Experiences of physical activity during pregnancy resulting from in vitro fertilisation: an interpretative phenomenological analysis

Objective To explore the qualitative experiences and decision-making processes surrounding physical activity (PA) for women who have undergone IVF treatment.

Background Physical activity (PA) during pregnancy is safe for both mother and fetus in the majority of cases, including for women who have undergone in vitro fertilisation (IVF) treatment; however, there is a paucity of research into decision-making and PA in this population.

Methods Eight women, who had undergone successful IVF treatment and were currently pregnant or had given birth within the last two years, participated in semi-structured interviews about their experiences of infertility and PA during pregnancy. Interview transcripts were analysed using interpretative phenomenological analysis.

Results Three superordinate themes emerged from the data: ‘navigating away from childlessness and towards motherhood’, ‘negotiating a safe passage’, and ‘balancing the challenges of pregnancy with the needs of the self’. Ten subthemes indicated the processes adopted to navigate experiences of infertility, the IVF process, and subsequent decision-making about PA during pregnancy.

Conclusion PA during pregnancy was experienced as a way to soothe the self and control the experience of pregnancy; however, this was mediated by concerns about safety and physical limitations on PA. Limitations of the study are considered, as well as implications for clinical practice and directions for future research.

Ahern, K. J. (1999). Ten tips for reflexive bracketing. Qualitative Health Research, 9, 407-411. doi:10.1177/104973239900900309
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179-211. doi: 10.1016/0749-5978(91)90020-T
Atkinson, L., Shaw, R. L., & French, D. P. (in press). Is pregnancy a teachable moment for diet and physical activity behaviour change? An interpretative phenomenological analysis of the experiences of women during their first pregnancy. British Journal of Health Psychology, 22. doi: 10.1111/bjhp.12200
Beaurepaire, J., Jones, M., Thiering, P., Saunders, D., & Tennant, C. (1994). Psychosocial adjustment to infertility and its treatment: Male and female responses at different stages of IVF/ET treatment. Journal of Psychosomatic Research, 38, 229-240. doi: 10.1016/0022-3999(94)90118-X

Benjamin, O., & Ha'elyon, H. (2002). Rewriting fertilization: Trust, pain, and exit points. Women's Studies International Forum, 25, 667-678. doi: 10.1016/S0277-5395(02)00350-3

Boivin, J., Domar, A. D., Shapiro, D. B., Wischmann, T. H., Fauser, B. C. J. M., & Verhaak, C. (2012). Tackling burden in ART: An integrated approach for medical staff. Human Reproduction, 27, 941-950. doi:10.1093/humrep/der467
British Psychological Society. (2009). Code of Ethics and Conduct. Retrieved from http://www.bps.org.uk/system/files/documents/code_of_ethics_ and_conduct.pdf
Brown, W. J., & Trost, S. G. (2003). Life transitions and changing physical activity patterns in young women. American Journal of Preventative Medicine, 25, 140-143. doi: 10.1016/S0749-3797(03)00119-3
Burke, S. M., Carron, A. V, Eys, M. A., Ntoumanis, N., & Estabrooks, P. A. (2006). Group versus individual approach? A meta-analysis of the effectiveness of interventions to promote physical activity. Sport and Exercise Psychology Review, 2 (1). pp. 19-35
Chang, S., Kenney, N. J., & Chao, Y. Y. (2010). Transformation in self-identity amongst Taiwanese women in late pregnancy: A qualitative study. International Journal of Nursing Studies, 47, 60-66. doi:10.1016/j.ijnurstu.2009.06.007
Chiaffarino, F., Baldini, M. P., Scarduelli, S., Bommarito, F., Ambrosio, S., D’Orsi, C., …Ragni, G. (2011). Prevalence and incidence of depressive and anxious symptoms in couples undergoing assisted reproductive treatment in an Italian infertility department. European Journal of Obstetrics & Gynaecology and Reproductive Biology, 158, 235-241. doi: 10.1016/j.ejogrb.2011.04.032
Cioffi, J., Schmied, V., Dahlen, H., Mills, A., Thornton, C., Duff, M., . . . Kolt, G. S. (2010). Physical activity in pregnancy: Women's perceptions, practices, and influencing factors. Journal of Midwifery & Women’s Health, 55, 455-461. doi:10.1016/j.jmwh.2009.12.003

