"The atomic bomb was my life"; the lived experience of mothers who became pregnant with assisted reproductive technology from their child's cancer

"The atomic bomb was my life"; the lived experience of mothers who became pregnant with assisted reproductive technology from their child's cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article "The atomic bomb was my life"; the lived experience of mothers who became pregnant with assisted reproductive technology from their child's cancer monir ramezani, malihe davoudi, elahe Ghayebie, Zahra Badiei This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6409232/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Having a child with cancer in a family that had a child with the help of assisted reproduction methods will be a different experience from other mothers. Therefore, this study was conducted to explain the lived experiences of mothers with children with cancer, which is the product of assisted reproductive methods. Methods: A phenomenological study was conducted with the participation of six mothers of children with cancer who were the product of assisted reproductive methods. The data were collected using semi-structured interviews and analyzed using MAXQDA software and Van Menen's approach. Results: 4 categories and eight subcategories (attacking the desire to become a mother: self-blame due to the desire to become a mother, hidden blame of others due to insisting on the experience of motherhood, regret arising from spirituality: regret for opposing divine providence, sadness caused by the place of divine testing with The child's illness, mourning the sufferings of the child and the family: discomfort of inflicting physical pain on the child, sadness of imposing financial problems on the family, fear of the future affected by cancer: fear of the child's death and non-recovery, fear of another illness) from the experience of this mothers were extracted. Conclusion: It seems that such mothers think that among the two options of forced motherhood and not motherhood; Contrary to God's will, they started having children, and they blame themselves for the child's illness. Therefore, it is recommended to provide more extensive and different support packages for these mothers. Assisted reproductive methods cancer child Background According to the World Health Organization, 10% of couples (1) suffer from infertility problems. Since infertility is a source of suffering for infertile couples, therefore, infertility can have destructive effects on the mental well-being (2). Therefore, couples look for assisted reproductive treatments to reduce the psychological burden of infertility. What should not be ignored are the concerns of more involvement of these children with health risks; as studies show, these children have a higher risk of premature birth, low birth weight and congenital anomalies (3, 4), premature birth and being smaller for their birth age (5). In this regard, Hargreave et al. (2019) observed a significant relationship between the use of the "frozen embryo transfer" method and the child's cancer (6). In addition, Wang et al. (2019) entitled "Chance of getting cancer among children born with assisted reproductive methods", confirmed the existence of a relationship between the use of assisted reproductive methods and the risk of getting cancer in children (7). In justifying these results, the researchers believe that it is probably due to the genetic changes caused by the use of drugs or reproductive methods or both (8) that cause changes in human eggs, placenta, umbilical cord blood or fetus (9). A child's cancer affects all family members, and family members experience a great emotional shock (10), meanwhile, the researchers' experience as a clinical nurse in the pediatric oncology department shows that mothers of children with cancer who were conceived using assisted reproductive methods have a different experience. However, in the researcher's search, no study was found that paid attention to the lived experience of this group of mothers. When the desired phenomenon is very little known and conceptualized, it is necessary to identify explain experiences with qualitative research methods (11). Phenomenology as a qualitative study has an effective role in clarifying unknown areas of human issues (12), which can reveal the possible meanings hidden in the experience. The assumption of phenomenology is that it leads us all to create a common sense with others (13). Therefore, this study was conducted using the phenomenological approach with the aim of discovering the meaning of child cancer based on the lived experience of mothers who were fertilized with assisted reproductive methods Methods Study design Due to the focus on lived experience, a qualitative phenomenological approach was chosen for this study, especially hermeneutic phenomenological approach and Van Manen's steps (14). Participants The entry criteria included mothers who have a child with cancer and the result of pregnancy using assisted reproductive methods, desire to participate and the ability to communicate with the interviewee. Sampling in this study was purposeful and with maximum diversity in terms of demographic variables. Six mothers were included in the study. Material A brochure containing the study objectives and how to implement it, a demographic information form for participants, and a consent form were prepared. Procedure The first author visited the pediatric oncology department. After reviewing the children's records, she approached mothers whose children were the product of a pregnancy through artificial assisted reproductive methods. She verbally explained the objectives and procedure of the study to them and provided them with a brochure containing the same information and contact information. The first author advised the mothers that if they agreed to participate in the study, they had three days to call her number and suggest a day and time they would like to be interviewed. After coordinating the day and time of the interview, the first author visited the care department at the appointed time. A demographic information questionnaire and an informed consent form were prepared for each participant. Then the interview began. One-on-one, semi-structured interviews were conducted in 2022-2023. This study was conducted in the oncology department. This department is the only pediatric oncology center in Mashhad, including 32 beds and five to six nurses in each shift who provide care to children and teenagers up to 18 years old. Patients from nearby cities also visit this center. Then, semi-structured interviews that lasted from 50 to 95 minutes were conducted. The interview questions were designed in two parts: general and in-depth questions. General questions like "How did you find out about your child's illness?" "How did you feel when you were told that your child has cancer?", "What did you do after the diagnosis of the disease?" What is the experience of "having a child with cancer after undergoing infertility treatment" like? They were(Interview protocol). During the interview, according to the participants' answers to obtain more details until the experience was completely described, the interviewers used the in-depth questions "What do you mean?" On the other hand "Please explain more" or "Could you give an example so that I can better understand what you mean?" used. The recorded interviews were transcribed verbatim on the same day. Sampling continued until no new data was added to the codes. In total, 10 interviews were conducted with six participants. Ethics approval and consent to participate This study was conducted with the approval of the Ethics Committee of Mashhad University of Medical Sciences. This study was carried out in accordance with the Declaration of Helsinki. All participants were informed about the purpose and type of study. Then, written informed consent was obtained Verbal consent was also obtained during the interview sessions. The participants were assured that their identity would remain confidential and the data would be published anonymously. Recorded audio files were deleted immediately after conversion to text. Participants were reminded of their right to withdraw. All participants provided informed and explicit consent