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Normalization as a Strategy for Maintaining Quality of Life While Coping with Infertility in a Pronatalist Culture

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Abstract

Purpose

Infertility could be highly stressful, particularly in a pronatalist culture. We aimed to develop the concept and a measure of normalization (maintaining normal life routines and feeling “normal”) as a strategy that could enable women with infertility maintain their quality of life (QoL) while coping with this condition. We tested its associations with women’s well-being, distress and QoL in Israel, where being childless is socially unacceptable and highly stigmatized.

Methods

One-hundred and eighty Israeli women undergoing infertility treatment at a fertility community clinic filled in questionnaires assessing normalization-related coping strategies, QoL, and psychological adjustment (distress, wellbeing). Eight months later, 55 women conceived; 55 women who had not conceived completed a second questionnaire.

Results

At baseline, normalization was related to higher QoL and better adjustment. Structural equation modeling showed that QoL was impaired mainly among women who felt different than others, compared, and blamed themselves. Over time, normalization was overall unrelated to conception or to changes in adjustment yet was protective against decrease in well-being among women who already had a child.

Conclusions

Infertility is highly stressful in a pronatalist culture like Israel. It requires treatment yet is not disabling. Patients who manage to maintain normal routines and not feel different than other people their age may experience better QoL and psychological adjustment.

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References

  1. McEwan KL, Costello CG, Taylor PJ. Adjustment to infertility. J Abnorm Psychol. 1987;96(2):108–16.

    Article  CAS  PubMed  Google Scholar 

  2. Domar A, Gordon K, Garcia-Velasco J, La Marca A, Barriere P, Beligotti F. Understanding the perceptions of and emotional barriers to infertility treatment: a survey in four European countries. Hum Reprod. 2012;27(4):1073–9.

    Article  PubMed  Google Scholar 

  3. Chachamovich JR, Chachamovich E, Ezer H, Fleck MP, Knauth D, Passos EP. Investigating quality of life and health-related quality of life in infertility: a systematic review. J Psychosom Obstet Gynecol. 2010;31(2):101–10.

    Article  Google Scholar 

  4. Verhaak CM, Smeenk JMJ, Evers AWM, Kremer JAM, Kraaimaat FW, Braat DDM. Women’s emotional adjustment to IVF: a systematic review of 25 years of research. Human Reproduc Update. 2007;13(1):27–36.

    Article  CAS  Google Scholar 

  5. Letherby G. Other than mother and mothers as others: the experience of motherhood and non-motherhood in relation to ‘infertility’ and ‘involuntary childlessness’. Women Stud Int Forum. 1999;22(3):359–72.

    Article  Google Scholar 

  6. Greil AL, Slauson-Blevins K, McQuillan J. The experience of infertility: a review of recent literature. Sociol Health Ill. 2010;32(1):140–62.

    Article  Google Scholar 

  7. Forrest L, Gilbert MS. Infertility: an unanticipated and prolonged life crisis. J Ment Health Couns. 1992;14(1):42–58.

    Google Scholar 

  8. van Balen F, Trimbos-Kemper TCM. Long-term infertile couples: a study of their well-being. J Psychosom Obstet Gynaecol. 1993;14(Special Issue):53–60.

    PubMed  Google Scholar 

  9. Todorova ILG, Kotzeva T. Contextual shifts in Bulgarian women’s identity in the face of infertility. Psychol Health. 2006;21(1):123–41.

    Article  Google Scholar 

  10. Whiteford LM, Gonzalez L. Stigma: the hidden burden of infertilty. Soc Sci Med. 1995;40(1):27–36.

    Article  CAS  PubMed  Google Scholar 

  11. Greil AL. Infertility and psychological distress: a critical review of the literature. Soc Sci Med. 1997;45(11):1679–704.

    Article  CAS  PubMed  Google Scholar 

  12. Gana K, Jakubowska S. Relationship between infertility-related stress and emotional distress and marital satisfaction. J Health Psychol. 2016;21(6):1043–54.

    Article  PubMed  Google Scholar 

  13. Johnson KM, Fledderjohann J. Revisiting “her” infertility: medicalized embodiment, self-identification and distress. Soc Sci Med. 2012;75(5):883–91.

    Article  PubMed  Google Scholar 

  14. Remennick L. Childless in the land of imperative motherhood: stigma and coping among infertile Israeli women. Sex Roles. 2000;43(11/12):821–42.

    Article  Google Scholar 

  15. Kahn SM. Reproducing Jews. A cultural account of assisted conception in Israel. Durham: Duke University Press; 2000.

    Google Scholar 

  16. Berkovitch N. Motherhood as a national mission: the construction of womanhood in the legal discourse in Israel. Women Stud Int Forum. 1997;20(5–6):605–19.

