The Impact Of Ivf On The Relationship Of Couple Research Proposal Sample

Introduction:

The aim of this research is to analyze the impact of requiring IVF on the relationship of the couple to successfully become pregnant for younger females.This poses a question: how does IVF treatment impact relationship of couples?This research is age-limited for women below 30 years. The age limit is kept low so that the relation in first few years of married life is specifically evaluated. The subjects of research are only those who are undergoing their first experience to achieve pregnancy by IVF treatment.

Context:

IVF is a treatment of conceiving a baby for those couple who are infertile, either due to male or female medical reason. A couple is said to be infertile is they fail to conceive one year after unprotected, regular intercourse. 84% of the couples achieve pregnancy in one year, 92% in two years and 93% in three years. Those who fail to conceive after three years have less than 25% chances of conceiving later in life (Cooke, I. D., Sulaiman, R. A., Lenton, E. A., & Parsons, R. J. 1981).On doctor’s advice mostly they decide to achieve pregnancy by assisted conception that is in vitro fertilization (IVF). IVF is a process in which fertilization is done by combining egg and sperm in a laboratory dish and then transferring the embryo into the uterus (Hasler, J. F., Henderson, W. B., Hurtgen, P. J., Jin, Z. Q., McCauley, A. D., Mower, S. A., & Trimmer, S. A. 1995). This causes a serious impact on the relation between both partners. Their relationship may strengthen during treatment, or it may lead to further despair(Holter, H., Anderheim, L., Bergh, C., &Möller, A. 2006). The regular procedures, multiple visits and cost of treatment are factors which concern them more. Moreover, the outcome of IVF is doubtful: majority gives birth to healthy baby whiles some unfortunate ones suffer from abortion, medically unhealthy child and twin or triplet.

Research methodology:

This study is based on grounded theory methodology.This approach was first articulated by Glaser and Strauss in 1967 in their book The Discovery of Grounded Theory. This theory allows reviewing earlier stages of research continuously, and if the researcher feels then they can change the direction of research. Here the research question is permanently fixed, and attention is focused on the area of research (Strauss and Corbin 1990: 37–40). This theory allows an open-ended research question and not one which ends with a yes/no answer. The data collection in this theory allows exploring by initial open coding, formulating tentative linkage and then going back to the field to collect further data. The report can be written in many ways as far as it contains references from literature, data collection, analysis and implications.This theory is selected for above research question as it is an open-ended question. In the process of data collection, any type of quantitative and qualitative type can be considered like video, image, texts, observations or uttered words. It allows considering and reconsidering factors for better analysis and results.

Procedure:

I intend to approach Gynecological and Obstetric hospitals and clinics to see how many patients are scheduled for IVF procedure. By applying purposive sampling method, only those women who are below 30 years will be included in this research irrespective of race, religion and class. I aim to include at least 200 participants, for this I will look for maximum number of cases around 4-500 as some of them may refuse directly to participate or may refuse at the time of written consent. I will approach each patient one by one in the clinic/hospital to ask for their participation, will explain the purpose of research and assure them that they will be given a copy of results. I will take their contact number or email ID so that I can approach them while starting research.
A written consent form will be given to patients below 30 years and their partners who agree to answer a list of prepared questions for this research. They will be asked to answer separately without communicating at that time.Three sets of the questionnaire are prepared: first set to be answered before the start of IVF treatment, second just after oocyte retrieval and third will be sent through e-mail to be filled after conceiving or failure of the procedure.The interviewer makes evaluations and self-analysis, and a questionnaire is prepared to be asked from 3 close relatives/friends.
In first set of record, I intend to acquire general information which includes recording age, male/female/mixed factor for infertility, duration of infertility, time spend in treatment (months), education of partner, occupation, residence and general health. Psychological factors before treatment will be recorded based on a study by Psychological General Well-being Index (PGWB) (Dupuy, 1984). In this anxiety, positive attitude, self-control, general health, and vitality are graded. Then the desire to have a child will be recorded for visual evaluation and graded from 0-10 with 0 indicating ‘not at all’ and 10 indicating ‘very strong desire.’ Psychological views for diagnosis of infertility will be asked through questions based on guilt, success, anger, contentment, frustration, isolation, anxiety and depression(Anderheim et al., 2005). Then I intend to ask about the relationship between diagnosis of infertility: “Do you feel that the crises of infertility have improved or worsen your marital communication and emotional intimacy?”“Do you notice a danger to your relation to the diagnosis of infertility?” “Are you prepared to undergo this treatment knowing that there are chances of failure?” “Does your partner have blaming attitude for being infertile?” “Do you have financial constraints?” “Do you discuss financial issues frequently?”
In the second set of record, taken after IVF procedure, the above psychological factors will be asked based on PGWB. Beside these, questions will be asked regarding the attitude of an individual partner without mutual communication while answering. The questions are based on support of male partner through the procedure, problems of emotional intimacy, coping with routine work/job, anxiety of results, social issues, impact on sexual relationship;mood swings specially irritability and depression in females, emotional withdrawal and decreased sex drive in women.
In the third set of record, taken through a mailed questionnaire, the above psychological factors will be asked based on PGWB. Two sets of the questionnaire are made: one for those who were successful in achieving pregnancy and second for those who failed the treatment. Emotions, support, strengthened/weakened relation, hopes for future, grief reaction and second attempt for the procedure will be asked from those who failed to conceive. Those who conceived will be asked about how strong their relation is from before? Has past misunderstanding (if any) solved after positive outcome? What are your future concerns? Do you feel that a chance to deliver unhealthy baby has affected your relation? Do you feel if at any trimester abortion occurs then your relation will be in danger? How will your partner take a twin or triplet pregnancy?
Besides interviews with the couple, the surveyor will analyze the level of mutual co-ordination and understanding among couples. A list of questionnaire is prepared to be asked from 3 relatives or friends: what was the relationship just after marriage? Has it changed over years? Does the couple have family or social pressure of conceiving? How is the relation at present? Or do you feel any change in behavior the couple has towards each other?