to have the interviews recorded. Data analysis MAXQDA software was used to facilitate data management. Van Menen (2011) utilizes three approaches, holistic and selective, and provides detailed approaches for topic extraction (14). In the holistic approach, the researcher considers the text as a whole and seeks to find the full meaning of the text. Therefore, the Second and third researcher repeatedly read the text of each interview. Then they interpreted the answers of the participants and the texts and immersed themselves in the data. Finally, they expressed the general impression of the texts in one or more sentences. In the selective approach, the researchers selected sentences or phrases that clarified the target phenomenon and extracted the thematic phrase. In the detailed approach, the text was read line by line and the phrases related to the desired phenomenon were extracted. After extracting thematic phrases, similarities and relationships were identified by comparing the content of each interview with previous interviews. Based on this, the themes were then classified into theme clusters, which were merged based on their relationships. Then sub-themes emerged, which were also combined based on the relationships between cluster themes. Sub-themes were merged based on their relationship and themes were created eventually. Trustworthiness of the date Trustworthiness of the date was confirmed via the credibility, dependability, confirmability, and transferability criteria presented by Lincoln and Guba. To increase the credibility of the data; the guide for the surveyors was designed using studies and dialogue between the members of the research team. On the other hand, in order to increase the validity of the data, it was tried to observe the maximum diversity in the sampling, so that mothers who had passed a significant period since their child was diagnosed with cancer (more than six months) were included in the study. On the other hand, the researcher-interviewer was present in the research environment for more than a year, established a friendly relationship with the participants, and gained their trust, and the participants were attracted to share their experiences. On the other hand, to help the validity of the study, the descriptive summaries and categories extracted by the participants were reviewed. To ensure dependability, the researchers kept audit trails. For this purpose, the process of data analysis, extraction of categories and sub-categories is presented in detail in the text of the article. On the other hand, an external auditor who was highly proficient in the field of qualitative studies, especially hermeneutic phenomenology, evaluated and confirmed the interview transcript and the coding process, extraction of sub-categories and categories. In terms of transferability, extensive explanations of the context and findings were presented in detail. Results Mothers between the ages of 28 and 46 were included in the study. Their children were between two and seven years old. All mothers were homemakers. Finally, by analyzing the data, four categories and eight subcategories (the category of attack on the desire to become a mother: self-blame due to the desire to become a mother, the hidden blame of others due to insisting on the experience of motherhood, the category of regret arising from spirituality: regret for opposing the divine will, grief Caused by the place of being tested by God with the child's illness, the category of mourning the sufferings of the child and the family: discomfort of inflicting physical pain on the child, grief of imposing financial problems on the family, the category of fear of the future affected by cancer: fear of the child's death and non-recovery, fear of Other diseases) were obtained. 1. Attacking the desire to become a mother: This theme indicates that part of the experience of these mothers includes self-blame, which is due to their efforts to give birth to a child, and has led to the experience of suffering from illness in the child. Because they believe that by prioritizing their feelings and interests, they have provided the ground for the child's illness and suffering. They expressed that in order to escape stigma, enjoy motherhood, or equalize themselves with other women who have no experience of infertility, they sought to satisfy the need to have children and became the source of harm to a child with an incurable disease. " My daughter was born because of my selfishness. If I was not selfish, if I did not want to be a mother, this child would not be bothered like this" (Mother No. 1). Some of these mothers consider the people around them to be guilty in this matter because they believe that their insistence on having children or the occurrence of negative feedback from their side has inevitably pushed these mothers in the direction of trying to have children with the use of artificial methods and as a result of these efforts, the child is faced with the suffering of disease. "Now I always have a guilty conscience about why I gave birth to him so that he would get sick. Now that my son is sick, I wish I had not gone for in vitro fertilization (IVF), I wish I had not gone for treatment. I am very sad for him; I cannot forgive myself" (Mother No. 3). 2. Regret arising from spirituality: This theme means experiencing the feeling of remorse that this group of mothers perceives as arising from not being in harmony with God's will to get pregnant. They expressed this feeling with words such as being punished by God for fighting the will of God's power or being tested again by him. Such mothers believed that their insistence on having a child and using artificial methods caused God to punish them, and this punishment was the child's cancer. In fact, they considered the child's illness to be their own punishment for fighting God's will. " God did not give me a child because he knew something I did not, but I took it by force. When you ask God for something by force…Now I always say I wish I did not do IVF, I say maybe it is because of IVF that I got such a bad disease, I say if I had conceived naturally, I would not have gotten this disease”. (Mother No. 3) In an objective conversation with peer mothers, they find the root of the child's cancer in the experience related to artificial fertility, and they conclude that this disease is the result of these artificial techniques. I always say that God did not want me to have a child; but I went to look for medicine and treatment, maybe these are the side effects of the ... They talk to mothers who are like me, and they also say that it is one of the side effects of IVF (Mother No. 4). Another part of mothers also believe that their child's illness exposed them to God's test; thus, they feel regret that they have exposed themselves to this test again. "I always say that God saw how much I was bothered to have a child. I say, God, after six years and all, you gave me the treatment, why did you give me what you wanted to give me? What kind of test is this? If it is a test, why are you testing it with my child, when you did it once?" You tested me for the sake of the child that is enough" (Mother No. 2). 3. Mourning the sufferings of the child and the family: This theme highlights the grief of mothers after witnessing the suffering and pain of the child (during therapeutic procedures) and the family. In fact, such mothers are psychologically under more pressure than the child endures aggressive cancer treatments because they believe that they are responsible for the child's pain. Because they were the ones who gave birth to the child using artificial reproductive methods. While the child had no existence and nature to experience pain without these efforts. Regret and self-blame are abundantly seen in these mothers. In this regard, one of the participants explained as follows: When I started chemotherapy, it was the worst, with every needle I was in, I was very sick. I could not bear the baby's needles and IV line. I could not bear the distilled water that the child screamed. I used to go out like this, I would put my scarf in my mouth and scream, I would not have gone, I wish I had not done it, so that it would not have bothered us, and we could breathe easily after all that difficulty. I have no breath left; to continue (Mother No. 4). Among other sources of suffering for this group of mothers, like other mothers whose children are the result of a natural pregnancy, is the experience of financial pressure on the family. Nevertheless, despite this similarity, it seems that the quality of this tension is more than the mothers of the second group. Because this group of families has gone through additional expenses for pregnancy and childbirth, and their financial resources may have been exhausted and they do not have enough assets to meet the treatment and care needs of the child. "An atomic bomb fell into life, it means to live, which means it was destroyed. Emotionally, Mali ruined everything; it was razed to the ground" (Mother No. 5). 