Vol.3, No.8, 470-478 (2013) Open Journal of Preventiv e Me dic ine
http://dx.doi.org/10.4236/ojpm.2013.38063
An exploratory study of South African women’s
experiences of In Vitro Fertilisation and Embryo
Transfer (IVE-ET) at fertility clinics
Athena Pedro*, Kelvin Mwaba
Department of Psychology, University of the Western Cape, Bellville, South Africa; *Corresponding Author:
Received 27 August 2013; revised 24 September 2013; accepted 6 October 2013
Copyright © 2013 Athena Pedro, Kelvin Mwaba. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Infertility is considered to be a growing problem
worldwide. In sub-Saharan Africa, at least 20% -
50% of coup les of re product ive age experien ce a
fertility problem and 30% are diagnosed with
infertility. This study explores the experiences of
women in South Africa who are involuntary
childless and explores their psychological and
emotional experiences of In Vitro Fertilisation
and Embryo Transfer (IVF-ET). Utilising a quali-
tative methodology, a diverse group of 21 mar-
ried women diagnosed with infertility and who
had undergone at least two cycles of IVF-ET were
recruited. Semi-structured, in-depth individual
interviews were conducted and the data were
analysed using thematic analysis. The results of
the study indicated that the women perceived
themselves as not conforming to a dominant
belief system and as a result felt compelled to
explore all the medical options available. They
reported emotional turmoil characterised by
primary binary emotions of anxiety-excitement
and nervousness-optimistic. These emotions
were experienced throughout the five stages of
the IVF-ET treatment cycles. A synopsis of the
psychological and emotional responses to the
IVF-ET treatment is discussed. The findings of
this study suggest the need for the incorpora-
tion of a mandatory psychosocial intervention
as part of infertility management. Greater atten-
tion to the psychological and emotional reper-
cussions of infertility treatment could lead to a
more personalised client-approach which, in
turn, would prepare infertile women and couples
for the emot ional demands o f t he treatmen t .
Keyw ords: Infertility; In Vitro Fertilisation and
Embryo Transfer; Social Constructionist;
Psychological and Emotional
1. INTRODUCTION
Research in sub-Saharan Africa indicates that at least
20% - 50% of couples of reproductive age, experience a
fertility problem, and 30% are diagnosed with infertility
[1,2]. This is considered to be an exceptionally high sta-
tistic in comparison to other regions in the world [1-3].
The incidence of infertility in South Africa is estimated
at 15% - 20% [4]. In Cape Town, a culturally diverse,
urban community in South Africa, approximately 1000
couples are referred to the Groote Schuur Ho spital Infer-
tility Clinic annually [5]. Since individuals may consult
different specialist in private practice and not in public
institutions where records are kept, reliable prevalence
and incidence data may be difficult to obtain [6]. Lack of
health services infrastructure may also attribute to the
lack of estimations of infertility [7].
The underlying causes of the increased incidence of
infertility in Africa are primarily the elevated incidence
and prevalence of sexually transmitted in fectio ns (STI’s),
infections or complications following unsafe abortions
and postpartum infections [1-3,5,8-10]. Data from a ter-
tiary public health institution in South Africa showed
that the leading causes of infertility were tubal factor
infertility (diagnosed in 57% of couples), male factor
infertility (36%), and anovulation (29%) [11].
The aetiology of infertility is generally divided into
four main categories, namely the female factor, the male
factor, combined male and female factors and unex-
plained, idiopathic or psychosomatic infertility [12,13].
Male and female factors each account for 40% while the
remaining 20% is either shared or unexplained factors
[14,15]. However, the bio medical definition o f infertility
indicates how involuntary childlessness is located within
discourses, which in turn informs the current under-

A. Pedro, K. Mwaba / Open Journal of Preventive Medicine 3 (2013) 470-478 471
standing of infertility and how it is responded to. Preg-
nancy is viewed as exclusively a female biological oc-
currence. In this light, prevailing discourses have pre-
sented biological reproduction as being associated with
women’s bodies, consequently fertility is viewed in
terms of women, and infertility as her failure [16]. Since
women are ultimately the ones to conceive and become
pregnant, infertility is often regarded as a woman’s
problem whether or not the cause has been determined to
be male factor infertility [1-3,8,17-19].
