Table 2 Overview of all 20 included studies
Authors and location | Aims | Data collection | Participant demographics | MAC detail | Data analysis | Main themes | |
|---|---|---|---|---|---|---|---|
Studies exploring the antenatal period and birth | |||||||
1 | Dornelles, MacCallum, Lopes, Piccinini and Passos (2016) [27] Brazil | To understand the perceptions of pregnancy achieved after ART Whether the above experience is affected by previous failed treatment cycles | Semi-structured interviews (Length approximately 90 min) | 19 expectant first-time mothers in the third trimester of pregnancy Demographics Mean age 35 years (range 25–44) Ethnicity White = 17 (89%|) Marital status Married = 12 (63%) Cohabiting = 7 (37%) Education University degree = 12 (63%) High school = 7 (37%) Pregnancy Singleton = 15 (79%) Twins = 1(5%) Triplets = 3 (16%) | MAC indication Female = 15 (79%) Male = 2 (10.5%) Combined = 1 (5.3%) Unexplained = 1 (5.3%) MAC type IVF = 15 (79%) OI = 0 (0%) IUI = 3 (16%) Not specifieda = 1 (5%) MAC treatment history First attempt = 11 (57%) Two or more attempts = 8 (43%) | Thematic analysis (Laville & Dionne 1999) [28] | Three main themes: 1) Tolerance of the demands of treatment/pregnancy 2) Consideration of the mechanics of treatment and pregnancy 3) Emotionally painful aspects of treatment/pregnancy |
2 | Sonego., Dornelles, Lopes, Piccinini and Passos (2017) [14] Brazil | To investigate the experience of pregnancy after ART from the father’s perspective | Semi-structured interview using the Pregnancy and Expectations of the Future Father (NUDIF, 1998b (Length approximately 90 min) | 13 men whose partners were in the 3rd trimester of pregnancy Demographics Mean age Not reported (range = 32–46 years) Ethnicity Not reported Marital status Married or cohabiting = 13 (100%) Education Elementary school = 2 (15%) High school = 4 (31%) Incomplete higher education = 1 (8%) Completed higher education = 6 (46%) Pregnancy Single = 10 (77%) Multiple = 3 (23%) | MAC indication Female = 9 (69%) Male = 3 (23%) Combined = 1 (8%) Unexplained = 0 (0%) MAC type IVF = 9 (70%) OI = 0 (0%) IUI = 2 (15%) Not specifieda = 2 (15%) MAC treatment history First attempt = 7 (54%) Two or more attemptsb = 6 (46%) | Content analysis (Laville & Dionne, 1999) [28] | Two main themes: 1) Subjective experience of the father during pregnancy 2) Effects of treatment on the experience of pregnancy |
3 | Walker, Mills and Gilchrist (2017) [10] UK | To explore the qualitative experiences and decision-making processes regarding physical activity in women who have undergone IVF | Individual semi-structured interviews (Length not reported) | 8 women who had successfully conceived via IVF/ICSCI in the last two years Demographics Mean age 33 years old (range = 24–39) Ethnicity White British = 8 (100%) Marital status Not reported Education Not reported Pregnancy Not reported | MAC indication Not reported MAC type IVF = 8 (100%) OI = 0 (0%) IUI = 0 (0%) Not specified = 0 (0%) MAC treatment history Not reported | Interpretative phenomenological analysis (IPA; Smith, Flowers & Larkin, 2009) [29] | Three main themes 1) Navigating away from childlessness and towards motherhood 2) Negotiating a safe passage 3) Balancing the challenges of pregnancy with the needs of the self |
4 | Warmelink, Adema, Pranger and Paul de Cock (2016) [30] Netherlands | To investigate the midwifery care needs during pregnancy of couples or women who have conceived as a result of fertility treatment | Semi-structured, in-depth interviews (Average length 55 min. Ranged from 28–91 min) | 9 interviews with 11 participants (two couples: Female = 9; Male = 2) Demographics Mean age Female mean age = 34.1 years (range = 32–38 years) Male mean age = 33.5 years (range = 32 -35 years) Ethnicity Dutch = 100% Marital status Not reported Education Not reported Pregnancy Not reported | MAC indication Female = 2 (22%) Male = 4 (44%) Combined = 1 (11%) Unexplained = 2 (22%) MAC type IVF = 10 (91%) OI = 0 (0%) IUI = 1 (9%) MAC treatment history Not reported | Content analysis (Boeije, 2008) [31] | Four main themes: 1) Normal but not normal: Paradoxical feelings 2) Understanding the impact of previous history 3) Psychosocial support 4) Care needs in general |