4. Fear of the future affected by cancer: Some of the mothers participating in the study stated that during the process of dealing with the diagnosis and treatment of the child, they constantly reviewed the bitter experience of trying to get pregnant, and this issue imposed additional bitterness on them. In fact, this group of mothers live in two painful worlds at the same time. A mental world centered on the past full of sad memories of infertility leads to an increase in the sense of belonging to the child. The other is living in the outside world, which is surrounded by the suffering of having a child who was conceived with difficulty, and the result of living in this world is the fear of losing the child and the ineffectiveness of treatments. " I did not get this baby, I had a hard time having a baby and it is very precious to me. The whole path of infertility treatment was in front of my eyes. Now my only fear is that the treatments will be useless and I will not have it anymore" (Mother No. 1). Among this group of mothers, those who have twins or multiple children have different fears about the future. They admit that one of the sources of their fear and panic about the future is the fear of contracting "another disease", which forces them to follow up diligently and meticulously. "Sometimes I am afraid; I am afraid that God will sit and see what I am doing with Fatima (one IVF cycle) and then go to Muhammad (the second IVF cycle) and he will get sick too. My son says, oh dear, I am doing a full check-up because I am afraid" (Mother No. 5). Discussion This study examined the meaning of having a child with cancer among mothers who became pregnant through assisted reproductive methods. The meaning of having a child with cancer in the mothers who participated in this study includes four categories: attack on the desire to become a mother, regret arising from spirituality, mourning the sufferings of the child and family, and fear of the future affected by cancer. These findings are consistent with the results of other studies in the field of the lived experience of mothers with children with cancer; however, the meaning of the lived experience of these two groups of mothers has differences in some cases. The points of similarity in the meaning of the experience include guilt, imagining the child's imminent death, being punished or tested by God, suffering caused by the child's suffering during treatment procedures, economic pressure (15, 16), changes in family processes (15, 16), and concern for the healthy child (17). In this regard, Naidoo et al. (2016) also reported that African mothers of children with cancer felt that they caused the disease. In addition, these women also felt that they were being punished (18). In addition, in another part of the similarities between the experiences of these two groups of mothers, this was consistent with the literature that showed that parents are prone to feelings of helplessness, fear, stress and despair in response to the unpredictable nature of cancer (18). Similarly, one study explained that parental uncertainty in childhood cancer was associated with persistent fear of consequences such as recurrence or death (19). As mentioned, despite this similarity, the sources of suffering in these two groups of mothers are different, which means that they believe that their continuous efforts to get pregnant and satisfy the instinct of desire to have children, which the insistence and insistence of others, were not without effect. Caused the birth of a child who lived a life full of incurable disease, suffered from its consequences such as experiencing painful treatment procedures and did not face the family with a double financial crisis. In addition, in another part of the basis of this suffering, they consider the child's illness as a punishment and punishment for their possible behaviors and mistakes, as well as the product of the negative effects of assisted reproduction techniques, as a means of opposing God's providence. Because they think, they have entered a path other than God's will. This distinctive point in the experience of this group of mothers is more visible compared to the results of a meta-analysis study: Pai et al. (2007) found that mothers with children with cancer experience guilt, with the difference that many of them attribute it to disability. In protecting their children from the suffering caused by illness, they attribute it (20). In addition, another study showed that part of this feeling is because mothers felt that they were neglecting their family members at home and had put the sick child as their priority (18). These differences are the result of the difference in the field of studies, which is not far from expected (mothers with children with cancer because of artificial pregnancy methods versus mothers with children with cancer because of a natural pregnancy). Another part of the different findings of this study emphasizes that the financial burden caused by treatment for such families may be more than other families. Because this group of families has the experience of spending money for pregnancy and the needs after it and the depletion of the family's economic resources in the back of their lives, and therefore they experience more financial issues and knots, which is also a potential source. It can be considered to create or strengthen feelings of guilt and self-blame in mothers. Overall, the results of this study revealed that the context of "getting pregnant using assisted pregnancy methods" could have a visible impact on the meaning of mothers' experience of having a child with cancer. It seems that this group of mothers reviews the experiences and the time course of the child from the mother's desire and efforts for his birth to "now" when the disease and its suffering are involved and evaluates the effects of the actions on the child and the family. In following this trajectory, she concludes that the main cause of the child and family's illness and suffering is actually "the mother herself". Because she interprets this way that while she could choose from two options "to become a mother, which was her desire of the heart, and not to become a mother, which was the will of God", she surrendered to God's will, but she defiantly chose the option of becoming a mother and giving priority to her need to become a mother has selfishly fought against God's destiny and will, so the consequence of such self-centeredness and stubbornness has been the child's incurable illness and its personal and family consequences. Strengths and limitations One of the strengths of this study is that this study examines the experience of this group of mothers for the first time, and searches conducted by researchers indicate that there is no study in domestic and foreign sources. It is also the first study to examine this phenomenon with a qualitative approach. Using a qualitative design allowed us to gain deep and nuanced insight into a complex topic. Two researchers independently coded the transcripts and ensured that the process was validated. In addition, member review of the results improved the quality of the study by increasing credibility. However, like other qualitative studies, this study has limitations, such as the fact that it is not generalizable, and due to the lack of a similar study, the authors are unable to compare its results with the results of other studies conducted on the same phenomenon and the same group of participants were not taken. Regardless, this study increases our understanding of the