Infertility, irrespective of its underlying etiology, is widely recognized as a condition that extends beyond biological dysfunction, exerting significant psychosocial, emotional, and relational strain, particularly on women.1 The pursuit of infertility treatment often exacerbates this emotional burden, with women consistently experiencing greater psychological distress related to infertility and its treatment compared to men.2,3 Polycystic ovary syndrome (PCOS), the most prevalent endocrine disorder affecting reproductive-aged women, is a leading cause of anovulatory infertility;4 thus, a substantial proportion of women seeking fertility treatment are diagnosed with PCOS.5

Although advancements in assistive reproductive technologies have shifted the focus of fertility care toward clinical outcomes,6 patient-centered care, encompassing emotional support, access, continuity, communication, and respect for individual preferences, remains underemphasized in clinical practice.7 Research on patients’ experiences with fertility services has highlighted the importance of both system-level and interpersonal factors in shaping satisfaction with care.6,8 System-level components include information provision, service accessibility, care coordination, and physical comfort. Interpersonal dimensions, which represent unmet patient needs, relate to provider attitudes, communication quality, privacy, and emotional support.9

A qualitative study using focus group discussions among 20 women experiencing infertility in Ghana reported that women expected to receive holistic healthcare that will foster their well-being and treatment satisfaction. They also expected regular health assessments and identified various healthcare expectations, which include psychological, educational, spiritual, social, and financial expectations.10

Other studies have shown that, even among financially stable patients, the primary reasons for discontinuing infertility treatment are the physical and emotional burdens associated with it.11,12 These findings reinforce the critical need for comprehensive, supportive fertility care that addresses the psychological dimensions of the treatment journey. In a qualitative study in Denmark by Schmid et al,13 reported widespread dissatisfaction among couples undergoing infertility treatment, largely due to the lack of psychological counseling and insufficient information about medical procedures.

In Oman, PCOS is the most common cause of infertility among women seeking fertility treatment.14 Cultural expectations surrounding fertility and childbearing place immense pressure on women to conceive, contributing to the stigmatization of infertility.15 This societal burden, coupled with the medical challenges associated with PCOS, suggests that Omani women may face unique psychological stressors that are not routinely acknowledged within the healthcare system. The extent to which their emotional needs are recognized and addressed during fertility care remains unclear.

This study is an extension of other studies by the authors on PCOS in Oman.16–18 It aimed to explore the experiences of Omani women with PCOS undergoing infertility treatment, focusing on their interactions with healthcare providers (HCPs), perceived communication barriers, and the extent of emotional support received. By situating these experiences within the broader sociocultural and health system context, this study seeks to inform culturally sensitive, patient-centered improvements in fertility care.

Methods

This qualitative study was conducted among Omani women of reproductive age (15–49 years) diagnosed with PCOS as the cause of primary or secondary infertility. Only women with secondary infertility and no live births were included in the study. Participants were recruited between January and May 2018 from Sultan Qaboos University Hospital (SQUH) and the Royal Hospital (RH), tertiary care hospitals located in Muscat, Oman. Ethical approval was obtained from the Sultan Qaboos University Medical Ethics Committee for SQUH and from the Ministry of Health’s Research and Ethical Review and Approval Committee for RH.

Purposive sampling was used to ensure diversity in age, infertility duration, and time since diagnosis. Eligible participants were identified from clinic appointment lists approximately one week in advance.19 Potential participants were contacted via telephone, briefed on the study, and invited to participate. The study information sheet was either emailed to participants in advance or provided in person on the day of the interview.

Twenty-three women were approached, of whom three declined: two due to time constraints and one who was unwilling to participate. The data obtained reached saturation after 20 interviews, where no new themes were identified following preliminary analysis; therefore, recruitment of participants ceased.

A semi-structured interview guide was developed based on a review of relevant literature and the study objectives to facilitate in-depth exploration of women’s experiences.20 The guide included open-ended questions covering satisfaction with fertility services, communication during consultations, and the presence or absence of emotional support. Basic demographic and clinical data were also collected.

The lead researcher conducted face-to-face interviews in private rooms within the fertility clinics, either before or after scheduled appointments. Written informed consent was obtained before each interview. The interviews were audio-recorded and guided by the participants’ responses to facilitate a participant-led approach.20 All interviews were conducted by the lead researcher in Arabic.