5 | French, Sharp and Turner (2015) [12] UK | To explore the antenatal experiences of males and females who have successfully conceived via fertility treatment | Individual interviews (Length approximately 1–3 h) | 20 participants 12 females; 8 males interviewed at 28 weeks’ gestation of first pregnancy Demographics Mean age Not reported (Age range = 35–39 years) Ethnicity Not reported Marital status Not reported Education Not reported Pregnancy Not reported | MAC indication Female = 7 (35%) Male = 6 (30%) Combined = 2 (10%) Unexplained = 5 (25%) MAC type IVF = 17 (85%) OI = 2 (10%) IUI = 1 (5%) MAC treatment history Not reported | Thematic analysis- constant comparison (Patton, 1990) [32] | Four main themes: 1) Fear of pregnancy loss 2) Difficulty adjusting to pregnancy and planning for parenthood 3) Gaps in care 4) Self-silencing |
6 | Ranjbar, Akhondi, Borimnejad, Ghaffari and Behboodi-Moghadam (2015) [9] Iran | To explore how women make sense of assisted pregnancy in Iranian culture and context | Semi-structured, interviews (Length approximately 30–60 min) | 12 women who experiences assisted pregnancy with their first child Demographics Mean age 29.51 (Age range = 24–36) Ethnicity Iranian Kurd = 2 (17%) Fars = 6 (50%) Turk = 3 (25%) Lor = 1 (8%) Marital status 100% married Education MSc/MA = 2 (16.7%) BS = 3 (25%) High School = 6 (50%) 9th grade = 1 (8%) Pregnancy Single = 12 | MAC indication Female = 12 (100%) Male = 0 (0%) Combined = 0 (0%) Unexplained = 0 (0%) MAC type IVF = 12 (100%) OI = 0 (0%) IUI = 0 (0%) Not specified = 0 (0%) MAC treatment history Not reported | Interpretative phenomenological approach (Van Manen, 1990) [33] | Three main themes: 1) Finding peace in life 2) Paradoxical feelings 3) Struggling to realise a dream |
7 | Dornelles, MacCallum, Lopes, Piccinini and Passos (2014) [34] Brazil | To explore women’s fears during pregnancy following conception via assisted reproductive technology (ART) | Semi-structured interviews (Length approximately 90 min) | 19 first time mothers in their third trimester of pregnancy Demographics Mean age 35 years (range 25–44) Ethnicity White = 17 (89%) Other ethnicity = 2 (11%) Marital status Married = 12 (63%) Cohabiting = 7 (37%) Education University degree = 12 (63%) High School graduates = 7 (37%) Pregnancy Single pregnancy = 15 (80%) Twins = 1 (5%) Triplets = 3 (15%) | MAC indication Female = 15 (79%) Male = 2 (11%) Combined = 1 (5%) Unexplained = 1 (5%) MAC type IVF = 15 (79%) OI = 0 (0%) IUI = 3 (16%) Not specifieda = 1(5%) MAC treatment history First attempt = 10 (53%) Two or more attempts = 9 (47%) | Content analysis (Laville & Dionne, 1999) [28] | Four main themes: 1) The baby’s survival 2) The health of the baby 3) The efficacy of the other 4) Childbirth |
8 | Lin, Tsai and Lai (2013) [35] Taiwan | To describe the experiences of pregnancy in Taiwanese women who had undergone at least three cycles of ART over a period exceeding three years | In-depth interviews (Length approximately 90–120 min) | 15 females interviewed within one year of delivering a baby Demographics Mean age 39 years (range 31–44) Ethnicity Not reported Marital status Married = 15 (100%) Education MSc = 5 (33%) Bachelor’s degree = 8 (53%) Junior college degree = 1 (7%) High School Diploma = 1 (7%) Pregnancy Not reported | MAC indication Female factor = 15 (100%) Male factor = 0 (0%) Combined = 0 (0%) Unexplained = 0 (0%) MAC type IVF = 15 (100%) OI = 0 (0%) IUI = 0 (0%) Not specified = 0 (0%) MAC treatment history First attempt = 0 (0%) Two or more attempts = 15 (100%) | Phenomenological qualitative method procedures adopted by Creswell (2009) [25] | Five main themes: 1) Emphasis on the safety and health of the foetus 2) Psychosocial reactions to physical and physiological conditions 3) Transition of identity 4) Insights after going through pregnancy and labour 5) Impact of society on pregnancy |