information needs for improving menstrual health literacy. Implications for practice and policy It is important for specialist careers to individualize care for their clients. The first step towards this goal is to listen to their voices, which will lead to an understanding of their experiences and needs. This will help to improve quality care for the child with cancer and their family careers. At the policy level, it is recommended that specific support pathways be designed for this group of mothers in pediatric oncology care settings. Conclusion Based on the obtained results, the perception of mothers with a child with cancer as a product of an assisted reproductive method is a disturbed perception because their experience of this phenomenon is derived from their experience of being infertile and this casts a shadow on their current experience. These findings reveal that these mothers do not have enough knowledge to understand that this is not the etiology of cancer. These destructive and disturbed feelings have prevented mothers from communicating and directly interacting with the medical staff, and this keeps the current state of lack of knowledge and insight about cancer. In addition, this group of mothers, who are actually self-accused, may behave inappropriately, and inadequately, and this problem will create a disturbance in the care of the child, who needs the mother's care. Therefore, it is suggested that nurses, pay more attention and continue to educate this group of mothers to find a correct understanding of the nature and because of their child's illness. In addition, it is necessary to provide these families with more special facilities in the field of financial support. Declarations Ethics approval and consent to participate This study was conducted with the approval of the Ethics Committee of Mashhad University of Medical Sciences. All participants were informed about the purpose and type of study. Then, written informed consent was obtained. The place and time of the interview and the time of completion of the interview were at the discretion of the participants. The participants were assured that their identity would remain confidential and the data would be published anonymously. Recorded audio files were deleted immediately after conversion to text. Consent for publication Not applicable Availability of data and materials The dataset generated and analyzed during the current study is not publicly available due to the sensitive nature of qualitative interview data. Competing Interests There is no conflict of interest Funding This study was financially supported by the Vice-Chancellor for Research, Mashhad University of Medical Sciences. Authors' contributions Conceptualization and study design, data collection: E GH data analysis and interpretation: EGH., MD Preparing the draft of the article: EGH., MD revising: All authors Final approval of the manuscript before sending it to the journal: All authors Acknowledgements The authors thank all those who helped us in the implementation of this research, especially the mothers who told us their experiences. References Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Human reproduction. 2007;22(6):1506-12. Assaysh-Öberg S, Borneskog C, Ternström E. Women's experience of infertility & treatment–A silent grief and failed care and support. Sexual & reproductive healthcare. 2023 :1;37:100879. Davies M, Moore V, Willson K, Van Essen P, Priest K, Scott H. Chan, A.(2012). 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Investigating Supportive Care Needs of Parents of Children with Cancer: Is a Parent Support Group Intervention a Feasible Solution? 2012. Pai AL, Greenley RN, Lewandowski A, Drotar D, Youngstrom E, Peterson CC. A meta-analytic review of the influence of pediatric cancer on parent and family functioning. Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43). 2007;21(3):407-15. Additional Declarations No competing interests reported. Supplementary Files Interviewprotocol.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6409232","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":451937044,"identity":"63e68139-e265-4812-aa0d-5b6eb3b14c72","order_by":0,"name":"monir ramezani","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"monir","middleName":"","lastName":"ramezani","suffix":""},{"id":451937050,"identity":"52fb401a-f9b6-4988-a0da-b6356e31a804","order_by":1,"name":"malihe davoudi","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"malihe","middleName":"","lastName":"davoudi","suffix":""},{"id":451937054,"identity":"bd9ab3ea-6e2e-4fdd-86ae-68cc5ed52957","order_by":2,"name":"elahe Ghayebie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYDACCQYGZgYDBgZ+uAgzsVokG0jTAgQGB4h1l3x088PHBQXb5IyvnTHd+IPBTp6BnfcBXi2Gd44ZG88wuG1sdjvH7DYPQ7JhAzO7AX4tMxLMpHkMbiduA2kBOjKBgZkNv8MMZ6R//w3UUr95do7ZzR8M9YS1yEvkmDEDtSQYSOeY3eBhOExYi4FETrE00C+GM26nld3mMThu2EbQlhnpGz8X/Lktzz87edvNHxXV8vz8xwjYcgCVy8BAwA6gLQ2EVIyCUTAKRsEoAABsWD1XsCDimQAAAABJRU5ErkJggg==","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"elahe","middleName":"","lastName":"Ghayebie","suffix":""},{"id":451937056,"identity":"46501f01-ee0f-4e16-9571-057335de9cc4","order_by":3,"name":"Zahra Badiei","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Zahra","middleName":"","lastName":"Badiei","suffix":""}],"badges":[],"createdAt":"2025-04-09 07:38:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6409232/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6409232/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85192821,"identity":"109f6b9f-efbd-4f71-83ab-b774b2019ce3","added_by":"auto","created_at":"2025-06-23 09:02:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":564640,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6409232/v1/26fcbb8f-8749-4354-ac81-441376e03dd3.pdf"},{"id":82195523,"identity":"2b4d33c9-b8e5-4f40-912e-872c4061cf20","added_by":"auto","created_at":"2025-05-07 14:57:24","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":13206,"visible":true,"origin":"","legend":"","description":"","filename":"Interviewprotocol.docx","url":"https://assets-eu.researchsquare.com/files/rs-6409232/v1/a9cfd5ce4c3aefb6d64297a7.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\"The atomic bomb was my life\"; the lived experience of mothers who became pregnant with assisted reproductive technology from their child's cancer","fulltext":[{"header":"Background","content":"\u003cp\u003eAccording to the World Health Organization, 10% of couples (1) suffer from infertility problems. Since infertility is a source of suffering for infertile couples, therefore, infertility can have destructive effects on the mental well-being (2).\u0026nbsp;Therefore, couples look for assisted reproductive treatments to reduce the psychological burden of infertility. What should not be ignored are the concerns of more involvement of these children with health risks; as studies show, these children have a higher risk of premature birth, low birth weight and congenital anomalies (3, 4), premature birth and being smaller for their birth age (5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this regard, Hargreave et al. (2019) observed a significant relationship between the use of the \"frozen embryo transfer\" method and the child's cancer (6). In addition, Wang et al. (2019) \u0026nbsp; entitled \"Chance of getting cancer among children born with assisted reproductive methods\", confirmed the existence of a relationship between the use of assisted reproductive methods and the risk of getting cancer in children (7). In justifying these results, the researchers believe that it is probably due to the genetic changes caused by the use of drugs or reproductive methods or both (8) that cause changes in human eggs, placenta, umbilical cord blood or fetus (9). A child's cancer affects all family members, and family members experience a great emotional shock (10), meanwhile, the researchers' experience as a clinical nurse in the pediatric oncology department shows that mothers of children with cancer who were conceived using assisted reproductive methods have a different experience. However, in the researcher's search, no study was found that paid attention to the lived experience of this group of mothers.