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研究生:葉依婷
論文名稱:未使用人工生殖科技之長期難孕夫妻的困擾與因應方式
指導教授:賀孝銘賀孝銘引用關係
學位類別:碩士
校院名稱:國立彰化師範大學
系所名稱:輔導與諮商學系所
學門:社會及行為科學學門
學類:心理學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
中文關鍵詞:難孕困擾因應方式人工生殖科技
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本研究以未使用人工生殖科技之長期難孕夫妻的觀點,深入瞭解難孕所產生的困擾,以及針對難孕所採取的因應方式。本研究以質性研究中現象學研究法進行研究,並使用低結構訪談大綱,以深度訪談法蒐集研究所需資料。研究者以立意取樣的方式決定研究參與者的選取,難孕年數均超過五年、婚姻關係續存,且均在結束訪談前並未有任何使用人工生殖科技之決定,研究參與者與其伴侶均未有親生子女。本研究共收集三位難孕丈夫與三位難孕妻子的資料,研究者將記錄所得的資料依Colaizzi (1978)之質性研究分析法加以分析,並統整與歸類。研究結果如下:
一、未使用人工生殖科技之長期難孕者的困擾
(一)男性面臨無法完成自我認定的傳宗接代、香火繼承的角色任務、無法完成為人父的,以及無法完成自己身為丈夫,希望保護、照顧、與滿足妻子心願的自我期待;女性面臨無法完成滿足公婆心願、與無法完成為人母、無法完成讓丈夫為人父的自我期待。
(二)因長期難孕而感受多重失落所衍生的情緒,包含對付出心力卻始終難孕感到深層的無奈、因長期難孕而深感不確定、在長期難孕經驗中,不斷地經歷失望,並對生命中可能沒有兒女感到遺憾。
(三)年齡增加,被迫面臨生育功能或狀態的下降,與日後養育心力的負擔,包含擔憂年齡增加影響女性的懷孕率、母體與寶寶的身體健康受影響、配合排卵期行房體力的不足、掙扎於是否在女性更年期前更積極努力的抉擇中,以及擔憂生育後養育小孩的心力負荷。
(四)人際互動經驗,面臨未被理解、接受或支持的隔離感,包含被男方父母誤會故意不生育,或被建議採行無法接受的醫療或民俗求子方式,此外,與未有親屬關係的他人互動中,無法感受被理解與支持感。
(五)難孕經驗中,需溝通與調適的婚姻生活,包含因接受醫療檢查的態度不一致、因無法確定伴侶對小孩的渴望,而難以抉擇是否積極接受醫療檢查與協助,以及性生活失去自由與親密感。
(六)難孕檢查經驗感受各層面的自主權喪失,包含必須配合檢查而付出大量時間、精神與體力、身體界限被侵入與性行為自主權的喪失、造成女性生理的劇烈疼痛,以及使男性面臨無法幫助妻子減輕痛苦的無助感。
二、未使用人工生殖科技協助之長期難孕者的因應方式
(一)權衡處境,評估與確認難孕對自己的意義,包含分析為何沒有懷孕與使用人工生殖科技的利益與代價,思考是否調整因應方式,以及原先對於難孕或相關事件的認知或信念加以思考,並重整與確認難孕相關經驗中,對自己而言的價值優先順序,以拒絕使用人工生殖科技或作為對目前難孕處境或因應方式選擇的思考依據。
(二)為解決難孕與無子,付出努力,包含尋求書面、網路、友人或醫療人員對於懷孕相關訊息與忠告,增加因應難孕方式的選擇性、採行醫療、藥物、與食物協助及調整生活與性生活方式等各種助孕方式,以求順利解決難孕狀態,以及逐步發展與規劃無子的生活方式。
(三)維持內在情緒平衡,穩定自我控制感,包含逐步調整態度,或調整相關的認知、行動以調適情緒,維持內在平衡,而當出現一時難以調適的情緒時,會以哭泣與發脾氣宣洩情緒。

經由本研究之探究,得以瞭解未使用人工生殖科技之長期難孕者所面臨的困擾,以及面對困擾情境時所採取的因應方式,此有助於心理相關工作者對未使用人工生殖科技之長期難孕者的經驗內涵有所理解,並據以提供對難孕夫妻與其支持系統適切的心理照護建議。
The purpose of this study was to explore the the disturbance and coping strategy of long-term infertile couples, who do not use assisted reproductive technology. The researcher examined the data by the phenomenological method and qualitative analysis. The researcher selected participants by purposive sampling. Three infertile husbands and three infertile wives participated in this study. Data was analyzed by using Colaizzi’s control analysis. The major themes emerged as:
1. Disturbances in long-term infertile couples, who did not use assisted reproductive technology
(1)Infertile husbands need to face the self-identity of not having a son to carry on the family name and the role of not accomplishing the mission of the family, the inability to become a father, and the inability to fulfill the expectation of husbands to protect, take care of and satisfy their wives’ wishes. Infertile wives need to face the inability to fulfill the wishes of their husbands’ parents, to become mothers and accomplish the expectations of allowing their husbands to become fathers.
(2)Long term infertility produces emotions from multiple feelings of loss or disappointment, including a deep sense of helplessness arising from having made great efforts in vain, deep feelings of uncertainty, and regret at the thought of the possibility of never having a child, following a long series of repeated disappointments.
(3)With increasing age, the ability or condition of fertility is decreasing and the burden of the duty of nurture in later life is increasing. The burdens include the effects of the pregnancy rate on women of increasing age, the health of the mothers and babies, insufficient strength for sexual activities during the ovulation period, the hard decision about whether greater effort should be made before the coming of the menopause, and the mental burdens and concerns related to raising a child after a baby is born.
(4)Interpersonal relationship experiences would include the isolation from enigmatic, and unsupportive external sources, including the misunderstanding from the parents of the husband regarding one’s intentionally not having a child or being advised to undergo unacceptable medical or alternative treatments. Moreover, the couple may also experience a lack of understanding and support from the interactions with those outside the family.
(5)When experiencing infertility, marriage requires continuous communication and adaptation, and problems may include disagreement with receiving a medical check, the uncertainty of one partner’s desire to have a baby, the difficult decision making regarding whether the couple should actively receive a medical check and assisted reproductive technology, and the loss of freedom and intimacy in terms of one’s sexual life.
(6)The infertility test experiences are full of losses from various levels of decision-making rights, including the great amount of time and strength requires for medical checks, a sense of body invasion and the loss of decision-making regarding sexual activity, the great physiological pain of women, and the helplessness experienced by husbands due to their inability to reduce their partner’s pain.