Audio recordings were transcribed and translated into English by a professional translator. The lead researcher (HS) reviewed all transcripts for accuracy and removed identifying information. Data were analyzed using the framework approach,21 and NVivo 11 software was used to store data and manage analysis.

Initial open coding was applied inductively to identify patterns from the data. Codes were then refined into a working analytical framework. To ensure analytical rigor, a subset of transcripts was independently coded by a second researcher, and discrepancies were resolved through discussion.22 The framework was iteratively applied to all transcripts, with new codes added as necessary. Data were then charted into matrices by theme and subtheme, facilitating synthesis and cross-case comparison.

Results

The average age of participants was 28.0 years (range 19 to 35 years). Most women were from Muscat (n = 7, 35.0%). Half of the women were in employment, and most had a high school education or higher educational degree (n = 17, 85.0%). The average number of years participants reported trying to conceive was four years (range = 1–12 years). Five (25.0%) participants had conceived previously, but ended in miscarriage.

Analysis of participants’ narratives yielded three overarching themes: (1) communication with HCPs, (2) provision of emotional support, and (3) experiences with fertility care services. Subthemes illustrate the key challenges women faced during their fertility journey [Table 1].

Theme 1: Communication with HCPs

1.1 lack of information and clarity on treatment

Participants frequently described receiving inadequate explanations from HCPs regarding their medical condition, diagnoses, and treatment procedures. Women reported confusion about the nature of PCOS and its relationship to infertility.

“It was all about asking me some questions and I will answer, but they didn’t provide any further response. They only gave me the plan and they will start telling me to come and go, come and go. They didn’t explain the reasons behind the pregnancy delay nor gave any models to illustrate them.” (31 years, 10 years of infertility)

As a result, many resorted to external sources, such as the internet or peers, which sometimes led to misinformation. The lack of printed educational materials compounded this concern:

“It is the physician who tells me about it and explains [it] to me orally, which is sometimes difficult to understand, and she doesn’t give me any leaflet with further information.” (27 years, four years of infertility)

1.1.1 language barriers

Several participants highlighted difficulties in understanding physicians who did not speak Arabic, noting reliance on nurses for translation. However, nurses were not always available, and some patients felt uncomfortable with their presence because of privacy issues. This language gap limited patients’ ability to fully understand medical information, ask questions freely, and engage in shared decision-making. As a result, some participants reported feeling less informed, more anxious, and less confident in their care, potentially impacting adherence to treatment plans and satisfaction with services.

“I was going to talk to the physician about many things, but I felt she will not understand me well because she is a non-Arabic speaker and my English is not that good, so I didn’t speak to her and she was also in a hurry and didn’t tell me about the treatment I use. She only entered my medications into the computer and told me to take them again.” (31 years, 10 years of infertility)

1.1.2 short consultation time

Time constraints during consultations were identified as a barrier to thorough communication and relationship-building with physicians. Participants attributed this to clinic overcrowding and the high patient load. They were also disappointed that they were not given enough time during the consultation, particularly given the long wait to obtain an appointment.

“I think because they are very busy and have a high number of patients, so there is no time to discuss anything else, I think they might feel that it is not important to ask about the patients' feelings, or it doesn’t cross their mind.” (28 years, three years of infertility)

1.2 role of nurses in communication

Participants generally reported feeling more at ease communicating with Omani nurses, whom they perceived as culturally sensitive, respectful of local norms, emotionally supportive, and more frequently accessible than physicians. Their frequent presence during routine procedures made them more accessible than physicians, fostering familiarity and trust. This accessibility encouraged patients to seek clarification on certain topics, discuss non-clinical concerns, and share sensitive personal information that they might withhold from other HCPs.

However, participants also noted that nurses’ involvement in clinical decision-making and provision of medical information was limited. As a result, while nurses served as a valued emotional and cultural bridge, their restricted authority meant that important medical questions and decisions still required a physicians input. This often led to delays in receiving comprehensive answers, increased dependence on physicians for critical discussions, and occasional frustration when physicians were not readily available.