9 | Smorti and Smorti (2013) [36] Italy | To explore the psychological processes that develop in women and men during their first pregnancy obtained with assisted reproduction treatment | Semi-structured autobiographical interview (Length approximately (50–90 min) | 15 Italian couples pregnant with their first child (29th-34 weeks pregnant) Demographics Mean age Female = 36 years Male = 38 years Ethnicity White = 14 (93%) Other ethnicity = 1 (7%) Marital status Married or cohabiting = 15 (100%) Education Women degree or high school = 13 (87%) Men completed secondary school = 13 (86%) Pregnancy Single = 12 (80%) Twins = 2 (13%) Multiple pregnancy = 1 (7%) | MAC indication Female = 6 (40%) Male = 5 (36%) Combined = 1 (4%) Unexplained = 3 (20%) MAC type IVF = 7 (48%) OI = 0 (0%) IUI = 8 (52%) Not specified = 0 (0%) MAC treatment history First attempt = 6 (40%) Two or more attempts = 9 (60%) | Identification of themes, patterns on global and qualitative level | Participants narrated their pregnancy experience as a process with four main phases: 1st phase: ‘Doubt’ phase 2nd phase: Anxious and overwhelming need to seek help and support re: fertility 3rd phase: struggle and the victory 4th phase: The monitoring phase |
10 | Dornelles and Lopes (2011) [37] Brazil | To understand the process of becoming a mother in the context of ART | Interview on Pregnancy and Expectations of the Pregnant women (NUDIF, 1998b) (Length not reported) | 3 participants in their third trimester of pregnancy with their first child Mean age 35 years (range = 25–37) Ethnicity Not reported Marital status Not reported Education: Higher education: 2 (67%) Middle education: 1 (33%) Pregnancy Not reported | MAC indication Female = 1 (33%) Male = 1 (33%) Combined = 0 (0%) Unexplained = 1 (33%) MAC type IVF = 1 (33%) OI = 0 (0%) IUI = 1 (33%) Not specifieda = 1 (33%) MAC treatment history First attempt = 1 (33%) Two or more attempts = 2 (66%) | Content analysis (Laville & Dionne, 1999) [28] | Six main themes: 1) Life growth theme 2) Theme relating to primary 3) Support matrix – 4) Identity reorganisation – 5) Stages of conception: pregnancy 6) Imaginary baby |
11 | Silva and Lopes (2011) [38] Brazil | To investigate the marital relationship during treatment and pregnancy in couples who became pregnant with the help of ART | Semi —structured interviews (Length approximately 120 min) | 6 participants (three couples) Mean age and range Not reported Ethnicity Not reported Marital status In a relationship = 6 (100%) Education Higher education = 4 (67%) Elementary school = 2 (33%) Pregnancy status Not reported | MAC indication Female = 2 (33%) Male = 1 (33%) Combined = 0 (0%) Unexplained = 0 (0%) MAC type IVF = 2 (66%) OI = 0 (0%) IUI = 0 (0%) Not specifieda = 1 (33%) MAC treatment history First attempts = 1 (33%) Two or more attempts = 2 (66%) | Content analysis (Laville & Dione, 1999) [28] | Six main themes: 1) Cohesion during treatment 2) Cohesion during pregnancy 3) Sexuality during treatment 4) Sexuality during pregnancy 5) Communication during treatment 6) Communication during pregnancy |
12 | Hayashi and Sayama (2009) [11] Japan | To qualitatively highlight the emotional processes experienced by women who achieved pregnancy via assisted reproductive technology | Semi-structured interviews (Average length = 64.5 min; range = 46–87 min) | 8 primiparas who achieved pregnancy via ART one to six months after delivery Demographics Mean age 34 years (age range = 28–42) Ethnicity Not reported Marital status Not reported Education status Not reported Pregnancy status Single = 6 (75%) Twins = 2 (25%) | MAC indication Not reported MAC type IVF = 7 (88%) OI = 0 (0%) IUI = 0 (0%) Other = 1 (12%) MAC treatment history Not reported | Phenomenological study method (Colazzi, 1978) [39] | Nine main themes: 1) Feelings of mission and pressure by becoming pregnant 2) Attention to the avoided jealousy 3) Wisdom in overcoming anxiety 4) Maternal self-consciousness 5) Release from feelings of loneliness 6) Recovery of self-confidence 7) Positive acceptance of infertility and the treatment experience 8) Confirming one’s own growth 9) Feeling authentic joy from pregnancy |