2. Coping strategies in long-term infertile couples, who did not use assisted reproductive technology
(1)The meaning of balance among situations, evaluation and infertility confirmation for the couples, include the reason for the unpregnancy, the benefits and the costs of using assisted reproductive technology, assessing whether coping strategy requires some adjustments and the extra consideration of the original cognition or belief in infertility or related incidences . So, during the reconstruction and infertility confirmation experiences, the value priority for the couples can be a consideration reference for the present condition of infertility or coping strategic options.
(2)In order to solve the problems of infertility and childlessness, the efforts devoted to various fertility assistances include searching books, the internet, friends or medical staff for information and advice related to pregnancy, the increasing solution to infertility of various options, practical treatment, drugs, food supplements, and life and sexual activity adjustment. It is hoped that the infertility condition can be improved for progressive development and making a plan for a childless lifestyle.
(3)Retaining the balance of internal emotions, and stabilizing the sense of control, including the attitude of progressive modification, or adjusting the related cognition and activity, are required to tune the emotions and maintain an internal equilibrium. When a sudden uncontrollable emotion arises, it can be released by crying and throwing a tantrum.

The researcher also focuses on the findings from the interviews and makes theconclusion. Meanwhile, the researcher analyzes the discovery and tries to present the concrete suggestions for further studies and related practitioners.
目 錄

 中文摘要 ………………………………………………………………………i
 英文摘要 ………………………………………………………………… iii
 目錄 ……………………………………………………………………………v
 附錄次 …………………………………………………………………………vi
參考文獻 ………………………………………………………………………vi
 表次 ……………………………………………………………………………vi
 圖次 ……………………………………………………………………………vi

 第一章 緒論 …………………………………………………………………1
  第一節 研究動機……………………………………………………………1
  第二節 研究目的與問題 …………………………………………………9
  第三節 名詞釋義 …………………………………………………………9

第二章 文獻探討………………………………………………………………12
  第一節 難孕夫妻心理社會相關研究 ……………………………………12
  第二節 難孕夫妻的困擾相關研究 ………………………………………29
  第三節 難孕夫妻的因應方式相關研究 …………………………………50

第三章 研究方法………………………………………………………………67
  第一節 研究方法……………………………………………………………67
  第二節 參與研究者…………………………………………………………68
  第三節 研究工具……………………………………………………………75
  第四節 研究程序……………………………………………………………76
  第五節 資料整理與分析……………………………………………………78
  第六節 研究品質之檢核……………………………………………………81
第七節 研究限制 …………………………………………………………83

 第四章 研究結果與討論……………………………………………………85
  第一節 未使用人工生殖科技之長期難孕夫妻的困擾…………………85
  第二節 未使用人工生殖科技之長期難孕夫妻的因應方式……………133
  第三節 綜合分析與討論 ………………………………………………181
 
 第五章 研究結論與建議 …………………………………………………225
  第一節 研究結論 ………………………………………………………225
第二節 研究建議 …………………………………………………………233

參考文獻…………………………………………………………………………239
 一、中文部分…………………………………………………………………239
 二、英文部分…………………………………………………………………245
 
附錄次 ………………………………………………………………………256
 【附錄一】訪談同意書 ……………………………………………………256
 【附錄二】前導性研究之訪談大綱 ………………………………………257
 【附錄三】正式訪問之訪談大綱……………………………………………258
 【附錄四】訪談日誌…………………………………………………………259
 
表次
 表1-1 各國平均每位女性一生中產下的嬰兒數統計資料表………………1
 表1-2 台灣地區1998年到2004年人工生殖科技治療週期統計表……… 4
 表3-1 研究參與者基本資料…………………………………………………71
 表3-2 意義單元之判定………………………………………………………79
表3-3 主題與類別之判定……………………………………………………80
表4-1 未使用人工生殖科技之長期難孕夫妻的困擾………………………85
表4-2 未使用人工生殖科技之長期難孕夫妻的因應方……………………133

圖次
圖4-1 未使用人工生殖科技長期難孕者之困擾與因應方式的概念架構圖223
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