نویسندگان:

زهرا محسنی دهنوی¹ ، رضوان‌ السادات جزایری² ، سمیه جابری³ .

¹کارشناسی ارشد مشاوره خانواده، گروه مشاوره، دانشکده علوم‌تربیتی و روان‌شناسی، دانشگاه اصفهان، اصفهان، ایران

²دانشگاه اصفهان

³دکتری مشاوره، استادیار گروه مشاوره، دانشکده علوم‌تربیتی و روان‌شناسی، دانشگاه اصفهان، اصفهان، ایران

چکیده فارسی: با توجه به اهمیت فرزندآوری در خانواده و کارکردهای آن برای تداوم و کیفیت روابط خانوادگی، هدف پژوهش حاضر واکاوی پویایی‌های زوجی در زنان نابارور بود. برای دستیابی به این هدف، روش پژوهش کیفی با رویکرد تحلیل مضمون به کار رفت. جامعه مورد مطالعه زنان نابارور 18 تا 40 ساله شهر اصفهان در سال 1402 و 1403 بودند. نمونه‌گیری براساس روش هدفمند انجام شد. گردآوری داده‌ها پس از مصاحبه عمیق نیمه‌ساختاریافته با 14 نفر از زنانی که حداقل به مدت یک سال در حال اقدام به فرزند‌دار شدن بودند و موفق به فرزندآوری نشده بودند، به اشباع رسید. داده‌های بدست آمده براساس روش کلارک و براون مورد تجزیه و تحلیل قرار گرفتند. 1040 کد مفهومی، 27 زیرمضمون و شش مضمون اصلی ماحصل تحلیل داده‌های پژوهش بود که عبارتند از: 1- فرایندهای زوجی، 2- کارکردهای فرزند، 3- شیوه‌های مقابله‌ای با ناباروری، 4- عوامل استرس‌زا بر رابطه زوجی، 5- یاری‌رسان‌های رابطه، و 6- پیامدهای نبود فرزند در رابطه زوجی. یافته‌های این پژوهش حاکی از تنوع پویایی‌های زوجی همسران نابارور بود که ممکن است بیش از رابطه زوجین عادی، تحت تأثیر فشارهای خارج از رابطه زوجی قرار گیرد. نتایج حاصل از این پژوهش می تواند به منظور شناخت هر چه بیشتر و بهبود کیفیت تعاملات همسرانی که درگیر پدیده ناباروری هستند مورد استفاده قرار بگیرد.

کلمات کلیدی: تحلیل مضمون ، زنان نابارور ، پویایی‌های زوجی .