Studies exploring birth and/or postpartum experiences | |||||||
13 | Díaz Sáez, Fernandez-Medina, Granero-Molina, Fernandez-Sola, Hernandez-Padilla and Lopez-Rodrugues (2021) [40] Spain | To describe and understand the breastfeeding experiences of first-time mothers who conceived using ART | Focus group (n = 8) lasting 86 min and Individual semi-structured interviews (n = 19) (Average length = 37 min.) | 27 women first time mothers Demographics Mean age 38 years (age range = not reported) Ethnicity Not reported Marital status Married = 21 (78%) Cohabiting = 6 (22%) Education Higher Education = 15 (56%) Medium = 2 (7%) Basic = 10 (37%) Pregnancy Single = 27 (100%) | MAC indication Not reported MAC type IVF = 16 (59%) OI = 0 (0%) IUI = 11 (41%) Not specified = 0 (0%) MAC treatment history Not reported | Hermeneutic phenomenology (Gadamer, 2005) [41] | Two main themes: 1) The transition from infertility to motherhood 2) The reality of becoming a breastfeeding mother after ART |
14 | Sadeghi, Mohammadi, Mohammadpourand and Abbasi (2019) [42] Iran | To investigate the challenges mothers face after assisted-reproduction techniques Part of a larger phenomenological study that aimed to discover the experience of motherhood after ART | Sem- structured interviews, (Length not report) | 13 mothers who conceived via ART Demographics Mean age 32 years Ethnicity Not reported Marital status Not Reported Education Diploma = 7 (54%) Bachelor = 6 (46%) Pregnancy Not reported | MAC indication Female = 8 (62%) Male = 5 (38%) Combined = 0 (0%) Unexplained = 0 (0%) MAC type IVF = 9 (69%) OI = 0 (0%) IUI = 3 (31%) Not specified = 0 (0%) MAC treatment history Not reported | Hermeneutic phenomenological method incorporating thematic analysis (Van Manen, 1990) [33] | One main theme: 1) ‘Over-challenged mother’ |
15 | Mohammadi, Shamshiri, Mohammadpour, Vehilainen-Julkunen, Abbasi and Sadeghi (2015) [43] Iran | To explore and describe the experience and meaning of mothering after ART among Iranian women | Semi structured interviews (Length approximately 45–70 min) | 9 first time mothers Demographics Mean age 32 years (age range = 28–45) Ethnicity Not report Marital status Not reported Education Diploma = 6 (67%) Bachelor = 3 (33%) Pregnancy Not reported | MAC indication Female = 6 (67%) Male = 3 (33%) Combined = 0 (0%) Unexplained = 0 (0%) MAC type IVF = 6 (67%) OI = 0 (0%) IUI = 3 (33%) Not specified = 0 (0%) MAC treatment history Not reported | Heideggerian hermeneutic phenomenological approach (cited in Van Manen, 1990) [33] | One main theme: 1) ‘Super-mothering’ |
16 | Bracks- Zalloua, McMahon and Gibson (2011) [44] Australia | To provide an in-depth understanding of early parenthood for IVF-conceiving fathers | Semi-structured interviews (Length approximately one hour) | 8 men whose partners had conceived via IVF Demographics Mean age 40 years old (range 29–53 years) Marital status Married = 7 (88%) Cohabiting = 1 (12%) Ethnicity Western = 8 (100%) Pregnancy Not reported | MAC indication Female = 4 (50%) Male = 4 (50%) Combined = 0 (0%) Unexplained = 0 (0%) MAC type IVF = 8 (100%) OI = 0 (0%) IUI = 0 (0%) Not specified = 0 (0%) MAC treatment history Not reported | Modified analytic induction (Bogdan & Biklem, 1998) [45] | Three main themes: 1) The concerned partner 2) Inattention from partner 3) Interaction with child |
Studies exploring the antenatal and postnatal period | |||||||