\u003c/p\u003e\n\u003cp\u003eWhen the desired phenomenon is very little known and conceptualized, it is necessary to identify explain experiences with qualitative research methods (11). Phenomenology as a qualitative study has an effective role in clarifying unknown areas of human issues (12), which can reveal the possible meanings hidden in the experience. The assumption of phenomenology is that it leads us all to create a common sense with others\u0026nbsp;(13). Therefore, this study was conducted using the phenomenological approach with the aim of discovering the meaning of child cancer based on the lived experience of mothers who were fertilized with assisted reproductive methods\u0026nbsp;\u003c/p\u003e"},{"header":" Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the focus on lived experience, a qualitative phenomenological approach was chosen for this study, especially hermeneutic phenomenological approach and Van Manen's steps (14).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe entry criteria included mothers who have a child with cancer and the result of pregnancy using assisted reproductive methods, desire to participate and the ability to communicate with the interviewee. Sampling in this study was purposeful and with maximum diversity in terms of demographic variables.\u0026nbsp;Six mothers were included in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterial\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA brochure containing the study objectives and how to implement it, a demographic information form for participants, and a consent form were prepared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe first author visited the pediatric oncology department. After reviewing the children's records, she approached mothers whose children were the product of a pregnancy through artificial assisted reproductive methods. She verbally explained the objectives and procedure of the study to them and provided them with a brochure containing the same information and contact information. The first author advised the mothers that if they agreed to participate in the study, they had three days to call her number and suggest a day and time they would like to be interviewed. After coordinating the day and time of the interview, the first author visited the care department at the appointed time. A demographic information questionnaire and an informed consent form were prepared for each participant. Then the interview began. One-on-one, semi-structured interviews were conducted in 2022-2023.\u003c/p\u003e\n\u003cp\u003eThis study was conducted in the oncology department. This department is the only pediatric oncology center in Mashhad, including 32 beds and five to six nurses in each shift who provide care to children and teenagers up to 18 years old. \u0026nbsp;Patients from nearby cities also visit this center.\u003c/p\u003e\n\u003cp\u003eThen, semi-structured interviews that lasted from 50 to 95 minutes were conducted. The interview questions were designed in two parts: general and in-depth questions. General questions like \"How did you find out about your child's illness?\" \"How did you feel when you were told that your child has cancer?\", \"What did you do after the diagnosis of the disease?\" What is the experience of \"having a child with cancer after undergoing infertility treatment\" like? They were(Interview protocol). During the interview, according to the participants' answers to obtain more details until the experience was completely described, the interviewers used the in-depth questions \"What do you mean?\" On the other hand \"Please explain more\" or \"Could you give an example so that I can better understand what you mean?\" used. The recorded interviews were transcribed verbatim on the same day. Sampling continued until no new data was added to the codes. In total, 10 interviews were conducted with six participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted with the approval of the Ethics Committee of Mashhad University of Medical Sciences. This study was carried out in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eAll participants were informed about the purpose and type of study. Then, written informed consent was obtained Verbal consent was also obtained during the interview sessions. The participants were assured that their identity would remain confidential and the data would be published anonymously. Recorded audio files were deleted immediately after conversion to text. Participants were reminded of their right to withdraw. All participants provided informed and explicit consent to have the interviews recorded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;MAXQDA software was used to facilitate data management. Van Menen (2011) utilizes three approaches, holistic and selective, and provides detailed approaches for topic extraction (14). In the holistic approach, the researcher considers the text as a whole and seeks to find the full meaning of the text. Therefore, the Second and third researcher\u0026nbsp;repeatedly read the text of each interview. Then they interpreted the answers of the participants and the texts and immersed themselves in the data. Finally, they expressed the general impression of the texts in one or more sentences. In the selective approach, the researchers selected sentences or phrases that clarified the target phenomenon and extracted the thematic phrase. In the detailed approach, the text was read line by line and the phrases related to the desired phenomenon were extracted. After extracting thematic phrases, similarities and relationships were identified by comparing the content of each interview with previous interviews. Based on this, the themes were then classified into theme clusters, which were merged based on their relationships. Then sub-themes emerged, which were also combined based on the relationships between cluster themes. Sub-themes were merged based on their relationship and themes were created eventually.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrustworthiness of the date\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTrustworthiness of the date was confirmed via the credibility, dependability, confirmability, and transferability criteria presented by Lincoln and Guba. To increase the credibility of the data; the guide for the surveyors was designed using studies and dialogue between the members of the research team. On the other hand, in order to increase the validity of the data, it was tried to observe the maximum diversity in the sampling, so that mothers who had passed a significant period since their child was diagnosed with cancer (more than six months) were included in the study. On the other hand, the researcher-interviewer was present in the research environment for more than a year, established a friendly relationship with the participants, and gained their trust, and the participants were attracted to share their experiences. On the other hand, to help the validity of the study, the descriptive summaries and categories extracted by the participants were reviewed. To ensure dependability, the researchers kept audit trails. For this purpose, the process of data analysis, extraction of categories and sub-categories is presented in detail in the text of the article. On the other hand, an external auditor who was highly proficient in the field of qualitative studies, especially hermeneutic phenomenology, evaluated and confirmed the interview transcript and the coding process, extraction of sub-categories and categories. In terms of transferability, extensive explanations of the context and findings were presented in detail.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eMothers between the ages of 28 and 46 were included in the study. Their children were between two and seven years old. All mothers were homemakers.\u0026nbsp;Finally, by analyzing the data, four categories and eight subcategories (the category of attack on the desire to become a mother: self-blame due to the desire to become a mother, the hidden blame of others due to insisting on the experience of motherhood, the category of regret arising from spirituality: regret for opposing the divine will, grief Caused by the place of being tested by God with the child's illness, the category of mourning the sufferings of the child and the family: discomfort of inflicting physical pain on the child, grief of imposing financial problems on the family, the category of fear of the future affected by cancer: fear of the child's death and non-recovery, fear of Other diseases) were obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.