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Kadınların Embriyo Kriyoprezervasyona Karar Verme Deneyimleri ve Dondurulmuş Embriyolarının Kavramsallaştırılması

Year 2024, , 136 - 145, 25.06.2024
https://doi.org/10.17049/jnursology.1439703

Abstract

Amaç: Bu araştırmanın amacı, kadınların Embriyo Kriyoprezervasyon (EK) işlemine karar verme deneyimlerini ve dondurulan embriyolarına yükledikleri anlamları açıklamaktır.

Yöntemler: Bu çalışmada, Husserl'in felsefi bakış açısına dayanan betimleyici bir fenomenolojik tasarım ve tematik analiz yaklaşımı kullanılmıştır. Yarı yapılandırılmış, derinlemesine görüşmeler yoluyla Nisan ve Ekim 2021 arasında toplanan verilerde hem rastgele örnekleme teknikleri hem de maksimum çeşitlilik örnekleme yöntemleri kullanıldı.

Bulgular: Görüşmelerin analizi sonucunda beş tema ve 10 alt tema ortaya çıkmıştır. Temalar şu şekildeydi: ‘‘Embriyo kriyoprezervasyonunda karar verme yolları’’, ‘‘Embriyo kriyoprezervasyonu sürecinde motive edici faktörler’’, ‘‘Embriyo kriyoprezervasyonuna ilişkin düşünceler’’, ‘‘Dondurulmuş embriyonun kavramsallaştırılması’’ ve ‘‘Sağlık sisteminden beklentiler’’.

Sonuç: Bu araştırmada, kadınların embriyo kriyoprezervasyonu konusunda yeterli bilgiye sahip olmadan embriyo kriyoprezervasyon işlemine sadece doktorlar tarafından karar verilmesinden rahatsızlık duydukları ortaya çıktı.Ayrıca, dondurulan embriyoların kalitesi arttıkça kadınların embriyolara ilişkin daha olumlu bir algıya sahip olma eğiliminde oldukları da ortaya çıktı.

Ethical Statement

Etik kurul onayı XXXXX Üniversitesi Yerel Etik Kurulu’ndan (Tarih: 13.01.2021, Sayı:70904504/39) alınmıştır.

Supporting Institution

Yazarlar, bu çalışma için finansal destek almadığını beyan etmiştir.

Thanks

Bu çalışmaya gönüllü olarak katılan ve hemşirelik bilimine katkıda bulunan tüm kadınlara teşekkür ederiz.

