Infertility is one of the main reproductive health problems in developed countries. It is estimated that almost 15% of men and women have fertility problems in Spain. In 30% of cases, the cause is attributed to the woman, in another 30% to men, there is a mixed cause in 25% of cases, and 15% of infertility cases have unknown causes. These proportions may vary from one country to another, and this is partly associated with the incidence of sexually transmitted infections and the differences in age between the populations studied. An increase in these problems has been observed in recent years, and therefore an increase in the demand for assisted reproductive techniques (ARTs).) (1). However, this problem presents low visibility, because the objectives for most research in this setting are merely clinical. There is a high number of studies oriented to learning the risks derived from ARTs, as well as to improve the success rates for pregnancies and live births. I don’t doubt these are important, because it is essential to improve techniques and have effective treatments available. But it is also critically important to understand the experience of women, the challenges they go through, and the coping strategies used for this situation. Understanding this experience is essential in order to detect their needs during this complicated and complex process; only thus we will be able to offer quality of care targeted to preserving, maintaining and improving the health of women, and not only of their children.

To receive a diagnosis of infertility represents a hard blow, which can have serious effects on mental health, and cause a reduction in quality of life. In the human species, maternity is far from being a strictly biological event; it has social, cultural, historic and psychological meaning (2), and has been socially considered as the “female essence”, as the condition par excellence for being a woman. Regardless of the changes in recent years, it is still considered that the “normal thing” is to be a mother, and that is the core life project for many women, associated with fulfilment and their personal accomplishment: “a child as the passport for the title of good, complete and integral woman. And fertile” (3). Therefore, when they receive an infertility diagnosis, a situation of conflict will arise, linked to a redefinition of their social identity (4).

In the context of my doctoral thesis, I conducted a qualitative study on Constructivist Grounded Theory, with the objective to understand the experience of the maternity process in women who had undergone ART. The theoretical-methodological approach chosen considers that persons are actors in the social world, and entails that the researcher will co-construct the meaning of the phenomenon studied with its participants: data are not separated from participants or researchers, but are constructed through interaction (5). Twenty women both from public hospitals and specialized private clinics in Spain, who had had a child during the past two years, were interviewed between 2019 and 2021.

Data revealed that discovering infertility is a hard road that begins with the desire to get pregnant as a natural process, and ends up with a structure of obstacles which puts to the test the psychoemotional wellbeing of women. Through comparison with other women, there is an initial suspicion that something is not working adequately in their bodies. This suspicion entails the search for answers and, as a consequence, the reception of a diagnosis which represents a terrible impact on the lives of women (6).

When women feel that their bodies are not able to conceive naturally, they start on a winding road which is difficult to go through. This road has an impact on the experience of pregnancy and maternity. The experience of this entire process will be modulated by different factors, and one of the main ones will be support by their partners. To perceive the process as a road which both partners are going through will allow women to adapt better to each stage. Likewise, feeling supported by those around them, by women who have suffered the same situation, or perceiving empathy by the healthcare staff, will allow the experience to become less bitter.

After accepting their diagnoses, some women decide to undergo ART, because they feel that this will allow them to achieve their dream. These treatments represent a physical and moral burden, and sometimes women are overcome by exhaustion and accumulated failures. Regardless of this, they continue trying, because they need to know that they have done everything they could to achieve their dream.

The experience of infertility has no expiry date, it does not end with a positive pregnancy test result. Women will perceive infertility as an endless event. This situation will determine the experience of pregnancy in women, an experience characterized by a journey with emotional ambivalence: feelings like happiness, excitement and hope will coexist with others like fear, uncertainty and frustration. These feelings will be deeper according to the searching process, its duration, and how supported they feel by their partners. Therefore, those women who have experienced long searching processes or have not felt supported by their partners will present a higher intensity of “negative” feelings.

The outcomes of this study have also shown that men perceive that attention is exclusively focused on women, and they feel out of place and even ignored during consultations. This reality should be incorporated into future studies; using a broader outlook to include male experience will allow a more complete understanding of the study phenomenon.

ARTs represent a high physical and mental burden for women. Their psychoemotional needs are not always addressed during the process. As healthcare professionals, we should provide care for the emotional needs of women, in order to prevent any impact on their quality of life. To receive care by empathetic professionals who understand the real dimension of infertility for women might help to alleviate pain, and cope better with diagnosis and treatments, as well as with pregnancy, childbirth and puerperium. Finally, healthcare staff can become a shelter for these women, because they will often have difficulties to display their fears and concerns.