Exploring the Marital Dynamics in Infertile Women

English Abstract: Introduction Despite the extensive changes in societies, the family still has important functions that are beyond the capacity of other institutions. Attachment, meeting psychological needs, fertility, and childbearing are among the unique functions of the family, among which childbearing is of particular importance. In the discussion of the function of childbearing, the phenomenon of fertility and infertility emerges. Infertility is defined as the inability to conceive after one year of natural, continuous, and unprotected sexual intercourse or the inability to terminate a pregnancy with birth (Practice Committee of the American Society for Reproductive Medicine, 2012). The cause of infertility can be related to women, men, or unknown (Broght & Wynz, 2018). In family relationships, the couple relationship is a dynamic relationship. The dynamics include contextual dynamics, intervention dynamics, and strategic dynamics (Nasr Isfahani et al., 2021). Couples’ dynamics can be defined as the effect of power, affection, and respect dynamics (Giwa, 2019). Therefore, it can be inferred that given that one of the functions of marriage is childbearing, some of these dynamics may be damaged by not fulfilling this goal (Miller, 1995). Considering the importance of the function of childbearing, research has been conducted. Khanabadi et al. (2019) found important categories to explain excellent marital quality in infertile couples. Pourmousavi et al. (2024) also identified the individual, family, marital, and physical consequences of infertility. Among the literature in the contexts out of Iran, Azize Diallo et al. (2024) examined the psychosocial burden of infertility from the perspective of infertile couples and found that participants faced psychological burden from society, family, and their spouse.  Despite the advances that have been made in the treatment of infertility in Iran in recent years, a number of couples still do not succeed in treatment. On the one hand, although both couples experience infertility crises, research reports that infertility affects women more than men (Gibson & Myers, 2000). On the other hand, social and cultural conditions also cause this problem to be considered a personality and identity failure for women which affects women’s lives (Karimi et al., 2016). Based on the importance of the topic and the lack of an integrated study that considers the dynamics of infertile women's marital relationships from various dimensions, the present study aims to analyze the dynamics of the couple relationships of infertile women.   Methods The present research design was qualitative with a thematic analysis approach. The target population were infertile women living in Isfahan in 2023 and 2024 who intended to have children and had not yet succeeded in achieving this goal. In order to conduct the research and select the participants, sources such as fertility and infertility specialist offices, medical diagnostic laboratories, and fertility and infertility centers were considered. Sampling was carried out based on the purposive availability method, in which 50 women who expressed their willingness were invited to participate in the study. The data collection was conducted through semi-structured interviews that lasted between 60 and 120 minutes. Data collection continued until saturation was reached, which was done with 14 participants. In this study, data analysis was carried out based on the six-step thematic analysis method while conducting the interviews (Braun & Clarke, 2023).   Findings The research findings in the demographic section showed that the duration of marriage of the women participating in the study was between 4 and 15 years. In addition, three of them had a diploma or lower, six had a bachelor’s degree, three had a master’s degree, and one had a second-level primary school degree. Six of these women were employed and eight were housewives. The research findings were then obtained with 1040 conceptual codes. Then, by merging the codes and continuing the coding process, 27 sub-themes and finally six overarching themes emerged. The first overarching theme included couple processes, which included three important sub-themes (i.e., couple intimacy, conflict resolution methods, and couple conflict content). The second overarching theme, which emerged as childbearing functions, included the six sub-themes of biological needs, upbringing and growth, couple relationship development, maternal experience, paternal role assignment, and the goal of living together. Avoidance, problem-focused coping, and arousal reduction were also three sub-themes that formed the overarching theme of ways couples cope with infertility. However, stressors on couple relationships were the fourth overarching theme of this study, which included factors such as individual, economic, social, family, consequences of unsuccessful treatment, couple factors, and sexual issues that affected the relationship of couples with infertility problems. However, in addition to these stressors, these relationships also had mediators that emerged as the fifth overarching theme. Charming individual characteristics, spouse support, spirituality, sex, relationship strengths, and supportive behaviors were the sub-themes of this theme. Finally, married women with infertility problems pointed out the positive and negative consequences of childlessness in the couple's relationship, which constituted the sixth overarching theme of this study.   Conclusion The findings of the present study, which aimed to analyze couples’ dynamics in infertile women, indicated six overarching themes in these relationships. The first theme (i.e., couple processes), refers to some relationship processes such as intimacy, conflict resolution methods, and the content of the couple conflicts. The seven dimensions of intimacy that emerged in this study were consistent with the results of Luk and Loke (2019) and Namvaran Gerami et al.’s (2018) studies. In addition, as another sub-theme, conflict resolution methods in the present study are consistent with the conflict resolution methods proposed by Rahim (1997). However, what emerged under the title of conflict content in the present study included several specific contents. In this regard, Mohammadyari et al. (2022) stated that conflicts in marital life can be due to the interpersonal relationship of couples, family of origin, gender, and legal issues. Another theme that emerged in the present study was the functions of the child in the couple relationship. The findings of the studies by Khadivzadeh et al. (2023) and Hajhosseini and Mohaddesi (2019) also pointed out the importance of becoming a mother and having a maternal role, which was in line with the findings of the present study. The third theme of this study was the methods of coping with infertility. The findings of this part of the study were found to be in line with the findings of the studies by Riahi and Zarezade Mehrizi (2012), Schmidt et al. (2005), and Peterson et al. (2006). The findings of the aforementioned studies, similar to those of the present study, pointed to the prevalence of avoidance and escape coping styles in infertile women in dealing with the stress of infertility. Stressors on the couple’s relationship was another theme of the study. Individual, couple, family, economic, social, sexual factors, and unsuccessful treatment were among the most stressful factors in the lives of these women. One of the most worrying life experiences is the existence of the infertility label. The existence of the infertility stigma can lead to discrimination from the spouse, family, or even friends (Behbahani Mandizadeh & Homaei, 2020). In the study by Karimi et al. (2016), harassing behaviors of family and those around them, including prying, interfering, receiving labels, blaming, and rejecting, were part of the stressors in the relationship of infertile couples, which was also confirmed by the present study. Another stressor was long treatment and occasional treatment failures, which Basirifar and Mosavinezhad (2022) also mentioned. Finally, marital and sexual relationships can be stressful factors for infertile couples, as was mentioned in Bokaei et al.’s (2016) study. In explaining the fifth theme, the existence of perceived social support (Amini et al., 2020), positive points of the spouse (Eftari et al., 2019), and spouse support and sociocultural status (Kazemian et al., 2013), all of which are facilitators of couple relationship, were in line with the present study. The last theme discussed was the consequences of not having children for the couple relationship. Schmidt et al. (2005) and Khanabadi et al. (2019) were among those who reported positive consequences for not having children in the relationship. However, on the other hand, Haghighatian et al. (2014), Izadi and Sajjadian (2017), Behbahani Mandizadeh and Homaei (2020), and Yao et al. (2018) stated negative consequences for not having children in the couple relationship, both of which were in line with the findings of the present study.     Acknowledgements We express our gratitude and appreciation to all women who, despite much suffering, shared their personal life experiences with the researchers and patiently assisted the researchers in conducting this research.   Conflict of Interest This research study is a part of a Master’s thesis in Family Counseling at the University of Isfahan with the ethics code IR.UI.REC.1403.098, which was conducted without any financial support, and the absence of any conflict of interest is declared.