References

  • 1. Roque M, Haahr T, Geber S, Esteves SC, Humaidan P. Fresh versus elective frozen embryo transfer in IVF/ICSI cycles: a systematic review and meta-analysis of reproductive outcomes. Hum Reprod Update. 2019;25(1):2-14. https://doi.org/10.1093/humupd/dmy033
  • 2. Zaat T, Zagers M, Mol F, Goddijn M, van Wely M, Mastenbroek S. Fresh versus frozen embryo transfers in assisted reproduction. Cochrane Db Syst Rev. 2021;2(2):CD011184. https://doi.org/10.1002/14651858.cd011184.pub3
  • 3. Katz O, Hashiloni-Dolev Y, Kroløkke C, Raz A. Frozen: social and bioethical aspects of cryopreservation. New Genet Soc. 2020;39(3):243-9. http://dx.doi.org/10.1080/14636778.2020.1802823
  • 4. Bach AS, Kroløkke C. Hope and happy futurity in the cryotank: Biomedical imaginaries of ovarian tissue freezing. Sci Cult-Uk. 2020;29(3):425-49. http://dx.doi.org/10.1080/09505431.2019.1681953
  • 5. Fitzgerald RP, Legge M, Rewi P, Robinson RJ. Excluding indigenous bioethical concerns when regulating frozen embryo storage: An Aotearoa New Zealand case study. Reprod Biomed Soc Online. 2019;8:10–22. https://doi.org/10.1016/j.rbms.2019.01.001
  • 6. Goswawi M, Murdoch AP, Haimes E. To freeze or not to freeze embryos: clarity, confusion, and conflict. Hum Fertil. 2015;18(2):113-20. https://doi.org/10.3109/14647273.2014.998726
  • 7. Bruno C, Dudkiewicz-Sibony C, Berthaut I, Weil E, Brunet L, Fortier C, et al. Survey of 243 ART patients having made a final disposition decision about their surplus cryopreserved embryos: the crucial role of symbolic embryo representation. Hum Reprod. 2016;31:1508–14. https://doi.org/10.1093/humrep/dew104
  • 8. Machado CS. The fate of surplus embryos: ethical and emotional impacts on assisted reproduction. JBRA Assist Reprod. 2020;24(3):310–5. https://doi.org/10.5935%2F1518-0557.20200015
  • 9. Raz A, Amer-Alshiek J, Goren-Margalit M, Jacobi G, Hochberg A, Amit A, et al. Donation of surplus frozen pre-embryos to research in Israel: underlying motivations. Isr J Health Policy Res. 2016;5:25. https://doi.org/10.1186/s13584-016-0085-4
  • 10. Gameiro S, Boivin J, Dancet E, de Klerk C, Emery M, Lewis-Jones C, et al. ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction-a guide for fertility staff. Hum Reprod. 2015;30(11):2476-85. https://doi.org/10.1093/humrep/dev177
  • 11. Jafarzadeh-Kenarsari F, Ghahiri A, Zargham-Boroujeni A, Habibi M, Hashemi M. Patient-centered fertility care: from theory to practice. JMRH. 2016;4(3):712-9. https://doi.org/10.22038/jmrh.2016.7186
  • 12. Shandley LM, Hipp HS, Anderson-Bialis J, Anderson-Bialis D, Boulet SL, McKenzie LJ, et al. Patient-centered care: factors associated with reporting a positive experience at United States fertility clinics. Fertil Steril. 2020;113(4):797-810. https://doi.org/10.1016/j.fertnstert.2019.12.040
  • 13. Veillard J, Fekri O, Dhalla I, Klazinga N. Measuring outcomes in the Canadian health sector: driving better value from healthcare. Toronto: C.D. Howe Institute Commentary. 438. 2015.
  • 14. Neubauer BE, Witkop CT, Varpio L. How phenomenology can help us learn from the experiences of others. Perspect Med Educ. 2019;8(2):90-7. https://doi.org/10.1007%2Fs40037-019-0509-2
  • 15. Sundler AJ, Lindberg E, Nilsson C, Palmer L. Qualitative thematic analysis based on descriptive phenomenology. Nurs Open. 2019;6(3):733-9. https://doi.org/10.1002/nop2.275
  • 16. Booth A, Hannes K, Harden A, et al. COREQ. Guidelines for reporting health research: a user’s manual. Int J Qual Methods. 2014;1-16. https://doi.org/10.1002/9781118715598.ch21
  • 17. Baltacı A. Nitel araştırmalarda örnekleme yöntemleri ve örnek hacmi sorunsalı üzerine kavramsal bir inceleme. BEÜ SBD. 2018;7(1):231-274. https://dergipark.org.tr/tr/pub/bitlissos/issue/38061/399955
  • 18. Moser A, Korstjens I. Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. Eur J Gen Pract. 2018;24(1):9-18. https://doi.org/10.1080/13814788.2017.1375091
  • 19. Glaser BG, Strauss AL. Discovery of Grounded Theory: Strategies for Qualitative Research. New York: Routledge, 2017.