In many cultures, pregnancy and motherhood repre-
sent a profound developmental milestone that is highly
revered [20,21]. Since South Africa is a pronatalist coun-
try, women often derive their value from their reproduc-
tive abilities [22-24]. Given that society places emphasis
on motherhood, [25] childless individuals are often stig-
matised [5,26] as they are viewed as culturally deviant
[5,27]. Pregnancy is perceived and accepted as a bio-
logical occurrence but motherhood is both biological and
social [28-30]. Social constructs pertaining to mother-
hood culminates all the cultural elements that contribute
to social roles and values attached to women in society
[29,31].
Even though infertility is primarily dealt with medi-
cally, the psychological and emotion al effects of infertil-
ity and infertility treatments are undeniable. Documented
research suggests that about 40% of infertile individuals
experience psychological distress associated with their
condition [32]. Burns (1999) revealed that anxiety and
major depressive episodes are the most commonly diag-
nosed psychiatric prob lems experienced by infertile ind i-
viduals, and that this incidence tends to be higher in in-
fertile women [33]. Domar, Zuttermeister and Friedman
(1993) reported that infertile women presented with
psychological distress levels similar to patients with ter-
minal illnesses such as cancer, heart disease and hyper-
tension [34].
This study explored the psychological experiences of
involuntary childless women who have undergone at
least two cycles of the In Vitro Fertilisation and Embryo
Transfer (IVF-ET) treatment. The study adopted a social
constructionist position which asserts that a particular
reality does not exist, but rather that meaning is socially
constructed through intrapersonal and interpersonal proc-
esses [35]. Translated to involuntary childlessness, the
existence of a physiological impairment in one or both
partners does not in itself determine how the individual
or couple experience infertility. Rather, infertility relates
to how individuals interpret, respond to and attach
meaning to physical symptoms and psychological condi-
tions [18] .
2. METHOD
This study was placed within a qualitative methodo-
logical framework as it provides personal descriptive
accounts of how involuntary childless women experi-
enced the In Vitro Fertilisation and Embryo Transfer
(IVF-ET) treatment. These descriptive accounts provided
in-depth insight into these women’s thoughts, feelings
and emotions of IVF-ET. The methodological framework
is situated within the interpretivist framework where the
role of language and discourse became central in the re-
search process.
2.1. Study Participants
Criteria for participation was that women had to be
married or in a committed relationship and at least have
undergone two cycles of In Vitro Fertilisation and Em-
bryo Transfer (IVF-ET). The snowball technique was
used to recruit these participants. As potential partici-
pants were identified a screening questionnaire was used
to determine whether these women matched the sample
criteria. The participants selected were then invited to a
briefing session whereby they were informed about the
study aims, procedures and ethical considerations. When
informed consent was provided the interview times and
venues were then decided upon. The aim was to recruit a
diverse sample of 30 women to participate in the study,
however at the 21st interview saturation point was
reached.
2.2. Data Collection and Study Instruments
From the onset of the study it was decided that semi-
structured in terviews would be appropriate for the study.
The interview guide was developed and pretested to en-
sure content validity. Some of the questions that were
modified related to the emotional (i.e. feelings) and psy-
chological (i.e. thoughts) responses to IVF-ET and sup-
port required. Before each interview the participants
were reminded that they were free to withdraw from the
study at any time and that they did not have to answer
questions that they deemed too personal or threatening.
Each of the participants w ere handed a copy of the inter-
view guide to peruse and explained how the interview
process would unfold.
The interviews were generally structured into three
phases; before the interview (“getting to know you bet-
ter”), the interview (“tell me your story”) and post inter-
view (“tell me how you feeling”). The pre and post in-
terviews were generally debriefing sessions. Each inter-
view started with the pre-interview which was the first
half an hour session. In this session, the id ea was to build
rapport; it was a general conversation between the inter-
viewer and the participant. The second phase of the in-
terview was the phase where the interviewer would cre-
ate the space and ask the participant to “tell me your
story”.
