How Individuals Use Metaphors to Negotiate Fertility Treatment Decision-Making with Their Romantic Partners

ABSTRACT

Fertility problems, or the inability to conceive or carry a pregnancy to term for a period of over 12 months while engaging in unprotected sex, affects 12% of women and 9% of men of childbearing age. To answer calls for more research about individuals’ fertility decision-making (DM) with their partners, we conducted in-depth, semi-structured interviews with 53 individuals who have experienced fertility decision-making with a romantic partner at some point in their lives. Our findings indicate at least three primary ways individuals and their partners navigated their decision-making communication in their infertility “journeys:” (1) the Driver-Navigator, (2) Driver-Passenger, and (3) Driver-Backseat Driver approaches. All decision-making communication approaches were viewed by individuals as collaborative (i.e. shared), but varied in degrees of “togetherness” (high, moderate, low) in how they communicated with each other about treatment decisions. Implications include helping couples and their clinicians to be aware of their DM approach(es) and offering alternative DM approaches based on understanding how and why certain approaches may (not) be effective in addressing goals, needs, and identities.

Acknowledgements

We wish to thank My-Linh Luc for her help in identifying themes for this project and giving feedback. We also wish to thank all our participants who generously shared their time and stories with us. This research would not be possible without them.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. Although some single individuals pursue fertility treatment (Grover et al., 2013; Weigel et al., 2020), couples are the most common patients (Barnes, 2014). We also chose to examine individuals within couples because we were interested in understanding how they co-constructed their nuanced fertility DM communication (Johnson, 2021).

2. Although this clinical definition of infertility by the WHO and CDC assumes a cisgender identity (i.e., one’s gender matching one’s sex at birth) and a heterosexual relationship (i.e., unprotected sex as the only way to conceive), reproductive health needs are experienced by patients with diverse gender identities and sexual orientations (Campo-Engelstein & Quinn, 2021), thus we refer to fertility health needs as “fertility problems” to be more inclusive of these experiences (Bute, 2009).

3. Intrauterine Insemination (IUI) is defined as a procedure in which sperm is injected into a uterus via a catheter (Mayo Clinic, 2021, September 3).

4. In-vitro fertilization (IVF) involves stimulating ovaries to produce multiple follicles, collecting the eggs, fertilizing embryos using sperm inside a laboratory, and then transferring them to a uterus (Mayo Clinic, 2021, September 10).

5. We use LGBTQ+ to reflect the language used by RESOLVE, the U.S. national infertility association, which advocates on behalf of LGBTQ+ reproductive rights (Resolve, n.d.).

Additional information

Funding

This work was supported by the University of Nebraska-Lincoln through the Research Council Faculty Seed Grant.