“The physician is the one who gave me the appointment and called me on the phone. The physician is the one who does everything.” (27 years, five years of infertility)

Theme 2: Provision of emotional support

2.1 absence of formal psychological support

While participants acknowledged the kindness, politeness, and occasional words of encouragement offered by HCPs, they overwhelmingly reported that their emotional well-being was neither explicitly assessed nor systematically addressed during consultations. Supportive gestures were often perceived as incidental rather than an integral part of care. Most participants viewed physicians’ roles as narrowly focused on diagnosing and treating the biological causes of infertility, with little engagement in discussing the psychological or social dimensions of their experiences.

This biomedical emphasis left many participants feeling that an important aspect of their care was overlooked, particularly given the emotional distress, anxiety, and social pressures commonly associated with infertility in their cultural context.

“No, no one asked me that question. No one asked me about any feelings regarding the pregnancy delay. It might be because of the sensitivity of the topic itself, some women don’t like to be asked such questions.” (27 years, two years of infertility)

Some participants referred to certain HCPs who routinely checked on a patient’s emotional well-being. This led to the conclusion that offering emotional support to patients in fertility clinics is a HCP’s personal choice, and it depends largely on their personality and their style in treating their patients.

“I think it is up to the physician and their personality to check on patient’s feelings.” (31 years, 10 years of infertility)

A participant shared her experience with a physician who she felt always showed concern for her well-being and asked about her emotions each time they met:

“I like her communication style, and I felt she knows my situation and understands my feelings and trying to reassure me. It is very rare to meet a physician with this style that cares about your feelings.” (24 years, four years of infertility).

2.2 need for emotional support

Several participants believed that HCPs avoided starting discussions about their emotional well-being as it may be considered disrespectful to them. These women thought it was embarrassing to be asked about their feelings towards pregnancy delay by their treating doctors because it is a sensitive issue culturally.

“No, no one asked me that question. No one asked me about any feelings regarding the pregnancy delay, it might be because of the sensitivity of the topic itself, some women don’t like to be asked such questions.” (27 years, two years of infertility)

2.2.1 social pressure and the desire to vent

Participants expressed a need for psychological support to help them cope with the social pressure, stigma, and emotional distress arising from infertility itself, the repeated cycles of treatment, and the uncertainty of outcomes. Several described feeling burdened by community expectations to conceive soon after marriage, the implicit or explicit blame directed at women for childlessness, and the emotional strain of discussing their situation with relatives or peers.

Many participants indicated they would be willing to share their feelings and personal struggles, but only if the physician initiated the conversation. As a result, opportunities for early identification of psychological distress were often missed, leaving some patients to navigate their emotional challenges in isolation or rely on informal support from family or friends, which was reported to be varied in quality and understanding.

“I don’t like to engage in such discussions, but if the physician I am dealing with will give me time and attention and talk to me, I will feel that I will be more encouraged to talk to her about my daily struggles and treatment stress and discuss my emotions.” (22 years, seven years of infertility)

2.2.2 emotional burden of treatment

Several participants expressed the tremendous burden they felt due to the extensive fertility treatment they received and reported feeling psychologically drained. These participants went on to discuss that they struggled to accept the large numbers of medications, injections, and medical tests needed to follow their ovulation response. Moreover, the frequent hospital trips and experiencing strong side effects from hormonal treatments affected their mood, which was compounded by failed treatment cycles.

“They gave me a chance to use some stimulators, such as clomid, which I continued to use them for several months, but nothing happened. Then they took a step higher and told us that they want to start intra-uterine insemination (IUI). For the IUI, it was the same thing. In the beginning, we have entirely refused, but the situation we had pushed us to start this experience and I have done the IUI. I have tried three times, and this was, of course, after the failed attempts using pills and injections, and they all were failed attempts. Then, I mean, I had an upset and frustrated feeling and was thinking seriously about quitting.” (31 years, 10 years of infertility)

2.2.3 positive impacts of emotional support

Participants who had access to psychological support within fertility clinics consistently described feelings of comfort, satisfaction, and renewed motivation in their treatment journeys. Many emphasized that emotional support was not merely helpful but essential in helping them cope with the immense psychological, social, and treatment toll of infertility. Women who received this support reported feeling more emotionally stable, resilient, and optimistic about continuing treatment, even in the face of setbacks.