  • 20. Şahiner E, Boz İ. Experiences of women undergoing infertility treatment from embryo transfer until pregnancy test and their conceptualization of their embryo. J Psychosom Obstet Gynecol. 2021;42:1-10. https://doi.org/10.1080/0167482x.2020.1865909
  • 21. Braun V., Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3(2): 77–101. http://dx.doi.org/10.1191/1478088706qp063oa
  • 22. Maguire M, Delahunt B. Doing a thematic analysis: A practical, step-by-step guide for learning and teaching scholars. AISHE-J. 2017;9(3).
  • 23. Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Med Teach. 2020;42(8):846-54. https://doi.org/10.1080/0142159x.2020.1755030
  • 24. Cypress BS. Rigor or Reliability and Validity in Qualitative Research: Perspectives, Strategies, Reconceptualization, and Recommendations. Dimens Crit Care Nurs. 2017;36(4):253-63. https://doi.org/10.1097/dcc.0000000000000253
  • 25. Chan CHY, Lau BHP, Tam MYJ, Ng EHY. Preferred problem solving and decision-making role in fertility treatment among women following an unsuccessful in vitro fertilization cycle. BMC Women’s Health. 2019;19(1):1-11. https://doi.org/10.1186/s12905-019-0856-5
  • 26. Driever EM, Tolhuizen IM, Duvivier RJ. et al. Why do medical residents prefer paternalistic decision making? An interview study. BMC Med Educ. 2022;22:155. https://doi.org/10.1186/s12909-022-03203-2
  • 27. Friesen-Storms JH, Bours GJ, van der Weijden T, Beurskens AJ. Shared decision making in chronic care in the context of evidence based practice in nursing. Int J Nurs Stud. 2015;52(1):393-402. https://doi.org/10.1016/j.ijnurstu.2014.06.012
  • 28. Blair L, Legare F. Is shared decisions making a utopian dream or achievable goal? Patient. 2015;8:471-76. https://doi.org/10.1007/s40271-015-0117-0
  • 29. Harter M. It’s time for shared decision making and person-centred care. Patient. 2020;13;643-44. https://doi.org/10.1007%2Fs40271-020-00471-2
  • 30. Tonelli MR, Sullivan MD. Person-centred shared decision making. J Eval Clin Pract. 2019;25(6):1057-62. https://doi.org/10.1111/jep.13260
  • 31. Dolan H, Li M, Trevena L. Interventions to improve participation in health-care decisions in non-Western countries: A systematic review and narrative synthesis. Health Expect. 2019;22(5):894-906. https://doi.org/10.1111/hex.12933
  • 32. Stormlund S, Schmidt L, Bogstad J, Løssl K, Prætorius L, Zedeler A, et al. Patients’ attitudes and preferences towards a freeze-all strategy in ART treatment. Hum Reprod. 2019;34(4):679-88. https://doi.org/10.1093/humrep/dez006
  • 33. Harzif AK, Shafira N, Mariana A, Lovita BT, Mutia HD, Maidarti M, et al. Communication and respect for patient value as significant factors in patient-centered ınfertility care: a survey of patients' experiences in two ınfertility centers. J Hum Reprod Sci. 2020;13(1):22-5. https://doi.org/10.4103%2Fjhrs.JHRS_62_19
  • 34. Streisfield A, Chowdhury N, Cherniak R, Shapiro H. Patient centered infertility care: the health care provider’s perspective. PXJ. 2015;2(1):93-7. http://dx.doi.org/10.35680/2372-0247.1062
  • 35. Kayssan M, Dolatian M, Omani Samani R, Maroufizadeh S. Attitudes of ınfertile couples, fertility clinic staff and researchers toward personhood of the human embryo in Iran. Cell J. 2017;19(2):314–23. https://doi.org/10.22074/cellj.2016.4989
  • 36. Peloquin S, Garcia-Velasco JA, Blockeel C, Rienzi L, de Mesmaeker G, Lazure P, et al. Educational needs of fertility healthcare professionals using ART: a multi-country mixed-methods study. Reprod Biomed Online. 2021;43(3):434-45. https://doi.org/10.1016/j.rbmo.2021.06.020
  • 37. Pedro J, Canavarro MC, Boivin J, Gameiro S. Positive experiences of patient-centred care are associated with intentions to comply with fertility treatment: findings from the validation of the Portuguese version of the PCQ-Infertility tool. Hum Reprod. 2013; 28(9):2462-72. https://doi.org/10.1093/humrep/det259 38. Akgün M, Boz İ. Person centered care approach in infertility. JERN. 2019;16(2):170-75. https://doi.org/10.5222/HEAD.2019.170
  • 39. Gülpınar N, Başkaya SS, Yeşilbudak Z, Boz İ. Determination of the caring behaviors and affecting factors women perceived during infertility treatment. JERN. 2019;16(1):21-6. http://dx.doi.org/10.5222/HEAD.2019.021