The questions probed specifically about the In Vitro

A. Pedro, K. Mwaba / Open Journal of Preventive Medicine 3 (2013) 470-478
472
Fertilization and Embryo Transfer (IVF-ET) treatment.
Some of the questions asked were “what made you de-
cide to seek treatment, did you try to find information
about the various treatment options available to you,
when did you first find out about IVF-ET specifically
and by whom, can you please describe the different
phases of the IVF-ET process and what expectations did
you have about the IVF-ET treatment”? Participants
were also asked to describe their thoughts and feelings
whilst undergoing treatment. The final phase of the in-
terview involved a debriefing session. The purpose of
these debriefing sessions was to alleviate the strain for
the participants by talking about how they felt sharing
their story and how they ex perienced the interview proc-
ess.
2.3. Ethical Considerations
The ethical considerations adhered to in this study
ranged from informed consent; minimizatio n of potential
harm/deprivation of benefits; and confidentiality and
protection of privacy. All the participants were volun-
teers and gave written consent indicating that they un-
derstood the purpose of the study and were willing to
share their experiences of infertility.
2.4. Data Analysis
The levels of analysis embarked on in this study were
preliminary analysis, thematic analysis, coding, and in-
terpretation. The first entry into analysis was to critically
assess the data as it was collected, ascertain gaps in the
information, and to commence with various concepts and
establish a framework to assess if the data collected pro-
vided more information on issues relating to the research
topic [36]. Each interview was read, summarized and
analysed by means of developing themes. The themes
that were established with the preliminary analysis were
scrutinized once data had become saturated and an ex-
tensive view of the topic acquired. Each theme was
placed in a specific file once it had been contextualised.
There were essentially five major steps that made up the
levels of analysis. The steps were; data organisation and
reduction, thematic analysis, coding, interpretation and
conclusion drawing.
3. RESULTS
3.1. Demographics of the Sample
A total of 21 women were recruited and participated in
the study. The women ranged in age from twenty six to
forty-one years. The average age of the participants was
30 years old. All of the participants are married 15 had a
post-matric qualification, whereas the remaining six par-
ticipants had a matric qualification. English was the first
language for 16 of the participants, while three partici-
pants were bilingual with both English and Afrikaans
languages, and the remaining two participants spoke Af-
rikaans as a mother tongue. Only fou r of the participants
were Muslim, the remaining 17 participants were all
Christian in religion. About 19 of the participants are
employed full time; only two of the participants are un-
employed. While 12 of the p articipants were of th e white
race, nine participants were of the coloured race and one
participant was a Christian Indian.
3.2. Themes Identified
The onset of the technological era has brought about
many advances like ART but it has also presented new
dilemmas. For instance, with the availability of the vari-
ous fertility treatment options, infertile women are faced
with great condemnation should they decide not to pur-
sue ART; rejecting ART is denying oneself the opportu-
nity for motherhood [37]. For many infertile women who
choose not to use ART, it is often perceived th at they are
choosing to remain childless [37].
Some of the participants expressed this dilemma:
“When I think about it, if I don’t try these treatments
then its my own fault because I won’t have a child if I
don’t try. On the other hand, it is so difficult to go
through all of this and to find the money to pay for it”.
“If we don’t try it then we are effectively throwing
away our chance to become parents to our biological
children”.
Participants expressed a strong belief in the success of
the biomedical treatment options available to infertile
women and couples. Some of these medical options in-
cluded drug therapy, surgical procedures, and insemina-
tions by the husband/donor, intra-uterine inseminations,
and IVF-ET [38].
For the participants there were three main reasons mo-
tivating their pursuance of treatment; their strong desire
to have their own biological child, their faith that medi-
cal treatment options were very real solutions to their
infertility struggle and their trust in the expertise and
supremacy of the doctors “playing God”. The fertility
treatment regimen comprises a range of medical proce-
dures with IVF-ET usually being the last hope in the
struggle of pursuing a biological baby [39].