“I can feel that Dr. X is more understanding of my feelings. She allows me to speak to her about certain issues when I’m frustrated. She encourages and motivates me, and she spends enough time with me for me to overcome my stress about the treatment.” (24 years, four years of infertility)

Participants consistently emphasized how seemingly small gestures of emotional support, particularly verbal encouragement during clinical consultations, had a disproportionately positive impact on their psychological well-being and perseverance with treatment. Many described how brief but intentional affirmations from HCPs served as emotional lifelines during moments of despair.

“One day I came to take some injections and one of the nurses said, “all the best” when she injected me with the dose, I felt very happy when she said it. I mean that they are very simple words, but they gave me so much hope.” (34 years, four years of infertility)

Theme 3: Experiences with fertility care services

3.1 discontinuity of care

Participants expressed frustration with frequent physician turnover during their treatment journeys, describing how disrupted continuity of care compounded their emotional and logistical burdens. This systemic issue forced patients to repeatedly mention medical histories with unfamiliar providers, exacerbating their distress and diminishing available time for actual treatment discussions.

“You know the main problem here is that every time I attend the clinic, I see a different doctor, and I don’t see the same one from my first appointment, and each one of them will ask me about my story and my medical history. It annoys me that I see a different doctor each time. It’s a waste of time.” (25 years, two years of infertility)

Participants expressed safety concerns regarding inconsistent physician follow-up, noting that frequent provider changes increased the risk of medical errors. Furthermore, participants identified inconsistent HCPs as a significant relational barrier hindering patient-doctor bonding.

3.2 perceived inexperience of staff

Participants expressed concern about the limited expertise of junior doctors, particularly when considering a critical structural barrier identified in the current fertility care model is the insufficient number of qualified specialists relative to patient volume, compounded by variable competency levels among treating staff. Participants reported concerns about the limited clinical experience of many frontline providers, particularly junior doctors who often lacked the expertise to independently manage complex fertility cases without consulting senior colleagues. They deferred decisions to senior colleagues, which affected patient confidence.

“Most of them don’t have the proper experience to the point that she asked for some help from a senior physician, and this disturbs the consultation and our confidence in them.” (35 years, 10 years of infertility)

Several participants voiced significant concerns regarding the suboptimal dietary guidance provided in fertility clinics, particularly for women managing PCOS-related weight challenges. These accounts revealed a troubling pattern of generic, non-individualized nutritional advice that failed to address their specific metabolic needs, ultimately undermining both clinical outcomes and patient motivation.

3.3 structural and logistical constraints

Many participants mentioned limited access to clinic services, such as scan rooms and finding slots for IUI procedures and other radiological procedures, due to the high volume of patients attending the clinic. Doctors usually get rushed to empty the scan room for the next patient because the same rooms are used for both pregnant women and patients experiencing infertility.

“They could add more scan rooms and equipment because you have to wait too long for your turn, and when it is your turn, you feel like the clinician is rushing the procedure, and I feel they want to finish it quickly.” (24 years, four years of infertility)

Several participants raised significant concerns regarding the lack of appropriate facilities for semen collection, highlighting a critical gap in patient-centered care for male partners. The current infrastructure forces men to provide samples under suboptimal conditions that fail to meet basic privacy and hygiene standards, creating unnecessary psychological and practical barriers to treatment.

A few participants mentioned the need for separate waiting area for pregnant women and women receiving infertility care. In their opinion, it is not suitable to mix them up as it hurts their feelings and makes them irritated to sit there and watch and hear pregnant women talking to each other about their pregnancy while they are following up for infertility.

Discussion

This qualitative study reveals a pronounced gap in the emotional and psychosocial support provided to Omani women undergoing infertility treatment, highlighting that these dimensions of care are frequently overshadowed by biomedical priorities. Participants described limited attention to their emotional well-being during consultations, with little assessment or discussion of psychological needs despite evident distress. Key unmet needs included emotional validation, coping support for treatment-related stress, guidance in navigating societal pressures, and consistent, clear communication to aid decision-making. Barriers to holistic care were attributed to time constraints, high patient volumes, predominant clinical focus on organic infertility causes, and cultural sensitivities surrounding emotional expression. Nonetheless, women expressed a strong desire to be heard, understood, and supported throughout their fertility journey. When emotional care was offered, typically by nurses, it occurred informally rather than as part of a structured service. Women with PCOS reported vulnerability due to weight-related stigma, reinforcing the need for a more integrated, empathetic, and culturally sensitive model of infertility care.

