‘Mother or nothing: The agony of Infertility‘ is the World Health Organization’s motto that prompted me to focus my doctoral research on assisted reproductive technologies (ARTs) specifically on the treatment of infertility in Guatemala (in the top 48 nations offering ARTs).

I initiated the first systematic research on the behaviour and consequences of ARTs on two distinct and highly diverse ethnic groups in Guatemala, namely the Maya and the Ladinos. The Maya are indigenous natives who maintain stronger links with their traditions and cultural beliefs, in particular with family planning. Ladinos, in contrast, have more Westernised beliefs in all aspects of their life including ARTs. I conducted a quasi-experimental survey in 2018 on 181 people in Guatemala (Maya and Ladino) and found that there are indeed differences between the Maya and Ladinos in their perceptions and their approach to ARTs. 

The Mayas’ and Ladinos’ approach to ARTs differed in many ways. The Maya seemed to have more conservative views compared to Ladinos on whether any form of ARTs and variations such as conception by egg donation will be socially acceptable in their community. In relation to religion, the Maya and Ladinos both believed religion should be considered before the couples embark on any form of ARTs.

When asked about medical concerns of ARTs, the Maya expressed a distrust of Western medicine, meanwhile Ladinos expressed their concerns for side effects such as mutations and deformities. When asked about government funding for ARTs, both ethnicities felt strongly that the Guatemalan government should not be financially responsible as Guatemala as a developing nation has other priorities.

That was then; now we are in the midst of a worldwide pandemic with cities and communities around the world in lockdown facing an uncertain and unpredictable future. Covid has brought changes to all aspects of life. In Guatemala, many Indigenous people have already begun to adopt new preventative measures such as masks and regular hand washing. Many people who live in rural areas are now accessing their preventative information through radio and TV programmes, as this is the most trusted of Covid information.

In 2000 the maternal mortality ratio for indigenous women in Guatemala was more than three times that of Ladino women. Covid may widen the gap between Maya and Ladinos even more as a result of the current pandemic and expected to linger into the ‘new normal’. The new guidelines could bring an uncertain future, economic hardship and delays in providing services which may affect fertility chances. It is well known that any delays and disruptions in fertility treatment may have significant impact on the outcomes of fertility treatment. For example, with increasing age the chances of successful conception drops significantly even if there is no disruption to any planned fertility treatment, there is also the well-known fact that women who are more socially withdrawn and are in a heightened emotional state have more difficulties for a normal birth and successful post-birth.  Currently, home insemination and intrauterine insemination are great alternatives, given the fact that so many fertility clinics are closed due to Covid. Because fertility treatments can be quite expensive, it’s important to know your options and do a thorough comparison of home insemination and IUI costs.

The current pandemic has without doubt had a significant impact on infertile couples’ levels of anxiety, feelings of isolation and their mental health. These feelings could very well be expected to linger well into the ‘new normal’.

As a researcher, I wondered how applicable pre-Covid scientific studies are on the psychological aspects of infertility for infertile couples. Would pre-Covid scientific studies  apply in treatment options, elevation of anxiety and planning for the future during this time of lockdown and beyond?   

While reading the scientific literature I came to another realisation. Thanks to Covid, some, if not most of our past methods of research (such as one-to-one questionnaire administration and experimental work) seems to be abandoned at least for the foreseeable future.

In the past, as a researcher it was logical to go to a lecture room or to invite participants to a research lab and ask them to complete a questionnaire, or to engage in some scientific task. But now all that, at least for the foreseeable future, is history. Qualtrics dictates most research methodologies, in addition to the problem is the realisation that most of the past materials including psychometric measures, become questionable in their applications. Take for example Eysenck’s Personality Questionnaire (EPQ). This questionnaire was used extensively in different facets of past research including as a measure of psychological assessment during and after pregnancy.

Consider completing some of the items as listed below taken from EPQ while you are in the current and ongoing pandemic lockdown:

• Do you like going out a lot?
• Do you hate being with a crowd who play jokes on one another?
• Do you like talking to people so much that you never miss a change of talking to a stranger?
• Do you find it hard to really enjoy yourself at a lively party?

Would such items make sense to you as a participant in a research measuring levels of extroversion? It appears that perhaps it is now the time to re-evaluate the validity, reliability and applicability many of the past research methodologies, psychometric measures and the research findings dating to pre-COVID-19 before planning and engaging in any research in the ‘new normal’ era.

The main aim for my research was to conduct the first scientific research on perception and behaviour of the Maya and Ladinos in Guatemala regarding ARTs. I achieved that through an extensive phase of one-to-one data collection and interviews, but Covid and the ‘new normal’, is bound to make significant changes to the Maya and Ladinos perception and behaviour towards ARTs for reasons mentioned above. It is now my realisation that Covid has also had an impact on my past research plans and findings, for example aspects such as what I can and cannot do, and what measures and methodologies to employ in the future. Writing a reflexive log during the lockdown will help to keep a record of the challenges I have and will be facing during these fast developing and unprecedented times in the academic life of a doctoral researcher.

While the agony of infertility is still ongoing, perhaps it is time to add to change the WHO motto of ‘Mother or nothing: The agony of infertility’ to ‘Mother or nothing: the agony of infertility in the new normal’.

Cecilia Isabel Urrutia is a doctoral researcher at Middlesex University in London working on perceptions, behaviour and consequences of children born by ART in Guatemala.