3.2.1. Optimism for IVF-ET
The women in this study were very optimistic that the
IVF-ET treatment would be successful. For many of the
participants, this optimism stemmed from their despera-
tion for a biological child and their belief in the medical
fraternity and its technological advancements. Below are
some of the comments of the participants.
“When you do look at your options available to you
then naturally you turn to the medical route and you
expect doctors to fix everything. When you are faced

A. Pedro, K. Mwaba / Open Journal of Preventive Medicine 3 (2013) 470-478 473
with having this want and this need of having your own
baby it is something that is in you, part of you down to
the core of your being, you will try anything. You will
do anything it takes. IVF meant hope and excitement
and to us it meant being able to have a baby”.
“Initially, I remember saying to myself after the
other treatments failed, everything will be fine and I
will fall pregnant, I still have another option with IV”.
“When I was faced with the IVF treatment I was very
hopeful. I was very confident that everything will be
fine”.
Participants shared their optimism and sense of hope
that the IVF-ET would work. For the participants IVF-
ET presented them with hope and optimism, excitement
and joy because they were presented with another op-
portunity of achieving their goal of having a biological
child. Whilst the participants were optimistic it was im-
portant to ascertain the understanding of the IVF-ET
procedure.
3.2.2. Knowledge of IVF-ET
Participants displayed a good understanding of the
IVF-ET procedure. They were asked to explain the
IVF-ET treatment and the various phases. This question
was asked to assess if the participants were aware of
what the procedure entailed, and to assess how they be-
haved towards treatment. The rationale was to assess
their response to treatment to ascertain whether they par-
ticipated in the treatment regimen consciously aware and
informed of what it entailed or if they participated
“blindly,” allowing the doctor and other medical person-
nel the leeway to perform the treatment. It was important
to ascertain this information as it is indicative o f the par-
ticipants’ perception of feeling in control and it high-
lights the participants’ level of trust they have for the
doctor as well as for the biomedical model of treatment.
Some of the participants’ responses below:
“At a particular point in your cycle then you’re
body’s producing eggs, you get medication to increase
your number of eggs. Once that part of the cycle was
completed, the eggs are harvested, they’re then fertil-
ized in a lab, and then I think it’s about three to four
days, they implant it and you wait for 10 - 12 days to
hear if your pregnant”.
“Yes, the first phase was where I was given injections
and the very low dosage initially, just to see how my
body was going to respond and then I had to take those
two injections simultaneously every day at a particular
time or within the same time period and then I think
about two weeks after that I went for a scan to check
how many eggs my body was developing and then my
body didn’t respond very well, because my numbers
were very low and the quality of my eggs was also not
very good. Then thereafter we increased my dosage and
still it didn’t make much difference and then they re-
moved the eggs from my body and fertilised it inside the
lab and then a few days after that they put it back inside
of me. It was unsuccessful”.
It is evident from the above responses that the partici-
pants were well versed and familiar with the IVF-ET
procedure. Generally, the participants were able to ex-
plain the procedure from the beginning to the end, prior
to undergoing treatment.
“IVF is traumatic. Traumatic in the sense of it’s a
new form of medication. You have to take it every night
at a specific time and needles… I don’t like needles, it
is horrible. The monitoring of the follicles and the
blood, I had bloods done almost every day because they
needed to check the hormone levels”.
“I experienced it to be very upsetting and distressing.
Because I needed to take these meds at specific times , I
would be monitoring the time very closely and as the
time got closer I would be getting more and more anx-
ious for the needle-use. So it was a very unpleasant
experience and I thought about it constantly as a result
keeping me on edge all the time—definitely not a
pleasant experience”.
Some of the participants reported that one cannot
really be prepared for the actual experience of blood tests,
injections and scans. Knowing about it and actually ex-
periencing it are two different experiences. These women
expressed that the various phases in IVF-ET presented
quite intense psychological strain. These participants
experienced a variety of intense emotions, with clearly
distinguishable highs and lows at different stages of the
IVF-ET procedure. These highs and lows could be de-
scribed as a roller coaster of intense emotions.