Clapp, J. F. (1990). The course of labor after endurance exercise during pregnancy. American Journal of Obstetrics and Gynecology, 163, 1799–1805. doi: 10.1016/0002-9378(90)90753-T

Clarke, P. E., & Gross, H. (2004). Women's behaviour, beliefs and information sources about physical exercise in pregnancy. Midwifery, 20, 133-141. doi: 10.1016/j.midw.2003.11.003
Cousineau, T. M., & Domar, A. D. (2007). Psychological impact of infertility. Best Practice & Research Clinical Obstetrics & Gynaecology, 21, 293-308. doi: 10.1016/j.bpobgyn.2006.12.003
Cramp, A. G., & Bray, S. R. (2009). A prospective examination of exercise and barrier self-efficacy to engage in leisure-time physical activity during pregnancy. Annals of Behavioral Medicine, 37, 325-334. doi:10.1007/s12160-009-9102-y

Crone, D., & Guy, H. (2008). ‘I know it is only exercise, but to me it is something that keeps me going’: A qualitative approach to understanding mental health service users' experiences of sports therapy. International Journal of Mental Health Nursing, 17, 197-207. doi: 10.1111/j.1447-0349.2008.00529.x
Currie, S., Gray, C., Shepherd, A., & McInnes, R. J. (2016). Antenatal physical activity: a qualitative study exploring women’s experiences and the acceptability of antenatal walking groups, BMC pregnancy and Childbirth, 16, 182. doi 10.1186/s12884-016-0973-1
Da Costa, D., Rippen, N., Dritsa, M., & Ring, A. (2003). Self-reported leisure-time physical activity during pregnancy and relationship to psychological well-being. Journal of Psychosomatic Obstetrics & Gynecology, 24, 111-119. doi: 10.3109/01674820309042808

De Vivo, M., Hulbert, S., Mills, H., & Uphill, M. A. (2016). Examining the effectiveness of the theory of planned behaviour in explaining exercise intention and behaviour during pregnancy: A meta-analysis. Journal of Reproductive and Infant Psychology, 34 (2) 122-138.

Diamond, R., Kezur, D., Meyers, M., Scharf, C. N., & Weinschel, M. (1999). Couple therapy for infertility. New York, NY: Guilford Press.

Domar, A. D., Conboy, L., Denardo-Roney, J., & Rooney, K. L. (2012). Lifestyle behaviors in women undergoing in vitro fertilization: A prospective study. Fertility and Sterility, 97, 697-701. doi:10.1016/j.fertnstert.2011.12.012

Duncombe, D., Wertheim, E. H., Skouteris, H., Paxton, S. J., & Kelly, L. (2009). Factors related to exercise over the course of pregnancy including women's beliefs about the safety of exercise during pregnancy. Midwifery, 25, 430-438. doi:10.1016/j.midw.2007.03.002
Eng, P. M., Rimm, E. B., Fitzmaurice, G., & Kawachi, I. (2002). Social ties and changes in social ties in relation to subsequent total and cause-specific mortality and coronary heart disease in men. American Journal of Epidemiology, 155, 700-709.

Evenson, K. R., Moos, M., Carrier, K., & Siega-Riz, A. M. (2009). Perceived barriers to physical activity among pregnant women. Maternal and Child Health Journal, 13, 364-375. doi:10.1007/s10995-008-0359-8

Ezmerli, N. M. (2000). Exercise in pregnancy. Primary Care Update for Ob/Gyns, 7, 260-265. doi: 10.1016/S1068-607X(00)00056-1

Gaston, A., Wilson, P. M., Mack, D. E., Elliot, S., & Prapavessis, H. (2013). Understanding physical activity behavior and cognitions in pregnant women: An application of self-determination theory. Psychology of Sport and Exercise, 14, 405-412. doi:10.1016/j.psychsport.2012.12.009

Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.