The psychological burden of infertility, intensified by repeated treatment failures and social pressures, was consistently voiced by participants. The distress experienced by these women aligns with previous research that equates the psychological toll of infertility with that of life-threatening illnesses such as cancer.23–25 Despite established evidence on the mental health impact of infertility and the benefits of psychological support,26–28 such support was noticeably absent from participants' in clinical encounters. Participants attributed this to time limitations, a focus on biomedical management, and cultural discomfort with discussing emotional issues. These findings echoed in other international qualitative studies,9,29,30 suggesting experiences of women are broadly ssimilar, although the provision of support may be related to cultural and societal factors, for the Omani and Middle Eastern context. Consistent with global findings,31–33 participants believed psychological support could mitigate emotional distress and potentially improve treatment outcomes. For women with PCOS, the dual burden of infertility and weight challenges further underscores the need for multidisciplinary care, including dietary and psychological services.

Nonetheless, there is an urgent need to integrate mental health services into fertility care in the Omani context, to screen and assess these common disorders among this sample and offer timely intervention. The nature and means to address this gap need careful consideration in relation to the cultural context.

Participants trusted physicians for medical expertise but felt a stronger emotional connection with nurses, particularly Omani nationals, due to more frequent interactions and perceived cultural familiarity. However, nurses were perceived to have limited roles, often confined to procedural tasks. Similar findings have been reported among Kuwaiti women undergoing in vitro fertilization, where limited counselling roles accompanied a stronger rapport with nurses.34 Literature supports enhanced patient satisfaction and engagement when fertility nurses play a more active role in education and support.35,36 This suggests that the nursing profession should consider establishing fertility nursing as a sub-specialty, incorporating insights from psychology to better equip nurses in these settings to deliver more structured psychological care. Unfortunately, nurses in fertility clinics in Oman perform their basic nursing tasks like checking and recording vital signs and weight, giving injections and preparing them for examination or investigations. These were similar to the primary roles of direct patient care reported by 73% of infertility nurses reported in the literature review.35

Participants also expressed dissatisfaction with fragmented physician care, language barriers with expatriate doctors, and poor communication, issues that hinder treatment continuity and increase the risk of error.37–39 Recommendations included having a lead physician assigned for each case and improving clinic infrastructure to enhance privacy, such as providing dedicated spaces for semen collection and separating waiting areas for pregnant and infertile patients. These issues have been similarly noted in other qualitative studies.8

Alongside medical and fertility interventions, patients voiced the need for incorporating tailored dietary guidance to help manage insulin resistance and support hormonal balance, both of which are crucial in improving reproductive outcomes. An integrated care model that combines medical, nutritional, and mental health support can significantly enhance both physical and emotional well-being, ultimately improving quality of life and fertility outcomes for these patients especially for women with PCOS who struggle with weight loss issues as an additional risk factor to fertility journey.40

This is the first qualitative study in Oman to explore the lived experiences of women in fertility care, including their emotional and psychosocial needs. The use of semi-structured face-to-face interviews and purposive sampling across two government fertility centers allowed for a diverse representation of perspectives.41,42 However, limiting participants to those with PCOS and attending specialized centers may restrict the transferability of the findings, though our data reached saturation. Finally, despite the study being conducted in 2018/2019, the findings are still believed to be invaluable and fill a gap that still exists around this topic in the literature, especially given that the current services in these centers have been unchanged since then, with findings reflecting similarities to regional and international perceptions of fertility care. Future studies could expand to include a broader range of infertility etiologies among women and male factor infertility and employ mixed methods approaches with validated psychological measures to complement qualitative findings.

Conclusion

Omani women undergoing infertility treatment face considerable emotional strain, yet their psychological needs are not adequately addressed in current fertility care settings. While they value the publicly funded services, they advocate for the integration of emotional support as a formal component of care. Delegating this responsibility to trained psychologists could overcome existing barriers faced by overburdened physicians and culturally constrained consultations. Tailored, multidisciplinary care, particularly for women with PCOS, may foster better treatment adherence, emotional resilience, and satisfaction with fertility services. Future research should examine the cost-effectiveness and acceptability of embedding psychological support within standard fertility care pathways in Oman.