17 | Boz, Teskereci and Akgun (2021) [46] Turkey | The experience of becoming a mother following successful IVF: a grounded theory | Semi-structured interviews (length not reported) | 18 mothers who had become pregnant and had a child following successful IVF Demographics Mean age 32 years (age range = 27–39) Ethnicity Not reported Marital status Not reported Education Higher education = 6 (33%) High school = 2 (11%) Secondary school = 8 (44%) Vocational school = 2 (11%) Pregnancy Not reported | MAC indication Female = 2 (11%) Male = 6 (33%) Combined = 1 (6%) Unexplained = 9 (50%) MAC type IVF = 18 (100%) OI = 0 (0%) IUI = 0 (0%) Not specified = 0 (0%) MAC treatment history First attempt = 16 (89%) Two or more attempts = 2 (11%) | Grounded Theory (Charmaz, 2014) [47] | Four themes: 1) Non-spontaneous path to motherhood a) treatment 2) Leaving the infertility world 3) Pregnancy under the shadow of fear 4) Getting stuck between fertile and infertile worlds |
18 | Allan, Mounce, Cullem Van den Akket and Hudson (2019) [48] UK | To explore non-donor IVF couples’ transition to early parenthood | Unstructured interviews with couples (length approximately 40–60 min) | 16 heterosexual couples with one live singleton infant Demographics Mean age Not reported (Female age range = 25–39) (Male age range = 29–41) Ethnicity Not reported Marital status Not reported Education Not reported Pregnancy Single = 16 (100%) | MAC indication Not reported MAC type IVF = 16 (100%) OI = 0 (0%) IUI = 0 (0%) Not specified = 0 (0%) MAC treatment history First attempt = 9 (56%) Two or more attempts = 6 (38%) Unknown = 1 (6%) | Thematically (Frost, 2010) [49] | Three themes: 1) Preparing for parenthood 2) Becoming a parent 3) Considering a sibling |
19 | Crespo and Bestard (2016) [50] Spain | To explore the psychosocial needs of women and their partners following assisted reproductive treatment in a Spanish Context | Repeated rounds of semi-structured interviews (Length approximately 30–90 min) | 51 participants (30 pregnant women; 21 partners) Demographics Mean age 37 years (age range = not reported) Ethnicity Spanish = 51 (100%) Marital status Married = 25 (83%) Single = 4 (13%) Divorced = 1 (3%) Education Higher education = 17 (57%) Secondary = 9 (30%) Primary = 4 (13%) Pregnancy Foetus reduction = 6 (50%) Single pregnancy = | MAC indication Female – not reported Male – not reported Combined – not reported Unexplained – not reported Same-sex couple = 1 (3%) One lone parent = 1 (3%) MAC type IVF = 26 (87%) OI = 0 (0%) IUI = 4 (13%) MAC treatment history Not reported | Does not state – text was coded into either predetermined or emergent topics | Two major themes: 1) Complexity of reasons for anxiety 2) Narrowing experience |
20 | Katsumara, Kamiya and Emisu (2014) [51] Japan | To clarify the experiences from pregnancy with a first child to puerperiuem and childcare, of women who became pregnant through fertility treatment | Semi-structured interviews (length approximately 29–60 min) | 9 women who received fertility treatment for a second pregnancy after giving birth to a first child through fertility treatment Mean age 37 years old (range = 33–43 years old) Ethnicity Not reported Marital status Not reported Education Not reported Pregnancy Not reported | MAC indication Female = 4 (44%) Male = 1 (12%) Combined = 0 (0%) Unexplained = 4 (44%) MAC type IVF = 6 (67%) OI = 0 (0%) IUI = 2 (23%) MAC treatment history Not reported | Content analysis (Greg et al., 2007) [52] | 17 main themes: 1) Growing desire for a second child; contrary to expectations 2) Lack of actual sense of pregnancy and delivery 3) Joy and pride in pregnancy 4) Anxiety and reassurance in selecting a birthing facility 5) Feeling of relief at having to come this far on a long journey 6) Acceptance that one can not have a natural delivery 7) Fluctuation between anxiety and abnormalities or disorders in the fetus and feeling that it will be all right 8) Thankfulness and stress with respect to family 9) Uncertainty about continuation of pregnancy 10) Longing for the birth of a healthy child 11) Delivery with little sense of fulfilment 12) Joy at becoming a mother and motivation for child rearing 13) Joy felt from existence of baby 14) Easing of worries regarding baby 15) Anxiety about raising one’s first child despite joyful birth after much difficulty 16) Weakness of one’s feelings and emotion towards birth 17) Connection between unsettling events and medical treatment |