Goodrich, K., Cregger, M., Wilcox, S., & Liu, J. (2013). A qualitative study of factors affecting pregnancy weight gain in African American women. Maternal and Child Health Journal, 17, 432-440. doi:10.1007/s10995-012-1011-1

Gross, H., & Bee, P. E. (2004). Perceptions of effective advice in pregnancy – the case of activity. Clinical Effectiveness in Nursing, 8, 161-169. doi:10.1016/j.cein.2005.03.002

Hanghøj, S. (2013). When it hurts I think: Now the baby dies. Risk perceptions of physical activity during pregnancy. Women and Birth, 26, 190-194. doi:10.1016/j.wombi.2013.04.004

Hausenblas, H., Giacobbi, P., Cook, B., Rhodes, R., & Cruz, A. (2011). Prospective examination of pregnant and nonpregnant women’s physical activity beliefs and behaviours. Journal of Reproductive and Infant Psychology, 29, 308-319. doi:10.1080/02646838.2011.629993

Hausenblas, H. A., & Symons Downs, D. (2004). Prospective examination of the theory of planned behavior applied to exercise behavior during women's first trimester of pregnancy. Journal of Reproductive and Infant Psychology, 22, 199-210. doi:10.1080/02646830410001723788

Hegaard, H. K., Kjaergaard, H., Damm, P. P., Petersson, K., & Dykes, A. (2010). Experiences of physical activity during pregnancy in Danish nulliparous women with a physically active life before pregnancy: A qualitative study. BMC Pregnancy and Childbirth, 10:33:. doi:10.1186/1471-2393-10-33

Heron, J. (2004). The course of anxiety and depression through pregnancy and the postpartum in a community sample. Journal of Affective Disorders, 80, 65-73. doi: 10.1016/j.jad.2003.08.004

Hinton, P. S., & Olson, C. M. (2001). Postpartum exercise and food intake: The importance of behavior-specific self-efficacy. Journal of the American Dietetic Association, 101, 1430-1437. doi:10.1016/S0002-8223(01)00345-5

Human Fertilisation and Embryology Authority. (2014). Fertility treatment in 2013: Trends and figures. London: Author.

Imeson, M., & McMurray, A. (1996). Couples’ experiences of infertility: A phenomenological study. Journal of Advanced Nursing, 24, 1014-1022. doi: 10.1111/j.1365-2648.1996.tb02938.x

Johnson, K. M., & Fledderjohann, J. (2012). Revisiting “her” infertility: Medicalized embodiment, self-identification and distress. Social Science & Medicine, 75, 883-891. doi:10.1016/j.socscimed.2012.04.020
Jutel, A. (2009). Sociology of diagnosis: A preliminary review. Sociology of Health & Illness, 31, 278-299. doi: 10.1111/j.1467-9566.2008.01152.x

Knowles, A. M., Niven, A., & Fawkner, S. (2011). A qualitative examination of factors related to the decrease in physical activity behavior in adolescent girls during the transition from primary to secondary school. Journal of Physical Activity & Health, 8, 1084-1091.

Küçük, M. (2012). Bed rest after embryo transfer: Is it harmful? European Journal of Obstetrics & Gynecology and Reproductive Biology, 167, 123-126. doi: 10.1016/j.ejogrb.2012.11.017

Leiferman, J., Swibas, T., Koiness, K., Marshall, J. A., & Dunn, A. L. (2011). My baby, my move: Examination of perceived barriers and motivating factors related to antenatal physical activity. Journal of Midwifery & Women’s Health, 56(1), 33-40. doi:10.1111/j.1542-2011.2010.00004.x

Leppanen, M., Aittasalo, M., Raitanen, J., Kinnunen, T. I., Kujala, U. M., & Luoto, R. (2014). Physical activity during pregnancy: Predictors of change, perceived support and barriers among women at increased risk of gestational diabetes. Maternal and Child Health Journal, 18, 2158-2166. doi:10.1007/s10995-014-1464-5

Levin, J. S. (1991). The factor structure of the pregnancy anxiety scale. Journal of Health and Social Behavior, 32, 368-381. doi: 10.2307/2137104

Liu, J., Tuvblad, C., Li, L., Raine, A., & Baker, L. A. (2013). Medical record validation of maternal recall of pregnancy and birth events from a twin cohort. Twin Research and Human Genetics. 16, 845-860. doi: 10.1017/thg.2013.31

Marquez, D. X., Bustamante, E. E., Bock, B. C., Markenson, G., Tovar, A., & Chasan-Taber, L. (2009). Perspectives of Latina and non-Latina white women on barriers and facilitators to exercise in pregnancy. Women & Health, 49, 505-521. doi:10.1080/03630240903427114