Disclosure

The authors declare no conflicts of interest. No funding was received for this study.

references

1. 1. Hart VA. Infertility and the role of psychotherapy. Issues Ment Health Nurs 2002;23(1):31-41.
2. 2. Peterson BD, Newton CR, Rosen KH, Skaggs GE. Gender differences in how men and women who are referred for IVF cope with infertility stress. Hum Reprod 2006 Sep;21(9):2443-2449.
3. 3. Pottinger AM, McKenzie C, Fredericks J, DaCosta V, Wynter S, Everett D, et al. Gender differences in coping with infertility among couples undergoing counselling for In Vitro Fertilization treatment. West Indian Med J 2006 Sep;55(4):237-242.
4. 4. Balen AH, Morley LC, Misso M, Franks S, Legro RS, Wijeyaratne CN, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update 2016 Nov;22(6):687-708.
5. 5. Joham AE, Teede HJ, Ranasinha S, Zoungas S, Boyle J. Prevalence of infertility and use of fertility treatment in women with polycystic ovary syndrome: data from a large community-based cohort study. J Womens Health (Larchmt) 2015 Apr;24(4):299-307.
6. 6. Dancet EA, Nelen WL, Sermeus W, De Leeuw L, Kremer JA, D’Hooghe TM. The patients’ perspective on fertility care: a systematic review. Hum Reprod Update 2010;16(5):467-487.
7. 7. Lok IH, Chan MT, Chan DL, Cheung LP, Haines CJ, Yuen PM. A prospective randomized trial comparing patient-controlled sedation using propofol and alfentanil and physician-administered sedation using diazepam and pethidine during transvaginal ultrasound-guided oocyte retrieval. Hum Reprod 2002 Aug;17(8):2101-2106.
8. 8. Annual Health Report 1978. Oman; 1976-2009. https://www.moh.gov.om/en/statistics/annual-health-reports/.accessed 19/9/2017
9. 9. Dancet EA, Van Empel IW, Rober P, Nelen WL, Kremer JA, D’Hooghe TM. Patient-centred infertility care: a qualitative study to listen to the patient’s voice. Hum Reprod 2011 Apr;26(4):827-833.
10. 10. Armah D, van der Wath A, Yazbek M, Naab F. Women’s expectations of infertility care in Ghana: a qualitative study. Int J Afr Nurs Sci 2024;21:100802 .
11. 11. Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA. Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern Med 2000 Feb;15(2):122-128.
12. 12. Hayes B, Bonner A, Pryor J. Factors contributing to nurse job satisfaction in the acute hospital setting: a review of recent literature. J Nurs Manag 2010 Oct;18(7):804-814.
13. 13. Land JA, Courtar DA, Evers JL. Patient dropout in an assisted reproductive technology program: implications for pregnancy rates. Fertil Steril 1997 Aug;68(2):278-281.
14. 14. Madhavanprabhakaran G, Al Farsi A, Francis F, Vaidyanathan G. Etiology and Risk Factors of Infertility Among Omani Couples: A Retrospective Study from a Tertiary Referral Center. Oman Med J 2026 Jan;41(1):e799.
15. 15. Domar AD. Impact of psychological factors on dropout rates in insured infertility patients. Fertil Steril 2004 Feb;81(2):271-273.
16. 16. ALSumri H, Szatkowski L, Gibson J, Fiaschi L, Bains M. Szatkowski L, Gibson J, Fiaschi L, Bains M. Psychosocial impacts of infertility among Omani women with polycystic ovarian syndrome: a qualitative study. Int J Fertil Steril 2023 Feb;17(2):107-114.
17. 17. Al Sumri H, Szatkowski L, Fiaschi L, Bains M. Views on child adoption among Omani women with infertility: a qualitative study. Journal of Positive Psychology and Wellbeing 2024;8(1).
18. 18. ALSumri H. Fiaschi L, Gibson J, Bains M, Szatkowski L. Association between polycystic ovarian syndrome and adverse pregnancy and neonatal outcomes among women in Oman. J Health Med Inform 2023.
19. 19. Bryman A. Social research methods. 4th ed. Oxford University Press; 2012.