Despite being aware of what these treatment proce-
dures entail, the intense emotions experienced by the
treatment procedure may cause women undergoing the
treatment to feel a sense of helplessness and therefore
experience feelings of dyscontrol.
3.2.3. Dyscontrol
Dyscontrol was a very prominent theme among the
women in this study. They expressed their frustration at
their inability to control their fertility or reproductive
inability. Compounding their frustration was having to
rely on their doctors who were in con trol of the situation
and their body, and yet unable to give a guarantee that
the treatment will work. These women express the fol-
lowing:
“I remember asking him how long it’s gonna take…
I’m feeling very impatient. I like to get things done and
I’m in control of everything, so, what… got to me the
most was the fact that I wasn’t in control of this”.
“I’m one of those type A personalities you know,
where you can’t help yourself you just have to always

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474
be in control of things. And it was extremely difficult
for me letting go of this and handing over my ‘power’
to other, especially someone I don’t know and trust. But
then you think to yourself it’s a doctor, he knows what
his doing”.
These responses demonstrate how important it is for
the participants to feel that they are in control of their
lives, their bodies and their future. Since infertility may
affect an individual’s sense of control, they often express
feelings of frustration and hopelessness. For many infer-
tile individuals being part of the management of their
infertility treatment is a means of asserting control (Me-
chanic, 1998).
3.2.4. Experiences of the In-Vitro Fertilisation
and Embryo Transfer (IVF-ET)
Treatment Procedure
The IVF-ET treatment procedure can be divided into
five distinct phases; from stimulation of the ovaries to
the waiting for the pregnancy result. These various
phases with particular focus on the emotional and psy-
chological responses to each of these phases will now be
presented.
Pretext to Commencing IVF-ET: Participants were
excited and hopeful about the prospects that IVF-ET held;
an opportunity to experience a pregnancy. Whilst they
had previously endured many trials of hormonal treat-
ment with Clomid and a few failed cycles of intrauterine
insemination/artificial insemination, th ey were still hope-
ful that IVF-ET may bring them success in their en-
deavours to conceive a healthy baby. These women ex-
pressed being “thankful” that they still had another op-
tion to try to conceive and felt that their chance of con-
ceiving was good and that they were not just going
through the motions of leaving their conception to
chance. For the participants, it was a means of taking
control of their infertility, control of their body and their
situation [40].
When the participants were asked to describe how
they felt approaching IVF-ET, they replied that they
were “excited yet nervo us and anxious about the medica l
aspect of having to do blood tests and scans” but felt that
“what ever had to be do ne was worth it”.
1) Phase (1) Stimulation of the Ovaries: The partici-
pants were given hormone injections to stimulate the
ovaries so that multiple eggs are produced.
“It was tiring at one stage, because I remember the
little bottles where you got to mix the powder with the
water, when they calculated the time, I had to inject
myself in the early hours of the morning and it actually
tiring and had to remind myself, every day at this par-
ticular time I must have my injections, I mustn’t for-
get”.
“Very traumatic and especially nerve wrecking for
you and your husband, because you both have some
expectations of the process, you are never really ready.
You don’t have a normal sex life for starters, because it
is all in a schedule worked out for yo u”.
The IVF-ET procedures can also be the source of
stress and anxiety for many infertile women (couples)
because it is a procedure which entails the patient inject-
ing themselves at a specific time daily for a period of
time, and undergoing close monitoring of hormone levels
through ultrasound scans and blood tests.
“All the injections, you r bu ms g e t so so r e , believe me.
It’s been really nerve wrecking and you want to do eve-
rything right and perfect to make sure that you don’t do
something wrong to jeopardise it”.
“The monitoring of the follicles and the blood, I had
blood done almost every day because they wanted to
monitor my hormone levels closely in case of hyper
stimulation”.
These women shared their experiences of injecting
themselves and the monitoring of hormones through
blood tests and ultraso und scans. Despite th eir dislike for
needles they were still willing to proceed with treatment.
