Childlessness, whether voluntary, involuntary or circumstantial, is becoming more common in our society. Statistically, greater numbers of Australian women and their Western counterparts will not bear children, thereby creating a larger quantum of couple families. The unwelcome socio-economic consequences have prompted research into reproductive intentions and behaviour to address barriers to reproduction. Studying those who are childless by ‘choice’ or ‘infertile’ provides important ‘reference points’ but also creates a myopic view of the childless that often overlooks circumstantial factors or ignores the fluctuating nature of fertility intentions. Moreover, the medical discourse on infertility has conditioned our thinking and focused research on the psycho-social effects and impacts of assisted reproduction treatment and its failure. This has blurred and obscured the distinction between infertility and involuntary childlessness. Too often these are viewed through the same prism of grief and bereavement as a temporary but pervasive ‘crisis’ and as impediments to adult development in the long term. The thesis provides new insights that challenge our conventional ways of thinking particularly its findings that although infertility and childlessness are related, they are separate phenomena. This has wide-ranging implications, especially for reformulating related clinical practice and counselling. There are several important considerations. One is the finding that the grief and bereavement model has its limitations beyond the infertility stage. Another is the theoretical reconstruction that the thesis provides of the grief that the involuntary childless experience. Finally, it makes a strong case for a more appropriate alternative which the thesis argues should be based on a growth-oriented model. The time point at which the information for this study was collected has rarely ever been used before. This adds significant weight to the findings and applications that potentially derive from them. The thesis also examines gender issues including the complexities in differential experiences, amongst and across gender categories. It builds on the existing body of knowledge on the gendered experience of involuntary childlessness and offers additional explanations for the variations found, around which clinical interventions should be framed. Overall, this study makes an important contribution to our knowledge and understanding by documenting the transitional process to involuntary childlessness in broader terms than has hitherto been the case. Contrary to conventional thinking related to adult development, the findings underscore the importance of viewing involuntary childlessness as an alternative developmental pathway.

Infertilitet beskrivs som en sjukdom i de reproduktiva organen där graviditet efter tolv månader eller mer med oskyddat samlag misslyckats. Infertiliteten drabbar cirka 10-15 procent av världens befolkning. Den allmänna sjuksköterskans roll blir aktuell på fertilitetskliniker där hen möter par som genomgår utredning eller behandling för infertilitet. Sjuksköterskans roll handlar i stort om att ge stöd, samtala och informera. Behandling av infertilitet kan ges i form av exempelvis inseminering eller provrörsbefruktning. Om behandlingen inte skulle resultera i biologiska barn finns adoption som alternativ för att få barn / Infertility is described as a disease in the reproductive organs where pregnancy after twelve months or more with unprotected intercourse failed. Infertility affects about 10-15 percent of the world's population. The role of the nurse becomes relevant at the fertility clinic where they meet infertile couples who are undergoing investigation or treatment. The role of the nurse is largely about providing support, dialog and information. Treatment of infertility can be given in the form of, for example, insemination or test tube fertilization. If treatment would not result in a biological child, adoption can be a alternative to having a biological child.

Bakgrund: Enligt Socialstyrelsen drabbar ofrivillig barnlöshet omkring 10-15 % av alla par i Sverige. Vanliga orsaker till infertilitet kan vara skador på äggledarna eller för lågt antal spermier.  Kvinnor och män kan reagera olika på beskedet kring infertilitet. Det är viktigt som sjuksköterska att ha förståelse för hur kvinnor och män upplever problemet. Syfte: Att belysa kvinnor och mäns upplevelser av ofrivillig barnlöshet. Metod: I litteraturstudien har nio kvalitativa artiklar granskats och analyserats. Artiklarna valdes ut ifrån databaserna CINAHL och PubMed. Resultat: Resultatet delades in i sju kategorier: meningen med livet, att längta efter barn, att känna utanförskap, att känna förändringar i förhållandet, att stötta och känna stöd och att gå vidare i livet utan barn. Slutsats: Litteraturstudiens resultat visade på både likheter och skillnader bland kvinnor och mäns upplevelser av infertilitet. Längtan efter föräldraskap, en social press att skaffa barn och känslan av utanförskap var vanligt. Det är viktigt som sjuksköterska att ha förståelse och kunskap om individers upplevelser och att de kan skilja sig åt. Det finns ett behov av fortsatt forskning inom ämnet. / Background: According to Socialstyrelsen 10-15 % of all couples in Sweden is affected by involuntary childlessness. Common causes of infertility can be injuries on the fallopian tube or a low sperm count. Women and men can react differently to the information about the infertility. As a nurse it is important to have an understanding about how women and men perceive this problem. Aim: To illustrate the lived experience of involuntary childlessness among women and men. Method: In this literature study nine qualitative studies have been compiled and analyzed. The articles were chosen from CINAHL and PubMed data bases. Result: The result was sorted in seven categories: the meaning of life, to be longing for children, to feel exclusion, to feel changes in the relationship, to support and to feel supported and to carry on life without children. Conclusion: The result of the literature study indicated similarities and differences in the lived experience of infertility among women and men. Desire for parenthood, a social pressure to conceive a child and feelings of alienation was commonly mentioned. As a nurse, it is important to have an understanding and knowledge about how the experience of infertility can differ among individuals. Further research on the subject is needed.