\u0026nbsp;Attacking the desire to become a mother:\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis theme indicates that part of the experience of these mothers includes self-blame, which is due to their efforts to give birth to a child, and has led to the experience of suffering from illness in the child. \u0026nbsp;Because they believe that by prioritizing their feelings and interests, they have provided the ground for the child's illness and suffering. They expressed that in order to escape stigma, enjoy motherhood, or equalize themselves with other women who have no experience of infertility, they sought to satisfy the need to have children and became the source of harm to a child with an incurable disease. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\"\u003cem\u003eMy daughter was born because of my selfishness. If I was not selfish, if I did not want to be a mother, this child would not be bothered like this\" (Mother No. 1).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSome of these mothers consider the people around them to be guilty in this matter because they believe that their insistence on having children or the occurrence of negative feedback from their side has inevitably pushed these mothers in the direction of trying to have children with the use of artificial methods and as a result of these efforts, the child is faced with the suffering of disease. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"Now I always have a guilty conscience about why I gave birth to him so that he would get sick. Now that my son is sick, I wish I had not gone for in vitro fertilization (IVF), I wish I had not gone for treatment. I am very sad for him; I cannot forgive myself\" (Mother No. 3).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.\u0026nbsp;Regret arising from spirituality:\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis theme means experiencing the feeling of remorse that this group of mothers perceives as arising from not being in harmony with God's will to get pregnant. They expressed this feeling with words such as being punished by God for fighting the will of God's power or being tested again by him.\u003c/p\u003e\n\u003cp\u003eSuch mothers believed that their insistence on having a child and using artificial methods caused God to punish them, and this punishment was the child's cancer. In fact, they considered the child's illness to be their own punishment for fighting God's will. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"\u003c/em\u003e\u003cem\u003eGod did not give me a child because he knew something I did not, but I took it by force. When you ask God for something by force…Now I always say I wish I did not do IVF, I say maybe it is because of IVF that I got such a bad disease, I say if I had conceived naturally, I would not have gotten this disease”. (Mother No. 3)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn an objective conversation with peer mothers, they find the root of the child's cancer in the experience related to artificial fertility, and they conclude that this disease is the result of these artificial techniques.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI always say that God did not want me to have a child; but I went to look for medicine and treatment, maybe these are the side effects of the ... They talk to mothers who are like me, and they also say that it is one of the side effects of IVF (Mother No. 4).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother part of mothers also believe that their child's illness exposed them to God's test; thus, they feel regret that they have exposed themselves to this test again.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"I always say that God saw how much I was bothered to have a child. I say, God, after six years and all, you gave me the treatment, why did you give me what you wanted to give me? What kind of test is this? If it is a test, why are you testing it with my child, when you did it once?\" You tested me for the sake of the child that is enough\" (Mother No. 2).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Mourning the sufferings of the child and the family:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme highlights the grief of mothers after witnessing the suffering and pain of the child (during therapeutic procedures) and the family. In fact, such mothers are psychologically under more pressure than the child endures aggressive cancer treatments because they believe that they are responsible for the child's pain. Because they were the ones who gave birth to the child using artificial reproductive methods. While the child had no existence and nature to experience pain without these efforts. Regret and self-blame are abundantly seen in these mothers. In this regard, one of the participants explained as follows:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWhen I started chemotherapy, it was the worst, with every needle I was in, I was very sick. I could not bear the baby's needles and IV line. I could not bear the distilled water that the child screamed. I used to go out like this, I would put my scarf in my mouth and scream, I would not have gone, I wish I had not done it, so that it would not have bothered us, and we could breathe easily after all that difficulty. I have no breath left; to continue (Mother No. 4).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAmong other sources of suffering for this group of mothers, like other mothers whose children are the result of a natural pregnancy, is the experience of financial pressure on the family. Nevertheless, despite this similarity, it seems that the quality of this tension is more than the mothers of the second group. Because this group of families has gone through additional expenses for pregnancy and childbirth, and their financial resources may have been exhausted and they do not have enough assets to meet the treatment and care needs of the child.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"An atomic bomb fell into life, it means to live,\u0026nbsp;\u003c/em\u003ewhich \u003cem\u003emeans it was destroyed. Emotionally, Mali ruined everything; it was razed to the ground\" (Mother No. 5).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Fear of the future affected by cancer: \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome of the mothers participating in the study stated that during the process of dealing with the diagnosis and treatment of the child, they constantly reviewed the bitter experience of trying to get pregnant, and this issue imposed additional bitterness on them. In fact, this group of mothers live in two painful worlds at the same time. A mental world centered on the past full of sad memories of infertility leads to an increase in the sense of belonging to the child. The other is living in the outside world, which is surrounded by the suffering of having a child who was conceived with difficulty, and the result of living in this world is the fear of losing the child and the ineffectiveness of treatments.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"\u003c/em\u003e\u003cem\u003eI did not get this baby, I had a hard time having a baby and it is very precious to me. The whole path of infertility treatment was in front of my eyes. Now my only fear is that the treatments will be useless and I will not have it anymore\" (Mother No. 1).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAmong this group of mothers, those who have twins or multiple children have different fears about the future. They admit that one of the sources of their fear and panic about the future is the fear of contracting \"another disease\", which forces them to follow up diligently and meticulously.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"Sometimes I am afraid; I am afraid that God will sit and see what I am doing with Fatima (one IVF cycle) and then go to Muhammad (the second IVF cycle) and he will get sick too. My son says, oh dear, I am doing a full check-up because I am afraid\" (Mother No. 5).