Analysis:

The analysis is done based on means, standard deviations, medians, and ranges. The data will be analyzed by dividing it into categories of age, education, income and male or female factor for infertility. It is expected that younger female age, better education, and income data will give a more healthy relationship feedback. Besides this, the male reason for infertility will also give a positive attitude in a relationship throughout the critical time as compared to a female factor of infertility. The record taken during the second stage and third stage have immense significance. Sexual relation and female irritability are the two factors which are expected to affect the second stage of data collection whereas third stage results depend on the outcome of IVF treatment. As the data is collected from those only who are undergoing this process for the first time, so relation during early year/years of marriage is very important. An already weak relation will result in greater misunderstanding and lack of co-operation throughout the treatment. Financial issues will further impact relation of a couple in first two stages of data collection.

Ethics:

This research is ethically justified as it protects all the rights of research participants, which is the key to all social and medical research. The law of voluntary participation is applied so that the participants are not coerced. Informed consent is taken after explaining the purpose and all the steps in the research. Ethical law to protect participants from any harm is given due consideration in this research. None of the participants will go through any social, physical or psychological harm.Confidentiality is essential in research and the participants in this research will be given confidence that all the information given by them will not be shared or made available to anyone not involved in research. A stronger guarantee of confidentiality is given by assuring the participants that they will remain anonymous throughout the research even to the researchers. To further assure that all ethical issues are considered, I intend to approach Institutional Review Board (IRB) where a board reviews that none of the legal issues is ignored.

Credibility and transferability:

Transferability of findings refers to the extent by which findings one a research are applicable to other situations. This research can be applied to a wider range of age group instead of limiting to age less than 30 years and other factors like number of attempts of IVF treatment can be increased. Religious and social factors can be separately evaluated.
Validity concept is explained in a wide range of terms in qualitative research studies. Credibility or internal validity means the subjective and objective components to believe the source or message of study in research is actually intended. External validity refers to the limit or extent to which the results of one research can be applied to other situation (Merriam, 39).Credibility tells about to what extent the findings or results of research are similar to reality. It is one of the most important tools to build trustworthiness. Several approaches can be considered to strengthen the validity of research. The adoption of well-established research method is very important. The steps taken in research such as questionnaire designed and method of data analysis should be compared with previous researches. Triangulation includes the use of various methods of collecting data like observations, interviews or focus groups.This constitutes major data collection strategy in qualitative research. Supporting data can be taken from documents to get background information and attitude or behavior of those in the study. Or another type of triangulation can be used which includes involving a huge range of informants. In this type views and experience are verified.Patton (2001) states that the use of triangulation in research strengthen the study by combining different methods. Tactics should be applied to exclude those subjects or informants who are reluctant or unwilling to co-operate so that a genuine data is collected. This approach of validity is used in research by review from other researches and including those factors that were not covered in them so that the aspect of relation is analyzed in detail.
Qualitative interviews include a firm and continuous reflection on the research topic. Reflexivity is defined as the process which involves reflection of researcher themselves and research relationship. Self-analysis includes assumptions, conceptions and knowledge and their effect on research decision especially while selecting and forming questions for the interview. Reflexivity on research relationship means that the researcher is evaluating their relation to those from whom the interview is conducted and the impact of this relation on response to questions. The researchers are concerned about the way meanings are produced and reproduced in a specific social, cultural and relational background.They take interviews are means to interpret meaning. So, the interpretation of qualitative data needs a reflection on the whole context of research. Results or findings do not emerge at the end of research, but a continuous thought process occurs. Findings from intermediate stage guide further interview and analysis. Reflexivity gives the opportunity to review the questions and revise them if the need is felt. It also allows the researcher to reframe the topic while progressing in the survey. At occasions, the researcher feels that questions designed are not adequately understood or are inappropriate, so an ongoing analysis occurs. Reflexivity has to be considered while carrying out this research as the questions drafted in this proposal are based on psychological views of the subjects and are drafted on the possibly predicted issues which may concern the couples while undergoing IVF treatment for pregnancy. I considered and reconsidered the questions and while progressing through the three steps of research. On review of other literatures, a need was felt to add background factors and interviewing family members or friends as an important tool which will strengthen the impact on the relation the treatment has.

References

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Crowe, M., & Ridley, J. (2008). Therapy with couples: A behavioural-systems approach to couple relationship and sexual problems. John Wiley & Sons.
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Ethics in Research.(n.d.). Retrieved from http://www.socialresearchmethods.net/kb/ethics.php
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Hasler, J. F., Henderson, W. B., Hurtgen, P. J., Jin, Z. Q., McCauley, A. D., Mower, S. A., & Trimmer, S. A. (1995). Production, freezing and transfer of bovine IVF embryos and subsequent calving results.Theriogenology, 43(1), 141-152.
Holter, H., Anderheim, L., Bergh, C., &Möller, A. (2006).First IVF treatment—short-term impact on psychological well-being and the marital relationship. Human Reproduction, 21(12), 3295-3302.
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Shaw, P., Johnston, M., & Shaw, R. (1988).Counselling needs, emotional and relationship problems in couples awaiting IVF. Journal of Psychosomatic Obstetrics & Gynecology, 9(3), 171-180.
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