Women's Experiences of Decisions-Making on Embryo Cryopreservation and Conceptualization of Their Frozen Embryo

Year 2024, , 136 - 145, 25.06.2024
https://doi.org/10.17049/jnursology.1439703

Abstract

Objective: The aim of this research is to clarify the experiences of women in deciding on the Embryo Cryopreservation (EC) procedure and the meanings they attribute to their frozen embryos.

Methods: This study employed a descriptive phenomenological design and a thematic analysis approach rooted in Husserl’s philosophical perspective. Random sampling techniques and maximum diversity sampling methods were both utilized, with data collected between April and October 2021 via semi-structured, in-depth interviews.

Results: Following the analysis of the interviews, five themes and 10 sub-themes emerged. The themes were the following: ‘‘Decision-making pathways in embryo cryopreservation’’, ‘‘Motivators in the embryo cryopreservation process’’, ‘‘Reflections on embryo cryopreservation’’, ‘‘Conceptualization of the frozen embryo’’, and ‘‘Expectations from the healthcare system’’.

Conclusion: In this investigation, it was discovered that women expressed discomfort with embryo cryopreservation when decisions were solely made by doctors without adequate information about the process. Furthermore, it was found that women tend to hold a more positive perception of embryos as the quality of frozen embryos improves.

Ethical Statement

Ethics committee approval was obtained from the XXXXX University Local Ethics Committee (Date: 13.01.2021, Number: 70904504/39).

Supporting Institution

The authors declared that this study has received no financial support.

Thanks

We would like to thank all the women who voluntarily participated in this study and contributed to nursing science.