    Article  Google Scholar 

  17. Remennick L. Contested motherhood in the ethnic state: voices from an Israeli postpartum ward. Ethnicities. 2008;8(2):199–226.

    Article  Google Scholar 

  18. Shalev S, Lemish D. “Dynamic infertility”: the contribution of news coverage of reproductive technologies to gender politics. Feminist Media Stud. 2012;12(3):371–88.

    Article  Google Scholar 

  19. de Mouzon J, Lancaster P, Nygren KG, Sullivan E, Zegers-Hochschild F, Mansour R, et al. World Collaborative Report on Assisted Reproductive Technology, 2002. Hum Reprod. 2009;24(9):2310–20.

    Article  PubMed  Google Scholar 

  20. Nachtigall RD. International disparities in access to infertility services. Fertil Steril. 2006;85(4):871–5.

    Article  PubMed  Google Scholar 

  21. Simonstein F. A rational cure for prereproductive stress syndrome—a perspective from Israel: a rejoinder to Häyry, Bennet, Holm, and Aksoy. J Med Ethics. 2005;31(9):557.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Birenbaum-Carmeli D, Dirnfeld M. In vitro fertilisation policy in Israel and women’s perspectives: the more the better? Reproduc Health Matter. 2008;16(31):182–91.

    Article  Google Scholar 

  23. Hashiloni-Dolev Y, Kaplan A, Shkedi-Rafid S. The fertility myth: Israeli students’ knowledge regarding age-related fertility decline and late pregnancies in an era of assisted reproduction technology. Hum Reprod. 2011;26(11):3045–53.

    Article  PubMed  Google Scholar 

  24. Haelyon H. “Longing for a child”: perceptions of motherhood among Israeli-Jewish women undergoing in vitro fertilization treatments. Nashim: J Jewish Women’s Studies Gender Issues. 2006;12:177–202.

    Google Scholar 

  25. Donath O. Cracks in pro-natalism: choosing a childfree life-style in Israel. Unpublished Master’s Thesis, Tel Aviv University, Tel Aviv, Israel. 2007.

  26. Benyamini Y. Hope and fantasy among women coping with infertility and its treatments. In: Jacoby R, Keinan G, editors. Between stress and hope: from a disease-centered to a health-centered perspective. Westport: Praeger; 2003. p. 141–66.

    Google Scholar 

  27. Deatrick JA, Knafl KA, Murphy-Moore C. Clarifying the concept of normalization. Image: J Nurs Scholarship. 1999;31(3):209–14.

    CAS  Google Scholar 

  28. Knafl KA, Deatrick JA. How families manage chronic conditions: an analysis of the concept of normalization. Res Nurs Health. 1986;9(3):215–22.

    Article  CAS  PubMed  Google Scholar 

  29. Robinson CA. Managing life with a chronic condition: the story of normalization. Qual Health Res. 1993;3(1):6–28.

    Article  CAS  PubMed  Google Scholar 

  30. Ryan SC, Coates VE. It’s a long road with no turning: normalization of life with diabetes. Soc Sci Health. 1998;4(4):218–29.

    Google Scholar 

  31. Hall NJ, Rubin GP, Dougall A, Hungin APS, Neely J. The fight for ‘health-related normality’: a qualitative study of the experiences of individuals living with established inflammatory bowel disease (IBD). J Health Psychol. 2005;10(3):443–55.

    Article  PubMed  Google Scholar 

  32. Krulik T. Successful ‘normalizing’ tactics of parents of chronically-ill children. J Adv Nurs. 1980;5(6):573–8.

    Article  CAS  PubMed  Google Scholar 

  33. Benyamini Y, Gefen-Bardarian Y, Gozlan M, Tabiv G, Shiloh S, Kokia E. Coping specificity: the case of women coping with infertility treatments. Psychol Health. 2008;23(2):221–41.

    Article  PubMed  Google Scholar 

  34. Benyamini Y, Gozlan M, Kokia E. Variability in the difficulties experienced by women undergoing infertility treatments. Fertil Steril. 2005;83(2):275–83.

    Article  PubMed  Google Scholar 

  35. McGee HM, O’Boyle CA, Hickey A, O’Malley K, Joyce CRB. Assessing the quality of life of the individual: the SEIQoL with a healthy and a gastroenterology unit population. Psychol Med. 1991;21(03):749–59.

    Article  CAS  PubMed  Google Scholar 

  36. O’Boyle CA, McGee H, Hickey A, O’Malley K, Joyce CRB. Individual quality of life in patients undergoing hip replacement. Lancet. 1992;339:1088–91.

    Article  PubMed  Google Scholar 

  37. Wettergren L, Kettis-Lindblad Å, Sprangers M, Ring L. The use, feasibility and psychometric properties of an individualised quality-of-life instrument: a systematic review of the SEIQoL-DW. Qual Life Res. 2009;18(6):737–46.

