P-673: Making meaning of infertility: Existential crisis or personal transformation?

Abstract

It is clear that for many people who choose to persue fertility treatment, the medical process is often an unfamiliar path. The aim of this study was to identify the ways fertility patients make meaning of their infertility by asking a simple but pointed question. The main intent was to elicit vivid descriptions or explanations of a unique medical challenge that may not be discerned from traditional self-report psychological questionnaires and thus be a lost opportunity to gather rich data from a large pool of patients. A randomized controlled efficacy study to test the effectiveness of an online psychosocial intervention at 3 US fertility centers. This study represents a sub-analysis of a larger study in which 282 participants (179 women and 113 men) responded to narrative question as part of a comprehensive online assessment battery. Patients were asked to write about a significant aspect of their infertility experience. In doing so, they were asked to reflect on their deepest thoughts and emotions and how they make meaning of their current fertility challenges. All participants consented to participate in an online study about how people cope with infertility and understood that their responses were confidential. Using grounded theory approach to qualitative inquiry, the narratives were reviewed for a coding scheme. Once good inter-rater reliability was achieved on a random selection of 50 narratives (i.e., good to very good agreement, kappa=.73 to .89 with pairs of three raters), the remaining set of narratives were divided and coded independently using a content analysis software program (Atlas.ti version 5.0.66, 2003-2006). A total of 37 codes were generated that fell into 6 primary code families: 1) Emotional Life (identification of both positive and negative affect states); 2) Existential Issues (expressions that reflect a challenge to self-concept and identity, often posed as a question, e.g., “Why me?”); 3) Personal Belief System (statements about one’s world view or beliefs about life’s joys and sufferings, religious beliefs, ideas about God, or one’s own theory of life, e.g. “hard work pays off”); 4) Marital Connection/Disconnection (expressions of cohesion or disruption in relationship and self-reflections on gender differences in partner coping styles); 5) Social World (descriptions of support/lack of support related to social relationships, work or career challenges, need for community and generativity as a result of infertility); and 6) Treatment Context (issues related to decision making, ethics, medical side affects/hassles and provider communication). The question of how one makes meaning of the infertility experience naturally pulls for reflections on both identity and worldview. Many of the narratives revealed profound existential issues, challenges to personal beliefs systems, and long term consequences related to self-worth that may go undetected in standard assessment batteries. In some cases, facing infertility strengthens one’s resolve in pursuing an identity as parent or contributes to a self-described shift in self-perception, e.g., “I am forever changed because of infertility”. Gender differences were also observed. Discussion will focus on the value of including a powerful narrative question in research, screenings or program evaluations and the potential therapeutic effect for individuals.