Despite the many advances of medical technology to help treat infertility, approximately half of women seeking fertility treatment will never give birth to a child. Women coping with treatment failure face many challenges, including deciding when to abandon treatment and how to let go of their dreams of having a baby to focus on other pursuits. In order to better understand how women cope with these challenges, in depth interviews and a focus group were carried out with 12 women for whom fertility treatment had not been successful. Data was gathered and analysed using Grounded Theory, and a model of the process of adjustment from pursuing treatment to coming to terms with involuntary childlessness was co-constructed from the data. The model conceptualizes women's journey as moving through three main phases; 'living in limbo' in which women are still undergoing treatment, 'leaving treatment' in which women decide to terminate treatment and abandon the search for a resolution to their infertility, and finally 'learning to live with involuntary childlessness' in which women start the 'work' of grappling with the questions that childlessness seems to raise about the meaning of their lives, their identity and self image, and their sense of social belonging. The model goes on to highlight the factors which seem to aid women in resolving these challenges. The findings of this study suggest that the emotional challenges of coping with unsuccessful fertility treatment extend well beyond the end of treatment, highlighting the need for good access to therapeutic support for women coping with involuntary childlessness longer term. Results also point to certain sources and types of support which may be particularly helpful, including peer support from other childless women, and therapeutic interventions which help women develop more positive perspectives on childlessness and to identify alternative sources of fulfillment. The results of this study also point to the need for social action which works to challenge the misconceptions and stigma surrounding infertility and childlessness which add a further challenge to the lives of women who are involuntarily childless.

Bakgrund: Ofrivillig barnlöshet drabbar omkring 15% av kvinnorna som försöker skaffa barn, i Sverige. Ungefär en tredjedel av de 15% är helt infertila. Utredningar visar att problemet i cirka var tredje fall ligger hos kvinnan, i var tredje fall hos mannen. I den återstående tredjedel av fallen går det inte att fastställa vad infertiliteten beror på. Att leva med ofrivillig barnlöshet kan ge psykiska och fysiska hälsokonsekvenser. Syfte: Syftet var att beskriva kvinnans upplevelser av att leva med ofrivillig barnlöshet. Metod: Metoden som användes var en litteraturöversikt där tio vetenskapliga artiklar av kvalitativ metod analyserades enligt Fribergs metod. Sökningar genomfördes i databaserna CINAHL Complete och Pubmed. Resultat: I resultatet presenteras tre huvudkategorier: Sociala och samhällsmässigaupplevelser av ofrivillig barnlöshet, känsla av lidande och kulturell skillnad i upplevelser av ofrivillig barnlöshet med sex underkategorier: Stigmatisering, samhällets förväntningar och social press, social status och isolering, otillräcklighet och förnedring, psykisk påverkan, religiös och kulturell påverkan på upplevelsen. Det framkommer i resultatet att ofrivillig barnlöshet kan bidra till psykiskt lidande. Slutsats: Kvinnans upplevelser av infertilitet speglas främst genom en brist i livslust med följder som social, emotionell och psykisk påverkan. I arbetet har författarna fångat upp den bristande vården kring att behandla och hjälpa dessa kvinnor med stöd. / Background: Involuntary childlessness affects about 15 % of women that are trying toget pregnant in Sweden. About a third of the 15% are completely infertile. Investigations show that in about every third case the problem lies with the woman, in every third case with the man. In the remaining third of the cases, it is not possible to determine what the infertility is due to. Living with involuntary childlessness can have psychological and physical health consequences. Aim: The aim of this study was to describe the women’s experiences of living with involuntary childlessness. Method: The method is a literature review where ten scientific articles of qualitative method were analyzed by Friberg’s method. The searchings were made in CINAHL Complete and Pubmed. Results: The result is presented in three main categories: Social and societal experiences of involuntary childlessness, feeling of suffering and culturaldifference in experiences of involuntary childlessness with six subcategories: Stigmatization, society's expectations and social pressure, social status and isolation, inadequacy and humiliation, psychological influence, religious and cultural influence on the experience. It appears in the results that involuntary childlessness can contribute to mental suffering. Conclusion: The women's experiences of infertility are mainly reflected in a lack of zest for life with consequences such as social, emotional and psychological impact. In their work, the authors have captured the lack of care around treating and helping these women with support.