This is an indication to what lengths many infertile peo-
ple are willing to go to in order to achieve a pregnancy.
The women express how they felt during this particu-
lar phase.
“When you actually get over this needles and injec-
tions thing and of course the blood test and scans, I
know it is a lot but believe it or not one get pass it if you
do it often enough. The waiting for the eggs really
made me anxious because we firstly had to check if the
eggs will appear, then to check how many are appear-
ing and then to see how many of these eggs matured, it
all entails waiting, waiting, waiting ”.
“Each step has its own emotions because when we
were waiting for the eggs to mature I was very anxious,
nervous with a hint of excitement and anticipation.
Then when the eggs are developed, anticipating the
number of eggs, obviously the more the better, was also
very exciting and at the same time also anxiety provok-
ing. At this po int optimism levels are rising because you
can see yourself progressing to the next phase. Once
you establish how many eggs you have and the number
is sufficient, you become ecstatic, happy, so thankful
and you feel so great”.
The mixed emotions expressed in the first phase of
treatment are evidence of the emotional impact of this
procedure. These women expressed feeling anxious,
nervous with a hint of excitement and anticipation for the
eggs to develop. Once the eggs have matured, the next
phase entailed the retrieval of the egg/s and this phase
was described as being very exciting yet anxiety induc-
ing.
2) Phase (2) Egg Retrieval: The women shared their

A. Pedro, K. Mwaba / Open Journal of Preventive Medicine 3 (2013) 470-478 475
experiences of this phase.
“In a way it was quite exciting but still nerve-
wrecking. Exciting because they were going to remove
the eggs and have them fertilised but nerve-wrecking
because it is all so delicate and anything could go
wrong at any time and there was nothing I could do to
control any wr ong or any risk”.
“I was very nervous all the way because these eggs I
prayed so hard for and went through so much for is
going to be taken out and taken to a lab. Part of me is
happy and excited because my eggs will get fertilised
but I was too nervous to enjoy that part. I was feeling
very optimistic about going to the next phase”.
The above responses show how emotiona lly torn these
participants were, in that they describe being nervous and
anxious and yet excited and optimistic. The participants
tended to approach IVF-ET on a phase-by-phase basis
whereby th ey do not focus on the last phase or end r esult
but rather on getting through one phase before focusing
on the next phase. The participants were asked wh y they
approached the IVF-ET procedure in this manner. The
participants explained that their doctors worked in this
manner, whereby every stage was dependent on the suc-
cess of the previous stage, so approaching the IVF-ET
procedure in this manner seemed logical and practical.
3) Phase (3) Fertilisation of Eggs and Sperm: On ce the
matured eggs have been retrieved, they are placed in a
petri dish with a fluid and fertilised with the hus-
band/partner’s (donor’s) sperm. This is a cr ucial stage of
the IVF-ET process and all the hard work and commit-
ment shown in the earlier phases has some sanctuary in
the success of this phase. The participants shared their
experiences of this phase with particular attention to how
they felt during this phase of the IVF-ET.
“I was feeling very optimistic by this stage because
things were successful with the other phases. I knew
this phase was a biggy but I planned on being optimis-
tic because I had good reason to be. In my mind I was
cautiously optimistic but in my heart I just knew it was
going to work”.
“You know to tell you the truth I had mixed feelings.
One minute I was optimistic and hopeful the next min-
ute I was a complete nervous wreck totally over-
whelmed by the process. Then I found myself being
positive and actually feeling that this treatment can
work, the next second I felt anxious, nervous, cautious.
I couldn’t keep up with the emotional turmoil”.
The responses expressed by these women showed the
intensity of emotions experienced as a result of the IVF-
ET procedure. The participants felt happy with the suc-
cess of the previous phases, but understood that the
IVF-ET procedure was a process and that at any stage a
problem could occur. Because of the “unknown”, the
participants found themselves emotionally bombarded
between positive and negative feelings all the time from
the beginning to the end.
“My emotions went up and down, like a roller-
coaster. You get good news then you feel on top of the
world and then its not so long then you get bad news
and you literally fall to the bottom of the pit”.
