Marital interdependence of infertile couples in mainland China

Abstract

Background: Infertility, defined as the inability to achieve a clinical pregnancy after one year of regular unprotected sexual intercourse, represents not only a health condition, but also a source of ambivalence regarding martial strain and intergenerational stress. Yet, little studies had been conducted to articulate and interpret their complex feelings during infertility experiences, epically with a dyadic perspective.

Objectives: The current study aims at exploring the ambivalence in the context of infertility among Chinese couples with infertility diagnosis. Furthermore, this study attempts to investigate the impacts of the ambivalence on quality of life for husbands and wives.

Methodology: This study adopts a mixed method. With qualitative descriptive approach, conjoint and individual interviews are used to collect collective and personal perceptions from 16 wives and 8 husbands. In the quantitative investigation, 422 infertile couples were recruited and analyzed. To capture the dyadic connectedness, actor-partner interdependence models (APIM) were utilized to analyze dyadic data from husbands and wives with infertility.

Results: Ambivalence described the complex emotions and their psychosocial difficulties experienced by the Chinese infertile couples. There are three categories of ambivalence, being identified from qualitative study as (i) decisional ambivalence on treatment, (ii) partner ambivalence and (iii) intergenerational ambivalence. Based on couple interviews, Chinese infertile couples performed different coping styles, namely, emancipation, solidarity, captivation and atomization to manage their ambivalence. These coping styles affected communication among the couples and thus influenced the couple’s sense of meaning, intimacy and relationships with the parents and in-laws. From the quantitative findings, intergenerational ambivalence tended to be negatively associated with quality of life for infertile couples. After controlling effects of marital affection on outcome variable, the negative effects of maternal familial ambivalence on quality of life decreased significantly, especially for wives. Therefore, high quality marital relationships could be a great buffer to alleviate the negative impacts of intergenerational ambivalence on quality of life for infertile couples.

Discussion: Ambivalence as a meta-emotion is an overarching concept on the mix of positive and negative emotions triggered by infertility. Ambivalence accumulates when these conflicting emotions coexist and interact with each other, which cause psychosocial distress for the couples. Concepts of decisional, partner and intergenerational ambivalence can be applied to understand lived experiences of people with other life circumstances and health conditions. Essentially, ambivalence may be associated with uncertainty of life, ambiguity in treatments, and complex and contradictory emotions caused by fertility. Since ambivalence may threaten psychosocial wellbeing of infertile couples, helping professionals should facilitate infertile couples to identify, articulate and cope with ambivalence to achieve emotional wellbeing.

Conclusion: As a meta-emotion, ambivalence encompasses complex and dynamic interplay of positive, negative and conflicting thoughts, values and feelings. Four coping styles performed by couples, namely, emancipation, solidarity, captivation and atomization, reflect dyadic cohesion and intuitional flexibility in response to infertility. Marital affection could be a buffer to reduce negative impacts of ambivalence and improving psychosocial wellbeing for infertile couples.