The topic of this thesis is involuntary childlessness and its impact on partner relationships. The theoretical part describes theories which try to explain, why people want to have children; here the knowledge about infertility, its therapy and other ways of solving this problem are summarized. The next part of the thesis deals with involuntary childlessness and its psychosocial aspects; special attention is paid to involuntary childlessness in connection to partner relationships. This part also summarizes the coping strategies of partners and presents the possible ways of psychological help for them. The empirical part was implemented by using the qualitative research, the semi-structured interviews and the method of Inclusion of Other in the Self scale. Total of 11 respondents took part, all women and each of them with experience in the area of involuntary childlessness. This part presents answers on the questions about the sense of parenthood for involuntarily childless women, their emotions and partner relationships. It surveys the areas of partner relationships, which were affected by the involuntary childlessness and describes what happens in relationship during this experience. It also shows the view of the individual respondents on the role of the social environment, on the life without...

Bakgrund: I Sverige definieras begreppet upprepade missfall som att en kvinna har fått tre eller flera missfall i följd och det uppskattas drabba ca en procent av världens alla par i fertil ålder. Då detta är en liten grupp kvinnor kan det vara svårt för den drabbade kvinnan att veta var hon kan vända sig med sina funderingar och vad hon har rätt till för vidare hjälp. Vid flera upprepade missfall växer behovet av att få svar på vad som sker och varför samtidigt som behovet av stöd och förståelse från sina närstående blir större. Tillgången till utredning och behandling ser olika ut men med hjälp från barnmorskans och vårdens sida kan lämplig planering utifrån kvinnan situation utvecklas. Syfte: Syftet med denna studie är att undersöka kvinnans upplevelse av upprepade missfall och belysa hennes behov under och tiden efter missfallet. Metod: Metoden för denna uppsats var en kvalitativ metasyntes med metaetnografisk analysmetod. Totalt kvalitetsgranskades 29 artiklar varav 16 gick igenom kvalitetsgranskningen och sammanställdes till ett resultat. Resultat: Sju kategorier med nyckelbegrepp bildades. Kategorierna som identifierades var missfallsprocessen, utrymme för sorg, undvikande beteende, partnerrollen, socialt stöd, förväntningar på vården och att bli gravid igen. Slutsats: Då alla kvinnor är olika varierar upplevelsen och behoven vid en missfallsprocess. Genom att ha kunskap om vad kvinnan går igenom både fysiskt- och psykiskt vid upprepade missfall bidrar det till en ökad förståelse för vad kvinnan behöver, både från sin omgivning men även från vårdens sida. Klinisk tillämpbarhet: Studien skulle kunna bidra till att utforska möjligheten att ändra på kriterierna för utredning vid upprepade missfall. Studien skulle även kunna leda till en förbättring av kunskapsläget både för individen, samhället och vården gällande hur bemötandet av denna grupp av kvinnor ser ut. Barnmorskor kan som yrkesgrupp stödja och hjälpa denna grupp kvinnor genom uppföljning i samband med att de kommer i kontakt med barnmorskemottagningen för att meddela att graviditeten har slutat i ännu ett missfall. Vidare kan etableringen av stödgrupper inom vården vara ett bra stöd för kvinnor som är med om upprepade missfall och dessa grupper skulle potentiellt ledas och samordnas av en barnmorska som innehar kompetens inom området upprepade missfall. / Background: In Sweden, the concept of recurrent miscarriage is defined as a woman having three or more miscarriages in succession and it is estimated to affect about one percent of all couples of childbearing age worldwide. Since this is a small group of women, it can be difficult for the effected woman to know where she can turn with her thoughts and what she is entitled to regarding further help. After enduring multiple recurrent miscarriages, the need to get some answers and at the same time the need to receive support and understanding from their close surroundings increases. The access to further investigation and treatment is different depending on where you are but with some help from a midwife and other healthcare providers, an appropriate plan based on the woman's situation can be developed. Purpose: The aim of this essay was to investigate the experiences of women who have endured recurrent miscarriages and their further needs that occurred during and the time after the miscarriage. Methods: The method used in this essay was a qualitative metasynthesis with metaethnographic analysis method. In total, 29 articles were collected of which 16 of them went through the quality review and were compiled to a result. Results: seven categories containing of key concepts were formed. The categories identified were the process of miscarrying, room for griefing, avoiding behavior, the partners role, social support, expectations of the healthcare and becoming pregnant again. Conclusion: Due to the fact that all women are different, the experiences and needs during a miscarrying process varies. By having the knowledge of what the woman goes through both physically and mentally during recurrent miscarriages, it contributes to a greater understanding of what the woman needs, both from her surroundings but also from the healthcare. Clinical applicability: This essay could help to explore the possibilities of modifying the criteria for an investigation of recurrent miscarriages. The essay could also lead to improvement of the knowledge situation for the individual, the society and the care providers regarding how this group of women wants to be treated. Midwives as a profession could help to support this group of women by initiating contact with the women when or after she has contacted the midwife clinic to announce another pregnancy loss. Furthermore, the establishment of support groups for women with recurrent miscarriages could be helpful and supportive for these women. The support groups could potentially be coordinated by a midwife with specific knowledge about recurrent miscarriage.