“With infertility treatment you have different stages
and within these different stages you very often get
good news or bad news, or and that’s why you don’t
know how to feel and that’s mixed emotion”.
“You feel good when things are going as they should
without focusing on the bad that could go wrong. So
when its good news you absolutely thrilled and at times
even feel a form of utopia like nothing can go wrong
now everything is perfect. It’s almost like your opti-
mism breaks free and prevails till the next hurdle. But
then at the same time you are aware that the negative
could strike at a ny m o m ent”.
These women reinforce how emotionally cautious one
should be because the optimism, hope and happiness one
feels may be short lived and one should be aware that a
bad experience may be imminent.
4) Phase (4) Embryo Transfer: About three days after
the eggs have been fertilised, after the blastocyst stage
has taken place. The laboratory technician s will decide if
the embryos are ready to be transferred back into the
womb. The participants were once again asked to de-
scribe how they felt during this phase of treatment. Par-
ticipants described having mixed emotions.
“There wasn’t one day when I can look back and sa y
‘I remember having felt just sad or happy or hopeful’.
Because in one day I felt nervous-excited, worried-op-
timistic all at once. I was nervous about the embryos
being put back but excited at the same time. I was wor-
ried that something would go wrong, but at the same
time I was optimistic that the procedure would be suc-
cessful. Its crazy, I know but that was how it was”.
“IVF can do things to you, that only IVF can. You
are not yourself, your emotions are all over the place.
The only feeling you are sure about is that you want
your own baby and you will do anything to get it”.
These responses clearly demonstrate the intensity of
the emotions felt. The participants describe experiencing
feelings that rapidly change from one extreme to another.
This phase of treatment is similar to the experiences de-
scribed in the egg retrieval phase, where mixed emotions
were apparent. Several women describe the emotional
strain in this phase and reported that in one day having
felt “nervous-anxious, worried-optimistic all at once”.
They described these emotions as being intertwined.
5) Phase (5) Waiting for Results: Once the embryos
have been successfully transferred, the next phase is the
10 day waiting period to see if the embryo has implanted
successfully. A blood test is taken 10 days later to verify

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476
if a pregnancy has successfully occurred [41]. Waiting
has become a very prominent theme with infertility and
infertility treatment. At every stage of the infertility
journey, waiting occurs. For the participants, with wait-
ing came anxiety, as having to wait for the results at
every phase before being able to proceed to then next
phase is very anxiety-inducing. However, the partici-
pants described the last phase; the 10-day waiting period
as being the worst part of the procedure.
“I think that once you know what you have to go
through and it is getting more bearable and now the
most stressful moment of the treatment is when you get
the final result. I think that one is the worst. The wait-
ing can really make you very anxious, and you will
sometimes think of all the bad things and this can
really freak you out. I think the waiting for the results
is the worst of all”.
“I’ve dreaded each time that something would go
wrong and each time we have really good news. But it
is the waiting that kills you. It takes so much out of you
that waiting, it makes you doubt yourself and your
chances of success, it really affects you in a deep per-
sonal way”.
Some of the women referred to the waiting as being
what “kills you, tak es so much from you, and makes yo u
doubt yourself and your body”. The intensity of the ag-
ony is evident and this phase of treatment demands a
high level of self-dialogue, introspection and self-moti-
vation. These women were asked to describe how they
felt when they experienced a successful treatment out-
come as well as an unsuccessful treatment outcome.
“Oh when the result is positive you are so happy and
so relieved you won’t believe it. It’s like climbing this
mountain and taking that last step to get to the top, oh it
feels like heaven”.
“When you hear that the IVF worked you immedi-
ately feel excited and you just want to dance and cele-
brate. It really felt good that it worked”.
“It’s just the worst thing in the world to put yourself
through this and it doesn’t work! You are devastated,
heart-broken, you want nothing you don’t want see
anyone and just want to be left alone”.