References

  • 1. Roque M, Haahr T, Geber S, Esteves SC, Humaidan P. Fresh versus elective frozen embryo transfer in IVF/ICSI cycles: a systematic review and meta-analysis of reproductive outcomes. Hum Reprod Update. 2019;25(1):2-14. https://doi.org/10.1093/humupd/dmy033
  • 2. Zaat T, Zagers M, Mol F, Goddijn M, van Wely M, Mastenbroek S. Fresh versus frozen embryo transfers in assisted reproduction. Cochrane Db Syst Rev. 2021;2(2):CD011184. https://doi.org/10.1002/14651858.cd011184.pub3
  • 3. Katz O, Hashiloni-Dolev Y, Kroløkke C, Raz A. Frozen: social and bioethical aspects of cryopreservation. New Genet Soc. 2020;39(3):243-9. http://dx.doi.org/10.1080/14636778.2020.1802823
  • 4. Bach AS, Kroløkke C. Hope and happy futurity in the cryotank: Biomedical imaginaries of ovarian tissue freezing. Sci Cult-Uk. 2020;29(3):425-49. http://dx.doi.org/10.1080/09505431.2019.1681953
  • 5. Fitzgerald RP, Legge M, Rewi P, Robinson RJ. Excluding indigenous bioethical concerns when regulating frozen embryo storage: An Aotearoa New Zealand case study. Reprod Biomed Soc Online. 2019;8:10–22. https://doi.org/10.1016/j.rbms.2019.01.001
  • 6. Goswawi M, Murdoch AP, Haimes E. To freeze or not to freeze embryos: clarity, confusion, and conflict. Hum Fertil. 2015;18(2):113-20. https://doi.org/10.3109/14647273.2014.998726
  • 7. Bruno C, Dudkiewicz-Sibony C, Berthaut I, Weil E, Brunet L, Fortier C, et al. Survey of 243 ART patients having made a final disposition decision about their surplus cryopreserved embryos: the crucial role of symbolic embryo representation. Hum Reprod. 2016;31:1508–14. https://doi.org/10.1093/humrep/dew104
  • 8. Machado CS. The fate of surplus embryos: ethical and emotional impacts on assisted reproduction. JBRA Assist Reprod. 2020;24(3):310–5. https://doi.org/10.5935%2F1518-0557.20200015
  • 9. Raz A, Amer-Alshiek J, Goren-Margalit M, Jacobi G, Hochberg A, Amit A, et al. Donation of surplus frozen pre-embryos to research in Israel: underlying motivations. Isr J Health Policy Res. 2016;5:25. https://doi.org/10.1186/s13584-016-0085-4
  • 10. Gameiro S, Boivin J, Dancet E, de Klerk C, Emery M, Lewis-Jones C, et al. ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction-a guide for fertility staff. Hum Reprod. 2015;30(11):2476-85. https://doi.org/10.1093/humrep/dev177
  • 11. Jafarzadeh-Kenarsari F, Ghahiri A, Zargham-Boroujeni A, Habibi M, Hashemi M. Patient-centered fertility care: from theory to practice. JMRH. 2016;4(3):712-9. https://doi.org/10.22038/jmrh.2016.7186
  • 12. Shandley LM, Hipp HS, Anderson-Bialis J, Anderson-Bialis D, Boulet SL, McKenzie LJ, et al. Patient-centered care: factors associated with reporting a positive experience at United States fertility clinics. Fertil Steril. 2020;113(4):797-810. https://doi.org/10.1016/j.fertnstert.2019.12.040
  • 13. Veillard J, Fekri O, Dhalla I, Klazinga N. Measuring outcomes in the Canadian health sector: driving better value from healthcare. Toronto: C.D. Howe Institute Commentary. 438. 2015.
  • 14. Neubauer BE, Witkop CT, Varpio L. How phenomenology can help us learn from the experiences of others. Perspect Med Educ. 2019;8(2):90-7. https://doi.org/10.1007%2Fs40037-019-0509-2
  • 15. Sundler AJ, Lindberg E, Nilsson C, Palmer L. Qualitative thematic analysis based on descriptive phenomenology. Nurs Open. 2019;6(3):733-9. https://doi.org/10.1002/nop2.275
  • 16. Booth A, Hannes K, Harden A, et al. COREQ. Guidelines for reporting health research: a user’s manual. Int J Qual Methods. 2014;1-16. https://doi.org/10.1002/9781118715598.ch21
  • 17. Baltacı A. Nitel araştırmalarda örnekleme yöntemleri ve örnek hacmi sorunsalı üzerine kavramsal bir inceleme. BEÜ SBD. 2018;7(1):231-274. https://dergipark.org.tr/tr/pub/bitlissos/issue/38061/399955
  • 18. Moser A, Korstjens I. Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. Eur J Gen Pract. 2018;24(1):9-18. https://doi.org/10.1080/13814788.2017.1375091
  • 19. Glaser BG, Strauss AL. Discovery of Grounded Theory: Strategies for Qualitative Research. New York: Routledge, 2017.
  • 20. Şahiner E, Boz İ. Experiences of women undergoing infertility treatment from embryo transfer until pregnancy test and their conceptualization of their embryo. J Psychosom Obstet Gynecol. 2021;42:1-10. https://doi.org/10.1080/0167482x.2020.1865909
  • 21. Braun V., Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3(2): 77–101. http://dx.doi.org/10.1191/1478088706qp063oa