20. 20. Mays N, Pope C. Rigour and qualitative research. BMJ 1995 Jul;311(6997):109-112.
21. 21. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol 2013 Sep;13:117.
22. 22. Carter N, Bryant-Lukosius D, DiCenso A, Blythe J, Neville AJ. The use of triangulation in qualitative research. Oncol Nurs Forum 2014 Sep;41(5):545-547.
23. 23. Sharma A, Shrivastava D, Sharma IV. Psychological problems related to infertility. Cureus 2022 Oct;14(10):e30320.
24. 24. Wischmann T, Stammer H, Scherg H, Gerhard I, Verres R. Psychosocial characteristics of infertile couples: a study by the ‘Heidelberg Fertility Consultation Service’. Hum Reprod 2001 Aug;16(8):1753-1761.
25. 25. Domar AD, Zuttermeister PC, Friedman R. The psychological impact of infertility: a comparison with patients with other medical conditions. J Psychosom Obstet Gynaecol 1993;14(Suppl):45-52.
26. 26. Leiblum SR. Infertility: psychological issues and counseling strategies. 1997.
27. 27. Hjelmstedt A, Andersson L, Skoog-Svanberg A, Bergh T, Boivin J, Collins A. Gender differences in psychological reactions to infertility among couples seeking IVF- and ICSI-treatment. Acta Obstet Gynecol Scand 1999 Jan;78(1):42-48.
28. 28. Humeniuk E, Pucek W, Wdowiak A, Filip M, Bojar I, Wdowiak A. Supporting the treatment of infertility using psychological methods. Ann Agric Environ Med 2023 Dec;30(4):581-586.
29. 29. Njogu A, Njogu J, Mutisya A, Luo Y. Experiences of infertile women pursuing treatment in Kenya: a qualitative study. BMC Womens Health 2022 Sep;22(1):364.
30. 30. Schmidt L. Infertile couples’ assessment of infertility treatment. Acta Obstet Gynecol Scand 1998 Jul;77(6):649-653.
31. 31. Greil AL, Slauson-Blevins K, McQuillan J. The experience of infertility: a review of recent literature. Sociol Health Illn 2010 Jan;32(1):140-162.
32. 32. Rooney KL, Domar AD. The impact of stress on fertility treatment. Curr Opin Obstet Gynecol 2016 Jun;28(3):198-201.
33. 33. Domar AD, Seibel MM, Benson H. The mind/body program for infertility: a new behavioral treatment approach for women with infertility. Fertil Steril 1990 Feb;53(2):246-249.
34. 34. Omu FE, Omu AE. Emotional reaction to diagnosis of infertility in Kuwait and successful clients’ perception of nurses’ role during treatment. BMC Nurs 2010 Mar;9(5):5.
35. 35. Mitchell A, Mittelstaedt ME, Wagner C. A survey of nurses who practice in infertility settings. J Obstet Gynecol Neonatal Nurs 2005;34(5):561-568.
36. 36. Brucker PS, McKenry PC. Support from health care providers and the psychological adjustment of individuals experiencing infertility. J Obstet Gynecol Neonatal Nurs 2004;33(5):597-603.
37. 37. Klitzman R. Impediments to communication and relationships between infertility care providers and patients. BMC Womens Health 2018 Jun;18(1):84.
38. 38. Wilkes S, Hall N, Crosland A, Murdoch A, Rubin G. Patient experience of infertility management in primary care: an in-depth interview study. Fam Pract 2009 Aug;26(4):309-316.
39. 39. Ranjbar F, Behboodi-Moghadam Z, Borimnejad L, Ghaffari SR, Akhondi MM. Experiences of infertile women seeking assisted pregnancy in Iran: a qualitative study. J Reprod Infertil 2015;16(4):221-228.
40. 40. Tay CT, Moran LJ, Wijeyaratne CN, Redman LM, Norman RJ, Teede HJ, et al. Integrated model of care for polycystic ovary syndrome. Semin Reprod Med 2018 Jan;36(1):86-94.
41. 41. Bogdan RC, Biklen SK. Qualitative research in education: an introduction to theory and methods. 3rd. Needham Heights, MA: Allyn & Bacon; 1998.
42. 42. Barriball KL, While A. Collecting data using a semi-structured interview: a discussion paper. J Adv Nurs 1994 Feb;19(2):328-335.