4. DISCUSSION
Women draw meaning and understand their childless-
ness from the values and norms of their socio-cultural
context in which they live and function. Accordingly,
women’s decisions surrounding motherhood, infertility
and ART are inextricably linked to the wider social
structure. Pregnancy is perceived and accepted as a bio-
logical occurrence but motherhood is both biological and
social [28-30]. For the participants in this study, it be-
came evident that they live in a society that on the one
hand pathologises infertility and on the other hand em-
brace the dominant belief that the biomedical profession
offers a cure and “promises” success. To this end,
women enter treatment sometimes naively unaware of
the psychological and emotional strain that accompanies
these treatment procedures. These women enter into an
almost blinding, addictive mode whereby their belief is
focused on the “promised” success of treatment rather
than on the reality of trauma associated with the treat-
ment experience. Since these treatments are conducted
on a cyclical basis, these women enter cycle after cycle
without fully realising the ex tent of ps ycholog ical trauma
they are experiencing. The psychological strain of un-
successful treatments is downplayed by the hope and
optimism offered by the “anticipated” and “presumed”
success of the next cycle.
Reproductive decisions are influenced by the social,
economic and political structure of a society. It is diffi-
cult to accurately understand how, or to what degree,
psychological ideologies and discourses, which formu-
late parenting as being an innate part of healthy devel-
opment and motherhood as necessary to womanhood,
have directly or indirectly influenced women’s experi-
ences and decision-making around infertility and its
treatments. In addition, how this has impacted their
frame of reference in terms of finding a solution. In try-
ing to overcome infertility, many infertile women place
themselves at great risk and are denied the opportunity of
letting go of the desire to have a biological child until
they have exhausted all of the options available to them.
The participants described the IVF-ET treatment as being
very distressing, painful or agonising and emotionally
taxing. Whilst the psychological trauma and suffering are
evident, there are no mandatory psychosocial support
and counselling services available at infertility clinics.
While some of the infertility clinics do have the services
of a psychologist available, this is not the norm and the
patient still has to cover the cost of the consultation
themselves. The fertility clinics generally do not provide
this support as part of the service of infertility manage-
ment. The psychological effects of infertility and its
treatments are hugely neglected by the medical practi-
tioners at infertility clinics. Apart from the lack of psy-
chological services provided, other forms of psychoso-
cial support are also lacking. The participants in this
study expressed the need to connect with other infertile
people attending the fertility clinic so that through inter-
action they could compare and validate experiences,
discuss various coping strategies and mechanisms and
pose as a source of information and general support.
Fertility specialists and healthcare practitioners work-
ing at these fertility clinics may benefit from the findings
of studies of this nature. The entire process of infertility
is characterised by intense emotions culminating in feel-
ings of hope and total devastation. Infertile women may
find themselves having to negotiate these binary emo-

A. Pedro, K. Mwaba / Open Journal of Preventive Medicine 3 (2013) 470-478 477
tions all the time. Experiencing a range of these emotions
simultaneously places women in a fragile psychological
and emotional state and predisposes them to psychologi-
cal difficulties. Future studies shou ld extend the scope by
investigating the psychological and emotional responses
to IVF-ET of infertile couples and infertile men whilst
undergoing the fertility treatment procedures. By high-
lighting and bringing to the fore the psychological diffi-
culties experienced by infertile women undergoing fertil-
ity treatment and specifically the IVF-ET treatment, the
specialists in the field may provide a more holistic treat-
ment regimen that includes psychological support such
as mandatory counselling. Since many fertility specialists
are not trained in counselling or psychological manage-
ment, the insight into the patients’ emotional needs may
prompt fertility clinics to employ a psychologist or psy-
chological counsellor as part of the treatment regimen for
the betterment of the client. This will also allow the pa-
tients to become more aware of the emotional cost that
accompany these treatments, assisting them to employ
more effective coping strategies whilst undergoing fertil-
ity treatments generally and more specifically the IVF-
ET treatment.
5. ACKNOWLEDGEMENTS
We would hereby like to acknowledge the National Research Foun-
dation for their financial assistance and co-funding of this study. There
is no conflict of interest of any parties contrib uting to this study.
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