couples but non of these interventions were able to relieving depression and stress of couples who undergo in vitro fertilisation. The positive side of article is that the authors have adequately explained the psychological impact on couples who undergo IVF through their randomised control trial and the downside of article is that researcher used less intervention in order to analyse the impact on psychology of couples. The article supports the present study by explaining the impact on psychology of couples who undergo the in vitro fertilisation.
Article 3: “Experiences of physical activity during pregnancy resulting from in vitro fertilisation: an interpretative phenomenological analysis.”
Walker, Mills and Gilchrist, (2017) explicitly elucidated that couples communication, bond, relationship, trust and belief greatly hampers after knowing the issue of infertility. Chloe Walker is Adult Psychologist at North Kensington & Chelsea Community Mental Health Team, London, UK, Hayley Mills is professor at School of Human and Life Sciences, Cantebury Christ University Cantebury, United Kingdom and Angela Gilchrist is professor at School of Psychology, Politics and Sociology at Cantebury Christ University Cantebury, UK. Researchers provides explicit information regarding experiences of physical activity during pregnancy resulting from in vitro fertilisation. Researchers conducted semi structured interview with eight women who have undergone in vitro fertilisation and were pregnant or had given birth within last two years. From the results it was identified that three superordinate themes were emerged from the data and ten subthemes were emerged that indicates navigate experiences of infertility the IVF process and subsequent decision making about PA during pregnancy. The strengths of the articles were the robust research conducted by the researcher focusing on the core issue and objective. The gap in the article was that researcher can increase the number of participants in order to enhance the effectiveness of the study. The article underpin the present study by elaborating the self control experience of pregnant women who undergo IVF.
Article 4: “Endurance with partnership: a preliminary conceptual framework for couples undergoing in vitro fertilisation treatment.”
Ying and et.al., (2018) presented statements about endurance with partnership. They presented the conceptual framework for couples undergoing in virto fertilisation treatment. All the authors were professors in different university of China. Authors states that in vitro fertilisation is directly related with woman which indicates that women are more prone to risk of emotional instability and they might develop emotions of guilt, tension, depression, anxiety and stress. Researchers used Endurance with Partnership Conceptual Framework (P-EPCF) for analysing the research. As per this model, researchers assess the impacts of infertility and IVF treatment can be mediated by the couples partnership and dyadic coping. Improvements can be expected in psychological well being and martial functioning of IVF couples. The strengths of this article is that researcher thoroughly and efficiently utilise the conceptual framework in order to underpin their study. The weaknesses of the research is that researchers were not able to articulate the research findings in succinct manner which becomes complex for readers. This article helps in understanding the concepts of psychological affects on couples who undergo in vitro fertilisation and thus becomes useful for present study.
Article 5: “Whose fault is it? Blame predicting psychological adjustment and couple satisfaction in couples seeking fertility treatment.”
Péloquin and et.al., (2018) discussed that elucidated that couples communication, bond, relationship, trust and belief greatly hampers after knowing the issue of infertility. The authors were qualified as professors at different university at Canada. Authors have examined couples psychological distress got increased and both partners become guilty of not satisfying the needs of each other. The study used dyadic approach to examine the nexus between blaming oneself, one's partner and both partners. In order to carry out the research study, the researcher surveyed 279 couples who have enrolled in fertility treatments. They were inquired about the extent to which they blamed themselves and their partner for fertility problems. The results indicates that partners men’s self-blame also predicted their own lower relationship satisfaction, whereas women’s self-blame predicted more depression and anxiety in their partner. The strengths of the research study conducted by researcher was the deep analysis and research methods. They have conducted research in effective and efficient manner. The weak part of the study was inadequate review and use of literature in the research study. This article greatly assists in understanding the psychological impact of couples who undergo in vitro fertilisation.
Article 6: “Exploratory randomized trial on the effect of a brief psychological intervention on emotions, quality of life, discontinuation, and pregnancy rates in in vitro fertilization patients.”
Domar and et.al., (2015) discussed the effect of a brief psychological intervention on emotions, quality of life, discontinuation and pregnancy rates in in vitro fertilisation patients. Alice D. Domar and Jacky Boivin were PhD scholars others researchers were qualified to masters and bachelors level. In the study researches states that women are more likely to be affected after knowing about infertility than men. The objective of the study is to determine whether a brief self-administered cognitive coping and relaxation intervention (CCRI) would lead to decreased treatment termination in in vitro fertilization (IVF) patients compared with routine care (RC). From the conclusion it was derived that CCRI technique is successful in improving the psychological status of patients but not statistically significantly more treatment cycle or a higher pregnancy rates. The strengths of the article are robust research and analysis of collected data through observations. Researcher able to explain the data in effective and succinct manner. The weak part of article is the less use of literature review in order to enhance the comprehension understanding of readers. The article has been selected for present research study in order to determine the impact of in vitro fertilisation on the psychology of women who undergo treatment.