In Australia, as in other industrialised countries, rates of childlessness amongst women are rising. This has been attributed, in part, to a rise in the number of women choosing never to give birth; however, women’s perception of what constitutes choice in remaining childless is under-investigated. The aim of this study was to investigate Australian women’s experience of childlessness at mid age and explore the role of choice in this reproductive outcome. It investigated the determinants of childlessness, considered the consequences of never giving birth, and explored how choice affects childless women’s evaluation of non-motherhood. / A cross-sectional study of the experience of never giving birth was conducted, which comprised two components. The minor component was a secondary analysis of survey data (collected in 1996) from the Women’s Health Australia (WHA) project. WHA is a longitudinal study which recruited a nationally representative sample of 14,099 women born between 1945 and 1952. These women are amongst the first to have lived all their reproductive lives since the introduction of the oral contraceptive. This study compared demographic characteristics, self-rated health, and life satisfaction between 1,069 mid-aged childless women (exclusive of known adoptive and step-mothers) and 12,643 of their peers who are mothers. It was found that at mid-age, childless women have higher levels of education and are more extensively engaged in the paid workforce than mothers, however, there were no differences in health status between mothers and childless women. Life satisfaction differences between the two groups are complex and mediated by marital status. / The major component of the investigation was a study-specific survey (October 2002) completed by 426 nulliparous women who were all participants in the mid-aged cohort of Women’s Health Australia. This component investigated the determinants of childlessness, the role of choice, and the experience of non-motherhood. / In contrast to existing studies into childlessness, this large quantitative investigation has a sample which comprises a broad selection of nulliparous women irrespective of their marital status, medical history, or level of choice in never giving birth. Using an original classification system, women were categorised into three childless groups which describe three levels of choice in never giving birth: 37.1% of respondents chose childlessness actively (Active Choice), 15.4% chose childlessness given their personal circumstances (Constrained Choice), and 47.5% felt denied the opportunity to give birth (Denied Choice). The predominant reason for childlessness amongst the Active Choice women was not experiencing a strong ‘maternal instinct’, the Denied Choice group mainly cited infertility or the lack of a husband/partner, whilst the Constrained Choice group gave a mixture of voluntary and involuntary explanations. / This study developed a balance sheet approach to assessing both the positive and negative aspects of non-motherhood – the Consequence of Childlessness Balance Sheet (CCBS). It also introduced a technique for measuring ambivalence that was developed within social psychology. In contrast to the public discourse that depicts childlessness as a negative life outcome, participants in this study gave a favourable evaluation of their lives. Even so, more than half (55.6%) of the participants experienced moderate levels of ambivalence. Comparisons between the three childless groups revealed that as choice increased participants were more likely to give a higher rating to the positive aspects of their lives, a lower rating to the negative ones, and experience lower levels of ambivalence. However, Denied Choice women generally did not find childlessness a devastating experience. / Therefore, amongst the mid-aged participants in this study the experience of childlessness was complex and diverse, varying with the level of choice women had in never giving birth. Childlessness was not, however, a burdensome or detrimental life outcome for these women.