  • 22. Maguire M, Delahunt B. Doing a thematic analysis: A practical, step-by-step guide for learning and teaching scholars. AISHE-J. 2017;9(3).
  • 23. Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Med Teach. 2020;42(8):846-54. https://doi.org/10.1080/0142159x.2020.1755030
  • 24. Cypress BS. Rigor or Reliability and Validity in Qualitative Research: Perspectives, Strategies, Reconceptualization, and Recommendations. Dimens Crit Care Nurs. 2017;36(4):253-63. https://doi.org/10.1097/dcc.0000000000000253
  • 25. Chan CHY, Lau BHP, Tam MYJ, Ng EHY. Preferred problem solving and decision-making role in fertility treatment among women following an unsuccessful in vitro fertilization cycle. BMC Women’s Health. 2019;19(1):1-11. https://doi.org/10.1186/s12905-019-0856-5
  • 26. Driever EM, Tolhuizen IM, Duvivier RJ. et al. Why do medical residents prefer paternalistic decision making? An interview study. BMC Med Educ. 2022;22:155. https://doi.org/10.1186/s12909-022-03203-2
  • 27. Friesen-Storms JH, Bours GJ, van der Weijden T, Beurskens AJ. Shared decision making in chronic care in the context of evidence based practice in nursing. Int J Nurs Stud. 2015;52(1):393-402. https://doi.org/10.1016/j.ijnurstu.2014.06.012
  • 28. Blair L, Legare F. Is shared decisions making a utopian dream or achievable goal? Patient. 2015;8:471-76. https://doi.org/10.1007/s40271-015-0117-0
  • 29. Harter M. It’s time for shared decision making and person-centred care. Patient. 2020;13;643-44. https://doi.org/10.1007%2Fs40271-020-00471-2
  • 30. Tonelli MR, Sullivan MD. Person-centred shared decision making. J Eval Clin Pract. 2019;25(6):1057-62. https://doi.org/10.1111/jep.13260
  • 31. Dolan H, Li M, Trevena L. Interventions to improve participation in health-care decisions in non-Western countries: A systematic review and narrative synthesis. Health Expect. 2019;22(5):894-906. https://doi.org/10.1111/hex.12933
  • 32. Stormlund S, Schmidt L, Bogstad J, Løssl K, Prætorius L, Zedeler A, et al. Patients’ attitudes and preferences towards a freeze-all strategy in ART treatment. Hum Reprod. 2019;34(4):679-88. https://doi.org/10.1093/humrep/dez006
  • 33. Harzif AK, Shafira N, Mariana A, Lovita BT, Mutia HD, Maidarti M, et al. Communication and respect for patient value as significant factors in patient-centered ınfertility care: a survey of patients' experiences in two ınfertility centers. J Hum Reprod Sci. 2020;13(1):22-5. https://doi.org/10.4103%2Fjhrs.JHRS_62_19
  • 34. Streisfield A, Chowdhury N, Cherniak R, Shapiro H. Patient centered infertility care: the health care provider’s perspective. PXJ. 2015;2(1):93-7. http://dx.doi.org/10.35680/2372-0247.1062
  • 35. Kayssan M, Dolatian M, Omani Samani R, Maroufizadeh S. Attitudes of ınfertile couples, fertility clinic staff and researchers toward personhood of the human embryo in Iran. Cell J. 2017;19(2):314–23. https://doi.org/10.22074/cellj.2016.4989
  • 36. Peloquin S, Garcia-Velasco JA, Blockeel C, Rienzi L, de Mesmaeker G, Lazure P, et al. Educational needs of fertility healthcare professionals using ART: a multi-country mixed-methods study. Reprod Biomed Online. 2021;43(3):434-45. https://doi.org/10.1016/j.rbmo.2021.06.020
  • 37. Pedro J, Canavarro MC, Boivin J, Gameiro S. Positive experiences of patient-centred care are associated with intentions to comply with fertility treatment: findings from the validation of the Portuguese version of the PCQ-Infertility tool. Hum Reprod. 2013; 28(9):2462-72. https://doi.org/10.1093/humrep/det259 38. Akgün M, Boz İ. Person centered care approach in infertility. JERN. 2019;16(2):170-75. https://doi.org/10.5222/HEAD.2019.170
  • 39. Gülpınar N, Başkaya SS, Yeşilbudak Z, Boz İ. Determination of the caring behaviors and affecting factors women perceived during infertility treatment. JERN. 2019;16(1):21-6. http://dx.doi.org/10.5222/HEAD.2019.021
There are 38 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynocology Nursing
Journal Section Research Articles
Authors

Esra Şahiner 0000-0001-6861-0014

Elif Özçetin 0000-0001-7490-5361

İlkay Boz 0000-0002-3529-9351

Publication Date June 25, 2024
Submission Date February 27, 2024
Acceptance Date June 14, 2024
Published in Issue Year 2024

Cite

AMA Şahiner E, Özçetin E, Boz İ. Women’s Experiences of Decisions-Making on Embryo Cryopreservation and Conceptualization of Their Frozen Embryo. Journal of Nursology. June 2024;27(2):136-145. doi:10.17049/jnursology.1439703

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