Article 7: “The impact of complementary therapies on psychosocial factors in women undergoing in vitro fertilization (IVF): A systematic literature review.”
LoGiudice and Massaro, (2018) discussed the influence of complementary therapies on psychological factors in women undergoing in vitro fertilisation. The authors were PhD scholars and registered nurses. They have conducted the research study in order to accomplish the aim and objective. The aim of their study is to assess the impact of therapies provided to women who undergo IVF treatment. The research study was systematic review where researchers analyse and conducted literature review. The articles were collected from CINAHL and PubMed data bases which were published from January 2010 to 2017, written in English and which examined the complementary therapy on the psychological well being of women who undergo IVF. Researchers found that 11 studies published bewteen 2010-2015 were based randomised control trial (n=7), that assess the psychological factor and most frequent was anxiety (n=8). The forms of therapies mostly used were Hatha Yoga, cognitive behavioural interventions and mind body therapies (n=2). The strength of the paper is the robust systematic review and selection of the articles. Researchers explicitly analysed the articles and present result in most understandable manner. The weak part of the research was limited selection of articles. The research study was selected in present research in order to enhance the effectiveness of the research study.
Article 8: “The impact of infertility on the psychological well-being, marital relationships, sexual relationships, and quality of life of couples: A systematic review.”
Luk and Loke, (2015) discussed the impact of Infertility on the psychological well-being, marital relationships, sexual relationships, and quality of life of couples. The researchers were professor at School of Nursing, University of Hong Kong. Researchers have conducted systematic review in order to assess the impact. The purpose of their systematic review is to identify the supporting evidence that effect of infertility of couples. In order to derive articles, researchers used MEDLINE, PsycINFO and CINHAL Plus from year 2000-2014 and which published in English. In the result section, researcher described that infertility impacts on couples in four aspect of their life which are psychological marital relationships, sexual relationships, and quality of life. The evidence of negative effect of infertility was found in the studies regarding psychological well being and sexual relationship. Inadequate result found on the effect on marital relationship and quality of life. The strengths of article were the source from where the articles were taken from. Researchers carried out the systematic review in explicit and understandable manner. Though, there were no such weaknesses identified in the study as researchers explicitly explained the impact of IVF on psychology of couples. The article selected is useful which helps in describing the psychological impact of couple who undergo IVF.
Frederiksen and et.al., (2015) discussed the efficacy of psychological interventions for psychology and pregnancy outcomes in infertile women and men. The article was not useful as it does not underpin the present research aim and objectives. Agostini and et.al., (2018) discussed about the effect of previous reproductive outcomes in subfertile women after in vitro fertilisation. The article was not useful as it does not support the objective of present research study. Lorber, (2014) presented article on in vitro fertilisation and gender politics. The article was not useful as it does not provide adequate information about psychological impacts of IVF on couples. Klonoff-Cohen, (2017) discussed prevailing knowledge about Male and Female lifestyle habits and In Vitro Fertilization in the 21st century. The article was not useful for the study as it does not support present research aim and objective.
Summing up the literature review, it can be understood that the assisted reproductive technology (ART) gave birth to in vitro fertilisation which is commonly referred as IVF. In vitro fertilization (ivf) is a reproductive technology in which an egg removed from woman, joined with sperm cell man test tube (in vitro) definition, meaning, what treatment for woman who cannot become pregnant naturally. The articles selected for the study adequately describe the IVF and its psychological affects on couples. The level of anxiety and depression increased as couple failed to conceive a child. Couples also shows feelings of self esteem due to their infertility which influence them to undergo IVF.
PROPOSED RESEARCH STRATEGY
A research strategy is simply a plan of how researcher aim to achieve research goals and objectives. Research strategyrefers as strategy through which a researcher is able to accomplish the goal and object of particular research. In order to attain the aim of research study, it is essential and vital for researcher to select precise research strategy (Taylor, Bogdan and DeVault, 2015). There are numerous types of research design which are utilised by researchers in order to carry out particular research study. These includes systematic review, meta-analysis, qualitative, quantitative, case study analysis, randomised control trials, etc. Every strategy possess specific functions but the purpose remains the same which is to provide assistance to researcher in order to carry out the research aim and objectives. In the present research project, qualitative research study will be used. Qualitative research study is a process of inquiring naturalistic which seeks in-depth comprehending of social phenomena within natural setting. It concentrates on the 'why' rather than 'what' of social phenomena and relies on direct experiences of human beings as meaning making agents in their every day life. Thus, through qualitative research strategy, researcher will be able to accomplish the aim and objectives of the research study effectively and efficiently. In this context, the advantages and disadvantages of qualitative research