A total of 23 participants undergoing assisted reproduction treatment using donated oocytes were invited to participate in the study, of which 20 were interviewed. Among those who did not agree to participate in the study, one was in the ovarian stimulation phase of the donor and the other two had not received successful assisted reproduction treatment. All three declined to participate in the study because of concerns about their disclosure of their infertility treatment through the use of donated oocytes.
The demographic characteristics of the participants are shown in Table 1. From the analysis of the interviews with 20 Muslim participants aged 29 to 47 years, 98 inferential codes were extracted. After having merged the duplicated codes and those having the same concept, finally 90 inferential codes, 9 subcategories and 3 main categories were deduced. The three main categories included distressing psychological symptoms, social stigma, and negative coping mechanisms (Table 2).
The sub-categories of self-esteem destruction, anxiety and stress, depression and spiritual discouragement have been merged into distressing psychological symptoms. The subcategories of concerns about disclosure, judgment of others, and conflict with religious teachings resulted in the main category of social stigma. The category of negative coping mechanisms was formed based on the subcategories of aggression and denial.
Distressing psychological symptoms
One of the main categories of research was distressing psychological symptoms which were inferred from the subcategories of self-esteem destruction, anxiety and stress, depression, and spiritual discouragement.
Destruction of self-esteem
The experience of 50% of oocyte recipients has shown that by realizing that they cannot use their own egg for fertility and must use a donated oocyte, they feel inferior and lacking, leading to loss of self-esteem which has increased. overtime. Combined with a feeling of guilt related to infertility, this feeling intensified in these women. In this regard, Participant 8 said: “I felt really depressed. For my husband’s sake, I felt weak and helpless. I was very upset that I had to beg another woman to give me her egg. My self-esteem- even was broken and I felt like my pride was gone. “
Anxiety and stress
Another sub-category of distressing psychological symptoms was anxiety and stress. According to the experiences of 60% of the participants, the problem of infertility associated with the use of a third party, donated oocytes and inflexible treatment programs, caused emotional distress such as anxiety and stress. This effect was so evident that in some cases the treatment cycle was interrupted or drugs were used on the advice of a psychiatrist to reduce their anxiety. Participant 2 said in this regard: “I felt I had no control over the newly created situation and became more anxious as I entered a new phase of treatment. We have had problems such as the lack of a specific drug, the success or failure of the treatment, or problems related to the cooperation of the donor; however, the doctor told me not to be anxious. Stress and anxiety can lead to treatment failure. Is not it ? I would like to fall sound asleep and wake up to see that it’s all over and the baby is on my lap. “
Feeling depressed was another experience expressed by 90% of participants. The need to bring in a third party for fertility, recurring medical expenses and multiple failures, blaming others, lack of overall husband support, and other destructive feelings and behaviors had led to depression in the women. Participant 7 said in a hateful voice: “I’m depressed now. I’m not enjoying anything. Nothing makes me happy. My depression has affected my husband as well. He doesn’t want to live with a depressed person in a miserable, dark house. We are far apart from one another. ‘other. “.
A sort of hopelessness and spiritual discouragement was expressed by 50% of the participants. Women who had a strong relationship with spirituality before the offer to use donated eggs had experienced this spiritual discouragement caused by problems such as multiple treatment failures and pregnancy failure using an autologous egg and, the need to use a third party for fertility. For example, participant 20 said in tears: “I was always waiting for a miracle to happen and thought that at last my prayers would be answered and we would have a child; but now I’m at my wit’s end, and I think my prayers are no longer effective and useful. I can’t even have my own cell so I can get pregnant. “
The category of social stigma included the three subcategories of concerns about disclosure, judgment of others, and conflict with religious teachings.
Concerns about disclosure and the consequent attempt to cover up the treatment process were among the predominant approaches (95%) of study participants. In addition to enduring the emotional burden of childlessness, these women were forced to hide from others the use of donated eggs as a method of treatment because they feared social stigma. Participant 17 expressed her desire to keep her use of donated oocytes secret as follows:
We didn’t want anyone to know about it. We were under a lot of pressure. We couldn’t consult anyone. We never told the details to those around us. We have just said that we are on treatment. If we let others know about it, we should also tolerate their mockery and scolding, and that stigma would stay with us forever.
Judgment of others
The judgment of others was also expressed by 55% of the participants. Concerns about the judgment of others for the use of donated oocytes, fear of others’ negative reactions to the technique, and their stigma as the cause of infertility presented challenges to these women regarding speaking out. of this issue with others, especially with their families. In addition, concerns regarding the apparent dissimilarity of the resulting offspring with the parents and, therefore, negative judgments from others as well as the tolerance of certain stigmas were among the major concerns of female recipients of infertile oocytes. Most of the participants spoke of the overwhelming pressure of others’ judgments about their treatment and use of donated eggs. They were always judged by annoying questions like why don’t you have children? Why don’t you treat? Or why don’t you use this method of treatment? Participant 7 said: “The judgment of others regarding egg donation was very cruel. They used to say that you wouldn’t understand a mother’s feelings until you became a mother or gave birth to a child. But what about now ?! If they come to know that I used a donated oocyte and the baby’s gene is not mine, they will probably say that you cannot understand a mother’s feelings until you have your. own child… “.
Regarding the judgment of others, Participant 13 said that “My husband’s family has often stigmatized me by saying that I am sterile; I couldn’t have children; my oocytes are weak and therefore I have to use another woman’s oocytes.
Conflict with religious teachings
Another challenge experienced and expressed by 35% of participants was the conflict with religious teachings. Before ensuring that the use of donated oocytes did not contradict the religious rules of Islam, a number of participants considered it unethical and against Sharia law. In this regard, Participant 7 said: “We are a religious community. It is important that this child is mahram. The resulting offspring is mahram to the paternal family, but what about the maternal family? We are so religious and this is an important issue for us; that if my child is a boy, is he mahram to my mother and sister or not? This problem, if it is solved for me, is still not solved for our loved ones. “
Negative coping mechanisms
Denial and aggression were two other subcategories from which the main category of negative coping mechanisms was extracted.
Behaviors such as visiting different doctors, performing multiple tests at different centers, interrupting the treatment process, or requesting other treatment methods in the hope that the previous diagnoses were wrong and to obtain a positive result reflected the psychological reaction of the patient. denial in 60% of cases. participants. Participant 1 said in this regard: “When the doctor told us that my oocytes were weak and that we had to use donated oocytes, we were very disappointed… My husband had accepted this problem a little, but I still did not believe it… The doctor must be wrong because we have not had similar problems in our family; my mother got pregnant at the age of 48… “.
Aggression was another behavior in 40% of participants, which was caused by other people’s insistence on having children or their disagreement with the use of a donated oocyte. In such a condition, the participants lost control of their behavior and emotions and behaved aggressively. Participant 9 said: “Even thinking about being pregnant using someone else’s oocyte made me quite nervous and aggressive; I reacted to my husband’s words aggressively. I even threatened him once he did. would not agree to use the donated oocyte, I would divorce. “