\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined the meaning of having a child with cancer among mothers who became pregnant through assisted reproductive methods. The meaning of having a child with cancer in the mothers who participated in this study includes four categories: attack on the desire to become a mother, regret arising from spirituality, mourning the sufferings of the child and family, and fear of the future affected by cancer.\u003c/p\u003e\n\u003cp\u003eThese findings are consistent with the results of other studies in the field of the lived experience of mothers with children with cancer; however, the meaning of the lived experience of these two groups of mothers has differences in some cases. The points of similarity in the meaning of the experience include guilt, imagining the child's imminent death, being punished or tested by God, suffering caused by the child's suffering during treatment procedures, economic pressure (15, 16), changes in family processes (15, 16), and concern for the healthy child (17). In this regard, Naidoo et al. (2016) also reported that African mothers of children with cancer felt that they caused the disease. In addition, these women also felt that they were being punished (18). In addition, in another part of the similarities between the experiences of these two groups of mothers, this was consistent with the literature that showed that parents are prone to feelings of helplessness, fear, stress and despair in response to the unpredictable nature of cancer (18). Similarly, one study explained that parental uncertainty in childhood cancer was associated with persistent fear of consequences such as recurrence or death (19).\u003c/p\u003e\n\u003cp\u003eAs mentioned, despite this similarity, the sources of suffering in these two groups of mothers are different, which means that they believe that their continuous efforts to get pregnant and satisfy the instinct of desire to have children, which the insistence and insistence of others, were not without effect. Caused the birth of a child who lived a life full of incurable disease, suffered from its consequences such as experiencing painful treatment procedures and did not face the family with a double financial crisis. In addition, in another part of the basis of this suffering, they consider the child's illness as a punishment and punishment for their possible behaviors and mistakes, as well as the product of the negative effects of assisted reproduction techniques, as a means of opposing God's providence. Because they think, they have entered a path other than God's will. This distinctive point in the experience of this group of mothers is more visible compared to the results of a meta-analysis study: Pai et al. (2007) found that mothers with children with cancer experience guilt, with the difference that many of them attribute it to disability. In protecting their children from the suffering caused by illness, they attribute it (20). In addition, another study showed that part of this feeling is because mothers felt that they were neglecting their family members at home and had put the sick child as their priority (18). These differences are the result of the difference in the field of studies, which is not far from expected (mothers with children with cancer because of artificial pregnancy methods versus mothers with children with cancer because of a natural pregnancy).\u003c/p\u003e\n\u003cp\u003eAnother part of the different findings of this study emphasizes that the financial burden caused by treatment for such families may be more than other families. Because this group of families has the experience of spending money for pregnancy and the needs after it and the depletion of the family's economic resources in the back of their lives, and therefore they experience more financial issues and knots, which is also a potential source. It can be considered to create or strengthen feelings of guilt and self-blame in mothers.\u003c/p\u003e\n\u003cp\u003eOverall, the results of this study revealed that the context of \"getting pregnant using assisted pregnancy methods\" could have a visible impact on the meaning of mothers' experience of having a child with cancer. It seems that this group of mothers reviews the experiences and the time course of the child from the mother's desire and efforts for his birth to \"now\" when the disease and its suffering are involved and evaluates the effects of the actions on the child and the family. In following this trajectory, she concludes that the main cause of the child and family's illness and suffering is actually \"the mother herself\". Because she interprets this way that while she could choose from two options \"to become a mother, which was her\u0026nbsp;desire of the heart, and not to become a mother, which was the will of God\", she surrendered to God's will, but she defiantly chose the option of becoming a mother and giving priority to her need to become a mother has selfishly fought against God's destiny and will, so the consequence of such self-centeredness and stubbornness has been the child's incurable illness and its personal and family consequences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne of the strengths of this study is that this study examines the experience of this group of mothers for the first time, and searches conducted by researchers indicate that there is no study in domestic and foreign sources. It is also the first study to examine this phenomenon with a qualitative approach. Using a qualitative design allowed us to gain deep and nuanced insight into a complex topic. Two researchers independently coded the transcripts and ensured that the process was validated. In addition, member review of the results improved the quality of the study by increasing credibility. However, like other qualitative studies, this study has limitations, such as the fact that it is not generalizable, and due to the lack of a similar study, the authors are unable to compare its results with the results of other studies conducted on the same phenomenon and the same group of participants were not taken. Regardless, this study increases our understanding of the information needs for improving menstrual health literacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for practice and policy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt is important for specialist careers to individualize care for their clients. The first step towards this goal is to listen to their voices, which will lead to an understanding of their experiences and needs. This will help to improve quality care for the child with cancer and their family careers. At the policy level, it is recommended that specific support pathways be designed for this group of mothers in pediatric oncology care settings.\u003c/p\u003e\n\n"},{"header":"Conclusion","content":"\u003cp\u003eBased on the obtained results, the perception of mothers with a child with cancer as a product of an assisted reproductive method is a disturbed perception because their experience of this phenomenon is derived from their experience of being infertile and this casts a shadow on their current experience. These findings reveal that these mothers do not have enough knowledge to understand that this is not the etiology of cancer. These destructive and disturbed feelings have prevented mothers from communicating and directly interacting with the medical staff, and this keeps the current state of lack of knowledge and insight about cancer. In addition, this group of mothers, who are actually self-accused, may behave inappropriately, and inadequately, and this problem will create a disturbance in the care of the child, who needs the mother's care. Therefore, it is suggested that nurses, pay more attention and continue to educate this group of mothers to find a correct understanding of the nature and because of their child's illness. In addition, it is necessary to provide these families with more special facilities in the field of financial support.