McMahon, C., Tennant, C., Ungerer, J., & Saunders, D. (1999). ‘Don't count your chickens’: A comparative study of the experience of pregnancy after IVF conception. Journal of Reproductive and Infant Psychology, 17, 345-356. doi: 10.1080/02646839908404600

Mottola, M., & Campbell, M. (2003). Activity patterns during pregnancy. Canadian Journal of Applied Physiology, 28, 642–653. doi:10.1139/h03-049

Nash, M. (2011). “You don't train for a marathon sitting on the couch”: Performances of pregnancy ‘fitness’ and ‘good’ motherhood in Melbourne, Australia. Women's Studies International Forum, 34, 50-65. doi:10.1016/j.wsif.2010.10.004

NICE (2013). Fertility: Assessment and treatment for people with fertility problems. Retrieved from http://www.nice.org.uk/CG156

Palha, A. P., & Lourenço, M. F. (2011). Psychological and cross cultural aspects of infertility and human sexuality. Advances in Psychosomatic Medicine, 31, 164-183. doi: 10.1159/000328922

Paul, M. S., Berger, R., Berlow, N., Rovner-Ferguson, H., Figlerski, L., Gardner, S., & Malave, A. F. (2010). Posttraumatic growth and social support in individuals with infertility. Human Reproduction, 25, 133-141. doi: 10.1093/humrep/dep367

Peoples, D., & Rovner-Ferguson, H. (2000). Experiencing infertility. New York: WW Norton & Company.

Pringle, J., Drummond, J., McLafferty, E., & Hendry, C. (2011). Interpretative phenomenological analysis: A discussion and critique. Nurse Researcher, 18, 20-24. doi: 10.7748/nr2011.04.18.3.20.c8459

Reading, A. E., Chang, L. C., & Kerin, J. F. (1989). Psychological state and coping styles across an IVF treatment cycle. Journal of Reproductive and Infant Psychology, 7, 95-193. doi: 10.1080/02646838908403580

Royal College of Obstetricians and Gynaecologists. (2006). Exercise in pregnancy (Statement No. 4). Retrieved from https://www.rcog.org.uk/globalassets/ documents/guidelines/statements/statement-no-4.pdf

Smith, J., Flowers, P., & Larkin, M. (2009) Interpretive Phenomenological Analysis: Theory, Method and Research. London: Sage.

Su, T., Chen, Y., Hung, Y., & Yang, Y. (2001). Comparative study of daily activities of pregnant and non-pregnant women after in vitro fertilization and embryo transfer. Journal of the Formosan Medical Association, 100(4), 262-268.

Symons Downs, D., & Hausenblas, H. A. (2003). Exercising for two: Examining pregnant women's second trimester exercise intention and behavior using the framework of the theory of planned behavior. Women's Health Issues, 13, 222-228. doi: 10.1016/j.whi.2003.09.004

Tabong, P. T., & Adongo, P. B. (2013). Infertility and childlessness: A qualitative study of the experiences of infertile couples in Northern Ghana. BMC Pregnancy & Childbirth, 13:72. doi: 10.1186/1471-2393-13-72

Van Hooft, E. A. J., & De Jong, M. (2009). Predicting job seeking for temporary employment using the theory of planned behaviour: The moderating role of individualism and collectivism. Journal of Occupational and Organizational Psychology, 82, 295-316. doi: 10.1348/096317908X325322
Verhaak, C. M., Lintsen A. M. E., Evers, A. W. M., & Braat D. D. M. (2010). Who is at risk of emotional problems and how do you know? Screening of women going for IVF treatment. Human Reproduction, 25, 1234-1240

Wallace, A. M., Boyer, D. B., Dan, A., & Holm, K. (1986). Aerobic exercise, maternal self-esteem, and physical discomforts during pregnancy. Journal of Nurse-Midwifery, 31, 255-262. doi:10.1016/0091-2182(86)90034-0

White, M. (2004). Working with people who are suffering the consequences of multiple trauma: A narrative perspective. The International Journal of Narrative Therapy and Community Work, 1, 45-76.

Willig, C. (2008). Introducing qualitative research in psychology: Adventures in theory and method (2nd ed.). Buckingham: Open University Press.

Yardley, L. (2000). Dilemmas in qualitative health research. Psychology and Health, 15, 215-228. doi:10.1080/08870440008400302