Background: Involuntary childlessness and infertility affect a large group of people and WHO calls it a global public health issue. Donated gametes can be used when a pregnancy is not achieved. Embryo donation involves the full genetic material of the donating couple and embryo donation for reproductive purposes are often associated with many emotional, ethical, legal and psychosocial aspects. Aim: The aim of the study was to examine views on embryo donation for reproductive purposes among couples with experience of cryopreserved embryos. Methods: A literature review was conducted in order to answer the aim. Two databases (PubMed and Web of Science) were used to identify relevant qualitative literature. A smaller search on Google Scholar was also included. Inclusion and exclusion criteria were pre-determined in order to limit which studies to include. Results: A total of 20 studies were included in the results. The results show that there are different views towards the status of the human embryo, views towards the genetic link, information sharing and screening, views towards the selection of recipients, views towards the contact and relationship between donors, recipients and offspring, and views towards the decision-making and whether to donate surplus embryos or not. Conclusion: The multiple understandings of the status of the human embryo emphasizes the complex nature of human embryos and may explain couples’ views on embryo donation for reproductive purposes. It has also the potential to explain what couples decide to do with their surplus embryos. The interests of the receiving couple, the donors, the future child, and the society should continuously be assessed and balanced when society regulates ART and embryo donation. / Bakgrund: Ofrivillig barnlöshet och infertilitet påverkar många människor och WHO kallar det ett globalt folkhälsoproblem. Donerade könsceller kan användas när en graviditet inte kan uppnås. Vid embryodonation innebär det att det donerande paret har full genetisk koppling till embryot och embryodonation för reproduktiva syften associeras ofta med många emotionella, etiska, rättsliga och psykosociala aspekter. Syfte: Syftet med studien var att undersöka synen på embryodonation för reproduktiva ändamål hos par med erfarenhet av frysförvarade embryon. Metod: En allmän litteraturstudie genomfördes för att besvara syftet. Två databaser (PubMed och Web of Science) användes för att identifiera relevanta kvalitativa studier. En mindre sökning utfördes även i Google Scholar. Inklusions- och exklusionskriterier bestämdes i förväg för att begränsa vilka studier som skulle ingå. Resultat: Totalt inkluderades 20 artiklar i resultatet. Resultatet visar att det finns olika uppfattningar om det mänskliga embryots status, om den genetiska kopplingen, informationsutbyte och screening, om synen på kontakt och relationen mellan donatorer, mottagare och avkomma samt synen på beslutsfattandet och om överskott av embryon ska doneras eller inte. Slutsats: De många uppfattningarna om det mänskliga embryots status betonar den komplexa karaktären hos det mänskliga embryot och kan förklara parens syn på embryodonation för reproduktiva ändamål. Det har också potential att förklara vad par väljer att göra med sina överskott av embryon. Det mottagande parets, donatorernas, det framtida barnets och samhällets intressen bör kontinuerligt bedömas och balanseras när samhället reglerar ART och embryodonation.

Childlessness in the Czech Republic, Germany, and Austria Abstract The main goal of this thesis is to examine and compare the state of childlessness in the Czech Republic, the Federal Republic of Germany and Austria. In Germany particularly, childlessness has become a phenomenon and a society-wide issue. Austria, where childlessness is at a high level in comparison with other European countries is in a similar situation. Data analysis in this thesis showed that childlessness is more widespread in the former West Germany and Austria than in the Czech Republic and former East Germany. This difference is caused, among other things, by the pro-natal policies adopted in the former communist countries which led to a temporary increase in total fertility rate. Further, the thesis deals with the perception of parenthood and childlessness in society on the basis of the European Values Study 2008 international survey and with the relationship between the ideal and preferred number of children on the basis of the Eurobarometer 2006 international survey. The results of the surveys show that childlessness cannot be considered as a new kind of lifestyle, and that the preferred family form still involves two children. Considerable part of the study focuses on the causes and consequences of childlessness and its possible...