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted with the approval of the Ethics Committee of Mashhad University of Medical Sciences. All participants were informed about the purpose and type of study. Then, written informed consent was obtained. The place and time of the interview and the time of completion of the interview were at the discretion of the participants. The participants were assured that their identity would remain confidential and the data would be published anonymously. Recorded audio files were deleted immediately after conversion to text.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset generated and analyzed during the current study is not publicly available due to the sensitive nature of qualitative interview data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no conflict of interest\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;This study was financially supported by the Vice-Chancellor for Research, Mashhad University of Medical Sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eConceptualization and study design, data collection: E GH\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;data analysis and interpretation: EGH., MD\u003c/li\u003e\n \u003cli\u003ePreparing the draft of the article: EGH., MD\u0026nbsp;\u003c/li\u003e\n \u003cli\u003erevising: All authors\u003c/li\u003e\n \u003cli\u003eFinal approval of the manuscript before sending it to the journal: All authors\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank all those who helped us in the implementation of this research, especially the mothers who told us their experiences.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBoivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Human reproduction. 2007;22(6):1506-12.\u003c/li\u003e\n\u003cli\u003eAssaysh-\u0026Ouml;berg S, Borneskog C, Ternstr\u0026ouml;m E. Women\u0026apos;s experience of infertility \u0026amp; treatment\u0026ndash;A silent grief and failed care and support. Sexual \u0026amp; reproductive healthcare. 2023 :1;37:100879.\u003c/li\u003e\n\u003cli\u003eDavies M, Moore V, Willson K, Van Essen P, Priest K, Scott H. Chan, A.(2012). Reproductive technologies and the risk of birth defects New England Journal of Medicine.366(19):1803-13.\u003c/li\u003e\n\u003cli\u003ePinborg A, Wennerholm U-B, Romundstad L, Loft A, Aittomaki K, S\u0026ouml;derstr\u0026ouml;m-Anttila V, et al. Why do singletons conceived after assisted reproduction technology have adverse perinatal outcome? Systematic review and meta-analysis. Human reproduction update. 2013;19(2):87-104.\u003c/li\u003e\n\u003cli\u003eQin J, Liu X, Sheng X, Wang H, Gao S. Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies. Fertility and sterility. 2016;105(1):73-85. e6.\u003c/li\u003e\n\u003cli\u003eHargreave M, Jensen A, Hansen MK, Dehlendorff C, Winther JF, Schmiegelow K, et al. Association between fertility treatment and cancer risk in children. Jama. 2019;322(22):2203-10.\u003c/li\u003e\n\u003cli\u003eWang T, Chen L, Yang T, Wang L, Zhao L, Zhang S, et al. Cancer risk among children conceived by fertility treatment. International journal of cancer. 2019;144(12):3001-13.\u003c/li\u003e\n\u003cli\u003eHargreave M, Jensen A, Toender A, Andersen KK, Kjaer SK. Fertility treatment and childhood cancer risk: a systematic meta-analysis. Fertility and sterility. 2013;100(1):150-61.\u003c/li\u003e\n\u003cli\u003eUyar A, Seli E. The impact of assisted reproductive technologies on genomic imprinting and imprinting disorders. Current opinion in obstetrics \u0026amp; gynecology. 2014;26(3):210.\u003c/li\u003e\n\u003cli\u003eEiser C, Eiser JR, Stride CB. Quality of life in children newly diagnosed with cancer and their mothers. Health and quality of life outcomes. 2005;3(1):1-5.\u003c/li\u003e\n\u003cli\u003eRubin GJ, Wessely S. The psychological effects of quarantining a city. Bmj. 2020;368.\u003c/li\u003e\n\u003cli\u003eMarmo S. Recommendations for hospice care to terminally ill cancer patients: A phenomenological study of oncologists\u0026apos; experiences. Journal of social work in end-of-life \u0026amp; palliative care. 2014;10(2):149-69.\u003c/li\u003e\n\u003cli\u003eStanhope V, Henwood BF. Activating people to address their health care needs: Learning from people with lived experience of chronic illnesses. Community mental health \u003c/li\u003e\n\u003cli\u003eVan Manen M. Writing in the dark: Phenomenological studies in interpretive inquiry: Routledge; 2016.\u003c/li\u003e\n\u003cli\u003eDuran S, TekİR \u0026Ouml;, Kıratlı D. \u0026ldquo;My life has changed suddenly!\u0026rdquo;Psycho-social problems in mothers of children with cancer2022.\u003c/li\u003e\n\u003cli\u003eSong\u0026uuml;l Duran, \u0026Ouml;zlem Tekir, Didem Kiratli et al. \u0026ldquo;My life has changed suddenly!\u0026rdquo;Psycho-social problems in mothers of children with cancer, 22 April 2022, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-1564424/v1]\u003c/li\u003e\n\u003cli\u003eMaleki M, Dehghan Nayeri N, Hamidieh AA, Pouraboli B. Parents\u0026rsquo; experiences of living with a child with cancer undergoing hematopoietic stem cell transplantation: a qualitative content analysis study. Frontiers in Psychology. 2024 Mar 12;15:1359978.\u003c/li\u003e\n\u003cli\u003eNaidoo D, Gurayah T, Kharva N, Stott T, Trend S, Mamane T, et al. Having a child with cancer: African mothers\u0026apos; perspective. South African Journal of Occupational Therapy. 2016;46.\u003c/li\u003e\n\u003cli\u003eMaunder K. Investigating Supportive Care Needs of Parents of Children with Cancer: Is a Parent Support Group Intervention a Feasible Solution? 2012.\u003c/li\u003e\n\u003cli\u003ePai AL, Greenley RN, Lewandowski A, Drotar D, Youngstrom E, Peterson CC. A meta-analytic review of the influence of pediatric cancer on parent and family functioning. Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43). 2007;21(3):407-15.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Assisted reproductive methods, cancer, child","lastPublishedDoi":"10.21203/rs.3.rs-6409232/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6409232/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Having a child with cancer in a family that had a child with the help of assisted reproduction methods will be a different experience from other mothers. Therefore, this study was conducted to explain the lived experiences of mothers with children with cancer, which is the product of assisted reproductive methods.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A phenomenological study was conducted with the participation of six mothers of children with cancer who were the product of assisted reproductive methods. The data were collected using semi-structured interviews and analyzed using MAXQDA software and Van Menen's approach.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e 4 categories and eight subcategories (attacking the desire to become a mother: self-blame due to the desire to become a mother, hidden blame of others due to insisting on the experience of motherhood, regret arising from spirituality: regret for opposing divine providence, sadness caused by the place of divine testing with The child's illness, mourning the sufferings of the child and the family: discomfort of inflicting physical pain on the child, sadness of imposing financial problems on the family, fear of the future affected by cancer: fear of the child's death and non-recovery, fear of another illness) from the experience of this mothers were extracted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e It seems that such mothers think that among the two options of forced motherhood and not motherhood; Contrary to God's will, they started having children, and they blame themselves for the child's illness. Therefore, it is recommended to provide more extensive and different support packages for these mothers.\u003c/p\u003e","manuscriptTitle":"\"The atomic bomb was my life\"; the lived experience of mothers who became pregnant with assisted reproductive technology from their child's cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 14:57:19","doi":"10.21203/rs.3.rs-6409232/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5becdee0-3912-4f76-9910-057b3413132d","owner":[],"postedDate":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-23T08:54:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-07 14:57:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6409232","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6409232","identity":"rs-6409232","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}