    Article  CAS  PubMed  Google Scholar 

  38. Hickey AM, Bury G, O’Boyle CA, Bradley F, O’Kelly FD, Shannon W. A new short form individual quality of life measure (SEIQoL-DW): application in a cohort of individuals with HIV/AIDS. BMJ. 1996;313(7048):29–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Browne JP, O’Boyle CA, McGee HM, McDonald NJ, Joyce CRB. Development of a direct weighting procedure for quality of life domains. Qual Life Res. 1997;6(4):301–9.

    Article  CAS  PubMed  Google Scholar 

  40. Stanton AL. Cognitive appraisals, coping processes, and adjustment to infertility. In: Stanton AL, Dunkel-Schetter C, editors. Infertility: perspectives from stress and coping research. New York: Plenum Press; 1991. p. 87–108.

    Chapter  Google Scholar 

  41. Benyamini Y, Gozlan M, Kokia E. On the self-regulation of a health threat: cognitions, coping, and emotions among women undergoing treatment for infertility. Cogn Ther Res. 2004;28(5):577–92.

    Article  Google Scholar 

  42. Benyamini Y, Nouman H, Alkalay Y. Perceived control over the medical procedure and its association with adjustment to a low-control situation: the case of infertility. Psychol Health Med. 2016;21(4):476–82.

    Article  Google Scholar 

  43. Kline RB. Principles and practice of structural equation modeling. New York: Guilford; 2005.

    Google Scholar 

  44. Phillips E, Elander J, Montague J. Managing multiple goals during fertility treatment: an interpretative phenomenological analysis. J Health Psychol. 2014;19(4):531–43.

    Article  PubMed  Google Scholar 

  45. Salmela-Aro K, Suikkari A-M. Letting go of your dreams—adjustment of child-related goal appraisals and depressive symptoms during infertility treatment. J Res Pers. 2008;42(4):988–1003.

    Article  Google Scholar 

  46. Lande Y, Seidman DS, Maman E, Baum M, Hourvitz A. Why do couples discontinue unlimited free IVF treatments? Gynecol Endocrinol. 2015;31(3):233–6.

    Article  PubMed  Google Scholar 

  47. da Silva SM, Boivin J, Gameiro S. Self-regulation and wellbeing when facing a blocked parenthood goal: a systematic review and meta-analysis. PLoS One. 2016;11(6):e0157649.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Kraaij V, Garnefski N, Schroevers MJ. Coping, goal adjustment, and positive and negative affect in definitive infertility. J Health Psychol. 2009;14(1):18–26.

    Article  PubMed  Google Scholar 

  49. Kraaij V, Garnefski N, Schroevers MJ, Weijmer J, Helmerhorst F. Cognitive coping, goal adjustment, and depressive and anxiety symptoms in people undergoing infertility treatment: a prospective study. J Health Psychol. 2010;15(6):876–86.

    Article  PubMed  Google Scholar 

  50. Imeson M, McMurray A. Couples’ experiences of infertility: a phenomenological study. J Adv Nurs. 1996;24:1014–22.

    Article  CAS  PubMed  Google Scholar 

  51. Wu AK, Elliott P, Katz PP, Smith JF. Time costs of fertility care: the hidden hardship of building a family. Fertil Steril. 2013;99(7):2025–30.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Newton CR, Sherrard W, Glavac I. The Fertility Problem Inventory: measuring perceived infertility-related stress. Fertil Steril. 1999;72(1):54–62.

  53. Marteau TM, Johnston M. Determinants of beliefs about illness: a study of parents of children with diabetes, asthma, epilepsy, and no chronic illness. J Psychosom Res. 1986;30(6):673–83.

    Article  CAS  PubMed  Google Scholar 

  54. Tasmoc A, Hogas S, Covic A. A longitudinal study on illness perceptions in hemodialysis patients: changes over time. Arch Med Sci. 2013;9(5):831–6.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Parry DC, Shinew KJ. The constraining impact of infertility on women’s leisure lifestyles. Leis Sci. 2004;26(3):295–308.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Bob Shapell School of Social Work, Tel Aviv University, 6997801, Tel Aviv, Israel

    Yael Benyamini

  2. Women’s Health Center, Maccabi Health Services, 1 Lishansky St, Rishon LeZion, Israel

    Miri Gozlan

  3. IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Ariel Weissman

Authors
  1. Yael Benyamini
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  2. Miri Gozlan
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Correspondence to Yael Benyamini.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Benyamini, Y., Gozlan, M. & Weissman, A. Normalization as a Strategy for Maintaining Quality of Life While Coping with Infertility in a Pronatalist Culture. Int.J. Behav. Med. 24, 871–879 (2017). https://doi.org/10.1007/s12529-017-9656-1

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  • DOI: https://doi.org/10.1007/s12529-017-9656-1

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