Perceptions and Experiences of Sub-fertile Couples Served at the In Vitro Fertilization Centres in the Gaza Strip
Shahd Bassam Abu Hamad
شهد بسام أبو حمد
Background: Infertility is a difficult experience with many overwhelming challenges originated from medical, social, financial and psychological factors. This study explores experiences and challenges that infertile/sub-fertile couples face when they utilize in vitro fertilization services in Gaza and flags priority areas for supporting them. Method: The study followed a quantitative, analytical cross-sectional approach. Data were collected from a convenient sample of 320 participants attending In Vitro Fertilization centers in the Gaza Strip. After consenting, a qualified data collection team administered face to face interviews with participants at the centers serving them. The study tool has been constructed by the researcher to incorporate medical, social, psychological and financial dimensions. Tool validation has been done through experts’ review and statistical testing. The SPSS software has been used for data entry, cleaning and analysis. Results: The mean age of respondents was 29.8 years, and the mean age of their husbands was 34.9 years. Despite that 76.6% of husbands are working, almost two thirds of them earn less than New Israeli Shekels 1000; 33.4% reported receiving social assistance, half of them indicated that their monthly income is not sufficient to meet their basic needs. Still, 82.2% didn’t receive any financial support when they seek In Vitro Fertilization services. One average, interviewed participants reported living with their infertility for around 5.5 years, three quarters of them were told about the reason of infertility, among them, 63.3% reported that disturbed spermatogenesis is the reason for couples’ infertility. Two thirds of cases have secondary infertility, 63.4% reported being pregnant before. Of the total surveyed women, 14.7% reported developing health problems attributed to infertility management. Sub-fertile couples reported starting seeking infertility management early, with 40% doing that within less than 1 year of marriage. On average, couples approached around 5 doctors for infertility management and tried two centers, nevertheless, only 13.2% were provided with medical documents that can be used when they approach other centers. More than half (56.9%) of the respondents confirmed visiting a traditional healer. The vast majority of couples reported exposure to social pressure (89.4%), especially by in-laws to conceive which increased their stress. The level of satisfaction reported by respondents about the services received was particularly high (93.34%). More importantly, General Health Questionanire-12 scores indicate significant level of psychosocial stress with one quarter showing signs of psychological distress (using 6 as cut off point) and three quarters reporting psychological distress when using 3 as a cut-off point. The overall quality of life score (wellbeing) was 71%, lower than the general population scores with the social domain eliciting the highest score (79.13%) and the environmental domain eliciting the lowest scores 65.93%. The main challenges facing sub-fertile couples were financial difficulties (91.6%), discrimination (76.6%) especially by in-laws, psychosocial stress (53.1%) and side effects of hormonal therapy (20.6%). Family was the main source of support for sub-fertile couples, as 82% reported being supported by their husbands, 55% by their in-laws and 54.4% by their parents. Psychosocial services are rarely provided at In Vitro Fertilization centers; instead focus was more on hormonal therapy and medical treatments. Conclusion: Sub-fertile couples face numerous challenges and should be better supported financially and psychosocially. Beneficiaries’ rights to get adequate information, counseling and informed choices should be maintained. Regulatory measures to promote and standardize services at IVF centers is a priority. Also, social discriminatorynorms and stigma around infertility should be addressed.