Wong QS, Chan CHY, Tam MYJ (2015) Swinging in a Pendulum: Ambivalence among Women Experiencing IVF Treatment Failure. J Family Med Community Health 2(8): 1065.

• Infertility
• IVF treatment
• Ambivalence
• Couple relationship

IVF: in vitro Fertilization; ART: Assisted Reproduction Technology

IVF treatment is one of the most significant means of Assisted Reproduction Technology. It is a demanding, invasive and timeconsuming process requiring women’s active involvement in each treatment stage. When many women place extremely high expectation on the treatment outcome after spending tremendous financial, psychological and physical resources on it, it is conceivable that they could experience complicated emotions when they are told fail to conceive.

Common emotions experienced when experience IVF treatment failures include feelings of loss of hope, negative psychological responses such as anxiety and depression, and low self-esteem [1,2]. It happens like they have lost their last hope in bearing child, when they perceive IVF treatment as their last resort.

In view of the complexity in the treatment nature and women’s psychosocial needs, it is worth exploring their struggles and ambivalent thoughts in making decisions in different aspects.

Three focus groups were launched between February and April in 2015, in which 16 women who had experienced at least one IVF treatment failure participated. They were considering to continue their treatment.

The mean age of the women was 36.6 years old, and they had married for 4.93 + 2.84 years in average. The mean of the IVF treatment failure they experienced is 2.5 times, and six out of sixteen had only one sub vented treatment cycle left.

During the three-hour focus groups, the women were facilitated to express and share their treatment experience, feelings, values and social life under some guiding questions. The content was later on analyzed into qualitative data for analysis.

In the sharing of the three focus groups, there are four salient themes identified, namely, treatment goals, continuation of treatment, husband’s involvement and disclosure issues.

Women shared their ambivalent thoughts in their initial treatment goals, on whether they were to fulfill their family ideal or it was simply their own wish for parenthood. Some had struggles and worries to get conceived even they were still trying hard in the treatments.

During the focus group, some women also revealed their indecisive thoughts on whether or not to continue their IVF treatment with both fear and hope. They were afraid of the side effects and sufferings, but they still endeavored and did not give up.

Apart from these decisional ambivalence, these women faced struggles in husband’s involvement in the treatment. They were protective to their husband and regarded them as a barrier to inhibit them to smoothly carry out the treatment procedures, while at the same time felt contentment for their supports in involving in the treatment stages, such as accompanying them to the hospital.

Last but not least, some women had ambivalent thoughts in disclosure issues, in the extent of telling their family members and friends about their treatment. Some of them regarded disclosing their situation as a relief but an anxiety at the same time. They hoped to remove misunderstanding that outsiders have about them, such as their tight schedule in treatment and side effects on their increasing body weight. They at the same time did not want to disappoint others and tend to keep secrecy.

The negative models of self introduced by [3] attribute relational ambivalence to the fear of rejection or abandonment, which is due to personal vulnerabilities such as doubt about own value and lovability. Thus, in face of adversity, one could be ambivalent to seek for intimacy and at the same time strive to keep distance with the spouse, and maintain a relationship at almost any cost.

From the content revealed by the women, they were shifting in-between the two attachment styles of avoidance and anxiety [4]. They hoped to maintain autonomy by shouldering all pains and sufferings without sharing or adding burden to their husband. However, they at the same time sought dependence in hoping their husband to accompany them throughout the treatment, or even help with the treatment procedures. They were deploying both hyper activating and deactivating strategies. Thus, these women could hold both positive and negative views towards the people around at the same time [5].

Ambivalent thoughts were revealed among women throughout their course of IVF treatment in several salient themes and aspects. As modern women, they wished to shoulder all pain and suffering without adding pressure to their husband or people around. However, at the same time, they wished someone could care and understand them.

According to [6], ambivalent individuals are less likely to benefit from social supports, receive little sympathy and support from others, and are less satisfied with their marriage. Therefore, in understanding more about the women’s complicated feelings, it sheds light on our development of psychosocial services in exploring their incongruence in vulnerabilities and on couple relationship.

Funding Source: General Research Fund, Research Grant Council (No.: HKU27400414).

1. Filetto JN, Makuch MY. Long-term follow-up of women and men after unsuccessful IVF. Reproductive biomedicine online. 2005; 11: 458- 463.

2. Verhaak CM, Smeenk JM, Evers AW, Kremer JA, Kraaimaat FW, Braat DD. Women’s emotional adjustment to IVF: a systematic review of 25 years of research. Hum Reprod Update. 2007; 13: 27-36.

3. Mikulincer M, Shaver PR, Bar-On N, Ein-Dor T. The pushes and pulls of close relationships: attachment insecurities and relational ambivalence. Journal of personality and social psychology. 2010; 98: 450-468.

4. Rouff L. Ambivalence – Its Role in Decision Making in Infertility Treatment. 2010.

5. Carter AM, Fabrigar LR, MacDonald TK, Monner LJ. Investigating the interface of the investment model and adult attachment theory. European Journal Of Social Psychology. 2013; 43: 661-672.

6. Ben-Ari A, Lavee Y. Abivalence Over Emotional Expressiveness in Intimate Relationships: A Shift From an Individual Characteristic to Dyadic Attribute. American Journal Of Orthopsychiatry (Wiley-Blackwell). 2011; 81: 277-284.

With the advancement in technology, many couples with infertility choose in vitro Fertilization (IVF) treatment as a significant mean to achieve their dream of parenthood. However, with very low success rate, many of them face treatment failures and experience complicated emotions.

In our qualitative study, we have contacted women (N=16) who have experienced IVF treatment failure, and were considering to continue on next treatment in order to conceive. During the focus groups launched, they revealed many ambivalent thoughts throughout the whole treatment. They swung between making their decisions and stances on various aspects, with more salient themes in treatment goals, continuation of treatment, husband’s involvement and disclosure issues. They tended to seek for intimacy of others by wishing to be cared and accompanied throughout the treatment, but at the same time kept distance by shouldering all the suffering without sharing. These thoughts will be discussed and analyzed under adult attachment theory.